Major Harvey Cushing's difficulties with the British and American armies during World War I

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This historical review explores Harvey Cushing's difficulties with both the British and American armies during his World War I service to definitively examine the rumor of his possible court martial. It also provides a further understanding of Cushing the man.

While in France during World War I, Cushing was initially assigned to British hospital units. This service began in May 1917 and ended abruptly in May 1918 when the British cashiered him for repeated censorship violations. Returning to American command, he feared court martial. The army file on this matter (retrieved from the United States National Archives) indicates that US Army authorities recommended that Cushing be reprimanded and returned to the US for his violations. The army carried out neither recommendation, and no evidence exists that a court martial was considered. Cushing's army career and possible future academic life were protected by the actions of his surgical peers and Merritte Ireland, Chief Surgeon of the US Army in France. After this censorship episode, Cushing was made a neurosurgical consultant but was also sternly warned that further rule violations would not be tolerated by the US Army. Thereafter, despite the onset of a severe peripheral neuropathy, probably Guillian Barré's syndrome, Cushing was indefatigable in ministering to neurosurgical needs in the US sector in France.

Cushing's repeated defying of censorship regulations reveals poor judgment plus an initial inability to be a “team player.” The explanations he offered for his censorship violations showed an ability to bend the truth. Cushing's war journal is unclear as to exactly what transpired between him and the British and US armies. It also shows no recognition of the help he received from others who were instrumental in preventing his ignominious removal from service in France. Had that happened, his academic future and ability to train future neurosurgical leaders may have been seriously threatened.

Cushing's foibles notwithstanding, all realized that he contributed greatly to both British and US war neurosurgery. United States Army surgeons who operated upon brain wounds in France recognized Cushing as their leader.

Abbreviations used in this paper:AEF = American Expeditionary Force; BEF = British Expeditionary Force; SOS = Service of Supply.

Abstract

This historical review explores Harvey Cushing's difficulties with both the British and American armies during his World War I service to definitively examine the rumor of his possible court martial. It also provides a further understanding of Cushing the man.

While in France during World War I, Cushing was initially assigned to British hospital units. This service began in May 1917 and ended abruptly in May 1918 when the British cashiered him for repeated censorship violations. Returning to American command, he feared court martial. The army file on this matter (retrieved from the United States National Archives) indicates that US Army authorities recommended that Cushing be reprimanded and returned to the US for his violations. The army carried out neither recommendation, and no evidence exists that a court martial was considered. Cushing's army career and possible future academic life were protected by the actions of his surgical peers and Merritte Ireland, Chief Surgeon of the US Army in France. After this censorship episode, Cushing was made a neurosurgical consultant but was also sternly warned that further rule violations would not be tolerated by the US Army. Thereafter, despite the onset of a severe peripheral neuropathy, probably Guillian Barré's syndrome, Cushing was indefatigable in ministering to neurosurgical needs in the US sector in France.

Cushing's repeated defying of censorship regulations reveals poor judgment plus an initial inability to be a “team player.” The explanations he offered for his censorship violations showed an ability to bend the truth. Cushing's war journal is unclear as to exactly what transpired between him and the British and US armies. It also shows no recognition of the help he received from others who were instrumental in preventing his ignominious removal from service in France. Had that happened, his academic future and ability to train future neurosurgical leaders may have been seriously threatened.

Cushing's foibles notwithstanding, all realized that he contributed greatly to both British and US war neurosurgery. United States Army surgeons who operated upon brain wounds in France recognized Cushing as their leader.

World War I, spanning from August 1914 to November 1918, saw the deaths of 10 million to 13 million soldiers. Even more millions were wounded.4 To focus on this insane killing, consider but one battle, the British-French Battle of the Somme, July to November 1916. British and French armies sustained about 600,000 casualties, and the Germans approximately 300,000.5 On the offensive's 1st day the British alone counted 21,000 dead and another 40,000 wounded.6,29

The US, traditionally isolationist,7 knew of the great carnage in Europe and remained neutral for the first 32 months of the war. On February 1, 1917, however, Germany resumed unrestricted submarine warfare, and in the ensuing weeks several US ships were sunk. These events plus an intercepted German communication to the Mexican government, urging concerted German-Mexican action against the US, inflamed the American people. On April 2, 1917, having popular backing, President Woodrow Wilson urged Congress to declare war on Imperial Germany. Both the Senate and the House adopted a resolution for war by April 6, and on that day President Wilson signed the resolution.20 In the following 19 months the US added 115,000 further military fatalities to the war's total.4

While neutral, however, the US had not been idle. It had sent military observers and medical participants to Europe. The first studied the fighting; the latter learned about care for the wounded in this new, industrial war.26,31 George Crile, professor of surgery at Western Reserve University, took a surgical group from Cleveland's Lakeside Hospital to the Ambulance Américaine in Paris, serving there from January to March 1915. A Harvard unit that included Harvey Cushing followed from April to June.8 Based on his experience in France, Crile opined that in case of war mobilization, army base hospitals should be organized from the existing staffs of large, well organized American civilian hospitals. University hospitals fit this bill particularly well. Army Surgeon General William Gorgas accepted Crile's concept and ordered 3 prominent members of the Army Medical Reserve Corps to organize such base hospitals. The organizers were George Crile, Harvey Cushing, and J. M. Swan, an internist from Rochester, New York. Eventually 50 base hospitals were formed, their unit number determined by their date of readiness. Once a base hospital was activated into the army, a regular medical officer was placed in command.32

