Post on 05-Mar-2023
transcript
Volunteering with the groups Project Healing Waters, Heroes
on the Water, and Casting for Recovery, I have been able to
observe the strides military medicine has accomplished. These
organizations sponsor war veterans and women undergoing
treatments for or in remission from breast cancer for a weekend
of fly fishing as a rehabilitative exercise. Over a weekend
these organizations teach the participant how to fly fish by
pairing a wounded soldier/cancer patient with a fly fisherman on
a one-to-one ratio. Observing the amazingly adaptive abilities
the injured perform while casting and then fishing, stimulated my
curiosity and interest regarding military medical advancements.
Following the Annales School’s principles, I continually
questioned the replication of my premise, that due to the
egregiousness of war, military medicine achieved great
advancements directly related to treating those wounded in
combat, and that medical knowledge has been transferred with
success into civilian medicine. I wanted to know if this was
just a modern-day result or has this been one of those rare but
positive war-time by-products.
3
America’s Civil War proved to be the best conflict at which
to begin researching for two reasons. With the exception of the
Battles of Palo Alto and Resaca de la Palma, fighting in the U.S.
Mexican War, 1846-1848, occurred in Mexico which made obtaining
documentary evidence difficult. Secondly, regardless the
combatant’s side for which surgeons served, the surgeon in
America’s Civil War especially at its onset, received the same
medical training. Examining how the surgeons applied their
knowledge within the constraints of battle, as well as creating
medical advances, became the genesis for my research.
Having visited some Civil War sites in and around Rome,
Georgia in 2002, I purchased the book Confederate Hospitals on the Move:
Samuel H. Stout and the Army of Tennessee, which I never read until needed
for this course. Author Glenna Schroeder-Lein aggregated Stout’s
own data—weighing 1,500 pounds—to demonstrate Stout’s competency
as a surgeon, an organizer, and as an administrator. Stout’s
data collection is as important today as it was during his
compilation. “Confederate medical statistics, as a result of the
burning of the surgeon general’s office upon the fall of
4
Richmond, are extremely fragmentary.”1 Through the compilation
of medical records, Stout devised treatments which enabled him to
successfully return healthy, able-bodied soldiers to the
battlefield at an unprecedented rate.2 In the Atlanta campaign
alone, where Confederate strength totaled 98,580 in July and
August 1864 and the Union strength totaled 197,745,3 Stout
achieved significant results. Based upon his estimates, his
hospitals saved the Confederate Army at least one division.4 In
July and August 1864, the reports for the constitutional diseases
(dysentery and diarrhea) were 1,550 cases in the Confederate Army
and 1,839 cases in the Union Army. The mortality rate from these
diseases for the Confederate Army was 1.2% and the Union Army was
2%. The wounds, accidents, and injuries for the Confederate Army
was 18,374, while the Union Army suffered 9,140. The mortality
1. James Breeden, “Medicine in the Atlantic Campaign,” Journal of Southern History 36, no. 1(February 1969): 31-2.
2. Glenda Schroeder-Lein, “That Attention and Care to Which They are Entitled,” in Confederate Hospitals on the Move: Samuel H. Stout and the Army of Tennessee (Columbia, SC: University of South Carolina Press, 1994), 62-3.
3. Breeden, 39. 4. Samuel H. Stout, “Personal and Official Correspondence, 1847-1955,”
Samuel Hollingsworth Stout Papers, 1800-1899, Manuscript Collection No. 274, box 1, folder 39, box 2, folders 1-2, Emory University Manuscript, Archives, and RareBook Library, Atlanta, GA.
5
rate from those hurt was 9.02% for the Confederacy and 20.8% for
the Union.5
Competently assessing and managing hospital accommodations
under his command, Stout’s anticipation of medical needs prior to
battle generated more effective treatment for wounded soldiers,
which also aided in a more successful recovery.6 While failing
to have direct knowledge of germ medicine due to its infancy
stage in the mid-19th century, Stout reacted to the results
contained in the patient records to replicate successful
treatments on patients and to implement new measures when patient
recovery and treatment lagged, such as actual bed configurations
within a ward, patient diet, ward, nurse, patient, and surgeon
cleanliness, and latrine location.7 Stout’s hospitals underwent
frequent relocations as the Union Army invaded farther into the
South. Without understanding the exact causes as to why patient
diseases in his hospitals decreased, especially malaria, Stout
reacted to the data his records showed by continuing to select
his hospital sites based upon specific geographic criteria—near
5. Breeden, 41. 6. Schroeder-Lein, “We are Packing Up in a Hurry to Move,” 132. 7. Ibid, “That Attention and Care to which they are Entitled,” 74, “To
be Better Supplied than any Hotel in the Country,” 111.
