PRESIDENTIAL ADDRESS
Master Surgeon, Teacher, Soldier, and Friend: Elliott Carr Cutler, MD (1888- 1947) Frederick P. Ross, MD, Fitchburg, Massachusetts
Elliott Carr Cutler was born in Bangor, Maine on July 30,1888 to a family that was “Yankee” in the best sense of the word, tracing its origins back to the 1640s. He received his A.B. degree from Harvard in 1909. During his senior year he was captain and stroke of the varsity crew, which defeated Yale. He went on to Medical School, graduating cum laude and first in his class in 1913. He was awarded the John Harvard Fellowship and elected permanent class secretary. (Figure 1). After spending five months on the “Grand Tour,” mostly in London and at the University of Heidelberg, Cutler returned to the new Peter Bent Brigham Hospital, where he served as a surgical house officer from November 1913 to March 1915. After serving overseas with the Harvard Unit American Ambulance Hospital in Paris, he returned to spend a year as House Surgeon at the Massachusetts General Hospital. At that time he published the first of his 266 contributions to surgical literature. During the winter of 1916-1917 Cutler was a voluntary assistant at The Rockefeller Institute in New York, working under Simon Flexner. When the United States entered World War I, he joined Base Hospital No. 5, the Harvard Unit, going overseas in May 1917. He served as a Captain with Base Hospital No. 5 at Canners and Boulogne but was detached for service with British casualty clearing stations. Then he was assigned to U.S. Evacuation Hospital No. 1 as Chief of the Surgical Service. He participated in the offensive actions at San Mihiel, Argonne-Meuse, and Champagne. In recognition of his extraordinary contributions as Chief of the Surgical Service of Evacuation Hospital No. 1, he was promoted to Major and awarded the
Distinguished Service Medal, our country’s highest noncombat award. His contributions were also recognized by France and Great Britain: he was made a Companion of the Order of the Bath of Great Britain and a Chevalier of the Legion of Honor of France. At the conclusion of the War, Cutler served with the Army of the occupation in Germany, rejoining Base Hospital No. 5 in April 1919 to return to the United States. He was the Resident Surgeon at the Peter Bent Brigham Hospital from August 1919 to
Reprint requests should be addressed to Frederick P. Ross, MD, Burbank Professional Building, Fitchburg, Massachusetts 01420. Presented at the Fifty-Ninth Annual Meeting of The New England Surgical Snnintv
Nntch -__,New ._.. Hsmmchira ___.__,,Oixvilln - .. .._ ,._. ._...r_...._, .Santamhar __P._...__.3%fbtnhmr __ __._I _. 1,
1978.
428
Figure 1. “The Chief” in 194 1.
The American Journal of Surgery
Presidential Address
Figure 2. Dr. Cutler during the Cleveland years.
September 1921 and was then appointed to the faculty as an Associate in Surgery and Director of the Surgical Research Lab at Harvard. In today’s era of specialization, which has been described as one in which we learn more and more about less and less until we know almost everything about almost nothing, it is difficult for us to appreciate the breadth of Cutler’s skills. He was truly a general surgeon and a pioneer in thoracic surgery. Cutler was trained in neurosurgery by Harvey Cushing, a master surgeon of the abdomen. After intensive experimental work in the laboratory, Cutler performed the first successful operation on the valves of the human heart, working closely with the great cardiologist Samuel Levine. In 1924, at age 36, Cutler was called to Cleveland as Professor of Surgery at the Western Reserve and Director of the Surgical Service at Lakeside Hospital. (Figure 2.) Both of these institutions grew under his guidance. He continued his work on cardiac surgery but his interests remained broad, and together with Alan Moritz and Robert Zollinger, he published a classic paper on the pathology of brain tumors based on his extensive experience at Lakeside Hospital. In 1932 Cutler was called back to Harvard to succeed Harvey Cushing as Moseley Professor of Sur-
Volume 137, April 1979
Figure 3. Secretary of War Patterson presents a second Distinguished Service Medal to Dr. Cutler in May 1947.