When the US entered the war, no American fighting units were in France, and it would be months before significant numbers of American soldiers arrived. The British, planning for their upcoming Passchendaele offensive, were short of medical officers and requested that their new US ally promptly furnish them with 6 base hospitals with their attendant medical personnel.33 They were duly provided and, hence, Harvard's Base Hospital No. 5 sailed from New York for England on May 11, 1917. It arrived in Camiers, France, on May 31 and was immediately incorporated into British General Hospital No. 11. In November, the Harvard unit moved into British General Hospital No. 13 at Boulogne.9

By 1917 Harvey Cushing had a considerable reputation owing to his prowess in the new field of neurosurgery. Among other notables he had operated on was General Leonard Wood from whom he had removed a meningioma.19 Not only had he been asked to help form army base hospitals but he was also on the national committee to standardize medical equipment for the war. He had the ear of national Red Cross leaders as well as Army Surgeon General Gorgas.10 Cushing was indeed an exceptional American physician who found himself in unfamiliar and exceptional circumstances (Fig. 1). Once mobilized to active duty, Cushing, who was inner directed and in every way his own man, had difficulty getting accustomed to the army with its inevitable rules, restrictions, and traditions.11 He had difficulty reining in his persona, which in civilian, academic life had been given considerable leeway owing to his exceptional surgical talents. Cushing's inner direction, apparently oblivious to the needs of those whom he led, resulted in an egregious episode shortly after Base Hospital No. 5 began its service with British.

Fig. 1.
Fig. 1.

Cushing impeccably dressed for army service with a serious demeanor. Frontispiece from From A Surgeon's Journal, Little Brown and Company.

The British Messines Ridge offensive took place June 7–14, 1917. Apprised of the forthcoming attack, area hospitals prepared to care for 30,000 casualties.12 This offensive and the receipt of the casualties to follow were Base Hospital No. 5's war baptism; this is what the base hospital was created for and trained for all those prior months. One might have expected Cushing, its chief medical officer, to have overseen the event to make sure that everything under his medical command proceeded as smoothly as possible. Strangely, he was nowhere to be found at his base hospital during this offensive. But where was he? He was out touring various other hospitals in the area from June 6 to 14 with Sir Anthony Bowlby who was in charge of forward British hospitals! According to his war journal Cushing was “ordered” to make this tour.12 In my opinion, however, common sense, a proper sense of duty, and loyalty to his colleagues should have caused Cushing, an American officer, to refuse this British order and remain with his base hospital, which received 1000 casualties.13 One can only speculate how he was received upon returning. Cushing subsequently described the hospital commander as “belligerent.”14 While no official action was apparently taken against Cushing for his absence, he would eventually discover the limits of the military's tolerance for his nonconformity.

At the beginning of May 1918 during Germany's final, devastating spring offensive, Cushing was abruptly relieved of his operative duties with the British with whom he had served for almost a year. He was ordered to report to American headquarters, Service of Supply (SOS) at Tours, southwest of Paris, where the medical administrative section of the American Expeditionary Force (AEF) in France was located. This activity was under the jurisdiction of the commanding general, SOS.30 After arriving at Tours, Cushing learned that he might “even be court martialed” for inadvertently enclosing needlessly harsh remarks another officer had made about the British in a letter home. This letter had been opened and read by British censors.15

Fulton, in his Cushing biography, cited this event but stated that Cushing was in trouble for castigating a British surgeon. More ominously, however, Fulton reported that a judge advocate who was involved in reviewing Cushing's offense possibly felt that Cushing should not only be court martialed but sent to the federal prison at Fort Leavenworth!24

Professor Michael Bliss' recent biography of Cushing concluded that “there was never any serious thought of court martialing him.”1 Professor Bliss appears to have based this statement on the following excerpt from a letter that General Merritte Ireland wrote to John Fulton on January 14, 1946.25 Ireland, eventually Surgeon General of the Army, was the Chief Surgeon of the AEF in France at the time of this Cushing incident and was familiar with its intimate details:34

Dear Doctor Fulton:

…I thought I wrote the whole story of Cushing's trouble in France on account of a letter he wrote which was picked up by the censor. There was never any idea of court martialing Cushing that I know anything about….

Sincerely yours,

(signed) M. W. Ireland

Despite General Ireland's assurances, made more than 20 years after the 1918 event, Cushing by his own account at the time feared court martial.

Various versions of Cushing's troubles in France are extant. The very suggestion that an action merited incarceration indicates that some army officials regarded Cushing's offense as most serious. I, therefore, sought clarification of the event and obtained the army documents concerning this episode from the National Archives at College Park, Maryland. The critical documents from the archives are presented in toto. Others are summarized, presenting their salient points. I also obtained pertinent documents from the Cushing-Whitney Library at Yale and relevant wartime writings by Dr. George Crile from the Western Reserve Historical Society in Cleveland. I reviewed Dr. J. M. T. Finney's autobiography at the Cushing Library.

