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February 1997 Volume 5 Number 5 Published by the WW II History Roundtable Edited by Jim and Jon Gerber Welcome to the February meeting of the Harold C.Deutsch WW II History Roundtable. Tonight’s program concerns the saving of lives on the battlefield. Our speakers tonight are Dr. William McConahey, a combat surgeon in Europe, and Mr. Charles Aling whose father was a combat surgeon, also in Europe. War exaggerates the best and the worst in human nature. It magnifies every sort of human want the need for medical care more than any other. The battlefield has always been the physician’s greatest laboratory, demanding improvisation and the courage to treat and observe on a massive scale. Medical progress during war time is interesting to study. For example, the use of anesthesia came into its own during the Civil War. However, surgical hygiene was still so primitive that many of the amputees operated on by dirty hands, using filthy instruments, rapidly died from infection. If this had taken place 10 - 20 years later when Joseph Lister’s germ theory explained infection, many of these deaths would have been prevented. New X-ray techniques, blood transfusions, the treatment of wound infections and burns, the conquering of disease, better orthopedic procedures and countless other developments have been generated by war and thereby improved medical care in peacetime. Unhampered by the restraints imposed on civilian medical practice, military physicians have had vast experience under desperate conditions. These conditions have often given rise to startling leaps forward in medical care that may have taken decades to accomplish in peacetime. World War II propelled medicine into a new era of aggressive cure and disease prevention. An example is America’s development of a system of blood banking and transport. The military system of blood banking was so effective that by 1943 it had become common practice to draw blood from thousands of donors in America, refrigerate it and fly it to the battlefields of the South Pacific and later to Europe and North Africa. Scientists developed an effective preservative to keep blood usable for long periods of time. After World War I researchers had clarified the mechanism of shock and medical officers were now beginning to understand how to use blood transfusions most effectively to prevent shock. It was found that plasma, the liquid part of blood, could be used to restore blood volume and had the advantage of being easily transportable when dried. The two surgical specialties that had the greatest changes during World War II were plastic and chest surgery. The treatment of burns, the repairing of injured hands and the reconstruction of limbs underwent a great deal of progress as surgeons understood that by restoring the structure of a limb they could also restore its function. Prior to this, damaged limbs were, for the most part, simply removed. The sub specialty of hand surgery was born in response to the large numbers of injuries caused by hand-to -hand combat on the islands of the South Pacific. In 1945, the U. S. Army Surgical Research Unit was established as the first American hospital for the treatment of burns, the forerunner of the specialized burn center. Thoracic surgeons, who until World War II, were involved mainly with infections of the chest cavity and cheat wall, now began to operate on the lung itself. They learned to stitch the lung, remove diseased portions and remove shrapnel and bullets from the lung as well as from the heart muscle itself. Surgeons learned to actually reach into the heart to remove bullets. With the development of penicillin, the problem of infection decreased. Penicillin had the advantage over sulfa in that it killed bacteria rather than just stopping its growth. It became possible to save a great deal of tissue that normally would have been cut away and many operations that would have been mandatory could now be avoided. New techniques were developed to increase the amount of penicillin that could be produced, so that by the end of the war enough of the antibiotic was available to be used on the civilian population. The use of penicillin completely changed the complexion of the civilian medicine after the war. Not only the front-line doctors, nurses and medics were forced by necessity to find innovative ways to do things. When the Japanese seized Java, they also came to control with it the trees that were the only source of quinine. The U.S. either had to find either a new source of quinine or another treatment for malaria. Researchers came up with Atabrine, a synthetic drug for treating malaria. Testing was done on willing conscientious objectors and on prison volunteers to provide rapid confirmation of the drug’s effectiveness. Because of the outbreaks of typhus during World War I, researchers fought hard to develop more effective insecticides and eventually found DDT to be very useful. Despite the problems in recent years with DDT, Army physicians used it in every combat and occupation zone to delouse soldiers and civilians alike. It was effectively used to delouse the populations of Naples and other southern Italian cities. From that time until the liberation of the Nazi death camps, DDT was invaluable in the destruction of typhus-bearing lice. The most effective mass inoculations of combatants ever attempted occurred in World War II. During the Civil War, the mortality rate for tetanus was in the range of 90% of diagnosed cases. Although tetanus antitoxin was used on troops in World War I, the death rate remained high, estimated at about 50%. But of the 10.7 million soldiers in World War II, doctors found only eleven cases of tetanus, of whom six had somehow not been given the tetanus toxoid. Of the four men who died, two were of the non immunized group and two had not received booster shots. Brigadier General Elliot Cutler, the chief surgical consultant in the European Theater of Operations during the war and in peacetime a professor of surgery at Harvard University stated, “This is, in my mind, one of the greatest miracles of modern medicine.” In spite of the tens of millions of soldiers and civilians who had died by the last months of the war, it appeared that humankind’s power to heal might just be achieving some equality with its power to kill. Then on August 6th, 1945 the atomic bomb was dropped on Hiroshima and history itself appeared to be mocking the hopefulness of the healers. Radiation sickness made its first hideous appearance as well as long-term certainty of genetic disturbances and then malignancies. When the US occupation forces arrived in Japan, they brought with them medical teams to begin the studies that have continued since as a collaborative Japanese-American effort, and remain as the only reliable source of measurements linking radiation doses with disease. Further reading on this subject: The Face of Mercy: A Photographic History of Medicine at War by Naytons and Nuland Random House 1993 Long Walk Through War: A Combat Doctor’s Diary by Klaus Huebner Texas A & M 1987 Battalion Surgeon by William McConahey, M.D. Rochester, Minnesota 1966 Surgeon On Iwo: Up Front With The 27th Marines. by James Vedder Presidio Press 1984 “From Death Comes Life” by Norman Berlinger, M.D. “American Heritage of Invention and Technology” Winter 1996 Vol. 11 Number 3 We continue to ask for stories or information from our members that can be included in The Round Tablette. The stories need not be long but rather something that you think will be interesting to our readers. See You Next Month