gery and Surgeon-in-Chief at the Peter Bent Brigham Hospital, and almost simultaneously, Dr. George Heuer was appointed Professor of Surgery at Cornell. These two appointments resulted in a revolution in residency appointments. Many of the resident surgeons at Peter Bent Brigham Hospital, including Richard Meagher, Frank Glenn, and Lee Kendall, transferred to Cornell. Dr. Cutler filled their spaces with a crew from Western Reserve that included Robert Zollinger, Earnest Bright, Samuel Snodgrass, and Charles Branch. The following year, his first group of new interns at the Peter Bent Brigham included J. E. Dunphy, T. B. Quigley, and Hartwell Harrison, who had just completed a medical internship at Western Reserve. When World War II began, the Chief once again accepted an early call to duty, serving as the Chief Consultant in Surgery under General Paul Hawley in the European Theater of Operations. Just as Cushing had persuaded his boys to go, so Cutler sent most of his resident and junior faculty team overseas to General Hospital No. 5, which shortly after acti-
429
Ross
vation was divided into the 5th and 105th General Hospitals, one serving in the European Theater and the other in the Pacific. In recognition of the Chief’s contributions in World War II, he was promoted to Brigadier General and awarded an Oak Leaf Cluster for his Distinguished Service Medal, the Order of the British Empire from Great Britain, and the Croix de Guerre from France. (Figure 3.) Returning to Peter Bent Brigham Hospital at the end of the War, he resumed all of his activities despite progressively severe pain from a spreading prostatic carcinoma. His early death in 1947 limited his active administrative and teaching responsibilities at the Brigham to only ten years, but his accomplishments during that time were outstanding. A remarkable number of his resident staff during that period went on to positions of national and international distinction. They included, among many others: in general surgery, Robert Zollinger, Charles Branch, Carl Walter, J. E. Dunphy, Stanley Hoerr, and Richard Warren; in neurosurgery, Sam Snodgrass, Donald Matson, Eben Alexander, and John Lowrey; in pediatric surgery, Orvar Swensen and Tague Chisolm; in plastic surgery, Joseph Murray; in cardiac surgery, Robert Gross, Charles Hufnagel, and Henry Swan; and in general, thoracic, and oncologic surgery, Edward J. Beatty. David Hume, who completed his residency training with Dr. Francis Moore, was also one of Cutler’s early appointees. (Figure 4.) The stories about the Chief are legendary. Arnie Porter describes entering his office in 1940 to find him sitting with his right hand in a bucket of plaster-Dr. Allan Whipple wanted models of famous surgeons’ hands-and his left hand holding a telephone, as he talked to his old Harvard friend, President Franklin D. Roosevelt, about becoming a general and making sure that the Harvard Unit would be called to early duty! It has been said that the Chief rarely appointed residents whose names began with A, B, or C because
JOHN E. ADAMS
HARTWELL HARRISON
EBEN ALEXANOER
T.B. DUIGLEY
CARL HOAR
GEORGE AUSTEN
HAROLD RHINELANDER
STANLEY HOERR
WYLIE BARKER
CHARLES HUFNAGLE
ALEXANDER BILL
CHESTER ROSOFF JOHN SCHLLLING
DAVID HUME
JAMES BLOOGETT
JOHN KINNEY
THOMAS BOTSFDRD
ERNEST LANDSTEINER
CHARLES BRANCH
CHARLES MacGREGOR
CHILTON CRANE J.E. DUNPHY ROBERT GROSS DWIGHT HARKEN
DONALD MATSON JOSEPH MURRAY LAWRENCE PICKETT ARNOLD PORTER
H. IHLLIAM SCOTT FIORINDO SIMEONE HENRY SWAN DEAN TANNER MELVIN TAYMORE CARL WALTER RICHARD HARREN ROBERT ZOLLINGER. Sr.
Figure 4. Some of Dr. Cutler’s “boys.”