While this incident is seemingly very small considering Cushing's overarching achievements, it assumes greater importance in the context of patriot Cushing's military service of which he was justifiably proud and about which he wrote an entire book. Had others not come to his aid, Cushing's military service might have come to an ignominious end with possible unforeseen future ramifications for his position at Harvard and his ability to develop future neurosurgical leaders.

Records from the National Archives and Dr. J. M. T. Finney's Recollections

The first communication concerning Cushing's censorship improprieties is a letter from a British adjutant general to the chief of the American Mission attached to the British armies in France.37

Confidential (hand written)

AG/152/26/PS

Chief of the

AMERICAN MISSION, att'd General Headquarters,

BRITISH ARMIES IN FRANCE.

I have the honor to forward the attached letter written by Major HARVEY CUSHING, United States Base Hospital No.5, which was intercepted by the War Office censors.

Major HARVEY CUSHING's tendency to indiscretions in his letters has been brought to my notice on two previous occasions.

  1. In September 1917, when he sent two letters containing extracts from letters which he had censored. No names were mentioned but the making of such extracts contravenes para.26 of Censorship Orders;

  2. Later in the same month, when he wrote a letter in the nature of a diary, containing a passage which disclosed the position of a Divisional Headquarters, and gave information regarding the disposition of formations and casualties.

Since that date five or six letters containing indiscretions of a minor character have been intercepted by War Office censors.

Major HARVEY CUSHING was informed in last October that in the event of further contravention of Censorship Orders occurring on his part his conduct would be reported to the Commander-in-Chief, American Expeditionary Force.

I think you will agree with me that in the passage quoted from page 5 in the attached typed extract is an offense against the last paragraph of para.10 Censorship Regulations (amended by GRO 3416), and that it is calculated to do harm.

It is inevitable that when different Nations are fighting side by side there should be a certain amount of mutual criticism of one another's methods and efficiency, but it is undesirable that such criticism should be disseminated, as the persons to whom it is repeated lose sight of the fact that the original author of the criticism may have been quite misinformed and irresponsible, and the information purported to be conveyed acquires a wholly undeserved appearance of authority.

I regret having to make this representation in the case of a medical officer of HARVEY CUSHING's eminence but I feel that I must request you to take steps to ensure that he keeps his correspondence within the limits which it has been found necessary to fix for all officers and soldiers serving with the British forces in this country.

(signed) G.H. Fowke, Adjutant General.

G.H.Q.

1st Echelon

1 May 1918

I am not in possession of the September or later letters but the appended typed extract was as follows:37

Extract from letter addressed by Major HARVEY CUSHING, U.S. Base Hospital No.5, France, to Mrs. HARVEY CUSHING, 305 Walnut Street, Brookline, Mass., U.S.A. dated 27 March 1918.

Coombs…'B' Battery, 236 R.F.A. the 18 pounders… wounded on the second day somewhere Bapaume….

Blundell… 7th Borderers was in the support line near the Cambrai road when he got his at 9 A. M. the first morning March 21st….

Holland, 3rd Grenadier Guards…they had just come out of the line near Arras on the morning of March 21st for divisional rest….

Hislop, 23rd Middlesex…sent up as hurried reinforcementsencamped at Achiet le Grand….

Burdet…1/6 Black Watch…hit on the first day near Beaumetz to the left of the Cambrai road….

Thompson…7th East Yorks XVIII Division…They were retiring and on the 2nd day were in bivouac behind Avrincourt on top of a canal bank….

Peter Bias…8/10 Gordons XV Division-hit on the 19th when battalion was moving up between Monchy and the Cambrai road: etc.etc. (pp 1 and 2; Fig. 2)

Fig. 2.
Fig. 2.

Photocopy of portions of Cushing's letter to his wife intercepted by British censors. Among the names included are Blondell, Holland, Hislop, and Burdett. Courtesy of the Cushing Archives, Harvey Cushing/John Hay Whitney Medical Library, Yale University.

S [a French intelligence officer—M.E.C.] in to lunch rather jumpy and tired. Most outspoken about the British and the fact that the French have had to bring up reserve divisions. He is in the Intelligence Office and one of the new men that knows the French cipher, quite a different thing from the codes by which messages are sent. Other ciphers in reserve of course-a single letter sent out over the wires would shift it to another cipher in a few minutes- in case of any suspicions that the cipher was known. But the British-stupid, pigheaded: Been told for two months by French intelligence office just where the attack was to be and practically the exact day – and been told over and over again. They would do nothing-no reserves sent over- their chief ammunition dumps within three miles of the line-warned about it several times-would take no action. Now Lloyd George is saying “Hold fast my brave lads we will send you reserves and guns”- from where? And the French have to move divisions up to stop the gap. France already nearly bled white and holding a line of 2 to 1 to the British who are enjoying a theatrical campaign in Palestine. There's probably a great deal of truth in all this, and British Staff work, done by swells rather than by Ludendorfs, Hindenburgs and Mackensens who have come from the people, has sadly fallen down, and when I [Cushing] try to say “but they are stubborn and brave and we must support them as allies for what they're worth; S gets excited and gesticulates. (p 5)

