Doctors Aweigh

Front matter

Contents

PAGE

CHAPTER

Foreword

Foreword

"DOCTORS AWEIGH" should prove extremely interesting to all members of the Navy Medical Corps and to the general reading public. The author, Rear Admiral Charles M. Oman, Medical Corps, United States Navy, has long been one of the representative officers of the Medical Department of the Navy.

His naval career has been a varied one, professionally and geographically. His first duty took him to the Philippines during the time of the insurrection. He had firsthand information of warfare as practiced by the Igorots and Moros, and so had his first taste of war surgery and tropical diseases in that part of the world. He was present at the tremendous earthquake in Messina in 1908 and did a great deal in the relief work among the wounded in that catastrophe. During World War I he was the commanding officer of the hospital ship Comfort and later commanded the Naval Base Hospital No. 1 at Brest, France. He was awarded the Navy Cross for his services in that war. Other duties took him to China and then back to the continental United States where he was the commanding officer of a number of large naval hospitals. In 1942 he commissioned, and was the first commanding officer of, the National Naval Medical Center at Bethesda, Maryland.

From this rounded service Doctors Aweigh will bring forth events of interest to everyone in the medical profession of this country — young and old, and be of special interest to relatives and friends of members of the armed forces.

Introduction

Introduction

ONE OF THE characteristics of our time is the desire to know. From all sides and from all groups of people of all ages comes a clamor for facts. For many generations medicine and surgery were Delphic mysteries, not to be revealed except to the initiated. But in the quarter century since the first bout of this war for human freedom all this has changed. Instead of the old hush-hush about many of the functions of the body and the diseases which attack it, a searchlight has been thrown on these matters. Today everybody is endocrine- and vitamin-conscious. Most Americans are more familiar with the setting and scenery of the alimentary canal than with the great gut of Panama.

Sometimes, to one like myself who has been trained in the older, more conservative school, this interest is more than a little disconcerting. As, for example, when a beautiful young woman comes up to you at a cocktail party and says with a flutter of her eyelashes, "Oh, Admiral Oman, so you are a Navy doctor? Then won't you tell me something about venereal diseases?"

One day a very lovely, intelligent, and talented movie actress called on me. She was most interested in the health problems we have to meet, and we discussed clothing, food, amusements, and a vast variety of subjects. What was apparently the most interesting subject — that of venereal diseases — was then approached. She said she had heard that the "sulfa" drugs were working miracles in curing gonorrhea.

"Yes," I said, "they are."

In fact, the admission rate for this condition has been markedly reduced, and the wards in Navy hospitals assigned to these diseases are rather sparsely occupied. However, as I remarked: "There is still something far more efficacious than the 'sulfa' drugs, and that is 'self-denial.'"

However, I am convinced that the lady I have just referred to is one of the isolated cases. The general public interest in medical matters today is not a morbid and sadistic curiosity. It is one more symptom of the trend of public thought, which is to demand more and more accurate and authentic information about whatever concerns the public good.

Essentially, the health of our Navy is a matter in which every thinking American must be concerned.

We have always carried out a program of health education. It is laid down in Navy regulations that the officers and men shall be instructed in personal hygiene, First Aid, and some of the simple laws of preventive medicine. This instruction, also according to regulations, is carried on by the medical officers of the Navy. How important and valuable this program is, is being shown in the daily communiqués from the naval battle fronts, telling of men who are able not only to help their wounded comrades, but to survive shipwrecks, weeks of exposure on rafts, and being cast up on tropical islands where the water supply is questionable at best, and where many tropical diseases are endemic. What brings these men through these trials and dangers is not only their American intestinal fortitude, all of them are armed with knowledge. Somewhere, aboard ship, in naval training stations, or in "boot" camps, doctors wearing the Navy's blue and the gold oak leaves and silver acorns which are the insignia of the Navy Medical Corps have taught these men how to protect themselves, if possible, from infection and disease.