430
he believed that authors’ names should always be listed alphabetically. An apocryphal story relates that the famous Atlas of Surgery was published under the names “Cutler and Zollinger” for that reason, despite the fact that Zolly did the lion’s share of the work. The Chief was also distinguished by his very short and rapid scrub. He believed that because he scrubbed so fast and hard, two minutes was sufficient for him, although the rest of the staff and residents were required to adhere rigidly to the ten minute scrub. Once a patient of his had a postoperative wound infection and Cutler asked his assistant, Sam Snodgrass, whether there had been any possible break in technique. Snodgrass replied, “I don’t know, sir. How long did you scrub?“! The residents maintain that this incident explains why Sam went into neurosurgery instead of becoming the Resident Surgeon at the Brigham. Very few American surgeons have received as many honors as Cutler. In addition to his decorations in World Wars I and II, he was made an Honorary Fellow in the Royal College of Surgeons of England, elected President of the American Surgical Association, and awarded the prestigious Bigelow Medal of the Boston Surgical Society. Cutler’s devotion to Harvard was legendary. In addition to his medical school activities, he served as a member of’the Board of Overseers from 1927 to 1932, as Chief Marshal at the commencement exercises in 1934, as President of the Associated Harvard Clubs in 1937, and as President of the Harvard Alumni Association in 1940. Each of these groups benefited from his boundless energy. His energy was not limited to his profession. He was the last to leave a good party and chided any of us, 25 years younger, who yawned the following morning. When making rounds, he trotted between the wards and was known to vault over laundry carts in his path. He often exhausted a series of youthful opponents on the tennis court. One of Cutler’s most important contributions was his strong leadership in upgrading the sprawling, slumbering network of Veterans Administration Hospitals immediately after World War II. He and General Hawley accomplished this by arranging affiliations with nearby university teaching hospitals and by integrating the house and senior staffs. The Veterans Administration network was soon transformed into a vastly more effective system of care for our country’s veterans that also provided excellent teaching and supported many research projects. For most of the year preceding Cutler’s death, I served as Harvey Cushing Fellow in Surgery at the Brigham, and my duties included being his right hand man and scrubbing with him for the decreasing
The American Journal 01 Surgery
Presidential Address
number of operations he performed. I was also involved in the day-to-day treatment of his disease, which included an unsuccessful try of a “wonder drug” supplied by one of his war-time Russian colleagues. Cutler’s bone marrow was progressively deteriorating, and he required increasingly frequent blood transfusions, which I administered at his home. The day after transfusion he would have a mild febrile reaction, so if he had an important meeting we would give him two units of blood two days beforehand. When Cutler was awarded the Bigelow Medal, he requested that the date of the annual meeting be moved ahead. Fortified by transfusions, he gave a great talk on “The Training of a Surgeon.” He was cheerful and witty, and his only slip was referring to me as his “last resident.” (I had assumed that position just two months earlier.) The next day he assembled his family and physicians and announced that the meeting had been his final public appearance and that he wanted no more transfusions to postpone the inevitable outcome. He stayed home, faded away, and died peacefully six weeks later. He left a note asking his family to allow an autopsy. It was characteristic of Cutler that this note expressed hope that some future sufferers of his disease might profit from his autopsy. The note also said, “If it will cause any distress to my long time dear friend and colleague, S. Burt Wolbach, to perform the autopsy, would he please delegate the task to one of his younger associates.” He was a meticulous technical surgeon. He taught us to keep the field dry, ligate individual vessels with
F&m? 5. L)r. Cutler wlylrRear Admiral Sir Gordon Gordon-Taylor In 194 1.
fine silk, and avoid mass ligatures. With tongue in cheek he said that no instrument kit should include more than two hemostats because one should never cut more than one blood vessel at a time! His insistence on hemostasis and gentleness, plus his daring and imagination, were the reasons he became a pioneer in surgery of the chest and heart. He was truly a Master Surgeon. His loyalty to his “boys” was legendary. When necessary he could be sharply critical, but always in private. In public he always supported us. When I became the resident I assisted one of the junior assistant residents with what was to have been his first cholecystectomy. We unexpectedly discovered cancer of the transverse colon. I took over and resected the lesion. The patient did poorly for several days, and X-rays revealed a sponge in the right upper abdomen, despite a documented correct sponge count. We reoperated, removed the sponge, and the patient then did well. On the day the patient was discharged I recounted this sorry saga to “the Chief.” He fixed me with his piercing blue eyes and said, “Freddie, I don’t know why you bother me with these details, you did absolutely the correct things: you removed both the cancer and the sponge! Two things you must remember, however. First, a significant proportion of circulating nurses can’t count! Second, never put a sponge all the way into any body cavity unless you put a heavy suture through it with a clamp on the end of the suture that is outside the patient.” In the thirty-one years since that episode, I have followed his advice precisely and passed it on to all my residents.
