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Chapter IX

Contents

CHAPTER IX

Third Service Command

Walter D. Wise, M.D.

ASSIGNMENT, ORIENTATION, AND EARLY ACTIVITIES OF SURGICAL CONSULTANT

    Lt. Col. (later Col.) Walter P. Wise, MC, was ordered to duty as surgical consultant to the Third Service Command and the Military District of Washington in August 1943. Previous to this time, he had been serving as medical director of Selective Service for the State of Maryland with the rank of lieutenant colonel. Rumor had had it that assignment as a surgical consultant carried with it the rank of colonel and that Colonel Wise would not be assigned to the area in which he lived. As noted, however, he was assigned to the mid-Atlantic area of the eastern seaboard, and his rank of lieutenant colonel remained unchanged until July 1944 when a promotion to the rank of colonel was received. Following this promotion, Colonel Wise was able to carry out his duties much more efficiently, to act with more. authority, and to command the respect due a surgical consultant.

    Since Colonel Wise was the fifth or sixth service command surgical consultant to be appointed, he profited considerably by the experiences of earlier appointees. For example, Col. Bradley L. Coley, MC, who was serving as surgical consultant to the Eighth Service Command, had presented before the American Surgical Association a paper dealing with the duties of a surgical consultant which proved to be a great help. Additional assistance was available through communication with many of the other consultants who were personal friends.

Owing to the fact that the commanding general of the Third Service Command did not know what functions the position of a surgical consultant entailed and had not been informed of Colonel Wise's appointment, the situation was at first embarrassing and this consultant's duties were rather vague for the first few weeks. He visited the nearby smaller hospitals and made reports in an effort to learn the routine, to improve the surgical services in the various hospitals, and to become familiar with methods of preparing and submitting reports. Soon, orders were received to report to a general hospital in another service command for a month's indoctrination. In retrospect, it seemed that a trip of a few weeks or a month with one of the established surgical consultants would have been a better aid in the training of a newly


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appointed consultant. Something was learned, however, about the paperwork in a general hospital, disposition boards, and, perhaps more important, about the weaknesses of some of the services in this particular hospital. After the month of training, Colonel Wise's routine work began with visits throughout the Third Service Command and the Military District of Washington which were continued until after V-J Day.

    At the time of Colonel Wise's appointment there was as yet no medical or neuropsychiatric consultant in the Third Service Command, and no orthopedic consultant was ever assigned. The vast number of fractures and other orthopedic conditions were seen by Colonel Wise, who, fortunately, had had a large experience in fractures. The services of the late Dr. Guy Leadbetter of Washington, a civilian orthopedist and consultant to The Surgeon General, were available. Dr. Leadbetter visited a number of the general hospitals and some of the regional hospitals with the surgical consultant with great benefit to the patients, the orthopedists, and the surgical consultant. Eventually, the medical and neuropsychiatric consultants were appointed. The three consultants--surgical, medical, and neuropsychiatric--visited all of the medical installations in Pennsylvania, Maryland, Virginia, and the District of Columbia. They also met most of the ships coming in to Newport News, Va., with sick and wounded and accompanied the patients on the train to McGuire General Hospital, Richmond, Va., where they were sorted for distribution to appropriate centers (fig. 32). Before McGuire General Hospital was opened, some shipments of wounded went to Woodrow Wilson General Hospital, Staunton, Va.

OBSERVATIONS CONCERNING HOSPITALS

Personnel and Interpersonal Relations

    By August 1943, the general hospitals in the Third Service Command were, with few exceptions, manned by well-selected, capable medical officers. Thee station hospitals, though the staffs were not permitted to do major-grade surgery except in emergencies, needed much more supervision and more frequent visits. The regional hospitals occupied an intermediate position in the type of surgery which was permitted and in the talents of the staffs. In correcting any inadequacies in the regional and station hospitals, Colonel Wise always had the full cooperation of the Office of the Surgeon General.

    With one or two exceptions, there was little or no evidence of use of political influence in the hospitals of the Third Service Command. Friendships of long standing, however, or ties newly made among the medical officers of the Army of the United States and the U.S. Army created sonic tenseness and at times inefficiency. In one important hospital, there was a staff that contained several friends of civilian days, and there was a group from one large city who had worked together at home. Some of these had received assignments by the commanding officer of the hospital which were not strictly based on merit, with some bad results. The consultant was slowly learning


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FIGURE 32. - McGuire General Hospital, Richmond, Va.


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about this situation when the Office of the Surgeon General obtained accurate inside information and sent representatives from both the Surgical and Medical Consultants Divisions, and the situation was remedied.