The story I have to tell here is the story of these seagoing doctors and their work. That work goes on in time of peace no less than in time of war. Naturally, it is a story which only a medical officer of the Navy can tell.

About forty-five years ago two brothers, born in a small town in Pennsylvania, set out from home to seek their fortunes on the seas. One, Joseph Wallace Oman, had an appointment to Annapolis. The other, myself, took the longer road, which led through the University of Pennsylvania's Medical School. Six months after graduation I was commissioned assistant surgeon in the United States Navy. That was in February 1902. A month later I had my orders to accompany a detachment of Marines to an Asiatic station. My brother was then serving as ensign aboard the U.S.S. Helena. Back in Pennsylvania the neighbors said, "So those two Oman boys have gone to sea," as though that marked us as a bad lot. For the intervening forty years both of us followed the sea, Wallace in the Line and I in the Medical Corps, passing through the various grades of the service until both of us attained the rank of rear admiral.

My brother has gone now, and there is only one seafaring Oman left. But the love of the sea, of the ships, and the men who sail it, which actuated both of us as boys and as men, is not diminished. It is concentrated now in me and is the primary cause of this book.

Chapter 1

CHAPTER I

Emergency Call, Pearl Harbor

CAPTAIN HAYDEN SANG in his shower.

The sounds that rose above the gurgle and splash of the plumbing might not have been recognized by many as song, but to the captain's family the sound indicated that to the head of the house all was right with that peaceful, sunny morning of December 7, 1941.

It was one of Hawaii's brightest. Pearl Harbor was unusually full of big ships gleaming in the early-morning sun. Among the eighty-six ships of the Pacific Fleet moored there, there were eight battleships, seven cruisers, twenty-eight destroyers, and five submarines. For days the air had tingled with bugles and with something else, though less easy to define. Not in months had the base been so full and so busy.

Upstairs, in Captain Hayden's quarters, the sounds from behind the shower curtain became staccato: "K—K—K—Katy!" Like most Navy captains, Hayden's musical repertoire was of the vintage of 1918. That particular number was produced in response to a sluice of extra-cold water. Through the chattering of his own teeth he heard, suddenly, the roar of planes approaching and flying low over the quarters. This was immediately followed by a violent explosion.

Let him tell it in his own words:

"I didn't pay much attention to this. The Naval Hospital is located alongside the Army Air Base at Hickam Field and across the channel from the Naval Air Station on Ford Island. We had planes flying around most of the time. As we were doing some construction work in the rear of the hospital, dynamite blasts were not unusual. The explosion of three hundred to five hundred pounds of dynamite sounds about the same as the explosion of an air bomb. Then I heard more planes and more explosions. Big ones. They shook the house. Doggone it, that wasn't quite normal. Especially on a Sunday. I jumped out of the shower, threw on some clothes, and started for the window of my room. Just then my thirteen-year-old son, Billy, dashed in.

"'They're Jap planes!' he yelled.

"'Japs?'

"'Sure. Take a look at them.'

"We looked out the window just as three planes went by the second floor of my quarters, only about seventy-five feet away. I could see the features of the men in them. They were Japs, all right."

That was how the Navy's Medical Corps got its call to action at Pearl Harbor. Captain Reynolds Hayden (MC), U.S.N., was commanding officer of the Naval Hospital there. How the Navy answered that call that day and has been answering it all during the progress of the war I shall try to tell as frankly and as fully as naval regulations and circumstances permit.

It was 7:55 a.m. when the first of those black vultures with the crimson ball on their wings swooped down on the Army Air Base, Hickam Field, and on the Naval Air Station on Ford Island, where our big, long-range planes were. In that early hour of the morning a number of ambulant patients were strolling around the hospital grounds, which were one of the beauty spots of Oahu. The first Jap planes zoomed low over their heads, but the fliers were too intent on reaching military objectives, before our anti-aircraft guns could get at them, to bother with these groups.

With the sound of the planes, the explosions of the first bombs, and the crackle of our own anti-aircraft batteries sounding all around him, Captain Hayden gave orders to his family to keep inside the house unless it caught fire, and started on the run across the lawn to the hospital.

