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Chapter VII

Contents

CHAPTER VII

Otolaryngology1

Norton Canfield, M.D.

Otolaryngology in the Office of The Surgeon General at the beginning of the war was a division of general surgery, and so it remained both in the Office of The Surgeon General and in most military hospitals, except in a few where the administration wisely saw fit to make it a separate service. Where there was a separate otolaryngology service, the specialty made its greatest progress because the service was usually under the direction of professional talent which was also responsible for separate services in the civilian teaching hospitals associated with large medical centers. In a rapidly expanding medical service, such as the Army was obliged to manage from 1941 to 1945, the administrative wisdom of surgical specialties' being professionally responsible to the chief of general surgery was undeniable in many instances. But the inflexibility of this policy as interpreted by some commanding officers led to patient care which was often unfortunate. So rapid and frequent was the shifting of personnel in many medical units that a set professional "chain of command" was deemed of major importance. Indoctrination of newly commissioned medical officers was, however, often insufficient to make Army policies for the administration of professional services completely acceptable to many civilian-trained specialists during their military service.

THE CHIEF SURGEON

In mid-1942 the European Theater of Operations, U.S. Army, was expanding, and the medical service was under the direction of the theater Chief Surgeon, Col. (later Maj. Gen.) Paul R. Hawley, MC, whose military career had been of long standing. His preliminary close association with the British which was so manifestly the result of his professional knowledge, human understanding, and military acumen, coupled with his absolute respect for professional integrity wherever it appeared, made him a superb "chief" in every respect. In addition to his excellent, but understandably not perfect, ability to select men for important posts and his willingness to replace officers who did not meet his expectations, General Hawley was so often correct in his decisions that even the professional consulting staff was hard put to it to substantiate recommendations when they ran counter to his ideas.

1For amplification of matters briefly reviewed in this chapter, see: Medical Department, United States Army. Surgery in World War II. Ophthalmology and Otolaryngology. Washington: U.S. Government Printing Office, 1957.


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Those consultants who were on duty in the Office of the Chief Surgeon, ETOUSA (European Theater of Operations, U.S. Army), for the period 1942-45 can never forget the "battle of the anesthetists" under the amazing leadership of Col. Ralph M. Tovell, MC. Colonel Tovell's strategy was based on solid professional polices and execution and was so keen that it took General Hawley by surprise, which he did not fancy. The general took special pains to make his displeasure emphatically obvious. The outcome, however, under the guidance of Colonel Tovell was so beneficial to the troops who needed professional medical care that the Chief Surgeon, in the presence of his professional advisers and his administrative staff, accepted completely Colonel Tovell's magnificent work, thereby demonstrating his stature (p. 300). General Hawley did this in a manner which was worthy of the finest of human character, and he let it be known that he was mistaken in his previous emphatic opposition to policies which eventually made anesthesia one of the great services during the war. This was but an example of the many instances in which he acceded to the high-grade professional advice from the men whom he preferred to have associated with him.

ACTIVITIES AND OBSERVATIONS

Appointment of Consultant in Otolaryngology ETOUSA.-In mid-1942, Col. (later Brig. Gen.) Elliott C. Cutler, MC, Chief Consultant in Surgery, ETOUSA, initiated a request to The Surgeon General for an otolaryngologic consultant for the European theater. The Surgeon General responded by requesting Dr. Lyman Richards of Boston and, later, Dr. Albert C. Furstenberg of Ann Arbor, neither of whom, because of their important civilian posts, could accept the position. By the gracious recommendation of Dr. Furstenberg, the post was offered to Dr. Norton Canfield (fig. 179). At that time, Dr. Canfield was a full-time head of the Division of Otolaryngology, Yale University School of Medicine. Earlier, he had been designated as essential for medical school teaching, but, when this position became available, the dean of the Medical School, Dr. Francis G. Blake, agreed to remove his name from the essential list. Thus, on 28 November 1942, the author entered the Army as a lieutenant colonel and was placed on temporary duty in Washington in the Office of The Surgeon General to prepare for his duties in the European theater.

At that time Col. (later Brig. Gen.) Fred W. Rankin, MC, was Chief Consultant in Surgery to The Surgeon General. Colonel Rankin outlined the functions that the otolaryngologic consultant in the European theater might be called upon to carry out. Arrangements were then made for the author's prompt transport to England. Within one week of landing in England in January 1943, he reported to the Chief Surgeon and was assigned as Senior Consultant in Otolaryngology, Office of the Chief Surgeon, ETOUSA. The author held this position from then until his return to the United States in 1945,


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after V-J Day. Before this consultant's arrival in the European theater, duties of the otolaryngologic consultant were performed by Maj. (later Lt. Col.) Frank D. Lathrop, MC, formerly associated with the Lahey Clinic in Boston, and by Capt. (later Maj.) Edmond P. Fowler, Jr., MC, Chief, Otolaryngological Section, 2d General Hospital, then at Oxford, England. The preliminary work of these two officers was of great assistance, especially in the procurement of special surgical instruments from British sources during the early part of 1943.

