Cushing’s dogged struggle against death: the astonishing case of a patient under cardiac arrest surviving craniopharyngioma surgery

The decisive role Dr. Harvey Cushing (1869–1939) played in medicine goes far beyond the development of neurosurgery. His scientific devotion and commitment to patient care made him an ethical model of strict professionalism. This paper seeks to analyze the decisions Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma (CP) involving the third ventricle. Cushing’s earlier failure to successfully remove two similar lesions alerted him to the proximity of HW’s tumor and the hypothalamus. Consequently, he decided to use the chiasm-splitting technique for the first time, with the aim of dissecting the CP-hypothalamus boundaries under direct view. Unexpectedly, HW suffered cardiac arrest during the surgery, but Cushing did not give up. He continued with the operation while his assistants performed resuscitation maneuvers. Such determined and courageous action allowed Cushing to succeed in an apparently hopeless case. Cushing’s unwavering willingness to save patients’ lives, even under extreme circumstances, was a fundamental trait defining his identity as a neurosurgeon. Analyzing the way Cushing dealt with HW’s case provides valuable lessons for neurosurgeons today, particularly the importance of assuming proactive attitudes and, in certain cases, making painstaking efforts to overcome daunting situations to save a life.

Aristotle on the Pleasure of Courage

Because virtuous action is the fulfillment of our nature and so is constitutive of good living, Aristotle argues for a conceptual connection be-tween virtuous action and pleasure. Yet courage does not seem to conform to this account of virtuous action. Because courageous action involves confronting the fearful, which is painful, and because courageous action can fail to achieve the desired (and presumably pleasant) goal, it seems contrary to experience to claim that all truly courageous action is pleasant. I offer a defense of Aristotle’s claim that courageous action is necessarily pleasant. To do this, I give a more detailed explanation of the hierarchical, metaphysical relation between process and activity in courageous action. Virtuous activity, as instantiated in courageous actions, is necessarily pleasant because it is an end-in-itself and complete, and so requires pleasure as the full engagement of the agent in the action.

Status and Challenges of Care in Africa for Adults With Congenital Heart Defects

The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa’s population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.

“The Glorious Work of the Reformation”: Andrew Fuller and the Imitation of Martin Luther

While a high view of the life and work of Martin Luther was maintained only in certain quarters of Anglophone Christianity by the close of the seventeenth century, the eighteenth-century Evangelical revival led to a profound rediscovery of him. This article examines the way one such Evangelical, the Baptist Andrew Fuller, who does not appear to have read Luther directly, regularly cited him as a model to be imitated when it came to preaching and courageous action.

Action and Suffering: Samson Agonistes and the Irony of Alternatives

To the various kinds of irony that critics have noticed in Milton's Samson Agonistes may be added another, the irony of alternatives. This irony is based on a proposition with alternative possibilities posited by one of the characters: either this will happen or that; but both choices eventuate, although they appear to be mutually exclusive. Milton calls this kind of proposition axioma disjunclum contingens in his Art of Logic. Samson s prophecy that he will either die or do some great deed, the doubts of his friends whether he has been slain by or is slaying the Philistines, their expectation of either good or bad news are all ironically resolved in the catastrophe, which combines alternatives and reveals the simplifying power of providence. Similarly, although the Chorus states that there are two kinds of heroism, active and passive, either of which may be Samson s, both eventuate. Samson s heroism includes both courageous action and Christian patience as he slays and is slain. In his conclusion, Milton fuses genuine tragedy with religious drama, because Samson as an active hero dies tragically, and as a martyr wins a spiritual victory and the crown of patience.