Waves of enemy bombers, escorted by fighter planes, were swinging in from the southeast to concentrate their attack on the heavy ships in the West, East, and Middle Lochs. It took only a few minutes after the first bomb dropped on the Fleet for the machine guns mounted on the battleships to open fire. Inside another five minutes the anti-aircraft batteries had swung into action. The air was full of the crash of exploding bombs and torpedoes, the roar of ack-ack guns, and the twisted, flaming skeletons of wrecked planes. The harbor was a sea of oil, ablaze in many places, in which terribly charred bodies floated and men made desperate attempts to swim.

Back in the Medical C.O.'s quarters, Billy Hayden flattened his nose against the window and let out an awed, solemn whistle: "Whew! And they call this the Paradise of the Pacific."

On that Sunday morning there were some 500 patients in the Naval Hospital. These were men from the station and sick and injured from the ships of the Fleet then in harbor. The official rating of the institution was 506 patients. Fortunately, the Medical Department was acutely aware of the ultimate significance of the events transpiring in the Pacific. We were keeping a big fleet in the Pacific, and it looked as if we would have to continue to keep it there, and to add to it for some time to come. Pearl Harbor provided the only hospital facilities for this fleet away from the mainland, except for small naval hospitals at Guam, Samoa, and Cavite.

There was no arguing against the fact that we needed enlarged hospital facilities and an abundant supply of drugs and surgical dressings. Although certain powers in authority and the public at large may have objected to appropriations requested for purely military naval expansion, there was always a ready and en response to the surgeon general's request for funds to provide for an increase in hospital facilities.

The hospital at Pearl Harbor grew. One by one, here and there new corridors, outbuildings, and pavilions were provided. Medical stores were built up. In Hawaii, there are no firms manufacturing drugs or medical supplies. All these must come from the United States, and it takes time to get them there.

The value of this foresight is proved by the fact, announced by the surgeon general of the Navy, Rear Admiral Ross T. McIntire, that "at midnight of December seventh there were 960 patients in a hospital whose official rating was 506 patients. And next day nearly 100 more were received who had been temporarily cared for at emergency dressing stations."

A mobile hospital with a capacity of 600 beds had been transported to Pearl Harbor and was practically set up and was functioning on that fateful day, December 7, 1941.

Whatever criticism may be made of our defense program at Pearl Harbor, it must necessarily stop short of the matter of medical preparedness. When it came to taking care of those injured in the raid, we were right on the spot; we were well staffed and well equipped.

Thank God for that!

By the time Captain Hayden got to the hospital, the officer of the day had ordered all hands to their stations. The hospital's three ambulances and all the fire-fighting apparatus were distributed about the grounds, so that in case a bomb were dropped, all the apparatus would not be destroyed at once. The immediate demand was for as many beds as possible for the casualties of the battle then going on. There was no possible way of estimating how many these would be. As ship after ship was hit or set afire, it was all too evident that everything the hospital had wasn't going to be too much. If only it were enough!

The first casualty brought in was a man who had been walking along the road by the hospital with his wife and small child. A falling fragment of shell cut off his left arm at the shoulder, with fatal results. Miraculously, the woman and child were not hurt.

All ambulant patients were moved from the wards to hospital tents set up behind the building. A number of men decided for themselves, and without benefit of medical advice, that they were well enough to get back to their ships and into the fight. They didn't stop for uniforms. Some of these men were killed. A few were injured and ultimately turned up at the hospital again. One lanky gunner's mate, who had been under treatment for a fractured rib, got out to his ship in time to help fire his gun before a bursting torpedo shattered both his legs. They brought him back to the same ward and the same bed he had crawled out of an hour before. Through grimly set lips he muttered: "It's just a damned merry-go-round!"

