Polyneuritis Ambulatoria

In 1926, while he still was Harvard's brilliant medical light, Dr. Harvey Williams Gushing was awarded a Pulitzer Prize for his biography of his great good friend, the late Sir William Osier. The award saluted a rarity, an able doctor who was also an able literary craftsman. The salute also confirmed Dr. Cushing's reputation as a thoroughgoing medical historian.

In line with that specialty Dr. Gushing accumulated memorabilia about the greatest doctors of our time. The items pertaining to his own activities during the War fill nine volumes. They contain day-by-day orders of the French, British and U. S. Armies with which Dr. Gushing successively served from the early spring of 1915 until after the Armistice. They include diaries of his experiences with the Harvard Unit of the American Ambulance at Neuilly, France; with the Base Hospital Unit which he organized in Boston and carried to France; and as "senior consult ant in neurosurgery" for the American Expeditionary Forces. They tell of his interest in gunshot wounds of the head (''g.s.w. skull"), a military accident with which he as a brain surgeon was particularly concerned. Eight brain opera tions a day was his goal.

Those nine historically pregnant volumes went with Dr. Gushing to Yale when in 1932 he became too old for Boston's Peter Bent Brigham Hospital. From his diaries he carefully culled enough memories to make a popular volume which he called From a Surgeon's Journal and published last week.-- However useful historians may eventually find Dr. Cushing's complete diaries, they will find From a Surgeon's Journal poor history, for it reveals too little about that medically significant author's own activities. One unconnected series of jottings, however, is interesting to historian, layman and doctor. That is Dr. Cushing's record of how polyneuritis ambulatoria crept upon him and crippled him be fore he, a nerve specialist, realized what was occurring. The disease frequently is the sequel of some infection like scarlet fever or influenza. Nerves become inflamed, the inflammation progressing along nerve trunks and branches and indirectly causing muscles to waste away.

The attack began on Aug. 3, 1918 at Neufchateau, France, when Dr. Gushing was laid low by a "malady which I regarded as the Spanish flu--three days' grippe--or what you will. ... I had suddenly aged and our driver had to help me upstairs--teeth chattering and done in. ... I did not know what was coming on. . . ."

Sept. 1: "Discover that my threatened blindness is an acute 2-diopter presbyopia which has rushed on me in a period of ten days--an accompaniment of the muscular enfeeblement of the grippe, according to [Dr.] George Derby. Specs for me henceforth."

Oct. 9, et seq.: "In bed with what they call the grippe and a hot water bottle-- not a bad combination. . . . More or less in bed owing to my hind legs, which are in a chronic state of being asleep up to the knees and threaten to leave me in the lurch. ... I am growing very tottery and had considerable difficulty in dressing this a. m. Even so, I shirk my job and ignominiously retire to blankets and a cheap novel at our forlorn and smelly billet. . . .

Too poor on my pins to go to Vichy as planned. . . .

"Wobbly in mind and body. Walking is very bad, and one dresses with great difficulty, buttoning being almost impossible--hands now almost as awkward and stiff as feet--a good deal of soreness but fortunately no pain. ... I must have touched bottom yesterday--without knowing it, for my soles are devoid of sensation.

Distinctly better today and able to bathe and dress again. . . ." His Journal continues: "It's a curious business--unquestionably still progressing --purely a sensory affair, fortunately without pain, though with considerable muscular wasting. The paresthesias are chiefly in soles and palms and I have a vague sense of familiarity with the sensation--as though I had met it somewhere in a dream. Like stepping barefoot on a very stiff and prickly doormat--a feeling, too, as though the plantar and palmar fascias had shrunk in the wash and were drawn taut. As [Sir William Richard] Gowers used to say, our sensations transcend our vocabularies. But it's so characteristic someone who has it ought to describe it--preferably a doctor." After the Armistice Dr. Cushing's condition improved. He regained control of his hands to such an extent that he could spend four consecutive hours removing a tumor from a brain. But his feet never completely recovered. For many years he suffered, limped, refused to have any operation performed. Last winter when gangrene threatened, he permitted Dr. Ashley Webster Oughterson, Yale surgeon, to remove the tip of his left foot's middle toe.

Last week Dr. Gushing, 67, completely recovered, was spry and lively as ever.

*First: heart disease.

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