"Highly qualified loser"? Harvey Cushing and the Nobel Prize.

Neurosurgery, in particular surgery of the brain, was recognized as one of the most spectacular transgressions of the traditional limits of surgical work. With their audacious, technically demanding, laboratory-based, and highly promising new interventions, prominent neurosurgeons were primary candidates for the Nobel Prize. Accordingly, neurosurgical pioneers such as Victor Horsley and, in particular, Harvey Cushing continued to be nominated for the prize. However, only António Egas Moniz was eventually awarded the prestigious award in 1949 for the introduction of frontal lobotomy, an intervention that would no longer be prize-worthy from today's perspective. Horsley and Cushing, who were arguably the most important proponents of early neurosurgery, remained "highly qualified losers," as such cases have been called. This paper examines the nominations, reviews, and discussions kept in the Nobel Archives to understand the reasons for this remarkable choice. At a more general level, the authors use the example of neurosurgery to explore the mechanisms of scientific recognition and what could be called the enacting of excellence in science and medicine.