There was constant danger that the hospital itself would be hit. Ten minutes after the raid began, a blazing enemy plane came down on a glide toward the center of the main building. For a minute it looked as if it would make a direct hit. Then it veered off slightly, carrying away a corner of the laboratory roof and half the animal house, to crash on the tennis courts. The pilot had been shot in the head and killed before the crash. The plane had evidently come down out of control.

About eight-thirty came a lull in the raid, when the raiding planes went back to their carrier to reload. During that respite, the first casualties began to turn up at the hospital. For the next three hours, while the enemy came back and renewed the assault, and later, the victims continued to come at an average of three a minute. They were brought to the hospital in every sort of vehicle — ambulances, military and civilian trucks, private cars, and delivery wagons. Civilians co-operated with the Navy in bringing the wounded in under fire. A pool of all vehicles was formed at the navy yard garage and moved up, two by two, to the dock to take on wounded for conveyance to the hospital and to the emergency field hospitals set up in various places.

The hospital ship Solace was anchored in the harbor. Some of the patients she carried had been transferred to the hospital. The white-painted ship became a mecca for the men swimming about in the oil-covered water. Approximately 141 patients were received on board the Solace. "Many," according to Captain George Eckert (MC), U.S.N., chief surgeon, "were so seriously burned as to be unrecognizable. Those who were conscious tried to mumble their names. But no one whimpered. Their morale was high."

At the hospital, the problem was how to handle such a flood of terribly injured men as quickly and as competently as possible. This was solved by Captain Hayden and his executive officer, who quickly examined each man brought in and assigned him to a place in one of the twelve wards or sent him directly to the operating suite.

Many patients were unconscious, or too badly injured to speak. Forty-seven per cent of all the cases brought to the hospital were burned. Many were thickly coated with fuel oil. Practically all were in a state of shock.

The Navy is a stickler for records. All through a man's career in the service, whether just for a hitch or for life, two careful, up-to-the-minute, detailed accounts are kept of him. One is his service record; the other is his health record. The service record is kept in duplicate. One set goes with him from ship to station, in the keeping of his commanding officer; the other set is kept in Washington at the Navy Department. Whenever anything happens to the man — from an abscessed tooth to a citation for distinguished service — it is immediately written into its appropriate place in his record of health or service.

In the stress and confusion of battle or during such a raid as occurred at Pearl Harbor, there is no time to search a man's health record before attending to his needs. But Navy regulations and sound common sense decree that every effort be made to keep a record of his injuries and the treatment given them, as his continued treatment and future pension claim depend on these records.

This is one of the times when the metal identification tag, which man in the United States Navy — officer and enlisted man alike — wears about his neck, is invaluable. Here are inscribed the man's name and rating, his blood type — in case blood transfusions are necessary — and the date of his inoculation against tetanus. And, as further proof of identity, the print of his right forefinger. In addition to these data, a man who has been given first-aid treatment at a field dressing station or by a Navy hospital corpsman is promptly tagged before being sent on to the hospital. The tag tells the medical officer, who examines the patient, exactly what first-aid treatment has been given — morphine, sulfanilamide, or blood plasma.

It is enormously important that the first examination of the injured be made by a medical officer of long and extensive experience. Always there is shock to be looked for and guarded against. To send a patient to the operating room while in a state of shock is to court disaster. Abdominal and head injuries need to be wisely appraised. Many head injuries seem slight on casual examination; yet these, if not recognized and properly treated, will result in fatal complications.

All scalp wounds are serious, and sometimes it is a question for the surgeon to decide whether the metallic foreign body should be removed or not. Actually, there is a fifty-fifty chance that the man who has a bullet in his brain will develop epilepsy.

During World War I, Dr. Harvey Cushing improved the surgical technique then followed, with the result that the mortality of head wounds was reduced from 60 per cent to 20 per cent. With the use of sulfa drugs, this mortality rate has now been cut considerably lower.

Naturally, the powers of the entire hospital staff were stretched to the limit on that fateful December 7. "Though occasional shell fragments and machine-gun bullets zipped through our temporary ward building," said Captain Hayden, "all hands were so busy they had no time to think of themselves. Fortunately, nobody was injured."

