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Chapter IV

Contents

CHAPTER IV

Ophthalmology

M. Elliott Randolph, M.D.

OPHTHALMOLOGY BRANCH

    Activation and functions. - The Ophthalmology Branch, Surgical Consultants Division, Professional Service, Office of the Surgeon General, was activated on 15 April 1944. Maj. (later Lt. Col.) M. Elliott Randolph, MC, (fig. 17) who previously had been on duty with the Army Air Forces, became its first chief. The functions of the newly created Ophthalmology Branch were as follows: To establish policies and procedures in general ophthalmology and care of the blind in the Army; to advise on assignments of qualified specialists in these fields; to correlate information and afford consultation and advice pertaining to ophthalmology and care and management of the blind; and to maintain liaison with the Navy, the Veterans' Administration, the Federal Security Agency, and civilian ophthalmologic groups.

    Office space was provided for Major Randolph in the office of Lt. Col. Walter H. Potter, SnC, the director of the spectacle program and chief of the Optical Branch in the Medical Supply Division. A cordial and smooth-functioning relationship existed between these two branches.

    Shortly after assuming his new duties, Major Randolph was informed by The Surgeon General that he was to be responsible for the program to rehabilitate the blind and deaf. This came as a considerable shock, and, while it seemed somewhat logical that the blind should be his responsibility, rehabilitation of the deaf seemed somewhat out of the question. Fortunately, Major Randolph's superiors in the Surgical Consultants Division shared his sympathies and were able to convince Maj. Gen. Norman T. Kirk, The Surgeon General, that someone else should be brought into the Division to be responsible for the program for the rehabilitation of the deaf. This was later accomplished (p. 105).

CARE OF THE BLIND

    Apparently, no provision had been made for the reception and care of blinded casualties until they began to arrive from overseas. These patients filtered into various receiving hospitals and then were turned over to the Veterans' Administration for rehabilitation. Following a Presidential direc-

1 See also the "Medical Department, United States Army. Surgery in World War II, Ophthalmology and Otolaryngology. Washington: U.S. Government Printing Office, 1957."


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FIGURE 17. - Maj. M. Elliott Randolph, MC, Chief, Ophthalmology Branch, Surgical Consultants Division., Professional Service, Office of the Surgeon General.

tive, Valley Forge General Hospital, Phoenixville, Pa., and Dibble General Hospital, Menlo Park, Calif., were designated as centers where each blinded casualty was to be sent. In either center, he was to receive certain phases of preliminary social rehabilitation while undergoing definitive medical care. When this had been accomplished, he was to be transferred to Old Farms Convalescent hospital (Special), Avon, Pa., for a course of 12 weeks' final social rehabilitation. The Presidential directive also stated that every blinded casualty originating in the Army, Navy, or Marines would be sent to an Army facility. The Navy, however, was not in accord with this program and asked that their casualties and also Marine casualties be transferred to the Navy hospital in Philadelphia.

    Old Farms Convalescent Hospital (Special) - Plans for the activation of Old Farms Convalescent hospital (Special) - commonly referred to as Old Farms or Avon ()ld Farms - were being crystallized upon Major Randolph's arrival in the Office of the Surgeon General, The facility was to be under the overall direction of Col. Frederic II. Thorne., MC, also formerly of the Army Air Forces, and more recently commanding officer of the regional hospital


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at Keesler Field, Miss. As the opening of Old Farms drew near, there was curiosity concerning the type of rehabilitation program for the blind that would be established there and who would direct it. Colonel Thorne, it was revealed later, had already asked for the transfer to Old Farms of key personnel from the rehabilitation facilities at Valley Forge General Hospital. Naturally enough, any program for the rehabilitation of the blind would have been successful with such men in control as the director of the program for the blind at Valley Forge, Sgt. (later Capt., MAC) Alan R. Blackburn, Jr., and his two associates, Sgt. (later 1st Lt., MAC) Richard E. Hoover and Sgt. (later 2d Lt., MAC) Paul Conlon. The personnel problem was finally solved by the transfer of Sergeant Blackburn to Old Farms Convalescent Hospital to direct its new program. Sergeants Hoover and Conlon remained at Valley Forge to direct the program there. On 21 July 1944, the first blinded casualties from Valley Forge General Hospital arrived at Old Farms for their final period of social-adjustment training before discharge from the Army.