Fowke's letter about Cushing and its attachment were forwarded to Brigadier General W. W. Harts who commanded the American troops operating with the British Expeditionary Force (BEF) in France. Harts, in turn, sent Fowke's letter with his own appraisal and recommendation to General Pershing, the Commanding General of the AEF in France.37

General Harts noted that Cushing had been previously warned by the British authorities not to include forbidden information in his letters, but to no apparent effect. Harts felt it unfortunate that the British found it necessary to make an official report on this case, after having given less formal warnings. Harts believed that Cushing should be detached from service with the British forces and be sent to duty where his opportunity to gather military information would not be so likely to lead him to further violation of the censorship regulations. Harts believed that Cushing's censorship violations were probably made mainly through carelessness, but he nevertheless thought that British requests that such steps be taken to prevent further repetitions should be given prompt attention. Harts suggested that in addition to being transferred, Cushing be officially reprimanded by proper authority.

Finney wrote discretely of Cushing's troubles in his autobiography without mentioning Cushing by name.22 Owing to his administrative duties as AEF surgical consultant, Finney had ready access to the AEF (Fig. 3) Medical Headquarters section. One day he was summoned to Colonel Ireland's office because of a telegram from British authorities stating that it would be advisable for the AEF to put in a request for the immediate transfer from British forces to the AEF of “a certain prominent American medical officer” then on duty with the British. Colonel Ireland, Chief Surgeon of the AEF in France, was disturbed about the matter for various reasons and was anxious to know whether Finney “could use this officer” in the US Army. Knowing “the officer” personally, Finney said that of course he could and would immediately put in a request for his transfer. And thus the following telegram was sent to Harvey Cushing on May 5, 1918, from the Headquarters of the AEF: Direct Major Harvey Cushing, Medical Reserve Base Hospital No. five, to proceed at once to Headquarters Service of Supply, reporting upon arrival to commanding general for temporary duty. The travel directed is necessary in the military service.”37

Fig. 3.
Fig. 3.

J. M. T. Finney on the Johns Hopkins surgical staff in peacetime and chief of professional services for the army in France during the war. He worked intimately with Cushing when Cushing was neurosurgical consultant to the US Army in France, 1918. Photograph courtesy of Alan Mason Chesney Medical Archives, Johns Hopkins Medical Institutions.

Cushing had been making arrangements to again begin work at British No. 13th General Hospital where Harvard's Base Hospital No. 5 had been moved. Upon receipt of this order he quickly departed Boulogne. When he arrived at Tours, Cushing was immediately notified that Major General Kernan, Commander of the SOS, demanded that he submit in writing an explanation of his violation of censorship rules.37 Following the chain of command, Kernan notified Merritte Ireland, Chief Surgeon of the AEF, of his demand on Cushing. Colonel W. D. McCaw actually received General Kernan's notification as Colonel Ireland was absent.37

On the 9th of May Cushing submitted the following explanation.37

From: Major Harvey Cushing, M.R.C.,

To: Commanding General, S.O.S., A.E.F.

Subject: Concerning Violation of Censorship Regulations

  1. This is the second time I have unwittingly broken rules relating to British censorship. On the first occasion, last September, I quoted from No. 46 Casualty Clearing Station a portion of a “Tommy's” letter which I had been censoring. It was amusing and had no bearing on the War, and I was unaware until shown the ruling that it was contrary to regulations to make such quotations when there was no possibility of identifying the writer.

  2. The first of the present extracts which must have been included in a letter to my wife were made in the course of an examination at No. 13 General Hospital (Boulogne) sometime in March of the men then in the hospital who had undergone amputations. I wished to get some information regarding their previous occupations and the possibility of their being resumed, and in the course of the patients' stories I set down their regiment and circumstances under which they became wounded.

  3. The last paragraph is a mere quotation of the gossip of a tired and anxious French intelligence officer who probably felt very differently the next day. Though it is little more than the outspoken British press says, even more forcibly themselves, I appreciate that my action, first in paying any attention to it, second in writing down what I remembered of it, and third, in letting it get out of my possession into the mail, is unpardonable. I was interested, in recalling the conversation, that it merely exemplified the ease with which Allies under stress may become irritated and as appears in the context I was defending the British to whom I am attached.

  4. Though I occasionally send notes of daily occurrences to Mrs. Cushing, I had no possible intention of these purely personal notes getting into the mail and I am profoundly sorry that they should have done so.

(Signed)

Harvey Cushing, Major, Medical Reserve Corps.

HC/LB

Cushing's explanation was forwarded by Colonel McCaw to General Kernan but it fell on deaf ears for the very next day General Kernan recommended to General Pershing, commander of the AEF, that Cushing be sent home.37

Hq. S.O.S., France, 10 May 1918.—To C.-in -C., A.E.F

  1. Returned, inviting attention to the enclosed explanation of Major Harvey Cushing, M.R.C.

  2. I recommend that this officer be returned to the United Sates and that he be given no further assignment to duty in the A.E.F.

(Signed)

F.J. Kernan, Major General

Commanding.

Most certainly Colonel Ireland and others in command positions mulled over Cushing's offense and this recommendation for several days. Cushing's eminence was known.

