100 Years Ago: An American Surgeon Goes to War, April 1915

Harvey Williams Cushing is often called the "father of modern neurosurgery" and is also remembered as a distinguished veteran of the Great War. Dr. Cushing saw the war on the Western Front at close quarters first in the early spring of 1915 when he served with a Harvard Unit in the American Ambulance at Neuilly, outside of Paris. He returned to America and advised the preparedness movement on medical matters. Shortly after the entry of the United States into the First World War, Cushing was commissioned as a major in the U.S. Army and served with distinction with both the British Army and the AEF. In the 1930 he published his wartime diary under the title From a Surgeon's Journal. This selection covers his arrival in Paris and the start of of his work at Neuilly 100 years ago.

April 1 , Paris 

It was a poor night, and a most bedraggled group of people made some tea in one of our baskets about 6 a.m. But despite the cold, our first bright clear day brought us cheer; and we finally slid into the Gare d'Orleans, where was breakfast, and a chance to pull ourselves together. Very exciting to look out on the streets of war-time Paris — officers speeding by in motor cars — an armored car with machine guns — ambulances and all else — all in gray war paint except for the red crosses and the red splashes of the old French uniforms. 

Greenough commandeered three big buses into which we clambered, bag and baggage, and set out across the river, through the Place de la Concorde, where Alsace and Lorraine are still draped in black, out along the Elysees, under the Arc to the Porte Maillot, and through it into Neuilly. A very interesting ride on a crisp, clear, spring morning. But the streets seemed very empty for Paris — children playing whip top on the Elysees paths as usual, showing that it was really not Sunday, though it looked it. Everyone not in uniform seems to be garbed in black. 

The converted Lycee Pasteur, now the Ambulance Americaine, is not far from the Porte Maillot, and as we approached it along the Boulevard d'Inkermann it was immediately recognizable: the handsome school building with its courtyard full of Ford motor ambulances, over which a bevy of uniformed drivers — youngsters from home, for the most part — were tinkering, some freshly arrived chassis being newly assembled. A row of patients and nurses waved a welcome from the upper terraces} Blake and others of the permanent staff, most of them in khaki, greeted us below. 

Ambulances and Vehicles at the Lycée

The hospital was quite a revelation, and we met so many people and saw so many familiar faces it 's impossible to set it all down. They have admitted no new cases to our 164 beds — indeed, have emptied them as far as they were able, so that we may have a fairly fresh start. 

The first man we saw had a dreadful paraplegia, with a huge bedsore, due to a section of the spinal cord. He'd been shot in the back by a pointed French bullet — recognizable in the X-ray. In a Frenchman, too! So war is doubly dangerous for the soldier — from behind as well as before. Many other minor cases — none of them very bad — we hurriedly glanced at as we were ushered through the several rooms. No Germans. They would require a guard, and the few they have had in the past did not make them very popular. 

Good Friday, April 2 

It is difficult to say just what are one's most vivid impressions: the amazing patience of the seriously wounded, some of them hanging on for months; the dreadful deformities (not so much in the way of amputations, but broken jaws and twisted, scarred faces); the tedious healing of the infected wounds, with discharging sinuses, tubes, irrigations, and repeated dressings — so much so that grating and painful fractures are simply abandoned to wait for wounds to heal, which they don't seem to do; the risks under apparently favorable circumstances of attempting clean operations, most of which seem to have broken down — a varicocele, an appendix, and, worst of all, a thoracotomy for a bullet in the pericardium which apparently was doing no harm. 

Some of this miscellaneous work savors of "souvenir surgery," and doubtless pressure may oftentimes be brought to bear by the wounded, for they are very proud of these trophies. From the man in question the unoffending bullet, which he wanted as an exhibit to show his visitors, was removed from the pericardial sac; but he got a collapsed left lung, a right pneumonia, then in turn a left pneumonia, and now a bad empyema, with a tube in his side which may or may not close some day. Still he seemed very proud and happy. 

The histories are all interesting, citing, as they do, the man's name, regiment, the place where he received the injury and under what circumstances, how long he had had on his clothes without changing them, where he got his first, second, and possibly third dressing before reaching our ambulance, and so on — each item full of horrible, though fascinating, possibilities. No doubt this will all seem very commonplace after we have been here a few days. 

I was going over a man this afternoon with a facial paralysis from a bullet wound in the mastoid. He got hit during an engagement on September 7 at a place called Croult, and, with a field full of other wounded, was left for dead. The enemy came over them a day or so later; a soldier poked at him and, finding him alive, swung at his head with the butt end of his musket, breaking his jaw. He was finally picked up during a counter-attack and, after a bad otitis media and erysipelas, is now ready — after seven months! — for a nerve anastomosis. It seems hardly worth while, under present circumstances, to attempt cosmetic operations. What's a simple facial paralysis, after all? 

An American-Operated Unit

Then, too, there are those not badly hurt who simulate worse things. For example, one strapping minor officer, a gymnasium instructor in peace time, threw out his chest and made a great fuss about a trifling crackle in his shoulder which Osgood immediately identified as a subacromial bursitis. Many of the men have deformed toes (possibly from sabots?) and they complain that their military shoes are bad, though those we saw seemed sensible enough. But there are other bizarre troubles with the men's feet of really serious nature. There are erythromelalgia-like feet — painful, blue, cold, macerated-looking extremities; and indeed the whole circulatory condition of many of the blesses is very bad. It is presumable that the worst of this is over, with the return of not only dry but warm weather. 

The standing in cold water, even though above the freezing point — one cause of the so-called water-bite — is as bad as frost-bite itself, especially when helped by the too-tight application of puttees which may shrink. Some of these poor devils must have so stood for days in hastily dug trenches without a chance of getting off their boots. 

Almost from the start, the majority of the men have been admitted with bronchitis, and many with influenza-like colds. Then, too, the African troops may have brought with them underlying tropical disorders of which we know little. One of them was a fine Turco in a gay Zouave uniform, with a through-and-through thoracic wound made by a German "ball," the wound of entrance so small it could hardly be found. 

Can you picture him, with no one around he can understand or who can understand him, industriously putting together the biggest and most intricate jig-saw puzzle "made in America" you ever saw, on a table in an American hospital in France, with Americans taking care of him? What can his thoughts of us be? They tell us the Germans don't take the blacks prisoners; but then, what may or may not we believe about all this business? Here we are as near the worst affair in history as Boston is to Worcester, and everyone appears to take it as though it had always been so, and always would be, and meanwhile goes about his own little business unconcernedly.