The Brigham Diary of Loyal Davis: a portrait of Harvey Cushing and a neurosurgical acolyte.

At 27 years of age, Loyal Davis wrote the Brigham Diary while training as an Associate in Surgery with Dr. Harvey Cushing. The diary is a daily record of the Cushing neurosurgical service between 1923 and 1924. The literary tone of the document is one of youthful enthusiasm and candor. Its contemporary portrayal of Harvard University's third Moseley Professor displays a demanding surgeon and scholar whose primary concern was the care of his patients and who taught the meticulous techniques of neurosurgery by example. In contrast to the experiences offered by current neurosurgical residency programs, Loyal Davis examined 107 patients, observed 81 operations, assisted Dr. Cushing during 23 operations, assisted Dr. Gilbert Horrax in 13 operations, and never performed an operation independently during his year at the Peter Bent Brigham Hospital. Despite these technical constraints, the young assistant learned the Cushing method of surgery and skilled patient care and was encouraged to continue laboratory investigations. Davis also emulated Cushing's exacting method of preparation of medical manuscripts, which were characterized by scientific innovation and an engaging literary style. The diary shows that Cushing often held inflexible surgical and scientific opinions and was contentious in their defense. These opinions were modified only when he was presented with unequivocal facts. The young surgeon sought Cushing's approval which carried a genuine but restrained benevolence. Harvey Cushing's impression on Davis was lasting and profound. The diary conveys the philosophy that uncompromised discipline is a necessary virtue and hard work is full satisfaction in itself. In the following years, Loyal Davis systematically patterned his surgical and scholarly endeavors after those of Harvey Cushing, an exemplar whose unstinting resolve was the pursuit of excellence.