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Preface

Contents

Preface

Prevailing United States Army doctrines in 1942 held that a combat force could best be supported by activating methods and procedures generally known at the outbreak of war. Exception was made for new developments which were expected to emerge from an intense scientific effort in this country, specifically that fostered by the Office of Scientific Research and Development, with the advice of the National Research Council. Otherwise, combat in the field was pictured as calling for the replacement of personnel and supplies and a reasonable modicum of skill in the adaptation of standardized procedures to specialized situations as they were encountered. It was not generally understood that experience in the field could point the way toward immediate and radical changes of methods and equipment and that quick footwork in making these changes spelled survival. To be sound, changes of this type required as much factual evidence as could be assembled.

As a consequence, no provision was made for the collection and analysis of surgical evidence so that corrective measures might be devised by those on the spot when confronted with unexpected happenings. The idea of sending out skilled observers to identify new problems and solve them then and there was not entertained. In fact, such an idea smacked of the academic and was dismissed by the stern reminder that medicine was on the march to help fight a war-not to indulge in research.

Interestingly enough, it was the combat components that pointed the way by the utilization of the services of experts to observe and report on the performance of machines of war. Many were the "bugs" that remained in new tanks, planes, and missiles, and these defects were constantly being ironed out. Precise and scientific measurement of novel developments by the enemy required alert and expert intelligence. One recalls the encounter with magnetic mines that threatened shipping in the North Atlantic. Combat commanders and their conventional military staffs cannot be expected to solve such problems unaided and, in fact, may not even be able to define them in terms that can lead to a solution elsewhere. The same may be said of a wound surgeon confronted by a case of anuria in a forward hospital.

Beginning in the North African campaign and continuing through Sicily, Italy, and southern France, the surgeons of the theater were hard pressed by the need for surgical evidence to guide their daily work. Some of the first compilations of the records of patients who had disappeared into the evacuation stream were made as follow up studies by members of the 2d Auxiliary Surgical Group. This was partly because the surgical teams had periods of inactivity that could be devoted to such pursuits and partly because of the wise insistence


of their commanding officer, Col. James H. Forsee, MC, on maintaining duplicated and full clinical records. It could have been so easy to let down standards and be too busy to keep records adequate for analysis.

The theater from which the greater part of this volume has originated was also fortunate in the assignment of affiliated hospital units from leading teaching hospitals with chiefs of surgery who insisted on the maintenance of high standards. A professor of surgery from Oslo, after 3 weeks in the forward area of the Fifth United States Army in Italy, said: "You are holding to the standards of university clinic surgery under fire and in tents with mud floors."

Finally, the small group of peripatetic officers who were identified as consultants were not deployed with the mission of commissars or gauleiters. They were searching for surgical evidence by direct observation and discussion. The achievement of a consultant was aptly described by Sir Patrick Berkeley Moynihan, following World War I:

"I have gathered a posie of other men's flowers and nothing but the thread that binds them is mine own."

Of course, the Mediterranean Theater of Operations provided a favorable environment for such undertakings. It was an experimental laboratory not only for surgery but also for medicine as a whole; for ordnance; for equipment; and, as many are reluctant to recall, even for rations. It was vital that wound surgery be carried on within a framework of inquiry, for this theater was the proving ground for the greater task that was to come.

EDWARD D. CHURCHILL, M. D.
John Homans Professor of Surgery,
Harvard Medical School, and
Chief of the General Surgical Services,
Massachusetts General Hospital.

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