New Edition of Surgeon to Soldiers Highlights Innovation, Camaraderie of Military Surgery

In the face of emerging threats and global aggression from China, Iran, North Korea, and Russia today, it is necessary that all surgeons—both military and civilian—understand the operational and medical aspects of World War II and consider how these experiences might apply to combat casualty care in the present day.^1,2 Thanks to the foresight, discipline, and scholarship of Edward D. Churchill, MD, FACS, we have a guide to help us in this endeavor.

In 1942, Dr. Churchill, a world-renowned thoracic surgeon, volunteered for deployment, and during the subsequent almost 3 years, he meticulously cataloged his journey across North Africa and throughout Europe as the chief surgical consultant for the Allied forces in the Mediterranean Theater of Operations (MTO) (see Figures 1a, above and 1b, right). Some 30 years later, Dr. Churchill published his experiences from World War II, titled Surgeon to Soldiers: Diary and Records of the Surgical Consultant, Allied Force Headquarters, World War II.

In the recent US conflicts in Iraq and Afghanistan, this monograph emerged as an inspiration and even a playbook of sorts for deploying surgical leaders like John Holcomb, MD, FACS, and Jay Johannigman, MD, FACS. Because of its limited first printing and significant popularity, copies quickly became hard to find. In fact, one original copy fetched a breathtaking bid of $1,175 at the 2023 American Association for the Surgery of Trauma (AAST) auction supporting military scholarships.

Developing the New Edition

The solution to navigating this supply-demand gridlock started nearly a decade ago. As many of you will appreciate, the path to the finish line in the publishing world is often nonlinear. Like many other pursuits in life, major projects such as this require persistence and a willingness to actively learn along the way.

Thanks to some assistance from LinkedIn, I was fortunate to connect with Keith Donnellan. Donnellan is a senior editor at Wolters Kluwer, the company that acquired Lippincott (the original publisher) years ago, and he is responsible for their surgical product line, including notable titles like The ICU Book and Mastery of Surgery. He embraced the vision of this unique project—republishing a wartime memoir with modern commentary for the benefit of military and civilian surgeons and medical planners alike—and became an important advocate for the project’s success.

At just about the same time, after lots of digital and archival digging, Donnellan and I found the original copyright for Surgeon to Soldiers in the Library of Congress (see Figure 2, below).

Interestingly, I also encountered some of Dr. Churchill’s correspondence with his editor from Lippincott in my research in the Countway Library in Boston, Massachusetts (see Figure 3, below). Now, the challenge was to find any surviving family that might hold claim to this copyright. More internet digging, including a search in Ancestry.com turned up one of Dr. Churchill’s grandchildren, Eric Churchill, MD. He works in family practice just outside of Boston and serves as the de facto ambassador for the Churchill family on all aspects related to the Churchill medical legacy.

I will forever cherish my first telephone conversation with Eric who generously took time to share his family’s perspective on his late grandfather’s contributions to military and civilian surgery. Eric then supplied several digitized historic photographs that greatly enhanced my Excelsior Surgical Society (ESS) presidential address and write-up on expeditionary surgeons published in the Journal of the American College of Surgeons. Eric gained the support of his family for publishing a new edition of the book, and he proved to be a great source of encouragement along the way.

Additional key stakeholders then rallied around this project with very strong support. Michael J. Sutherland, MD, MBA, FACS, Senior Vice President of ACS Member Services, was instrumental in our meetings with the publisher, helping to convince them to back this project. Mary M. (Peggy) Knudson, MD, FACS, and Eric Elster, MD, FACS, also provided key endorsements that led to project approval.

Leading up to the project launch, we realized that the publisher no longer had any copies of this book in its archives, so we had to find a willing donor to contribute a copy of the book for digital processing. Juan A. Asensio, MD, PhD, FACS, FCCM FRCS(Eng), our ad-hoc ESS historian, selflessly kept this project moving along by offering up his copy of Surgeon to Soldiers. Of course, this required that the publisher “deconstruct” Dr. Asensio’s sacrificial book (see opening spread image). We plan to frame this book in a shadow box and present it to the College as a memento to both the collaborative spirit and the sacrifice required to complete this project.

In 2023, the ACS decided to officially republish Surgeon to Soldiers in an effort to make this book accessible to a new generation of surgeons. Through the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS), the ACS enlisted the support of more than 100 surgeons to provide commentaries to accompany most chapters in the book. Available in both e-book and hardcopy formats, Surgeon to Soldiers, 2024 Edition, provides a modern context for the service, sacrifice, and innovation that is forged in the crucible of the MTO of World War II (see Figure 4, below).

Volunteerism, Leadership, Mentorship

As a civilian surgeon with no prior military experience and no obligation to serve, Dr. Churchill volunteered his expertise for two primary reasons.