    During the fall of 1944, Major Randolph continued to make trips almost every week to Old Farms. The main purpose of these trips was to permit Lieutenant Blackburn to pour out his tales of woe. The former used every means at his disposal to bolster the morale of the latter. In spite of his unhappiness, Lieutenant Blackburn was doing a magnificent job. Additional personnel were becoming available, and, as the year drew to a close, it appeared that morale was ever improving (fig. 18). At the same time, considerable difficulty was being experienced with the Veterans' Administration because it was believed that this organization was not prepared to assume the responsibility of looking after the blind after the Army had completed its mission of social-readjustment training. At about this stage in the program, Major Randolph was relieved from his assignment in the Office of the Surgeon General (p. 102). A full account of subsequent developments at the Old Farms Convalescent Hospital (Special) is given in another volume of the history of the Medical Department, United States Army.2

    Valley Forge General Hospital. - Meanwhile, the program for the blind was functioning most efficiently at Valley Forge General Hospital under the overall direction of Lt. Col. James N. Greear, ,Jr., MC. The program benefited immeasurably by Colonel Greear's foresight and organizational ability. Every available soldier who had had any experience with rehabilitation of the blind was transferred to Valley Forge General Hospital. The specific rehabilitation aspects of the program were under the direction of Sergeant Blackburn until his transfer to Old Farms, he was ably assisted by a number of Army and civilian workers.

    Dibble General Hospital. - Inasmuch as it was found necessary to establish an additional rehabilitation center for the blind at Dibble General Hospital. Lt. Col. Norman Cutler, MC, was placed in charge of the eye service and made responsible for initiating a rehabilitation program for the blind

2 See footnote 1, p.95.


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FIGURE 18. - Final social rehabilitation of the blind at Old Farms Convalescent Hospital, Avon, Pa. A. A group of blinded working out adjustment problems in a tension-free atmosphere. B. Riding with sighted guides.


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FIGURE 18. - continued.  C. Weaving as a hobby and possible future vocation.  D. Gardening with special tools.


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similar to that at Valley Forge General Hospital. He started from nothing, and since all key personnel were at Valley Forge the going was pretty difficult at first. Soon, however, some civilian personnel qualified in rehabilitation of the blind were obtained on the west coast and orienters3 were trained by the staff at Dibble. Equipment was gradually assembled, and, by October 1944, a training program was running most efficiently. A separate building was erected for projects of the rehabilitation program.

OTHER CONSULTANT ACTIVITIES

    Ophthalmologic personnel. - One of the first things the chief of the Ophthalmology Branch did after his arrival in the Office of the Surgeon General was to review the ophthalmologic personnel in each of the eye and plastic surgery centers. Fortunately, this author knew personally the chief of the eye section at most of the centers and kept in contact with their problems through personal telephone calls. The equipment situation was fairly satisfactory, but all the centers were in critical need of additional ophthalmologists. As the patient census at each hospital became greater after D-day, the need for additional trained ophthalmologists became more apparent. The Army Air Forces released about 10 qualified ophthalmologists who were eagerly pressed into service and distributed to the various eye centers. The ideal of 1 ophthalmologist to 50 patients was never realized. At Valley Forge General Hospital, the largest of the eye centers, the average was about 1 to 190.

    Field trips. - During this time, the consultant in ophthalmology made numerous trips to Valley Forge General Hospital because of its proximity. There, he learned firsthand some of the problems concerning the rehabilitation of blinded casualties and also the needs and problems of the clinical side of Army ophthalmology. About the last of May 1944, the consultant in ophthalmology visited the eye services at Woodrow Wilson General Hospital, Staunton, Va., Nichols General hospital, Louisville, Ky., and Lawson General Hospital, Atlanta, Ga. Each service was staffed with a particularly outstanding ophthalmologist, and the services were excellently run. Major Randolph visited Dibble for the first time during the summer of 1944. The eye cases were beginning to overflow, and there was a great need for more space and more trained ophthalmologists, a situation which was not alleviated.