6
railroads with a readily available wood supply, high elevation
avoiding low, marshy, and boggy areas, a nearby, clean water
source unhampered by a current or previously encamped army, and
viable soil quality for the planting of a garden.8 After seeing
the great inefficiency and unwillingness of the Quartermaster
Department to transport wounded soldiers, Stout requested an
order from General Bragg to be placed in charge of administering
the ambulatory transportation, so he could anticipate the needs
of the wounded and ill under his care.9 Stout’s actions enabled
the Confederacy to maintain a fighting force.
While Stout’s achievements were remarkable in and of
themselves, how Stout’s records and actions compared to other
Civil War surgeons located in different theatres were imperative
to determine the depth of Stout’s achievements. Schroeder-Lein
offered very few comparisons to Stout with his counterparts,
Confederate and Union, but did include a quote by H.H. Cunningham
regarding Stout’s individual importance to the Confederacy.
Schroeder-Lein also referenced Cunningham, whose seminal work,
8. Schroeder-Lein, 96-97.9. Ibid, 126-7.
7
Doctors in Gray: The Confederate Medical Service, analyzed the practice of
Confederate medicine, so it was to that source I next referenced.
Credited as being the authoritative source of Confederate
medicine by George W. Adams of Southern Illinois University,
Wyndham B. Blanton, and the Civil War History journal, H.H.
Cunningham’s work analyzed the Confederacy’s medical department
using vast resources of surviving hospital records, official war
records and finances, diaries, and publications. Regarding
personnel, Cunningham devoted much print to Stout, second only to
Confederate Surgeon General Samuel Prescott, and corroborated
many of Schroeder-Lein’s assertions regarding Stout, especially
Stout’s benefit to the Confederacy’s medical department.
Cunningham confirmed that not just in the Army of Tennessee, but
in all the Confederate forces, diseases, especially diarrhea,
dysentery, and sepsis—rampant among the Confederate troops and
Union prisoners—“…appear to have helped cause more than half of
all deaths.”10 Sanitation, though ordered to be practiced
throughout Confederate hospitals, was a problem plaguing the
10. H.H. Cunningham, “Chapter 10: Prevalence and Treatment of Disease,”in Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press, 1986), 185.
8
Confederacy; Schroeder-Lein indicated that Stout’s hospitals
suffered slightly less problems than the Confederate Army
overall,11 but rampant disease still plagued Stout and the
Confederacy.
While Cunningham confirmed Schroeder-Lein’s research that
disease was directly attributable to sanitation practices,12 my
next area of emphasis questioned if ambulatory practices hindered
the Confederacy as they did Stout’s hospital corps?
The wounded usually underwent a most uncomfortable tripeven when ambulance transportation was available to move them from the field hospitals....Some spring vehicles were supplied early in the war….The wounded were drenched by the rain falling through leaky covers.Drivers were not always considerate of their charges….The movement by rail was at times a most disagreeable experience for the wounded and a trying one for the medical officials.13
The Richmond Ambulance Committee seemed to be the exception of
poor ambulance transportation due to the Committee’s large supply
of wagons, efficient organization as a separate, volunteer unit
(of citizens), and an operating budget and supplies consisting of
funds and materials from their own, private purses.14
11. Schroeder-Lein, 109. 12. Cunningham, “Chapter 5: Administration of General Hospitals,” 88. 13. Ibid, “Chapter 7: Medical Officers in the Field,” 121-2. 14. Cunningham, 121-2.
9
The bibliography compiled by Cunningham, while abundant and
enriched, was less than desirous and difficult to read, cite, and
research, unlike his footnotes which were much easier to
navigate. The included primary source photographs of people and
orders written and issued added interest to the work, but
overall, did not clarify conceptual knowledge. Notwithstanding
the bibliography, Cunningham and Schroeder-Lein referenced Union
counterparts throughout their work including George Worthington
Adams’ seminal work, a Union counterpart to Cunningham’s, Doctors
in Blue: Medical History of the Union Army in the Civil War.
Adams’ research relied heavily on government documents,
hospital and surgeons’ records, memoirs and diaries, and
newspapers. Additionally, Adams included primary source
photographs by Matthew Brady and Alexander Gardner; however,
these photographs, while conceptually formative and valuable,
were captioned-only and took me quite some time to research and
locate their documentation within the National Archives. Adams’
bibliography was as infuriatingly difficult to research as
Cunningham’s and was less complete, because Adams chose to
include only “…the more useful and more interesting ones
10
[sources].”15 Maddening though the bibliography was, Adams’
research was thorough and proved that the Union medical
department and the Confederacy suffered similar maladies in
similar proportions to one another during the fighting for
sanitary reasons.16 Likewise, the ambulance system in the North
was just as tortuous and vexing to its wounded and medical staff
as it had been in the South.17
Amputation, the germination of my inquiry, proved an
interesting lesson. Each army documented similar statistical
results from the two methods of amputations performed, as well as
discussing the importance of the time-frame in which the
operations were performed and the effects of sepsis on treating
the wounded and occurring post-operatively. Both Adams and
Cunningham discussed each combatant’s surgical amputation
procedures which were the same—circular and flap, though Adams
provided more vivid descriptions and statistics relating to the
procedures, and Cunningham provided more statistical results from
the procedures. 15. George Worthington Adams, “Sources, Appendix, and Index: A Note on
the Sources,” in Doctors in Blue: Medical History of the Union Army in the Civil War (Baton Rouge: Louisiana State University Press, 1996), 231.