First, in his own words, “In a professional sense, I played the role of a parent to these young surgeons, and I wanted to join them and help take care of them.”³  This sentiment harkens back to the days when “residency” and “house officer” were literal terms. A man of his word, Dr. Churchill did indeed “take care of them” for nearly 3 years, and they in turn took care of him as this group of surgeons maintained close professional and personal connections long after the war.

Second, Dr. Churchill feared he would lose professional credibility if he remained stateside. In chapter 3 of Surgeon to Soldiers, he further noted that, “Doctors need to learn to be more a part of the world outside of medicine.” Certainly, by heeding this admonition through involvement in organizations like the ACS, our commitment to providing optimal patient care can extend beyond the individual patient in our OR to include the community in which we live.

Dr. Churchill had never worn a uniform, yet he entered the US Army at the senior rank of O-6. He referred to himself tongue-in-cheek as a “chicken colonel,” and his close friends and colleagues dubbed him “Colonel Pete.”⁴ 

Nevertheless, the hardships of battle quickly transformed him from a bit of an ivory tower dandy to an expeditionary surgeon.⁵ He saw action on or near the front lines on a regular basis and met with famous and infamous commanders such as Secretary of War Henry Stimson and General George Patton. Most importantly, he earned the respect of both allies and opponents with his technical facility as a surgeon and his thoughtful and empathetic leadership style.

Lessons from Most Recent "Great Powers" Conflict

Ensuring we fully internalize the surgical lessons learned from World War II could make the difference between winning and losing a future “great powers” conflict. Surgeon to Soldiers provides essential insights into such diverse and relevant topics as burn care, resuscitation, wound management, treatment for injury from chemical weapons, and infectious diseases.

Background information on the initial miscue of over-reliance on plasma by the US, as described in Dr. Churchill’s memoir, and the process of resetting both the doctrine and supporting logistics offers sobering commentary on how far the medical establishment can stray when conducting thought experiments during peacetime, and the challenges associated with undoing such misguided efforts.

The value of collecting data and reporting results emerges as a central theme. Likewise, medical conferences held in various locations across the MTO throughout the conflict served to disseminate lessons learned and galvanize resolve among the allies while offering a bit of a reprieve from the crushing frontline work of combat casualty care.

Modern-Day Applications

From 2005 to 2012, 192 civilian surgeons representing the ACS, AAST, and the Society for Vascular Surgery served as senior visiting surgeons in Landstuhl, Germany.⁶ Ostensibly modeled on the consultant system in which Dr. Churchill served, this platform offered civilian surgeons—many with military backgrounds—an opportunity to mentor younger military colleagues.⁷

The investment by these professional societies and individual surgeons has paid long-lasting dividends for combat casualty care. The individual relationships established in this program positively influenced the careers of many of our current leaders in combat casualty care. Moreover, many involved in this program shaped the long-term military medical strategy and policy both directly and indirectly.⁸

In 2016, the National Academies of Sciences, Engineering, and Medicine convened an expert panel to critically examine military and civilian trauma systems of care.⁹ In the shared pursuit of continuously improving outcomes for both military and civilian trauma patients, this report noted, “Military and civilian trauma care and learning will be optimized together, or not at all.”

No such opportunity for synergy between military and civilian trauma surgeons and systems existed in Dr. Churchill’s day. We now have the unique opportunity to mitigate and even eliminate the age-old “peacetime effect” of allowing our trauma skills to atrophy between conflicts.¹⁰ For more information about this topic, read the January 2025 Bulletin article, “Military and Civilian Surgery Partner for Innovation, Effectiveness.”

Excelsior Surgical Club

After World War II, “Colonel Pete” became a well-deserved cult of personality. Although he was never promoted beyond “chicken colonel” for his service to the nation, Dr. Churchill was awarded the Distinguished Service Medal, an award typically reserved for general officers.

As a member of the Hoover Commission’s Committee on Federal Medical Services, Dr. Churchill attempted to help reorganize the Medical Corps of the Department of Defense, but he was met with more than a little resistance despite his affirming and persuasive approach to advocacy. Nevertheless, he continued to support the optimal care of the surgical patient by contributing the introduction to the “Physiologic Effects of Wounds” chapter in the Army Surgeon General’s series Surgery in World War II and by his continued service as an editor for Annals of Surgery.

More than 50 years since his death, Dr. Churchill continues to inspire surgeons of all specialties. The current Edward D. Churchill Professor of Surgery at Harvard Medical School is held by a true pioneer and leader in cardiothoracic surgery, Thoralf M. Sundt III, MD, FACS, son of the late neurosurgeon and Korean War hero, Thoralf M. Sundt Jr., MD, FACS.