For the next three days all hands worked twenty-four hours a day, snatching sleep when they could. In the operating rooms, four operating teams, two teams working at a time in relays, attended to the urgent surgical cases as rapidly as possible. For the next ten days the hospital staff was divided into watches so the work could go on continuously round the clock.

"I was proud of them," said Captain Hayden, "especially of my nurses and hospital corpsmen. Many of these were youngsters doing their first hitch. But they stood their baptism of fire well. As soon as the enemy planes started to roar over and around us, they dashed from their quarters to the main hospital building through a shower of anti-aircraft shell fragments and stray machine-gun bullets. Their first thought was to care for their patients and to get ready for those who they knew would soon be coming. After the raid, all hands worked until they dropped. You never had to keep them at it.

"Our twenty-eight nurses were especially devoted. I will always remember my chief nurse, a frail-appearing little woman who looked as though a good gust of wind would blow her away. But she was made of steel wire. She was everywhere: encouraging, supervising, directing. On Wednesday it was necessary to order her to bed to get some sleep. The staff took great pride in the fact that though we were understaffed for such a great number of serious casualties, we were able to care for our own without any outside medical assistance, except some volunteer trained nurses and 500 flasks of blood plasma from Honolulu."

The staff of the Pearl Harbor Hospital and that of the U.S.S. Solace were cited en masse by the commander in chief, United States Pacific Fleet, for distinguished services during, and subsequent to, the Japanese attack on December 7, 1941! There are combatant units which have been cited for gallantry in action, but this is the first time on record that the entire staff of a hospital or a hospital ship has received that honor.

Among the unsung heroes of that opening battle of the war were the hospital's Chinese galley force. Anyone who has lived in the East knows you can kill a Chinaman, but you can't surprise him. His imperturbability equals that of the Great Wall his ancestors built.

The hospital's cooks and mess boys lived up to the traditions of their race. With the great tide of seriously injured patients, slight casualties, helpers, and stray sailors whose ships had been blown up and who didn't know where to go, turning up at the hospital, every inch of space inside and out was crowded. Yet, somehow, by some miracle and the equanimity of the Chinese temperament, those boys served that day, between noon and 3 p.m., 4,500 Sunday dinners. Then they pitched in and produced an equal number of suppers.

Next day they did it again. After that, the hospital was cleared of all except the patients and staff, and the housekeeping settled down to a routine.

Character and habit are what make for morale in any emergency. Sometimes force of habit produces amusing results. When the U.S.S. Arizona was blown up in a world-shattering explosion, the Hayden children ran excitedly to the front door to see. Automatically Mrs. Hayden called after them: "Don't let the mosquitoes in."

One striking difference between the medical picture presented by World War I and the one we are fighting today lies in the enormously increased number of burn cases. As a result of modern warfare, burns have become a major casualty. Of the patients sent to the Pearl Harbor Hospital, 254 were burn cases.

Practically all these were flash burns, caused by the temporary but intense heat from exploding bombs or torpedoes. These were preponderantly second-degree burns, and many burns covered some 80 per cent of the body surface.

It was immediately noticeable that those parts of the body surface which were covered by any kind of clothing, even the lightest skivvy shirt or cotton shorts, were not burned. When the attack occurred, many men aboard ship were below deck and in various stages of undress. At the call of "battle stations," they ran to their stations without waiting to pull on their clothes. Some wore trousers and no shirts. Some were in their underclothes. Others wore only a pair of trunks, or sprang naked from the showers. Those wearing undershirt and trousers were burned only on the arms and face. Those with trousers but no shirts were burned over the entire body above the waist. Those wearing trunks were burned over the entire body except about the hips. This experience has led to the orders, now in force throughout the United States Navy, that at "battle stations" the men shall be fully clothed; and many wear "flash-proof" clothing.