    Civilian consultants in ophthalmology. - On 2 September 1944, Major Randolph wrote a personal letter to each surgical consultant in each service command designating the types of eye cases which should be sent to various hospitals and, in addition, recommending that a civilian consultant in ophthalmology be appointed in each service command. Certainly, each plastic and eye center was located conveniently near a large medical center so that the use of civilian consultants could have been very practical and helpful. Nothing,

3 Orienters was an appellation given enlisted personnel who were assigned to a newly blinded person to watch over him and to orient him in every respect with reference to his person and his environment.


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however, came of the recommendation except in the Ninth Service. Command, where Dr. Frederick Cordes of San Francisco kept in close touch with Dibble General Hospital and was tremendously helpful.

    Acrylic artificial eyes. - In Mardi 1944, General Kirk returned from his visit to the European theater where he was impressed with the achievements of the new plastic artificial eye which had been devised by Capt. (later Maj.) Stanley F. Erpf, DC, at. the 30th General Hospital, England. He conceived the idea of recalling Captain Erpf to this country to work on standardizing production techniques with two other dental officers who had been experimenting along similar lines in the Zone of Interior, Maj. Milton S. Wirtz, D.C. and Maj. Victor H. Dietz, DC. Inasmuch as the stock of artificial eyes in this country was being rapidly depleted, it. was extremely fortunate that. the process of fabricating such eyes from dental acrylic was discovered at that time. This project was the responsibility jointly of the Optical Branch under Colonel Potter, his associate Mr. Stanley W. Rybak, and the. Ophthalmology Branch.

    It was decided that. a training center for the fabrication of plastic artificial eyes would be set up at Valley Forge General Hospital, and each service command was instructed to send one or two dental surgeons for a period of 4 to 6 weeks' training under the tutelage of the aforementioned officers. Although those in charge of the project were assured in. emphatic terms that there was not an inch of room available at Valley Forge, adequate space was, nonetheless, quickly found and the program became an outstanding success. These dental officers were then distributed, after a training period, to the eye centers throughout the country and they, in turn, set up laboratories for training enlisted personnel. The program kept functioning in each hospital until the closing of each center.

    Liaison with consultants in ophthalmology overseas. - Major Randolph, during his first term in the Office of the Surgeon General, kept. in contact with Col. Derrick T. Vail, MC, the senior consultant in ophthalmology in the European theater. Colonel Vail's needs were mostly those of ophthalmic supplies, and the filling of his demands was speeded up in this country whenever it was possible. Maj. (later Lt. Col.) Trygve Gundersen, MC, was part-time consultant in the Mediterranean theater. Major Randolph kept. in fairly close contact with him. The author, however, knew nothing whatsoever about ophthalmologic consultants in the Pacific areas. His personal friends among the ophthalmologic personnel who had been so unfortunate as to be sent to the Pacific all wanted but one thing-to be sent home as quickly as possible.

    First tour ends. - About Christmas 1944, Colonel Vail arrived in the United States from Europe. Strangely enough, the thought immediately occurred to Colonel Greear that he had had enough of Valley Forge General Hospital and was most anxious to get into administrative work again. He calculated, also, that Major Randolph was more than anxious to get into


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clinical work and away from administrative work. Thus it seemed to him that Colonel Vail might be the solution to each problem. Major Randolph never knew quite how the details were worked out, but on 22 February 1945 he was transferred to Valley Forge General Hospital, Colonel Greear was transferred to Europe, and Colonel Vail took over as chief of the Ophthalmology Branch. This seemed to satisfy everybody but Colonel Vail. As usual, however, Colonel Vail did the job in his customary, superb way. Meanwhile, Major Randolph was promoted to lieutenant. colonel in January, shortly before his reassignment to Valley Forge General Hospital.

THE SECOND TOUR

    Colonel Vail remained as the consultant in ophthalmology and chief of the Ophthalmology Branch until 28 July 1945. He was succeeded by Major Gundersen, who requested and received his release from the Army about the end of November 1945. Again, Colonel Randolph was notified by Lt. Col. Michael E. DeBakey, MC, that his former position was open and that there was not enough time to train another man to take over. Colonel Randolph resumed his former position on 8 December 1945.