The annual Edward D. Churchill Lecture (now hosted in even years by the ESS, which is the ACS Military Chapter, and in odd years at the ACS Clinical Congress) affords an opportunity for civilian and military surgeons alike to reflect on Dr. Churchill’s legacy, including his trailblazing efforts to improve the care of his patients, and his work to enhance our profession and our society.

Finally, as detailed in chapter 35 of Surgeon to Soldiers, in February 1945, Dr. Churchill gathered in the Excelsior Hotel in Rome, Italy, to debrief with his team of surgical leaders on the lessons they had gleaned from combat both directly and from Allied surgeons.

The following year, with the war over and attendees of this inaugural meeting now back in the US, these same surgeons established the Excelsior Surgical Club with Dr. Churchill as the lone “Honor Member.” These surgeons sought to “advance their knowledge of the science of medicine and surgery” in the company of friends who had shared the hardships of a grueling deployment (see Figure 5, below).⁵ These bonds of respect and friendship lasted for decades until the final living member, Michael E. DeBakey, MD, FACS, passed away in 2008.

In 2014, as the Military Health System and the ACS were forming a strategic partnership, Dr. Elster and others were inspired to re-animate the Excelsior Surgical Society as the academic home for military surgeons and their civilian mentors.

In 2015, the first meeting of the new embodiment of the society was held in Chicago, Illinois, during the 101st ACS Clinical Congress. As a result, the year 2025 holds special significance as the 80th anniversary of the end of the war that gave birth to the Excelsior Surgical Club and the 10th anniversary of the “new” Excelsior Surgical Society.

In recognition of this momentous occasion, the ACS and the ESS this month will host an international surgical congress at the Excelsior Hotel in Rome.

This international program will feature military and civilian surgical leaders who, like Dr. Churchill, seek to advance the ESS mission of “preserving the lessons of the past, improving care in the present, and anticipating challenges of the future” for both military and civilian surgery. All ACS members are welcome and encouraged to attend this historic celebration, and connect with and support military surgeons in an effort to optimize combat surgical care.

Acknowledgement

I would like to extend my deepest gratitude to the extraordinary individuals whose inspiration, contributions, and support made publication of Surgeon to Soldiers, 2024 Edition possible. To Col. Jennifer M. Gurney, MD, FACS, Immediate Past-President of the ESS; Capt. Matthew D. Tadlock, MD, FACS, current President; and Col. Matthew J. Bradley, MD, FACS, President-Elect—thank you for your encouragement and partnership in this effort. To Dr. Knudson, inaugural MHSSPACS Medical Director, and Brian J. Eastridge, MD, FACS, current MHSSPACS Medical Director—your pioneering efforts in military-civilian collaboration have been a guiding example for us all. Finally, to Dr. Elster, Past-President of ESS and coeditor of Surgeon to Soldiers, 2024 Edition—your scholarship and mentorship have left indelible marks on this project, on me, and on many future military surgeons.

Dr. Jeremy Cannon is the Immediate Past-President of the ESS and an editor of Surgeon to Soldiers, 2024 Edition. He also is a professor of surgery at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center of Philadelphia.

References

1. Epstein A, Lim R, Johannigman J, et al. Putting medical boots on the ground: Lessons from the war in Ukraine and applications for future conflict with near-peer adversaries. J Am Coll Surg. 2023;237(2):364–373.
2. Cannon JW. Invited commentary: Total war: A succinct surgical overview and why civilian surgeons should care. J Am Coll Surg. 2023;237(2):373–375.
3. Churchill ED. Surgeon to Soldiers. Philadelphia, PA: JB Lippincott Company; 1972.
4. Cannon JW, Fischer JE. Edward D. Churchill as a combat consultant: Lessons for the senior visiting surgeons and today’s military medical corps. Ann Surg. 2010;251(3):566–575.
5. Cannon JW. Expeditionary surgeons: Essential to surgical leadership in World War II and today. J Am Coll Surg. 2024;238(5):785–793.
6. Knudson MM, Evans TW, Fang R, et al. A concluding after-action report of the senior visiting surgeon program with the United States military at Landstuhl Regional Medical Center, Germany. J Trauma Acute Care Surg. 2014;76(3):878–883; discussion 883.
7. Moore EE, Knudson MM, Schwab CW, et al. Military-civilian collaboration in trauma care and the senior visiting surgeon program. N Engl J Med. 2007;357(26):2723–2727.
8. Schwab CW. Winds of War: Enhancing Civilian and Military Partnerships to Assure Readiness: White Paper Presented at the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014. J Am Coll Surg. 2015;221(2):235–254.
9. National Academies of Science, Engineering, and Medicine. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press; 2016.
10. Cannon JW, Gross KR, Rasmussen TE. Combating the peacetime effect in military medicine. JAMA Surg. 2020; Epub ahead of print.