In addition to their burns, numbers of the men had been overboard in water heavily coated with fuel oil, and were covered with it from head to foot. A number of these patients were in a state of shock, even when there was no sign of any physical injury. Those who were burned and covered with fuel oil presented a serious problem. No attempt could be made to remove the oil at the time. Immediate local treatment for the burns had to be applied over the oil.

How to remove fuel oil is a problem for extensive research. The best method found at Pearl Harbor to remove the heavy oil was by the use of a gauze or cotton sponge saturated with mineral oil. Of course this must be done slowly and with all the gentleness possible. The mineral oil leaves a thin film which, however, is not difficult to cleanse away. At least this method is preferable to the old one of using tincture of green soap. Since then some common proprietary preparations have been found to be most useful as detergents.

As soon as possible after their reception at the hospital or aboard the hospital ship all the burn cases were given a tanning process.

Aboard the Solace all the stainless-steel buckets available were collected in the pharmacy. One pound of tannic-acid crystals was added to each bucket of water, and these were distributed to each operating room, dressing room, and ward. In the rush, no attempt was made to observe sterile precautions. Dressings were soaked in the solution and placed on and around the burned areas and kept wet for twenty-four hours.

At the hospital, sprays of tannic acid, gentian violet, and triple dye were made up and used continuously. Everything which would spray the solution was put to use. Ordinary Flit guns were emptied, refilled with the medicated spray, and used to spray patients. Even though this tanning process was frequently applied over the fuel oil, a reasonably efficient tanning resulted.

As soon as the necessary cradles could be manufactured, each severely burned patient was placed under a heat cradle, several blue electric lights being used to supply the heat, and the cradles covered with blankets.

Why, one may ask, apply heat to bodies already terribly burned? It should be borne in mind that deaths resulting from burns are produced by shock induced by the burn and the loss of body fluid. Heat helps to prevent this. Treatment of the severely burned continued day and night until they were evacuated to the West coast ten days later.

Only the operating suite had been blacked out before the raid But strict black-out precautions became imperative because another raid might come at any time. Ward work was therefore continued with only the dim light from blued flashlights. This made the care of the injured, especially intravenous administration of plasma, extremely difficult.

In the great majority of war injuries of no matter what kind, the primary cause of death is shock. From the earliest times, surgeons have noted a startling clinical picture which appears in patients following severe injuries or major operations. There is an almost classical group of symptoms — pallor, moist skin, rapid, feeble pulse, and a lowering of blood pressure. These indicate acute failure of the circulation. In other words: shock. Typical shock is seen follow extensive surgical operations and in the victims of war wounds, burns, industrial accidents, and automobile injuries. It was a common and deadly combination in soldiers during World War I, and caused more deaths than any other single condition.

The term shock was originally applied to this condition when it occurred immediately after an injury. Later, the word came to include states of low blood pressure which might appear some hours after the injury. We now speak of primary and secondary shock. Primary shock generally follows soon after pain or injury. It resembles fainting. It is not due to hemorrhage. Secondary shock develops, insidiously, some hours after injury, burns, or hemorrhage. Its outstanding feature is low blood pressure. It has been found that practically every man injured during battle is in a state of shock, either real or potential. The condition is influenced or caused by hemorrhage, tissue destruction, mental trauma, fatigue, and many other factors. Shock must receive the first attention after hemorrhage is controlled.

Fortunately, today we can afford to wait and let shock be relieved before operating. I remember during World War I, when I was commanding officer of the Naval Hospital at Brest, we used to make every effort to operate on our surgical cases as soon as they were brought in to us; if possible, within the "golden period" of six hours after the injury. We believed, as the profession did then, that after that period infection was practically certain to set in, cutting down the chances of recovery. Today the sulfa drugs have extended the traditional "golden period" from six hours to from three to four days. The first time this miracle-working new drug was tested severely in a vast number of cases during conditions of war was at Pearl Harbor. "The experience," Captain Hayden said, "completely demonstrated that the free local use of sulfanilamide powder in wounds permits us safely to select the best time to operate on these patients."