Ross
Rear Admiral Sir Gordon Gordon-Taylor (Figure 5) served as Surgeon-in-Chief Pro-Tempore at the Brigham in 1941 and again in 1947 just before Dr. Cutler’s death. They were the greatest of friends, and many of us came to know Sir Gordon quite well. After Dr. Cutler’s death, he wrote: The death of Elliott Cutler . . . will occasion deep sorrow in the hearts of his many friends in the United Kingdom. Perhaps no surgeon in the United States ever yearned or strove more earnestly to forge lasting bonds of friendship, not only between the surgeons, but between the people of the great English-speaking countries on either side of the North Atlantic and to this end he directed both written and spoken word . . . perhaps the finest ambassador in surgery the world has known. Dr. Cutler continued to be recognized long after his death. The modern Army hospital at Fort Devens is named after him. Hartwell Harrison spoke at the unveiling of a portrait of Dr. Cutler at this hospital, and quoted Sir Gordon Gordon-Taylor: “Dr. Cutler’s
432
name will live on in that great galaxy of young surgeons whom he trained and inspired, who adored him, who accompanied him across the seas to the hospitals in Britain and France and who are now, in increasing numbers, filling important surgical posts and carrying on the ‘Cutler Tradition’.” Dr. Harrison also said, “This hospital today is being named for a truly ‘happy warrior’ who carved a path of scholarly attainment, surgical superiority and faith in honest team play.” In 1965, eighteen years after his death, Harvard Medical School honored him by establishing a Professorship of Surgery in his name. It is fitting that the only two occupants of the Cutler chair, J. Hartwell Harrison and Francis D. Moore, Sr., are with us today. Nearly all of us who are senior surgeons were directly influenced by Elliott Cutler. I can also assure the younger surgeons that whether they realize it or not, they were indirectly influenced by this giant of our profession. He was a truly great man-master surgeon, teacher, soldier, and, especially, friend.
The American Journal of Surgery
Master Surgeon, Teacher, Soldier, and Friend: Elliott Carr Cutler, MD (1888- 1947) Frederick P. Ross, MD, Fitchburg, Massachusetts
Elliott Carr Cutler was born in Bangor, Maine on July 30,1888 to a family that was “Yankee” in the best sense of the word, tracing its origins back to the 1640s. He received his A.B. degree from Harvard in 1909. During his senior year he was captain and stroke of the varsity crew, which defeated Yale. He went on to Medical School, graduating cum laude and first in his class in 1913. He was awarded the John Harvard Fellowship and elected permanent class secretary. (Figure 1). After spending five months on the “Grand Tour,” mostly in London and at the University of Heidelberg, Cutler returned to the new Peter Bent Brigham Hospital, where he served as a surgical house officer from November 1913 to March 1915. After serving overseas with the Harvard Unit American Ambulance Hospital in Paris, he returned to spend a year as House Surgeon at the Massachusetts General Hospital. At that time he published the first of his 266 contributions to surgical literature. During the winter of 1916-1917 Cutler was a voluntary assistant at The Rockefeller Institute in New York, working under Simon Flexner. When the United States entered World War I, he joined Base Hospital No. 5, the Harvard Unit, going overseas in May 1917. He served as a Captain with Base Hospital No. 5 at Canners and Boulogne but was detached for service with British casualty clearing stations. Then he was assigned to U.S. Evacuation Hospital No. 1 as Chief of the Surgical Service. He participated in the offensive actions at San Mihiel, Argonne-Meuse, and Champagne. In recognition of his extraordinary contributions as Chief of the Surgical Service of Evacuation Hospital No. 1, he was promoted to Major and awarded the
Distinguished Service Medal, our country’s highest noncombat award. His contributions were also recognized by France and Great Britain: he was made a Companion of the Order of the Bath of Great Britain and a Chevalier of the Legion of Honor of France. At the conclusion of the War, Cutler served with the Army of the occupation in Germany, rejoining Base Hospital No. 5 in April 1919 to return to the United States. He was the Resident Surgeon at the Peter Bent Brigham Hospital from August 1919 to
Reprint requests should be addressed to Frederick P. Ross, MD, Burbank Professional Building, Fitchburg, Massachusetts 01420. Presented at the Fifty-Ninth Annual Meeting of The New England Surgical Snnintv
Nntch -__,New ._.. Hsmmchira ___.__,,Oixvilln - .. .._ ,._. ._...r_...._, .Santamhar __P._...__.3%fbtnhmr __ __._I _. 1,
1978.