In the course of these deliberations someone wrote a memorandum concerning Cushing for the adjudicating officials to consider.37

May 14/18

Memorandum re Major Harvey Cushing

Major Cushing was, for many years, a distinguished surgeon connected with the Johns Hopkins University; he is now the professor of surgery in Harvard Medical School. He came to France as director of Base Hospital No. 5 and has been on duty with the British for about one year. Major Cushing is without question, the most advanced brain surgeon in the United States, and I think it is fair to say that he is in all probability, recognized as the most accomplished brain surgeon in the world. He has served considerable part of his time, since coming to France, in casualty clearing stations and in special hospitals where the British treat brain cases. Major J.M.T. Finney, general consultant in surgery for the A.E.F. intends to place Major Cushing in charge of the brain surgery of the A.E.F. Major Cushing has already been to Neufchâteau (about two weeks ago) to make the preliminary arrangements for his new duties.

Cushing, not privy to General Kernan's recommendation or discussions concerning his fate, reported daily to medical headquarters. In his diary on May 11 he wrote, “Col. McCaw, who is in charge here as acting Chief Surgeon in the absence of both Bradley and Ireland, though very friendly, shakes his head over my sorry case and says, ‘Come in again tomorrow'.” And 2 days later Cushing wrote, “Col. McCaw says so far as he can see I…will be sent home….I go about with my tail between my legs and humbly report once a day to ask if there are any orders for me….”15

Unmentioned in Cushing's From a Surgeon's Journal, and perhaps even unknown to him during these days, several of Cushing's American surgical peers in France, though recognizing his difficult nature, nevertheless sought to intervene for him (Fig. 4). George Crile wrote in his wartime diary,2

It was only a few days ago I learned that H. had been asked to come to H.Q. on account of an Allied complaint about H's indiscreet letters; his biting unjust criticism of the regular army, of his colleagues, and in particular as to the conduct of the war. He was threatened with court martial, and would have been court martialed had not Finney and I befriended him through Ireland and finally having to go to Bowlby [who was in charge of forward hospitals for the B.E.F. including British Base Hospital No.13 to which Harvard's Base Hospital No. 5 was attached–M.E.C.] to make the plea that his services just now were much needed and that in spite of his critical attitude and lack of cooperation, his skill and knowledge are too great to lose. As it stands he will be reprimanded, I understand, quite directly. H. came directly from G.H.Q. where he was waved only by the intervention of a regular army officer- Ireland….

Fig. 4.
Fig. 4.

George W. Crile formulated how American hospitals could be mobilized for service during World War I. Crile's model was used by the army in World War II as well. Crile later founded the Cleveland Clinic, one of the world's foremost medical institutions. This photograph was provided by Western Reserve Historical Society.

Considering that Crile had not seen the actual complaint against Cushing but being familiar with Cushing's personality he surmised its contents quite accurately. And so, at a medical meeting in Paris devoted to various war medicine issues, on the 18th of May Colonel Ireland (Fig. 5) gently broke the news to a greatly relieved Cushing that the censorship matter would be dropped.15 On May 21 the following letter was sent to Cushing:37

OFFICE OF THE CHIEF OF STAFF

May 20, 1918

Chief of Staff.

Major Harvey Cushing, MRC (thru C.G., SOS)

Violation of Censorship Regulations

  1. The Commander-in-Chief directs me to inform you that his attention has been called to serious violations on your part of the Censorship regulations. He is convinced, however, that such violations were due entirely to your misconception as a civilian of requirements of military censorship regulations, all of which are essential from a military point of view. Your offense was a serious one as it might unwillingly have been the means of giving valuable information to the enemy.

  2. The Commander–in–Chief appreciated the splendid work you are doing so unselfishly for our troops and those of our Allies, and wishes to be assured that in the future no action on your part will detract from your value to the American Expeditionary Forces.

  3. There will be no further action taken in this matter.

James W. McAndrew

Fig. 5.
Fig. 5.

Merritte Ireland was Chief Surgeon for the American Army in France during World War I. He then became Surgeon General of the Army. He was described by General Pershing as “abounding in vitality, mental and physical, quick and accurate in decision…. He understands men and knows how to work with them for the common end.”34

JWMcA./cd

Cushing was off the hook but under the velvet glove paragraph of appreciation lay a steel fist. Any further skirting of censorship (or it may be assumed any other) rules by Cushing would not be tolerated by the AEF.

Appraisal

The British complaint against Cushing comprises 2 parts, either of which could have been grounds for action against him. The first lists the names of soldiers and their units that Cushing transcribed. The second quotes the vicious criticism of the British “calculated to do harm.” The extracted pages 1 and 2 from Cushing's letter presented above and supplied by the British in their complaint are greatly truncated from his original letter. As a humanist Cushing was appalled by the destructiveness of war, particularly on the broken human beings he saw daily. A complete text of the pertinent portions of the offending letter to his wife is as follows:37

One thinks only of soldiers are here and forgets previous occupations. On going through the wards…to see dressings I asked some of these men with amputated arms and legs what they did in peace time….

Coombs, age 23, shifted just two years ago from polisher in a silversmith shop to B battery 236 RFA the 18 pounders- wounded on the 2nd day [of the German spring offensive which began on 21 March, 1918—M.E.C.] somewhere near Bapaume and Frank had to take his right arm off yesterday near the shoulder for gas infection….