16. Adams, “Army Sanitation and Hygiene,” 196-7. 17. Ibid, “Improvement in Field Tactics,” 99-100.
11
“The ‘flap’ operation…was preferred by about six surgeons
[Union Army] out of ten. Its advantages over the older
‘circular’ operation were its speed and the fact that it left a
better stump; its admitted disadvantages were that it sacrificed
more of the limb and made a larger wound.”18 Ability of a
surgeon to perform arterial ligations (tying off of blood
vessels) and the impending work load played key factors as to
what type of amputations were performed. Regrettably, statistics
for “…which operation was more subject to infection and sloughing
of the flesh, which of the two involved the greater risk of
hemorrhage, and which would best withstand the rigors of
transportation,”19 were not kept, as surgeons argued over these
factors. Amputations occurring within 24 hours of the wound were
known as primary amputations. Secondary amputations occurred
more than 24 hours after the wound. Cunningham’s operative
statistics for the Confederacy noted that primary amputations
performed in and around Richmond, VA from 1 June-1 August 1862
demonstrated a greater survival rate than secondary amputations.
Of the 272 primary amputation operations performed, 82 soldiers
18. Ibid, “Operations and Infections,” 133. 19. Ibid, 133-4.
12
died (30% mortality rate), but of the 308 secondary amputation
operations performed, 163 soldiers died (52.9% mortality rate).20
Interestingly, Adams and Cunningham cited their surgeons’
reference to Crimean War amputation results for preferring and
choosing a procedural predilection,21 and Adams noted that
“modern surgery makes use of both operations and of others as
well, letting the circumstances of the case determine.”22
Schroeder-Lein’s research did not deliberate or examine
amputation.
Medicine, being so personal in nature for the patient,
caused me to want to understand the magnitude of gains,
particularly for amputees. Lacking a scientific background other
than my own personal experiences, I needed an Everyman to fully
appreciate the gravity of advancements. Researching the National
Museum of Health and Medicine archives to better understand what
it meant to be 19th century amputees, I discovered the concise
case study of double leg amputee Private Columbus Rush, Company
C, 21st Georgia, age 22. Wounded from a shell fragment fired
20. Cunningham, “Chapter 11: Surgery and Infections,” 222-5. 21. Adams, 130-4 and Cunningham, 222-5. 22. Adams, 134.
13
during the assault on Fort Steadman, Virginia on 25 March 1865,
Rush’s legs were fractured below his right knee and at his left
kneecap. Undergoing the double amputation surgery the afternoon
of his wounding, Rush recovered quickly and was discharged from
Washington, D.C.’s Lincoln Hospital on 2 August 1865. The
following year, physicians outfitted Rush with prosthetics while
he was hospitalized (for a different malady) at St. Luke’s
Hospital, New York City. With the assistance of two canes and
his prosthetics, Rush could walk.23 Included in Pvt. Rush’s case
study were two portrayals of Rush—sitting without prosthetics and
using his prosthetics to stand.
23. “The Case of Private Columbus Rush,” in past exhibit To Bind Up the Nation’s Wounds: Trauma and Surgery, National Museum of Health and Medicine, Silver Spring, MD, accessed 4 January 2015, http://www.medicalmuseum.mil/index.cfm?p=exhibits.past.nationswounds.page_02.
14
Pvt. Columbus Rush double amputee24 Pvt. Columbus Rush
with prosthetics25
Additional research by Adams covered splints delineating how
World War I experiences with the splint actually saved lives and
limbs, and even though this device was invented by Surgeon John
T. Hodgen in 1863 and made available to Civil War surgeons, its
Civil War implementation never materialized due to the ignorance
of its operation and application.26 Adams’ reference to World
War I’s surgeons successfully implementing and improving upon a
Civil War medical invention directed my research to other World
War I medical military advancements.
Notably, after the end of America’s Civil War and before the
beginning of World War I, Joseph Lister, Robert Koch, and Louis
Pasteur revolutionized germ theory.
Lister is known as the inventor of antiseptic surgical techniques, which helped to reduce the infection mortality rate….Koch’s Postulates, which prove both that specific germs cause specific diseases and that disease germs transmit disease from one body to another, are fundamental to the germ theory. Pasteur’s…24. “Amputation,” (Columbus Rush portrait as double amputee),
http://www.medicalmuseum.mil/index.cfm?p=exhibits.past.nationswounds.page_02. 25. “Amputation,” (Columbus Rush photograph wearing prosthetics and
standing with cane), http://www.medicalmuseum.mil/assets/images/exhibits/nationswounds/amputation3_lg.jpg.