    A bright spot of these early days in Washington during December 1945 was the consultant's relationship with Brigadier Sir Stewart and Lady Duke-Elder who had been invited to this country by General Kirk. Sir Stewart had been the consulting ophthalmologist to the Royal Army throughout World War II. Colonel Randolph accompanied them on a tour of several hospitals in the East, and it was a great experience. Colonel Randolph spent the remaining months in the Office of the Surgeon General working on the history of ophthalmology in World War II. In April 1946, when he finally convinced Colonel DeBakey that this history had been completed, he was released from the Army.

RECOMMENDATIONS

    One cannot be associated in an administrative medical position in the Army without realizing that certain recommendations should be given serious consideration. The following recommendations in the event of another national emergency are prompted by the author's experiences as the consultant in ophthalmology to The Surgeon General during World War II:

    1. A consultant in ophthalmology should be placed on active duty at once in the Office of the Surgeon General. If a man of high qualification is present in the Army, let him be considered as consultant. If such a man is not available, the executive committee of the American Ophthalmological Society might be asked for its opinion as to a desirable civilian ophthalmologist.
     2. Upon the activation of each oversea theater, a consultant in ophthalmology should be placed on duty at once and be made responsible for the ophthalmologic program within the theater. Whether he should serve part


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time or full time in this capacity would depend upon the size and burden of the theater.
    3. On the assumption that there will be an eye center in each service command, or similar command in the Zone of Interior, the chief of the center (presumably an ophthalmologist of outstanding qualifications and competence) should serve part time as consultant in ophthalmology within the command. In particular, he should advise the service command surgeon on the qualifications and assignment of ophthalmologists. The policy of having the surgical consultant or the surgeon of the command evaluate the qualifications and make the assignment of such highly specialized physicians as ophthalmologists is open to question.
    4. A consultant in charge of the care of blinded casualties should be appointed immediately. He should be chosen after consultation with leading authorities in the field, and should have had a long and outstanding experience in work with the blind. He should work closely with the consultant in ophthalmology, but he would probably serve as well in a civilian capacity as in a military capacity. In World War II, the delayed appointment of a consultant in charge of the care being given blinded casualties seriously delayed the program.
    5. An optical section should be activated at once in the Office of the Surgeon General and should be given responsibility for all supplies and for the administrative details of the artificial-eye program. It should work in close cooperation with the consultant. in ophthalmology. An officer, thoroughly experienced in the problems of optical and medical supplies and possessing special familiarity with the spectacle program, should be assigned to the office of the consultant in ophthalmology in each overseas theater.
    6. The ophthalmologic and otolaryngologic services should be separated administratively in large installations, such as regional and general hospitals. A competent man should head each service, and he should be independently responsible to the chief of surgery. A single chief of section in the ophthalmologic service cannot possibly provide competent administrative and professional supervision of a patient load of 200 per officer, as was frequently required in World War II.
    7. Monthly reports should be submitted by oversea consultants to the consultant in ophthalmology in the Office of the Surgeon General. Abstracts of these reports could then be incorporated in a monthly newsletter for distribution to oversea and Zone of Interior installations.
    8. During basic training, all medical officers should receive a certain number of lectures on traumatic ophthalmology. More advanced work could be made available in elective courses.
    9. Articles dealing with military ophthalmology should be microfilmed for general oversea distribution. This activity should be one of the responsibilities of the consultant in ophthalmology in the Office of the Surgeon General.


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    10. During World War II, the Army Air Forces convinced many doctors of the desirability of joining this branch with the result that an unnecessarily large number of outstanding ophthalmologists joined the Army Air Forces and spent the rest of their Army days performing the most trivial types of ophthalmology in regional and station hospitals. A large number of this country's then leading ophthalmologists were responsible for large clinics in Florida and the Southwest.. The need for such men in the huge Army eye centers was glaringly apparent. The hospitals in which these men were serving could have been handled adequately by an ophthalmologist who had recently received certification by the American Board of Ophthalmology eligible for such certification.