Blondell is 34, a joiner [undecipherable] with the 7th Borderers, was in the support line near the Cambrai road when he got his at 9 AM, the first morning. He never even saw the Boche….

Holland is an Edinburgh boy of 25 in the 3rd Grenadier Guards a brass polisher in a foundry. They had just come out of the line near Arras on the morning of March 21st for divisional rest-were on parade-he was the only one in his platoon hit-his right arm….

Hislop is 42, 23rd Middlesex, a backyard manager in Stockton Court, Durham-out only 9 months part of it in Italy. Sent up as hurried reinforcements encamped at Achiet Le Grand and he got it 5 minutes later….

Burdet is a husky young coal miner of 20 from Fifeshire in the 1/6 Blackwatch over 10 months-hit on the first day near Beaumetz to the left of the Cambrai road....

Thompson a postman and farmer from Walbury of the 7th East Yorks XVII Division-out 18 months-back from leave only one day. They were retiring and on the second day-his birthday was on Mar 22- were in bivouac behind Avrin Court on the top of a canal bank-a shell got him and killed 7 out of 8 of his pals….

Peter Bias age 20 with a strange dialect and a well-nigh toothless grin comes from the Orkney Islands which he never intended to leave and hopes never will again. He's a plow boy with one leg a year in France with the 8/10 Gordons XV Division-hit on the 19th when battalion was moving between Monchy and the Cambri road.

The army unit designations, though completely inappropriate in a letter from a war zone, were not gratuitous but may be seen as literary device balancing the individual's wartime and peacetime occupations. Naturally, British authorities abstracted only portions of the letter that clearly violated censorship regulations.

Finney's autobiography22 indicates that the British requested that the AEF recall Cushing from British Base Hospital No. 13. This was the direct cause of the telegram sent to Cushing from American sources on May 5. All available evidence indicates that the AEF did not ultimately contemplate a court martial for Cushing. Nevertheless, rumors of such an action must have been present. Why else would Cushing have mentioned such a possibility in his war diary? George Crile, writing at the time, also stated that Cushing was threatened with court martial.

What American authorities did recommend was disciplinary action, a reprimand, and banishment. General Harts believed that Cushing should be detached from the BEF and placed where he could not again compromise military information, while General Kernan recommended that Cushing be shipped home.

How fast Cushing fell in esteem! In October 1917, when he was doing his landmark work on brain debridements18 at Casualty Clearing Station No. 46, General Slogget, Director General of the British Army Medical Service in France, offered him the position of “consulting surgeon” with the rank of Colonel in the British Army Medical Service if such an army transfer could be arranged with the AEF. In his letter making this offer Slogget continued, “I appreciate immensely all you have done for our Army and should be truly sorry if you have to leave us.”16 But within 6 months, the British wanted him out for repeatedly breaking censorship regulations.

Fulton, without knowledge of Fowke's letter of complaints against Cushing, deemed Cushing “a physician of the written word…impelled to write everything down with unconscious disregard for military regulations.”24 But Cushing himself was a censor, reading and passing on the mail of soldiers in the ranks. He therefore had some knowledge of censorship regulations. Furthermore, he had received multiple warnings about his own censorship violations. To me it appears that Cushing's actions were willful. They may have compromised the military situation had they been intercepted. Perhaps Cushing thought that since he had Slogget's high regard he was immune from the rules binding ordinary officers serving under the British. Or perhaps he didn't think at all.

While censorship violations played a key role in Cushing's ouster, one may speculate that the British just became tired of his constant, hypercritical carping as noted by Crile. His censorship infractions may have been the means to rid themselves of Cushing. He had been away from Base Hospital No. 13 so often (his place taken by Horrax,28 Towne, and Gothals38) that it was clear Cushing was not essential for the treatment of brain wounds there.

Cushing seems to have been oblivious to a major point in the British complaint against him. In his letter of explanation to General Kernan he admits to only 2 instances of censorship violations. Adjutant General Fowke's letter of complaint against Cushing indicates 4 major and 5 or 6 minor censorship violations in a 9-month period. The British clearly cut Cushing a lot of slack before cashiering him. Cushing ignored the fact that he was a repetitive censorship violator, thus bending the truth. Any objective reader, however, would have noted the discrepancy between the British and Cushing's versions of events.

As for the AEF, it neither dismissed nor reprimanded Cushing as had been recommended. Possibly the AEF high command did not think Cushing's transgressions deserved such a severe punishment, especially as they had been committed while he served under the British. The command was also aware of Cushing's unique abilities. Furthermore, the AEF had come to the war late. It was belatedly learning industrial age warfare and was beset with many problems, militarily, logistically, and medically.21,27 To court martial or cashier such a prominent person as Cushing could have proven a significant distraction for General Pershing and his staff. One might have envisioned Congressional or other inquiries on the matter that would have been time consuming to satisfy. At this time the AEF was gearing up to take over its very own portion of the line against the Germans, from the Meuse River to the Argonne Forest. So, in my opinion, Cushing also got off for the good of the army.