428
Figure 1. “The Chief” in 194 1.
The American Journal of Surgery
Presidential Address
Figure 2. Dr. Cutler during the Cleveland years.
September 1921 and was then appointed to the faculty as an Associate in Surgery and Director of the Surgical Research Lab at Harvard. In today’s era of specialization, which has been described as one in which we learn more and more about less and less until we know almost everything about almost nothing, it is difficult for us to appreciate the breadth of Cutler’s skills. He was truly a general surgeon and a pioneer in thoracic surgery. Cutler was trained in neurosurgery by Harvey Cushing, a master surgeon of the abdomen. After intensive experimental work in the laboratory, Cutler performed the first successful operation on the valves of the human heart, working closely with the great cardiologist Samuel Levine. In 1924, at age 36, Cutler was called to Cleveland as Professor of Surgery at the Western Reserve and Director of the Surgical Service at Lakeside Hospital. (Figure 2.) Both of these institutions grew under his guidance. He continued his work on cardiac surgery but his interests remained broad, and together with Alan Moritz and Robert Zollinger, he published a classic paper on the pathology of brain tumors based on his extensive experience at Lakeside Hospital. In 1932 Cutler was called back to Harvard to succeed Harvey Cushing as Moseley Professor of Sur-
Volume 137, April 1979
Figure 3. Secretary of War Patterson presents a second Distinguished Service Medal to Dr. Cutler in May 1947.
gery and Surgeon-in-Chief at the Peter Bent Brigham Hospital, and almost simultaneously, Dr. George Heuer was appointed Professor of Surgery at Cornell. These two appointments resulted in a revolution in residency appointments. Many of the resident surgeons at Peter Bent Brigham Hospital, including Richard Meagher, Frank Glenn, and Lee Kendall, transferred to Cornell. Dr. Cutler filled their spaces with a crew from Western Reserve that included Robert Zollinger, Earnest Bright, Samuel Snodgrass, and Charles Branch. The following year, his first group of new interns at the Peter Bent Brigham included J. E. Dunphy, T. B. Quigley, and Hartwell Harrison, who had just completed a medical internship at Western Reserve. When World War II began, the Chief once again accepted an early call to duty, serving as the Chief Consultant in Surgery under General Paul Hawley in the European Theater of Operations. Just as Cushing had persuaded his boys to go, so Cutler sent most of his resident and junior faculty team overseas to General Hospital No. 5, which shortly after acti-
429
Ross
vation was divided into the 5th and 105th General Hospitals, one serving in the European Theater and the other in the Pacific. In recognition of the Chief’s contributions in World War II, he was promoted to Brigadier General and awarded an Oak Leaf Cluster for his Distinguished Service Medal, the Order of the British Empire from Great Britain, and the Croix de Guerre from France. (Figure 3.) Returning to Peter Bent Brigham Hospital at the end of the War, he resumed all of his activities despite progressively severe pain from a spreading prostatic carcinoma. His early death in 1947 limited his active administrative and teaching responsibilities at the Brigham to only ten years, but his accomplishments during that time were outstanding. A remarkable number of his resident staff during that period went on to positions of national and international distinction. They included, among many others: in general surgery, Robert Zollinger, Charles Branch, Carl Walter, J. E. Dunphy, Stanley Hoerr, and Richard Warren; in neurosurgery, Sam Snodgrass, Donald Matson, Eben Alexander, and John Lowrey; in pediatric surgery, Orvar Swensen and Tague Chisolm; in plastic surgery, Joseph Murray; in cardiac surgery, Robert Gross, Charles Hufnagel, and Henry Swan; and in general, thoracic, and oncologic surgery, Edward J. Beatty. David Hume, who completed his residency training with Dr. Francis Moore, was also one of Cutler’s early appointees. (Figure 4.) The stories about the Chief are legendary. Arnie Porter describes entering his office in 1940 to find him sitting with his right hand in a bucket of plaster-Dr. Allan Whipple wanted models of famous surgeons’ hands-and his left hand holding a telephone, as he talked to his old Harvard friend, President Franklin D. Roosevelt, about becoming a general and making sure that the Harvard Unit would be called to early duty! It has been said that the Chief rarely appointed residents whose names began with A, B, or C because
JOHN E. ADAMS
HARTWELL HARRISON
EBEN ALEXANOER
T.B. DUIGLEY
CARL HOAR
GEORGE AUSTEN
HAROLD RHINELANDER
STANLEY HOERR
WYLIE BARKER
CHARLES HUFNAGLE
ALEXANDER BILL
CHESTER ROSOFF JOHN SCHLLLING