Chief Consultant in Surgery - Under the wise counsel and able advice of Elliott Cutler, the otolaryngologic consultant during his entire tour of duty was given full professional authority. As he looks back upon the experience, it would be hard for this consultant to believe that any superior could have been more thoughtful and helpful in the execution of his duties. General Cutler's experience in World War I as a medical officer with combat forces admirably fitted him for the much more important post which he held as Chief Consultant in Surgery for the European theater in World War II. His military knowledge, high professional integrity, consummate geniality, and untiring efforts were largely responsible for the success in the handling of surgical problems in the European theater.

FIGURE 179.-Col. Norton Canfield, MC.

Associations with British - Immediately upon the assumption of his position in England, the author was placed in touch with the British authorities in his specialty. His association throughout the rest of the time in Europe with Brigadier Myles L. Formby, RAMC, was entirely satisfactory. Not only were many professional ideas exchanged, but the actual surgical care of members of both armies was at all times a matter of closest cooperation. One of the most pleasant and beneficial associations of the specialty officers in Europe during the period 1943-45 was the association with both British military and civilian


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specialists. The meetings of the Royal Society of Medicine in London were open to all medical officers of the U.S. Army, and it was the pleasant duty of the Senior Consultant in Otolaryngology to arrange for specialists in the theater to attend these meetings. On their own initiative, U.S. Army otolaryngologists attended meetings, both Army and civilian, at British installations near their own stations.

Administrative considerations - It was the policy in the European theater not to train otolarygologists, although there were available men capable of conducting such training in several of the large general hospitals. As the theater expanded, no one consultant could cover all of the hospitals; consequently, a system of regional consultants was initiated by General Hawley. The outstanding men in any one locality were assigned as regional consultants with orders to travel, if necessary, to nearby hospitals for consultation on individual difficult cases. The transfer of patients from one hospital to another was permitted under certain circumstances, always with the idea that the injured or sick soldier would receive the best possible professional care. It was the express policy of General Hawley that the administrative side of military medicine justified itself only when it could make the best possible professional care available to the sick and wounded (p. 349). Military considerations sometimes seemed to make this policy ineffective, but it never assumed this flavor by any design of the Chief Surgeon whose professional qualifications were of an exceedingly high order.

Relations with Army Air Forces - The Army Air Forces in Europe had their own unit medical service to which no otolaryngologic consultant was assigned during the war. At the operational airfields, much of the medical support found to be necessary for the pilots and aircrews was in the field of otolaryngology, and a number of qualified otolaryngologists were assigned to the various airbases. The U.S. Army hospitals in the area of East Anglia, where Army Air Forces activities were the greatest, provided most of the medical service for the Army Air Forces, and capable otolaryngologists were always assigned to these hospitals. Before D-day, battle casualties were confined largely to bomber crews flying between East Anglia and the European mainland. These casualties were given preliminary medical attention at airfields and were then quickly transferred to Services of Supply hospitals for definitive care. Much credit is due Captain Fowler for his initiation in the theater of special attention to aero-otitis and for his direction of the subsequent care given to aircrews by otolaryngologists assigned to those medical units which directly supported the Air Forces. The Senior Consultant in Otolaryngology and other highly qualified specialists were active in medical training courses given at Eighth Air Force headquarters for flight surgeons assigned to individual airfields.

Manual of Therapy - The training of otolaryngologists before their Army service had been largely directed toward providing definitive care to an individual needing medical attention. In a theater of operations, however,


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FIGURE 180.-An otolaryngologic clinic in a general hospital.

it was not always possible for the original specialist to give final care. Therefore, practices which at times seemed contradictory to the civilian training of medical officers were necessary because of troop movements on the one hand and the need to concentrate special surgical ability on the other. It was one of the duties of the senior consultant group to formulate policies to comply with such exigencies, and the Manual of Therapy, ETOUSA, setting forth these policies, was written and distributed in 1944.

