Wednesday, April 8, 2009

Ether, a gorilla, and poppies

‘Mr Gorilla though ill and unacclimatized (having been in Liverpool only 24 hours) cost 250 pounds.’ Harvey Cushing, an American neurosurgeon born 140 years ago today, wrote these words in his diary while still a young man and working in England. He is remembered because Cushing’s disease was named after him, but also because he was a pioneer in teaching neurosurgery, as well as being a Pulitzer Prize winning author.

Cushing was born in Cleveland, Ohio, on 8 April 1869, the son and grandson of physicians. He graduated from Harvard Medical School in 1895. After an internship at Massachusetts General Hospital, he studied surgery under William Stewart Halsted at Johns Hopkins Hospital, in Baltimore, where he returned to work after several years of living overseas. In 1902, he married Katharine Stone Crowell and they had five children. In 1912, he was appointed professor of surgery at Harvard Medical School, remaining there for two decades, but for war service in Europe with the US Army Medical Corps. From 1933, he was Sterling Professor of neurology at Yale University School of Medicine. He died in 1939.

Cushing is particularly remembered for being the first to describe a type of obesity of the face and trunk, caused by a malfunction of the pituitary gland, now known as Cushing’s disease or syndrome. But he also developed many of the basic surgical techniques for operating on the brain, and was considered the world’s leading teacher of neurosurgeons in the first decades of the 20th century. Wikipedia lists several other achievements including the use of x-rays to diagnose brain tumors, and the introduction to North America of blood pressure measurement.

However, Cushing was also an accomplished writer. He was awarded the Pulitzer Prize in 1926 for a biography of Sir William Osler, a Canadian physician sometimes described as the father of modern medicine. And, for a quarter of a century, he wrote diaries. Two of these found their way into print: From a Surgeon’s Journal: 1915-1918 published by Little, Brown & Company in 1936; and A Visit to Le Puy-en-Velay published by The Rowfant Club in 1944. First editions of this latter book, which only had a small print run but contain some fine sketches, fetch several hundred pounds each - see Abebooks.

Extracts from both published works and the unpublished diaries can be found online in Elizabeth Thomson’s 1950 biography Harvey Cushing - Surgeon, Author, Artist - which is available at Internet Archive. Thomson explains how, early in 1893, possibly on New Year’s day, Cushing began to keep a journal: ‘In a small diary which had been a Christmas gift, he began to jot down the principal happenings of his days, and here, rather than in his letters, was recorded his complete absorption in his work - here also were revealed moments of uncertainty and inadequacy that rarely found their way into the cheerful notes he sent to his father and mother. ‘Still working over the poisons. Contemplate taking some myself,’ and ‘HARD luck again etherizing. . . . Dr P. must think I’m a clumsy dunce.’

Here is a short collection of Cushing’s diary entries over the next few months, as described by Thomson: ‘On Friday, January 13, he noted in his diary: ‘Encysted hydrocele . . . with Dr Porter - A K Stone assisted. Promised later to help in a bandaging course with policemen.’ On the 14th: ‘Big operating day. Etherized well but don’t seem to hit it off with the house officers.’ On the 16th: ‘Etherized 3-4 times and pretty poorly. Couldn’t study in evening and went to bed early. I fear for the Chemistry exam.’ And again in March, ‘Etherized this noon for Dr Porter who removed a dermoid cyst from a young girl’s neck. Beautiful operation. Assisted him till Alex came.’ On the 30th: ‘Shattuck told an old hypochondriac to remember the Eleventh Commandment - ‘Fret not thy Gizzard’ & forget all the others if necessary.’ On the 30th: ‘Walked out to park with Codman. Saw first robin . . . Bandaging class with policemen.’ ’

In 1900, Cushing sailed for Europe, and from the day he landed in Liverpool until his departure over twelve months later, he kept a detailed diary, much of it medical. This diary also records his reactions to people (‘often astute but often impatiently critical’ says Thomson) and places, but it does not mention any current affairs (such as the Boer War, the Boxer Rebellion, or even the death of Queen Victoria). Here is one entry from 1901 (a trephine is a surgical instrument with a cylindrical blade): ‘It does not come within the realm of everyday experience to be called upon to trephine a gorilla. This happened to me yesterday the day before an orang-outang and the day before that I saw Sherrington do a chimpanzee. Experimentation on a large scale certainly and expensive. Mr Gorilla though ill and unacclimatized (having been in Liverpool only 24 hours) cost 250 pounds.’