26. Adams, 133.
15
accomplishments…include disproving spontaneous generation, showing how heat could kill microbes…and developing the first laboratory vaccines.27
Relying on surgical records, surgeon diaries and letters,
government documents, and primary source photographs, J.D.C.
Bennett demonstrated that due to germ theory knowledge, and as
the war progressed, advancements in disease prevention through
inoculation (voluntary in the Royal military), sanitation, and
surgical innovations eventually ensued by the conclusion of World
War I. Dishearteningly, sepsis sanitation still plagued World
War I combatant armies for the very same reasons they had in
America’s Civil War, a breakdown between administration and
surgical application occurred. While Lister’s knowledge was
known to Allied and Central combatant surgeons alike, and wound
care had evolved to “…drainage at the most dependent point
[closest attachment to the body], washing out with antiseptics,
and application of dressings,”28 surgeons preferred to continue
operating as they had done since 1877. Two works went widely 27. “Germ Theory,” in Contagion: Historical Views of Diseases and Epidemics, Harvard
University Library Open Collections Program, accessed 24 January 2015, http://ocp.hul.harvard.edu/contagion/germtheory.html.
28. J. D. C. Bennett, “Medical Advances Consequent to the Great War 1914-1918,” Journal of the Royal Society of Medicine 83 (November 1990): 738, accessed 15 December 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292926/pdf/jrsocmed00130-0076.pdf
16
unknown and undisseminated so understanding the principles of
debridement and antiseptics remained untaught. The 1898
Fredrich’s treatise demonstrated the revolutionary effects of
debridement in wound care, “so as to avoid the disadvantages of
the painful and long lasting postoperative treatment involved in
the care of an open wound,”29 and the 1915 work of Alexis Carrel
and Henry Dakin interpreted the principle of antiseptics “…that
bacteria are killed by a chemical reaction with their proteins
and other cell constituents. The reaction is hindered by
contamination with proteins in blood, pus etc. Increased
strength of antiseptics is associated with irritation and damage
to the tissues.”30 As a result, surgeons still believed
projectile wounds were relatively sterile and thought best to
leave the wounds open and just treat them by applying antiseptics
on the wounds.31
The Director General Army Medical Services, Lt. General Sir
John Goodwin, while refusing to correlate the mortality rates
attributable to disease versus wounding, recognized sanitation
29. Ibid, 739. 30. Bennett, 738-9. 31. Ibid, 739.
17
was of paramount importance. “Goodwin ascribed the vast
improvements in rates of disease to the advances made regarding
water purification, disposal of waste and field sanitation
generally and to the improved education in hygiene of the Army as
a whole, and last but not least to the increase in preventive
inoculation.”32 Due to these actions, tetanus outbreaks dropped
90%; France imposed compulsory inoculations for typhoid and
experienced a dramatic decline in outbreaks, while non-vaccinated
British troops suffered a 50 to one mortality rate by 1916.33
Sterilization and hygiene also improved in World War I.
Bennett included three images, two photographs and one drawing,
from The War Illustrated 12 June 1915 and 13 August 1915 magazines
which depicted: how an entire train car was altogether
disinfected between wounded ambulatory transfer commissions, a
bathing accommodation train car provided for soldiers, and a
mobile bacteriological lab which sought out bacteria throughout
the battlefields.
While America’s Civil War surgeons neglected implementing
the splint, World War I surgeons did not. Femur fractures
32. Ibid. 33. Ibid, 740.
18
resulted in an 80% mortality rate at the start of World War I.
The dramatic decrease in mortality rates resulting from
implementation of the Thomas splint, precipitated the British
Army to train all ambulance drivers and orderlies in splint
usage, establish fracture clinics in hospitals, and implement
mobile X-ray usage.34
World War I turned from a regional dispute to one of total
attrition. In desiring to win a war of attrition, governments
allowed trench warfare to ensue, poisonous gases to be deployed,
and affected more civilians than had been affected in previous
wars. As a result, a new disease, trench fever, appeared not
long after the onset of war and disappeared soon after World War
I’s Armistice. Trenchfoot, not new to warfare but uncommon,
reappeared and whose incidences were treated with preventive
medicine. British forces went from 38.45 cases for every 1,000
soldiers in 1915 to 3.82 cases per 1,000 in 1918. Studying
respiratory physiology and anatomy increased among surgeons so
they could implement effective treatments in response to gassing.