Nevertheless, Cushing remained in limbo for 2 weeks while others decided his fate. For Cushing to realize that his recall from duty with the British was public knowledge among his peers was a significant reprimand in itself. In quarters that had suffered Cushing's biting intolerance, there might have even been some satisfaction in Cushing's predicament. As Professor Bliss pointed out, however, the affair was soon forgotten, at least on the surface. Hugh Bayne, one of Cushing's friends wrote, on the of July 14, “Congratulations on your deserved promotion. I'm glad your little cloud blew over so nicely….”17

Cushing's “dust up” with the British and American armies did not diminish and possibly enhanced his medical effectiveness once he returned to the AEF. There, he seemed to interact well with colleagues. Perhaps his chastisement by the British and the warning from General Pershing's headquarters had taught him that no matter how great his medical expertise and reputation, he could be more useful to himself and the great war enterprise by conforming to expected behavioral norms. So highly was Cushing regarded among his AEF colleagues that when Finney had to return to the US for several weeks Cushing took his place. He indefatigably visited American sector hospitals, sited neurosurgical facilities, taught arriving young surgeons the rudiments of neurosurgery, purchased neurosurgical equipment as needed, and even operated occasionally as the situation demanded. One appreciates Cushing's “grit” knowing that he continued to do these myriad duties for the final 3 months of the war when afflicted with numb and weak feet, legs, and hands, ataxic gait, visual changes, and even intermittent diplopia, probably Guillian Barré's syndrome.36

In Cushing's telling,15 his considerable difficulties with the BEF and AEF seemed to have somehow disappeared after his (unpublished) letter of explanation/contrition.37 Various archives and writings, however, reveal that much more went on behind the scenes. Cushing did not have access to all the information in his AEF file presented here. He might not have known of Ireland's decisive action retaining him in France against the advice of a more senior officer. He also did not know of Crile's personal diary writings. Nevertheless, he must have soon realized that Crile and others rallied to his side. Nowhere in From a Surgeon's Journal, however, was there any mention of this help or even an oblique thanks to those who championed him.

Cushing's personal foibles notwithstanding, all AEF surgeons recognized the unique greatness of Cushing's surgical achievements. As was explicitly stated by Harold Neuhoff, neurosurgeon in Mobile Surgical hospital No. 2, American surgeons doing brain surgery in France regarded him as their leader.35 After Cushing's death in 1939, Finney, putting Cushing's censorship “foolishness”9 aside, wrote, “[He] rendered outstanding service during the World War, first with the British and later as Chief of the Department of Brain and Neurosurgery in the A.E.F.”23 And in 1942 Crile wrote,3

Harvey was a very intense, meticulous, hard-working personality. One was always conscious of his drive. Harvey seldom relaxed- there was always something wrong somewhere that goaded him or that he felt called upon to criticize. In every sense of the word Harvey was a perfectionist. Even in the war where there is little time for masterly technique he gave to his last, meticulous care and technically perfected detail. The most striking memory I have of Cushing's work and viewpoint during the war was his incessant activity for the improvement of handling brain cases.

Acknowledgments

I thank Mr. Roderick Engert, retired from the US Army Center for Military History, and Mr. Timothy K. Nenninger, Chief Textual Records Reference Staff, Textual Archives Service, National Archives and Records Administration, College Park, MD 20740-6001. Their efforts made this paper possible. My wife, Dr. Betty Oseid, carefully proofread the manuscript and our daughter, Sarah Young, helpfully deciphered some of Dr. Crile's handwriting. My former LSU colleague David G. Kline, M.D., made several important suggestions. Florence Gillich, Historical Medical Library Assistant, and Melissa J. Graffe, Ph.D., John R. Bumstead Librarian for Medical History of the Harvey Cushing/John Hay Whitney Medical Library at Yale, were particularly helpful in helping me search the Cushing Archives. Ms. Kristen McDonald of the Manuscripts and Archives Section, Yale University Library, retrieved the Ireland-Fulton correspondence. The picture of J. M. T. Finney was provided by Mr. Andrew Harrison, Cultural Properties Archivist and Reference Coordinator, Alan Mason Chesney Medical Archives, Johns Hopkins Medical Institutions. Dr. Crile's 1942 comments on Cushing and Dr. Crile's picture were secured through the efforts of Ms. Vickey Catozza, Reference Librarian, Western Reserve Historical Society, Cleveland, Ohio. General Ireland's picture was taken from the frontispiece of the work by Lynch et al.,30 which is in the public domain. I also thank the several reviewers of my original paper who made many helpful suggestions as well as the production and editorial staff of the Journal who fine-tuned this work. Samuel C. Ramer, Associate Professor of History, Tulane University, carefully read my revised manuscript, graciously helped clarify certain points, and suggested its final form.

Disclosure

The author reports no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

This paper was presented in part at the Peyton Meeting, Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, July 28, 2012.

References

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Article Information

Address correspondence to: Michael E. Carey, M.D., 900 Amethyst St., New Orleans, LA 70124-3606. email: michaelbettycarey@yahoo.com.

Please include this information when citing this paper: published online June 20, 2014; DOI: 10.3171/2014.5.JNS122285.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Cushing impeccably dressed for army service with a serious demeanor. Frontispiece from From A Surgeon's Journal, Little Brown and Company.