Otolaryngologic service prior to D-day - During the time of the troop buildup before D-day, otolaryngologic service in the various hospitals was largely similar to that rendered to any fairly healthy civilian group (fig. 180). Outpatient clinics were, in general, very busy with routine respiratory infections, tonsillitis, otitis media, and sinusitis. The problem of hearing loss was not great, but many soldiers were sent to the European theater with hearing defects which required their assignment to special duties in order not to endanger them and their comrades unduly in combat (fig. 181). As the war progressed, a system for issuing hearing aids was instituted with considerable success.

Otolaryngologic service after D-day - After D-day, the nature of professional service from otolaryngologists necessarily changed, although as a group these specialists were rather busy before D-day. Thereafter, however, their activities were directed toward the wounded in their specialty, and, in general, they were well prepared for the onslaught of casualties as they


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FIGURE 181.-Audiometric testing for hearing acuity.

poured into the hospitals. Let it be known that many medical officers were on duty before D-day without much professional activity. These included the plastic surgeons and the oral surgeons who immediately assumed much more importance when the wounded began to appear. This naturally led to some conflict of ideas concerning the responsibility for certain types of cases, and expected controversies were encountered. Wounds of the head and neck were frequent, and professional policies of treatment had been carefully enumerated by medical officers of World War I, whose writings were well documented but not widely distributed for use in World War II. Again, the Manual of Therapy referred to earlier was extremely useful. As the fighting proceeded, hospitals were quickly transferred to the European mainland, and specialty services were established along the chain of evacuation of the wounded. Medical records noted previous treatments in sequence, but of course they were in many cases too briefly or incompletely prepared because of the tactical situation.

Relations with French - After the liberation of Paris by the Allies, large hospitals in the vicinity were used by the U.S. Army. Again, association with French surgical specialists and attendance at their meetings were sources of professional interest which continued during the years following the final victory.

Redeployment - After V-E Day, the selection of medical officers for redeployment to the Pacific was a difficult and unpleasant task for the professional consultants. Although most of the men in Europe had had more


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than 2 years of duty, it was necessary to assign many of them to duty in the Pacific. V-J Day, however, came so soon after V-E Day that much of this work was fortunately found to be unnecessary, and most of the specialists from the European theater were returned directly to the United States.

REASSIGNMENT IN THE UNITED STATES

Following the duty in Europe, this author was assigned as Consultant in Otolaryngology to The Surgeon General at his offices in Washington, D.C. Upon his return, he found Maj. (later Lt. Col.) Leslie E. Morrissett, MC, who had so ably directed the program for hearing rehabilitation centers in the Zone of Interior. After the war, prompt demobilization was a source of satisfaction to many of the specialists, but there was much more work to be done in the Office of The Surgeon General. The author remained on active duty until May 1946 attending to administrative matters and collecting data for the history of the Medical Department of the U.S. Army in World War II. His recommendations for the initiation of several clinical research projects which might have been carried out by officers remaining on duty were not acted upon by The Surgeon General, although it would have been possible to arrange for a very excellent facial nerve surgery service under the direction of Colonel Lathrop at Cushing General Hospital, Framingham, Mass. In addition, this consultant inspected the three aural rehabilitation centers and found them to be of the highest possible order. These centers were gradually closed, but The Surgeon General saw the wisdom of this extraordinarily fine program and established a permanent aural rehabilitation center at the Forest Glen Section of Walter Reed General Hospital, Forest Glen, Md. This involved a construction program in an old building, but a permanent hearing and speech center with a highly qualified staff was established. So effective was the program for aural rehabilitation that later the Veterans' Administration, also under the leadership of General Hawley, established a program for those servicemen who were discharged and were found to have service-connected hearing impairment. That story is still being written and will constitute one of the brightest spots in the annals of military and Veterans' Administration medicine.

SUMMARY

In looking back on his experiences as Senior Consultant in Otolaryngology in the European theater during World War II, this author is convinced that, if knowledge and experience in any way can be carried forward into future years, much grief will be prevented.

One of the civilian medical profession's main objections to military medicine is the fact that professional ability does not necessarily lead to a commensurate advance in military rank. The history of this problem in the U.S. Army was reviewed on several occasions by General Hawley, and he, at various times, admitted that a solution was difficult to find (pp. 336-338).


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It is the belief of this writer, whose experience can be said to have been extremely gratifying from his standpoint, that a small corps of well-trained otolaryngologists with every opportunity for professional advancement as well as advancement in military rank should be the solid policy of The Surgeon General during peacetime.

The consultants' program fully justified the high importance placed upon it during World War II, and the civilian organization which existed following the war, namely the Association of Medical Consultants of World War II (later The Society of Medical Consultants to The Armed Forces), attested to this fact.

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