DAVID HUME
JAMES BLOOGETT
JOHN KINNEY
THOMAS BOTSFDRD
ERNEST LANDSTEINER
CHARLES BRANCH
CHARLES MacGREGOR
CHILTON CRANE J.E. DUNPHY ROBERT GROSS DWIGHT HARKEN
DONALD MATSON JOSEPH MURRAY LAWRENCE PICKETT ARNOLD PORTER
H. IHLLIAM SCOTT FIORINDO SIMEONE HENRY SWAN DEAN TANNER MELVIN TAYMORE CARL WALTER RICHARD HARREN ROBERT ZOLLINGER. Sr.
Figure 4. Some of Dr. Cutler’s “boys.”
430
he believed that authors’ names should always be listed alphabetically. An apocryphal story relates that the famous Atlas of Surgery was published under the names “Cutler and Zollinger” for that reason, despite the fact that Zolly did the lion’s share of the work. The Chief was also distinguished by his very short and rapid scrub. He believed that because he scrubbed so fast and hard, two minutes was sufficient for him, although the rest of the staff and residents were required to adhere rigidly to the ten minute scrub. Once a patient of his had a postoperative wound infection and Cutler asked his assistant, Sam Snodgrass, whether there had been any possible break in technique. Snodgrass replied, “I don’t know, sir. How long did you scrub?“! The residents maintain that this incident explains why Sam went into neurosurgery instead of becoming the Resident Surgeon at the Brigham. Very few American surgeons have received as many honors as Cutler. In addition to his decorations in World Wars I and II, he was made an Honorary Fellow in the Royal College of Surgeons of England, elected President of the American Surgical Association, and awarded the prestigious Bigelow Medal of the Boston Surgical Society. Cutler’s devotion to Harvard was legendary. In addition to his medical school activities, he served as a member of’the Board of Overseers from 1927 to 1932, as Chief Marshal at the commencement exercises in 1934, as President of the Associated Harvard Clubs in 1937, and as President of the Harvard Alumni Association in 1940. Each of these groups benefited from his boundless energy. His energy was not limited to his profession. He was the last to leave a good party and chided any of us, 25 years younger, who yawned the following morning. When making rounds, he trotted between the wards and was known to vault over laundry carts in his path. He often exhausted a series of youthful opponents on the tennis court. One of Cutler’s most important contributions was his strong leadership in upgrading the sprawling, slumbering network of Veterans Administration Hospitals immediately after World War II. He and General Hawley accomplished this by arranging affiliations with nearby university teaching hospitals and by integrating the house and senior staffs. The Veterans Administration network was soon transformed into a vastly more effective system of care for our country’s veterans that also provided excellent teaching and supported many research projects. For most of the year preceding Cutler’s death, I served as Harvey Cushing Fellow in Surgery at the Brigham, and my duties included being his right hand man and scrubbing with him for the decreasing
The American Journal 01 Surgery
Presidential Address
number of operations he performed. I was also involved in the day-to-day treatment of his disease, which included an unsuccessful try of a “wonder drug” supplied by one of his war-time Russian colleagues. Cutler’s bone marrow was progressively deteriorating, and he required increasingly frequent blood transfusions, which I administered at his home. The day after transfusion he would have a mild febrile reaction, so if he had an important meeting we would give him two units of blood two days beforehand. When Cutler was awarded the Bigelow Medal, he requested that the date of the annual meeting be moved ahead. Fortified by transfusions, he gave a great talk on “The Training of a Surgeon.” He was cheerful and witty, and his only slip was referring to me as his “last resident.” (I had assumed that position just two months earlier.) The next day he assembled his family and physicians and announced that the meeting had been his final public appearance and that he wanted no more transfusions to postpone the inevitable outcome. He stayed home, faded away, and died peacefully six weeks later. He left a note asking his family to allow an autopsy. It was characteristic of Cutler that this note expressed hope that some future sufferers of his disease might profit from his autopsy. The note also said, “If it will cause any distress to my long time dear friend and colleague, S. Burt Wolbach, to perform the autopsy, would he please delegate the task to one of his younger associates.” He was a meticulous technical surgeon. He taught us to keep the field dry, ligate individual vessels with
F&m? 5. L)r. Cutler wlylrRear Admiral Sir Gordon Gordon-Taylor In 194 1.