    A situation that seemed to the surgical consultant to need improvement was the occasional lack of ability on the part of the Regular Army medical officer to give proper value to the professional qualifications of an outstanding temporary medical officer commissioned in the AUS (Army of the United States). This resulted in some inequities not conducive to good service. Likewise, some of the highly trained surgeons of the AUS would not or could not assume administrative responsibilities demanded by the Army. It was in such situations that the consultant could be of great value. He, too, was of the AUS, however, and sometimes went down to defeat at the hands of an occasional hospital commander who had been trained to adhere to rigid requirements of the Regular Army.

Outstanding Performance of Personnel

    Upon assuming duties as surgical consultant, Colonel Wise found that, as previously mentioned, there was already much surgical talent in the command, particularly in some regional hospitals and in the general hospitals. Some of this talent was, of course, ordered overseas; some remained for the duration; and some had already returned from overseas. Other talented surgeons came later. Not all who deserved commendation can be mentioned, and it may be wrong to name any for fear of unjust omissions. It would seem lacking in appreciation. however, not to mention the high type of work done by such men as James Barrett Brown and Bradford Cannon in plastic surgery; Rettig Arnold Griswold, John C. Lyons, John Owen, and Leslie E. Bovik in general surgery; T. Campbell Thompson, Henry F. Ullrich, George O. Eaton, Leonard B. Barnard, and Sims Norman in orthopedics ; Brian B. Blades in chest surgery; and M. Elliott Randolph in ophthalmology. Each of these surgeons had associates of ability. Outstanding help was given the regional hospital at Fort George G. Meade, Md., by Lt. Col. John H. Mulholland, MC, of the 1st (Bellevue Affiliated Unit) General Hospital.

Equipment

    The hospitals were superbly equipped with instruments, traction apparatus on the wards, X-ray machines, and physiotherapy equipment. When Germany was defeated and the end of the war seemed in sight, many temporary wartime medical officers gave consideration to this plethora of Army hospital equipment and the dearth of it in civilian hospitals. Remembering that this valuable material had already been paid for by the public, they wondered if it could not be made available at reasonable rates to the civilian hospitals at the close of the war. Suggestions along these lines were made


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well in advance of V-J Day, and hopes were high, but realization fell far below hopes.

Effects of Rapid Demobilization

    After V-J Day, rapid demobilization so damaged medical organizations as to make it difficult to keep the Zone of Interior hospitals manned with capable surgeons. The consultant had little or no time for supervision of the deteriorating surgical work because he was kept at service command headquarters trying to find replacements for officers being let out. Unfortunately, the discharge of patients from hospitals could not keep pace with the discharge of medical officers. The signing of the armistice stopped surgical admissions to a tremendous degree, but it did not speed up the healing of the cases of osteomyelitis of the femur nor did it provide the needed plastic surgery in those previously wounded or burned.

SUMMARY OF ACTIVITIES

    There were many incidents outside of the routine duties of the consultant which served to keep up his interest and to be stimulating. Among these was the recognition of the dangers of Pentothal sodium (thiopental sodium) as an anesthetic agent and a report of these findings to the Office of the Surgeon General, with the resulting directive from that Office as to the proper use of the drug. Another was attendance at a very secret conference dealing with Japanese balloons which were being sent on the stratospheric air currents and which had landed in considerable numbers in the Northwest and also in the north-central region of the United States. There were many other experiences which were more of personal than of historical interest.

    The duties of the service command consulting surgeon in essence were to obtain the best treatment for ill or injured members of the Armed Forces and any others treated in service command facilities. To this end, he evaluated surgical personnel and equipment of all kinds; consulted about individual patients, classes of patients, new and old measures and procedures; and attempted to be an activator of hospital staffs. He stimulated staff meetings, grand ward rounds, conferences, and journal clubs; helped arrange for speakers: and tried to see that new procedures of merit were not neglected, while trying to discourage procedures that had been tried and found wanting or did not justify further trial. In this he was aided a great deal by formal meetings and discussions at installations within his service command and by many meetings arranged by the Office of the Surgeon General and held in Washington or commands within reasonable distances.

COMMENT

    The sudden expansion of the Army Medical Corps and the rapid establishment of the many oversea and Zone of Interior hospitals and other medical units was necessarily a great drain on medical and surgical talent. As a re-


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sult, all demands could not be met in the way desired. This naturally led to much effort in the attempt to get the most advantageous disposition of available men. These efforts, in turn, were accompanied by disappointments here and criticisms there. Though the ideal could not be reached, nevertheless the surgical service received by the patients was, all things considered, of a high order.