By 1916 drift gas mortality had dropped to about 5% within the
34. Bennett, 740.
19
first 48 hours of the wounded being admitted to battlefield
clearing stations, while only 1-2% of those who reached base
hospitals died within the second to third week after exposure.35
Social advances were gained—England’s infant mortality rate
dropped to 91 per 1,000; post-revolution Russia experienced an
almost total eradication of obesity, alcoholism, gout, gastritis,
appendicitis, biliary disorders, and constipation; gout
disappeared in Germany. With these advancements, “profound
changes in the pattern of disease, new diseases and injuries on a
vast scale together with the social upheaval of the Great War
acted as a catalyst for changes in medical administration. In
1917 David Lloyd George…set up committees to decide how the
future health services would be run—in particular the need to
bring preventive and curative medicine together.”36
While America’s Civil War saved patients through amputation,
rehabilitation for these patients as well as those who underwent
resection did not happen until World War I’s advent of fracture
clinics and orthopedic wards. Major Tait McKenzie advocated
physical therapy rehabilitation as the method of treatment for
35. Ibid, 741. 36. Ibid.
20
the maimed soldiers he served as a physician at Heaton Park,
Manchester, England. Also a sculptor and Physical Education
instructor at the University of Pennsylvania, McKenzie possessed
an in-depth understanding of correct muscle movement and was thus
able to design devices that would assist in restoring proper limb
movement. McKenzie’s article included many drawings of machines
he designed for the purpose of providing rehabilitative treatment
to wounded muscle groups. Keeping detailed, longitudinal data,
McKenzie demonstrated that rehabilitative care provided benefits
to the army, the patient, and eventually carried over into
civilian life. By 1916, of the men discharged from Heaton Park
command dépót [sic], 50% were rendered fit for active service and
rejoined their fighting units; 30% were unable to return to
active duty but served new units in lines of communication or
worked on war efforts at home. 20% were deemed unfit and
received permanent discharges. “The average time of each man
spent in treatment was well under three months, and the fact must
not be lost sight of [sic] that, even though a man is not sent
back in category ‘A,’ [original fighting line unit] his
opportunities for a useful career in civil life after the war
21
have been enormously increased and the burden on the nation in
future pensions correspondingly lightened.”37
The genesis of my research began through rehabilitative
exercise. As well as having been a physical therapy patient
myself, I wanted to know how different the physical therapy field
is today 99 years later from when McKenzie advocated physical
therapy as a form of treatment. I consulted Dr. David Lott, PT,
DPT, OCS, CEAS, CKTP, Cert MDT, CCI, who confirmed that while
McKenzie’s equipment is outdated in parts used to construct the
machinery, the machines’ design concept methodology is still
current. Dr. Lott even showed me further examples of McKenzie’s
work and said that every physical therapy student studied
McKenzie at some point in their education.38
I wanted to know how the strides gained in World War I
medicine coupled with the technological advances achieved in the
between the war years translated into World War II military
medicine progress, so I sought sources that highlighted
medicine’s contributions to battlefield successes. At a 1948
37. R. Tait McKenzie, “The Treatment of Convalescent Soldiers by Physical Means,” British Medical Journal 2 (12 August 1916): 218.
38. Dr. David Lott, interview by author, Corsicana, TX, 6 January 2015.
22
conference, General Dwight Eisenhower, Supreme Allied Commander
in Europe, gave a presentation to the Committee on National
Security Organization, where he was asked to give his opinion as
to the greatest advancements achieved in World War II. General
Eisenhower rated air evacuation as one of the chief factors in
cutting down the fatality rate of battle casualties citing
evacuations occurring between 6 June 1944 and 8 May 1945 and the
thousands of lives saved due to the evacuations.39 The elevation
of ambulatory care from its 19th century implementation to World
War II developed with the advancement of airplanes, and as a
result, ambulatory care was no longer regulated to ground-only
movements. Air evacuations accomplished several strategic
moves: moving patients between theatres; moving patients within
theatres; moving patients from overseas to Zones of Interior, and
evacuating patients from debarkation hospitals to interior,
general hospitals.40 At the height of air evacuations, April
1945, 82,000 patients were transported from east of the Rhine to
hospitals behind allied lines. Overall, mortality rates were low
39. Mae Mills Link and Hubert A. Coleman, “Contribution to Military Medicine,” in Medical Support of the Army Air Forces in World War II, (Washington, D.C.: Office of the Surgeon General, USAF, 1955), 412.