  • View in gallery

    Photocopy of portions of Cushing's letter to his wife intercepted by British censors. Among the names included are Blondell, Holland, Hislop, and Burdett. Courtesy of the Cushing Archives, Harvey Cushing/John Hay Whitney Medical Library, Yale University.

  • View in gallery

    J. M. T. Finney on the Johns Hopkins surgical staff in peacetime and chief of professional services for the army in France during the war. He worked intimately with Cushing when Cushing was neurosurgical consultant to the US Army in France, 1918. Photograph courtesy of Alan Mason Chesney Medical Archives, Johns Hopkins Medical Institutions.

  • View in gallery

    George W. Crile formulated how American hospitals could be mobilized for service during World War I. Crile's model was used by the army in World War II as well. Crile later founded the Cleveland Clinic, one of the world's foremost medical institutions. This photograph was provided by Western Reserve Historical Society.

  • View in gallery

    Merritte Ireland was Chief Surgeon for the American Army in France during World War I. He then became Surgeon General of the Army. He was described by General Pershing as “abounding in vitality, mental and physical, quick and accurate in decision…. He understands men and knows how to work with them for the common end.”34

References

Note: Several references were not verified at the source by the Journal of Neurosurgery. These references are archival sources, and we trust their validity.

1

Bliss M: Harvey Cushing: A Life in Surgery OxfordOxford University Press2005. 344345

2

Crile GW: papers Western Reserve Historical Society Cleveland OH; Series 3 container 37 folio 125

3

Crile GW: papers Western Reserve Historical Society Cleveland OH: MS 2806 C 59 F229

4

Crutwell CRMF: A History of the Great War: 1914–1918 ed 2ChicagoAcademy Chicago Publishers1991. 630631

5

Crutwell CRMF: A History of the Great War: 1914–1918 ed 2ChicagoAcademy Chicago Publishers1991. 276

6

Crutwell CRMF: A History of the Great War: 1914–1918 ed 2ChicagoAcademy Chicago Publishers1991. 268

7

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 80

8

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 3

9

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 102111254

10

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 89

11

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 102

12

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 115

13

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 142

14

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 146

15

Cushing H: From a Surgeon's Journal: 1915–1918 BostonLittle Brown and Co1936. 352355

16

Cushing H: papers Cushing Whitney Library Yale Medical School Reel 111 frames 0166–0168

17

Cushing H: papers Cushing Whitney Library Yale Medical School Reel 112 frame 408

18

Cushing H: A study of a series of wounds involving the brain and its enveloping structures. Br J Surg 5:5586841917

19

Cushing HEisenhardt L: Meningiomas: Their Classification Regional Behaviour Life History and Surgical End Results Part 2 New YorkHafner Publishing Co1962. 408412

20

Eisenhower JSD: Yanks: The Epic Story of the American Army in World War I New YorkFree Press2001. 310

21

Eisenhower JSD: Yanks: The Epic Story of the American Army in World War I New YorkFree Press2001. 11353

22

Finney JMT: A Surgeon's Life: The Autobiography of J. M. T. Finney New YorkGP Putnam and Sons1940. 177198199

23

Finney JMT: A Surgeon's Life: The Autobiography of J. M. T. Finney New YorkGP Putnam and Sons1940. 304305

24

Fulton JF: Harvey Cushing: A Biography Springfield, ILCharles C Thomas1946. 426427

25

Fulton JF: papers manuscripts and archives Yale University Library P.O. Box 208240 Wall Street New Haven CT 06520-8240; MS # 1236 box 214 folder 310

26

Grotelueschen ME: The AEF Way of War: The American Army and Combat in World War I CambridgeCambridge University Press2007. 24

27

Grotelueschen ME: The AEF Way of War: The American Army and Combat in World War I CambridgeCambridge University Press2007. 1058

28

Horrax G: Observations on a series of gunshot wounds of the head. Br J Surg 7:10541919

29

Howard M: The First World War OxfordOxford University Press2002

30

Lynch MCWeed FWMcAfee L: The Medical Department of the United States Army in the World War: Volume II Administration American Expeditionary Forces Washington, DCGovernment Printing Office1927. 52

31

Lynch MCWeed FWMcAfee L: The Medical Department of the United States Army in the World War: Volume I The Surgeon General's Office Washington, DCGovernment Printing Office1923. 92

32

Lynch MCWeed FWMcAfee L: The Medical Department of the United States Army in the World War: Volume I The Surgeon General's Office Washington, DCGovernment Printing Office1923. 9293101103

33

Lynch MCWeed FWMcAfee L: The Medical Department of the United States Army in the World War: Volume I The Surgeon General's Office Washington, DCGovernment Printing Office1923. 101

34

Merritte Weber Ireland: US Army Medical Department Office of Medical History (http://history.amedd.army.mil/surgeongenerals/M_Ireland.html) [Accessed May 15 2014]

35

Neuhof H: The treatment of craniocerebral wounds and its results. Ann Surg 72:5565881920

36

Reich SG: Harvey Cushing's Guillain-Barré syndrome: an historical diagnosis. Neurosurgery 21:1351411987

37

Textual Archives Service National Archives and Records Administration College Park MD 20740-6001

38

Towne EBGoethals TR: Finger exploration of gunshot wounds of the brain. Ann Surg 71:5315591920

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