A couple of quotes out of Cushing’s From a Surgeon’s Journal: 1915-1918 can also be found on a web page hosted by the Commonwealth Air Training Plan Museum (in Bradon, Canada). The page explains how the poppy flower came to be used as a symbol for those who died in the wars, and quotes the famous poem - In Flanders Field - by the Canadian poet and surgeon John McCrae which starts: ‘In Flanders fields the poppies blow; Between the crosses, row on row, . .’ And then it also quotes Cushing who wrote about McCrae in his diary.

28 January 1918
‘I saw poor Jack McCrae . . . last night - the last time. A bright flame rapidly burning out. He died early this morning . . . Never strong, he gave his all with the Canadian Artillery during the prolonged second battle of Ypres and after at which time he wrote his imperishable verses. Since those frightful days he has never been his old gay and companionable self, but has rather sought solitude. A soldier from top to toe - how he would have hated to die in bed . . .

They will bury him tomorrow. Some of the older members of the McGill Unit who still remain here were scouring the fields this afternoon to try and find some chance winter poppies to put on his grave - to remind him of Flanders, where he would have preferred to lie . . .’

29 January 1918
‘We saw him buried this afternoon at the cemetery on the hillside at Wimereux with military honors - a tribute to Canada as well as to him. . . A company of North Staffords and many Royal Army Medical Corps orderlies and Canadian sisters headed the procession - then ‘Bonfire’ . . . with his master’s boots reversed over the saddle - then the rest of us . . . the Staffords, from their reversed arms, fix bayonets, and instead of firing over the grave, as in time of peace, stand at salute during the Last Post with its final wailing note which brings a lump to our throats - and so we leave him.’

Postscript: The full work, From a Surgeon’s Journal: 1915-1918, can be found online at Internet Archive. Here is one sample extract:

22 April 1915
‘The morning passed with Tuffier, and now waiting for him for a moment at his private hospital. Here at this place are several officers, one a general with half his face blown off and quite blind. T. says most of the officers have been killed, and that is why the men are so brave! It puts courage into them. Queer idea; but possibly I don’t quite understand.

He tells me of peculiar wounds that he has seen. An officer, hit in the trenches by an explosion of an enemy hand grenade, had a small wound of entrance near the inner canthus of the right eye, without special symptoms. An X-ray showed an undeformed cartridge in the frontal lobe of the brain. This was extracted and it proved to be an intact French Lebel cartridge! I give it up. He explains that the captured French ammunition, which of course does not fit the German Mauser rifles, is used with whatever else may be handy to fill the hand grenades, now so murderously thrown about in the trench fighting.

Another instance was that of a woman who had been injured in the thigh by a fragment of the first of the aeroplane bombs dropped on Paris. There was in addition a trifling wound of the scapular region, and a point of tenderness low down in the back, where subsequently an X-ray showed the presence of a French rifle bullet! She had been hit by a falling ball that had been fired from a mitrailleuse (“devil’s coffee mill”) at the aeroplane. Strange coincidence that she should have got both injuries at one and the same instant.

Lunch with T. and a Belgian officer, who constitute a committee to supply artificial limbs to the amput├ęs. A month ago 7000 were needed and the French can only make 400 a month at the best - the American manufacturers 500. Hence it will take the better part of a year to supply those already wanted. Many more will be needed before we’re through. Later to see a review at the Invalides of the 29th and 30th Regiments (territorial) of infantry - very moving. There is something about French troops on the march that dims one’s eyes.’

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