40. Ibid, 410.
23
—for every 100,000 patients air evacuated, three died, and 85,000
patients air evacuated within the Zone of Interior incurred a 0%
mortality rate.41 “World War II not only demonstrated the
medical importance of transporting patients to a hospital by
airplane, but also shortened the medical supply line by
furnishing a means whereby patients could be moved comfortably
over hundreds of miles in a few days and thousands in a day or
two.”42
Women, whose roles in medicine during America’s Civil War
and World War I had been quite limited, began to have more active
assignments in World War II, and one of those roles was
accompanying the flight surgeon as a flight nurse on air
evacuations. Long before its need arose, the concept of the
flight nurse was created by “Miss Lauretta M. Schimmoler, who as
early as 1932 envisioned the Aerial Nurse Corps of America.”43
Acceptance of women in the military, as well as the role air
evacuations would play, were not yet understood. Neither the
Surgeon General’s Office nor the Red Cross desired to take on the
41. Link and Coleman, 411. 42. Ibid. 43. Link and Coleman, “The Flight Nurse,” 368.
24
Aerial Nurse Corps, “and as late as 12 July 1940 the Chief of the
Medical Division expressed…it is not believed that in time of
war, as a routine measure, nurses will be used on airplane
ambulances.”44 However, over two years later and because of the
personal interest of Brigadier General David N. W. Grant, Air
Surgeon, assigned to the 349th Air Evacuation Group, the first
formal graduation of nurses occurred on 18 February 1943. Many
of the nurses were former stewardesses, and they were given a 4-
week training course which “…included some class work in air
evacuation nursing, air evacuation tactics, survival, aeromedical
physiology, and mental hygiene in relation to flying. In
addition, the nurses received some training in plane loading
procedures, military indoctrination and a one-day bivouac.”45 As
inauspicious as their training and acceptance was in the military
during World War II, by the time the Korean War occurred, the
military’s attitude towards women in the role of flight nurses
and air evacuations would change.
44. Col. W. F. Hall, letter to Dr. Marjorie Nesbitt, 13 October 1939, quoted in Link and Coleman, “The Flight Nurse,” 370.
45. Link and Coleman, 371.
25
In two separate interviews, Alice Dorn, a flight nurse in
the Korean War assigned to the 801st Medical Air Evacuation
Squadron, a part of the 315 Air Combat Troop Carrier Squadron,
discussed the evolvement in flight nurse training and air
evacuations. As opposed to the ultimate six weeks training
flight nurses were given by the end of World War II, Dorn’s
nursing training lasted six months in Riverside, CA and another
two months of training in Alabama was dedicated to the specific
care of the wounded on airplanes. Upon completion of her
training, Dorn volunteered for duty in the Far East and was sent
to Japan. When the flight nurses arrived in Japan, it was
apparent that the military still struggled with the concept of
the flight nurse.
They couldn’t quite decide, were we flight nurses, or were we hospital nurses? The reason we were [assigned]with the troop carrier squadron was because they would take supplies to Korea and come back empty on their return trip. So they decided…that this would be a goodway to bring patients from Korea back to Japan….They would usually be treated in Tokyo or there were severalhospitals, big hospitals in Japan.46
Dorn described the rotation of flight nurses between Japan
and Korea which correlated with the number of flights on which 46. Alice Dorn, interview by Mik Derks, 4 May 2005.
26
the nurses flew. If air evacuations occurred in C-46s and C-47s,
the smaller planes, flights were usually traveling to and from
Kimpo and Pusan to Seoul six and seven times a day. The larger
planes, C-54s, transported patients between Korea and Japan
usually three times a day. On the smaller planes, the medical
staff consisted of one flight nurse and one medical technician,
while on the larger planes, there were always two nurses and two
medical technicians; there was never a doctor available.
Regrettably, the planes were loud, unheated, and outfitted with
four rows high of stretchers, the lowest being the floor of the
airplane, and bucket seats for the men who were ambulatory. Due
to the noise, communication between hospital medical staff was
nonexistent. “We didn’t know the patients well; we did have
records, and we were told about the patient as we left, but you
didn’t get to know him….Here, they came on; they were your
patient [sic]; you checked the records, you change dressing [sic]
or gave IVs, if it was necessary, or a sedation….You were really
on your own and hoped you made a good decision.”47
47. Dorn, interview by Dirks.
27
Dorn also addressed the implementation of helicopters for
air evacuation as well. Due to unnavigable terrain by vehicular
traffic, helicopters brought patients from the front two-at-a-
time to the first aid stations or M.A.S.H. units. From the
M.A.S.H. units, the wounded would be air evacuated to a hospital
in Korea utilizing the smaller planes. If the wounded required
lengthy hospital stays, usually the amputees, they would be air
evacuated to Japan then to Hawaii and finally to a stateside
hospital near their home which could handle their necessary
treatment. Helicopters were also used to transport patients from
Seoul to the hospital ship Constellation stationed in Incheon
Harbor.
Air evacuation advanced the need for a change in how
medicine was dispensed. Dorn discussed the advent and use of
collapsible fluids and the clotting factor serum albumin. IVs
were originally dispensed in glass bottles, but in the Korean
War, the IVs were dispensed from packs which could collapse and
not break. Dorn saw air evacuations and the role of the flight
medical staff as getting the patient to the specialized care he
28
needed so that limbs and lives could be saved.48 From a
physician’s standpoint, the success of air evacuations of the
wounded resulted in new gains, particularly in thoracic medicine.