fine silk, and avoid mass ligatures. With tongue in cheek he said that no instrument kit should include more than two hemostats because one should never cut more than one blood vessel at a time! His insistence on hemostasis and gentleness, plus his daring and imagination, were the reasons he became a pioneer in surgery of the chest and heart. He was truly a Master Surgeon. His loyalty to his “boys” was legendary. When necessary he could be sharply critical, but always in private. In public he always supported us. When I became the resident I assisted one of the junior assistant residents with what was to have been his first cholecystectomy. We unexpectedly discovered cancer of the transverse colon. I took over and resected the lesion. The patient did poorly for several days, and X-rays revealed a sponge in the right upper abdomen, despite a documented correct sponge count. We reoperated, removed the sponge, and the patient then did well. On the day the patient was discharged I recounted this sorry saga to “the Chief.” He fixed me with his piercing blue eyes and said, “Freddie, I don’t know why you bother me with these details, you did absolutely the correct things: you removed both the cancer and the sponge! Two things you must remember, however. First, a significant proportion of circulating nurses can’t count! Second, never put a sponge all the way into any body cavity unless you put a heavy suture through it with a clamp on the end of the suture that is outside the patient.” In the thirty-one years since that episode, I have followed his advice precisely and passed it on to all my residents.
Ross
Rear Admiral Sir Gordon Gordon-Taylor (Figure 5) served as Surgeon-in-Chief Pro-Tempore at the Brigham in 1941 and again in 1947 just before Dr. Cutler’s death. They were the greatest of friends, and many of us came to know Sir Gordon quite well. After Dr. Cutler’s death, he wrote: The death of Elliott Cutler . . . will occasion deep sorrow in the hearts of his many friends in the United Kingdom. Perhaps no surgeon in the United States ever yearned or strove more earnestly to forge lasting bonds of friendship, not only between the surgeons, but between the people of the great English-speaking countries on either side of the North Atlantic and to this end he directed both written and spoken word . . . perhaps the finest ambassador in surgery the world has known. Dr. Cutler continued to be recognized long after his death. The modern Army hospital at Fort Devens is named after him. Hartwell Harrison spoke at the unveiling of a portrait of Dr. Cutler at this hospital, and quoted Sir Gordon Gordon-Taylor: “Dr. Cutler’s
432
name will live on in that great galaxy of young surgeons whom he trained and inspired, who adored him, who accompanied him across the seas to the hospitals in Britain and France and who are now, in increasing numbers, filling important surgical posts and carrying on the ‘Cutler Tradition’.” Dr. Harrison also said, “This hospital today is being named for a truly ‘happy warrior’ who carved a path of scholarly attainment, surgical superiority and faith in honest team play.” In 1965, eighteen years after his death, Harvard Medical School honored him by establishing a Professorship of Surgery in his name. It is fitting that the only two occupants of the Cutler chair, J. Hartwell Harrison and Francis D. Moore, Sr., are with us today. Nearly all of us who are senior surgeons were directly influenced by Elliott Cutler. I can also assure the younger surgeons that whether they realize it or not, they were indirectly influenced by this giant of our profession. He was a truly great man-master surgeon, teacher, soldier, and, especially, friend.
The American Journal of Surgery
