426 - The Surgical Legacy of World War II - Part 3: Blood and Valor

One account by surgeon Francis Moore, MD, in November 1943 at Massachusetts General Hospital in Boston describes the Army and Navy’s appetite for surgeons as “insatiable.” The doc- tors who were not able to serve were key partners with the War Department. Dr. Moore and others put their own careers on hold, making sacrifices to train young surgeons in battlefield tech- niques, which were often at odds with the groundbreaking surgi- cal research being done at fine institutions around the US. (Dr. Moore eventually would collaborate with Joseph Murray Boston, a WW2 veteran and Nobel prize-winning surgeon, on the first kidney transplant in 1954.) While the Medical Department of the War was recruiting doctors, the Army and Navy’s technical schools for the enlisted were quickly filling up with multi-talent- ed, patriotic men who enlisted to serve their country. These men, and eventually women, were trained as nurses, “operat- ing room techs,” and other medical assis- tants and went off to war alongside the newly commissioned commanding officers: the surgeons. Individual surgical “units” were based around one surgeon as the commanding officer, but the rest of team comprised of four enlisted OR techs, usu- ally at the rank of sergeant. The breadth of life experience and practical skills that an enlisted man who came through an Army or Navy operating room technician train- ing program was invaluable in the lead-up to D-Day. The composition of a “model” surgical team was described at the time as “a mature general surgeon whose primary interest is abdominal work, a general surgeon whose primary interest is chest work, a younger man with a sound surgical background. If his hospital training has been in orthopedics, so much the better. There is no need for an orthopedic surgeon in the civilian sense of the word. An anesthetist who masters the intricacies of gen- eral anesthesia in all its varieties. Four enlisted men with clear heads and steady hands.” As the war raged on, the ideal surgical team became harder to realize in practice. As a result, the role of techs and nurses expanded, and the contribution these seasoned men and women made to the successful operations in these small groups is well documented. T he abbreviated surgical residency that some young doctors received prior to entering the European Theatre of Operations was perfectly acceptable to the career military within the Auxiliary Surgical Groups, but perhaps not as much to the ful- ly-trained, newly commissioned medical officers in the units. Some surgeons commissioned for D-Day were of the caliber of Lt. Col. Dwight Harken, known as the father of cardiac surgery, who could success- fully remove shrapnel from the hearts and great vessels of the wounded. In contrast, others were essentially third-year residents. The Office of Surgical Consultants (OSC) issued regular directives to medical personnel regarding updates in outcomes and current issues regard- ing the care being given to the wounded soldiers. “Meatball” surgery, a term made famous in the memoir of Capt. Richard Hornberger and later in the TV series “M.A.S.H.”, may have been quick and effi- cient, but it was an insult to an established surgeon with training and skill. Dr. Michael DeBakey would later state, “The best thing that can be done is not always the best thing to do.” The disobedience to the directives of the OSC was widely known, within the units and throughout the medical command structure of the Army. It was the topic of numerous communications with OSC mem- bers, and the report of the Activities of the Surgi- cal Consultants in 1962 stated, “The fact must be emphasized that there was a wide variation in the professional abilities of medical officers. In cer- tain instances, the application in the Army of certain surgical procedures, therapeutic measures, or drugs used in civil practice had to be prohibited. This was necessary in order to minimize undesirable results or untoward accidents known to occur when all med- ical officers were permitted to use the particular procedures, methods, or drugs in question.” Some medical directives affected the standard of care for POWs and wounded civilians. When the 5th ASG encountered wounded retreating soldiers and civilians, they were uncertain of their orders regarding their care. Directives from the OSC stated they were to receive the same treatment as Ameri- cans. (NO T !) FOL L OWING DOC T ORS ’ ORDERS Photo credit:USMilitary JUNE 2019 | The Surgical Technologist | 255