“Accounts on human loss show that chest wounds were involved in
about one-third to one-half of the total killed in the Korean
War. However, the mortality of thoracic wound among treated
patients fell to 5%....An increased number of severely ill
patients were alive at admission due to rapid evacuation.”49
“The development of military medicine over the centuries is
the story of the emergence of one of our most important social
innovations that, like other social innovations before it, took
considerable time to evolve.”50 Beginning as early as Greek and
Roman wars, military medicine made great strides. The Greeks and
Romans knew how to treat blood loss, disease, infection, and
shock, but as the size of the Greek armies, their lack of
48. Ibid. 49. Thomas F. Molnar, Jochen Hasse, Kumarasingham Jeyasingham, and
Major Szilard Rendeki, “Changing Dogmas: History of Development in Treatment Modalities of Traumatic Pneumothorax, Hemothorax, and Posttraumatic Empyema Thoracis.” Annals of Thoracic Surgery 77, no. 1 (January 2004): 376, accessed 10 January 2015, http://www.annalsthoracicsurgery.org/article/S0003-4975(03)01399-7/fulltext#section.0040 .
50. Richard A. Gabriel and Karen S. Metz, “The Emergence of Military Medicine,” in A History of Military Medicine, vol. 2, (New York: Greenwood Press, 1992), 269.
29
expansion, and the 4th century collapse of the Roman army
interfered with the essential application, this knowledge was
lost.51 It would stay buried until several changes transpired.
The Renaissance’s great gift to man was “…the reemergence, for
the first time in more than a thousand years, of a habit of mind
that allowed social, religious, and medical precepts to be
challenged on the basis of demonstrated and observable data.”52
Unfortunately, the soldier had yet to have enough value for
medical advancements to occur. Oddly, it took the deadliness of
war to stimulate the soldier’s value to society. In the 18th
century,
…the shift in the basis of political power from divine rightto coalitions of popularly based constituencies required that the life of the soldier be invested with sufficient social worth to sustain the support of the population for governmental policies….Until the political orders that gave birth to armies came to value the life of the common soldier—really a phenomenon of the nineteenth century—the provisionof military medical care on the battlefield seemed a needless extravagance.53
Thus, America’s Civil War became the war to value life enough so
that it spawned many surgical advances upon which other wars
sought to improve.
51. Ibid, 270. 52. Ibid, 272. 53. Ibid, 271.
30
In Dallas, Texas there are three hospitals specializing in
the treatment of amputations—Baylor Medical Center’s Baylor Institute
for Rehabilitation Amputee Program, UT Southwestern Medical Center’s
Amputation Rehabilitation, and Texas Scottish Rite Hospital for
children. The Hanger Prosthetics and Orthotics Company, also
located in Dallas, is the largest prosthetics company in America.
“The war [American Civil War] pushed Confederate Army veteran
James Edward Hanger to start his own prosthetics company. It’s
reported that Hanger became the war’s first amputee after a
cannonball struck him.54 “He created his own prosthesis and
founded his company.”55 Currently at the Baylor University
Medical Center is a unique, permanent collection, the Adrian E. Flatt,
M.D., Hand Collection. Dr. Flatt is a “distinguished orthopaedic hand
surgeon [who] has served as a hand surgery consultant to both the
U.S. Air Force and U.S. Space Program….Seeking to prove that
there are no ‘typical surgeon’s hands,’ …Dr. Flatt has cast the
54. “The J.E. Hanger Story,” Hanger, accessed 29 January 2015, http://www.hanger.com/history/Pages/The-J.E.-Hanger-Story.aspx.
55. Keely Grasser, “Military Medicine: A History of Innovation,” Phoenix Patriot (Winter 2012): 18, accessed 27 January 2015, http://phoenixpatriotmagazine.com/wp-content/uploads/2012/09/Phx_Patriot_Winter121.pdf.
31
hands of several ‘people of consequence.’”56 Today, the
collection contains over 120 pairs of hands from people and
‘achievers of consequence.’ The free, 24-hour exhibit is on
display in the lobby of the Truett Hospital building.
Wishing to establish a similar exhibit at one of the three
amputation treatment center hospital facilities, delineating the
different types of prosthetics in actual exhibits, print media,
and possibly, re-created, hands-on devices, as well as including
graphic displays, borrowing prosthetics from the National Museum of
Civil War Medicine, e.g., acquiring modern-day prosthetics such as
those worn by Oscar Pistorius during the 2012 Olympics, creating
display cases, and label copy poses difficulties. The scope of
the project is large. Reductions of VA hospitals and budget cuts
faced by hospitals, private and public alike, as well as the rise
in patient out-of-pocket expenses, prove to be stumbling blocks
as justification of space and expenses for the exhibit seem
trivial. However, the value of seeing the advent of prosthetics,
beginning with America’s Civil War where the citizen-soldier
56. “EMotion Pictures: An Exhibition of Orthopaedics in Art,” American Academy of Orthopaedic Surgeons, last modified 2014, accessed 14 December 2014, http://www.aaos75th.org/gallery/artist_upclose.htm?id=568.
32
mattered to his government once again, to today’s miraculous
medical inventions demonstrates that the citizen-turned-soldier
will not be cast aside and forgotten. Additionally, for those
suffering maladies not caused by war-inflicted wounds have the
opportunity to experience a high quality of life similar to those
patients, also not wounded in war, who receive angioplasty
surgeries or blood transfusions or physical therapy—“medical
treatments and processes that take place at doctors’ offices,
clinics and hospitals throughout the world each day that have
roots in military medicine.”57
57. Grasser, 16.
33
BibliographyAdams, George Worthington. Doctors in Blue: Medical History of the Union
Army in the Civil War. Baton Rouge: Louisiana State University Press, 1996.
