From a Surgeon's Journal (1915-1918)

by Harvey Cushing, M.D.
[Atlantic Monthly Press and Little, Brown, $5.00]
THE war journal of Colonel Harvey Cushing comprises eight volumes of manuscript, and from them has been compiled this book of close to 200,000 words. One of the outstanding books dealing with America’s participation in the World War, it will interest any American proud of his country and of her surgical preëminence. Fascinating reading for anyone who saw service on the Western Front, it will be part of the education of ambitious young surgeons far beyond this generation.
In his war service Cushing was much more than an eminent surgeon. A reader of character, a keen observer of everything that went on around him, he is a man of the world, sometimes a bit inclined to be cynical, but always sympathetic and kindly. There is something in the address and bearing of a great surgeon or physician that invites confidences. Such a diarist, writing in trains, in tents, ambulances, during intervals of operating, by daylight and darkness, of the things he saw and heard, inevitably recorded some things that did not rise above rumor and gossip, and opportunity to verify them never came to him. Nor does the career of a great surgeon prepare him for discipline or subordination. The editor has not served Colonel Cushing well when from such a wealth of material he has sometimes selected matters the inaccuracy of which he might easily have established, and included gratuitous statements of things of which the diarist was not really competent to speak.
Dr. Cushing entered the war in April 1915 with the Harvard Unit, one of those university groups which was to supply the professional personnel for certain wards in the Ambulance Américaine at Neuilly. He soon had his first view of that strange warfare of trenches, ‘fit only for weasels, moles, or rats,’that extended from Flanders to Switzerland, a double line of ditches across the face of France. He saw the men who came from the first gas attack at Ypres. The opportunity not only to be of service to individual wounded, but to accumulate knowledge which at the end of the war was to furnish an epochal contribution to physiology, neurology, and surgery, at once appealed to him. His photographic mind absorbed many strange sights.
On his return to America, Cushing set about organizing Base Hospital No. 5 in preparation for our probable entry into the war. After much delay the unit sailed on May 12, 1917, to join British No. 11, General, at Camiers. Swallowed up in the British machine, Base Hospital No. 5 lost its identity for the time, speedily adjusting itself to the change. Life became a round of strange wounds, lice, scabies, mumps, measles, tetanus antitoxin, duckboards, and thousands of the freak occurrences of war. Cushing saw Annamites and Egyptians, Zulus, Kaffir laborers, Chinese coolies, Algerians and Indians, in numbers far outnumbering the native males of the region, and among women ‘none too moral or fastidious,’and foresaw a post-war melting pot exceeding ours in America. General No. 11 was behind the taking of Messines and Wytschaete. It also served behind the lines of Passchendaele during the summer of 1917, and there were few cases of wounds received in battle that did not register Cushing’s attention. He saw every phase of wartime surgery. Eight major cases a day took only the hours once given to a single case at home. The months from July to October were of service more devoted and thrilling than fiction has ever devised. No American can read this account in its simple, direct style without a little pressure at the heart, if he has one.
In June 1918, Cushing was relieved from duty with the British and ordered to Neufchateau for duty as Senior Consultant in Neurological Survey. He seems to have accepted this change with rather chilly approval, ending, as it did, hopes he had cherished for a fused Neurological Service for the Anglo-American Armies. From the standpoint of the American Chief Surgeon, the use of such a surgeon as Cushing in an operating team, merely number one among hundreds of other operating surgeons, was a waste. The man’s knowledge and skill were too great. They had to be made available on a larger scale. It was the experience that comes to many an army medical officer. When he gets to the age of greatest usefulness in the actual practice of his profession he has to be taken for administrative duties. Something like that happened to Cushing, Consultant brought the rank of Colonel, but he seems to have felt a little out of the current of affairs. Consultants have to be consulted, and do some waiting for such requests. ‘Meanwhile,’ says Cushing, ‘the Consultants carry on ignobly as an impatient body of pundits.’
There are many things in this Journal which should be read by our Army Medical Corps. Nor should the reading be confined to the army.
Congress is blamed when appropriations are denied for preparedness. When a Regular Division could go into battle and its Evacuation Hospital be equipped with supplies dating from before the War with Spain, — ‘no x-ray, no Dakin’s fluid, no nurses, no sterilizer suitable for field work, and little compressed bundles of ancient gauze and tabloid finger bandages with which to dress the stinking wounds of these poor lads,’ — as was found by Consultant Cushing in June 1918, someone was to blame. It was those who failed to ask, or who, asking, were denied by those who originate appropriations.
Colonel Cushing continued as the head of his specialty under his friend General Finney, of Johns Hopkins, until the end of the war, being on the ground at St. Mihiel and in the desperate battles of the Meuse-Argonne. He sailed for home February 5, 1919, returning to America with a rank not signified by shoulder straps or citations, but which his countrymen, particularly his old comrades of the American Expeditionary Forces, accord him, that of being one of the very small select group of the best surgeons in the world.
Such a reward as that comes to few men. Mere generals of many varieties are numerous for at least a full generation after every great war.