American Academy of Orthopaedic Surgeons. “EMotion Pictures: An Exhibition of Orthopaedics in Art.” Last modified 2014. Accessed 14 December 2014, http://www.aaos75th.org/gallery/artist_upclose.htm?id=568.
“Amputation.” In past exhibit To Bind up the Nation’s Wounds: Trauma and
Surgery. National Museum of Health and Medicine. Silver Spring, MD. Accessed 4 January 2015. http://www.medicalmuseum.mil/index.cfm?p=exhibits.past.nationswounds.page_02.
———. In past exhibit To Bind up the Nation’s Wounds: Trauma and Surgery. National Museum of Health and Medicine. Silver Spring, MD. Accessed 4 January 2015. http://www.medicalmuseum.mil/assets/images/exhibits/nationswounds/amputation3_lg.jpg.
Bennett, J.D.C., FRCS, DHMSA. “Medical Advances Consequent to the Great War 1914-1918.” Journal of the Royal Society of Medicine 83(November 1990): 738-742. Accessed 15 December 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292926/pdf/jrsocmed00130-0076.pdf.
Breeden, James O. “A Medical History in the Later Stages of the Atlanta Campaign.” Journal of Southern History 35, no. 1 (February 1969): 31-59.
“The Case of Private Columbus Rush.” In past exhibit To Bind up the Nation’s Wounds: Trauma and Surgery. National Museum of Health and Medicine. Silver Spring, MD. Accessed 4 January 2015. http://www.medicalmuseum.mil/index.cfm?p=exhibits.past.nationswounds.page_02.
34
Cunningham, H. H. Doctors in Gray: Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1986.
Dorn, Alice M. Goblirsch. Interview by Mik Dirks for Wisconsin Public Television. 4 May 2005, Madison, Wisconsin. “Wisconsin Korean War Stories.” Wisconsin Veterans Museum Research Center. Accessed 24 December 2014. http://www.wisvetsmuseum.com/collections/oral_history/transcriptions/D/Dorn,%20Alice%20-%20WPT%20-%20_OH%201039_.pdf.
Gabriel, Richard A. and Karen S. Metz. “The Emergence of Military Medicine.” In A History of Military Medicine, 271-9. Vol.2. New York: Greenwood Press, 1992.
“Germ Theory.” In Contagion: Historical Views of Diseases and Epidemics. Harvard University Library Open Collections Program. Accessed 24 January 2015. http://ocp.hul.harvard.edu/contagion/germtheory.html.
Grasser, Keely. “Military Medicine: A History of Innovation.” Phoenix Patriot (Winter 2012): 16-20. Accessed 27 January 2015. http://phoenixpatriotmagazine.com/wp-content/uploads/2012/09/Phx_Patriot_Winter121.pdf.
“The J. E. Hanger Story.” Hanger. Accessed 29 January 2015. http://www.hanger.com/history/Pages/The-J.E.-Hanger-Story.aspx.
Link, Mae Mills, Ph.D. and Hubert A. Coleman. “Contribution to Military Medicine.” In Medical Support of the Army Air Forces in World War II, 410-412. Washington, D.C.: Office of the Surgeon General, USAF, 1955.
———. “The Flight Nurse.” In Medical Support of the Army Air Forces in World War II, 368-371. Washington, D.C.: Office of the Surgeon General, USAF, 1955.
35
Lott, David. Interview by author. 6 January 2015. Corsicana, Texas.
McKenzie, Maj. R. Tait. “The Treatment of Convalescent Soldiers by Physical Means.” British Medical Journal 2 (12 August 1916): 215-218. Accessed 15 December 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2348780/pdf/brmedj07061-0009.pdf.
Molnar, Thomas F., Jochen Hasse, Kumarasingham Jeyasingham, and Major Szilard Rendeki. “Changing Dogmas: History of Development in Treatment Modalities of Traumatic Pneumothorax, Hemothorax, and Posttraumatic Empyema Thoracis.” Annals of Thoracic Surgery 77, no. 1 (January 2004): 372-378. Accessed 10 January 2015. http://www.annalsthoracicsurgery.org/article/S0003-4975(03)01399-7/fulltext#section.0040.
Schroeder-Lein, Glenna R. Confederate Hospitals on the Move: Samuel H. Stout and the Army of Tennessee. Columbia, SC: University of South Carolina Press, 1996.
Stout, Samuel H. “Personal and Official Correspondence, 1847-1955.” Samuel Hollingsworth Stout Papers, 1800-1899. Manuscript Collection No. 274, box 1, folder 39, box 2, folders 1-2. Emory University Manuscript, Archives, and Rare Book Library. Atlanta, GA.