Tag Archives: shrapnel wounds

Sir William Osler on Military Medicine – Part The Final (3)

In two previous posts (here, and here), I discussed medicine’s beloved William Osler’s thought on military medicine in his early and middle years. In these times – up to about 1905, when he moved to Oxford to become the Regius Professor of Medicine – his concern was largely about individual workers and their work to discover and characterize diseases found throughout the world. Only lately (after 1900) had he come to write about the role of armies in their “public health” function of carrying out successful mass immunization programs against smallpox and, later, typhoid.

In 1914 speech to soldiers and officers (1), Osler – ever the internist’s internist – still keyed his thoughts to disease and its prevention. He said:

What I wish to urge is a true knowledge of your foes, not simply of the bullets, but of the much more important enemy, the bacilli.
In the wars of the world they have been as Saul and David—the one slaying thousands, the other tens of thousands. I can never see a group of recruits marching to the depot without mentally asking what percentage of these fine fellows will die legitimate and honourable deaths from wounds, what percentage will perish miserably from neglect of ordinary sanitary precautions ?

But, four months into the war, he noticed something which was to him remarkable. In a letter to the U S medical community published in the Journal of the American Medical Association (2) he wrote, “The outstanding medical feature of the campaign in France and Belgium is that wounded, not sick, are sent from the front. So far, disease has played a very small part and the troops have had wonderful health, in spite of exposure in the trenches.” In the same letter, he actually took notice of combat injuries, commenting that wounds from artillery weapons (shrapnel) were more dangerous than bullet wounds because the shrapnel was usually contaminated with mud and dirt. And the dirt and mud of this fertile region were heavily populated with bacterial pathogens. As Osler put it, “The surgeons are back in the pre-Listerian days and have wards filled with septic wounds.”

1915 appears to be the last time Osler spoke about war medicine, in a speech “Science and War”, given early in October. Here he acknowledged that science had, in the early 20th century, made the waging of war “more terrible, more devastating, more brutal in its butchery”. But Sir William Osler, non-surgeon, Professor of Medicine and honorary Colonel in the Oxfordshire Regiment, saw – perhaps only dimly – the future of combat medicine, also a product of science: “[an] enormous number spared the misery of sickness, the unspeakable tortures saved by anesthesia, the more prompt care of the wounded, the better surgical technique…”. Add effective shock management, antibiotics and modern imaging, and we have the picture of modern combat casualty care as practiced nearly 100 years later.

William Osler survived the war, but died at age 70 of pneumonia, in 1919. It is said that he never recovered from the loss of his only son, Edward Revere, an artilleryman  who succumbed to shrapnel wounds sustained at Ypres in August 1917.

(1) Osler, William, “Bacilli and Bullets” , Oxford Pamphlets, Oxford Press, 1914. Accessed online at http://ia600307.us.archive.org/5/items/bacillibulletsby00osle/bacillibulletsby00osle.pdf, 02 November 2012.
 
(2) Osler, William, “Medical Notes on England at War”, correspondence, in JAMA, vol LXIII [63], No 26, December 26, 1914, p 2303 ff
 
(3) Quoted in Cushing, Harvey, “The Life of Sir William Osler”, Vol 2, pp 492 – 495, Oxford, Clarendon Press, 1925.
 
©2012 Thomas L Snyder
 
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Medical Care at the Battle of Midway, Part II: Combat Casualty Care Aboard a Sinking Ship; Rescue Ships and Medical Care

Last week, I commented that some lessons of previous wars have to be learned anew; the case I cited was that of flash burn prevention, relearned only after the Battle of Coral Sea. This week, we read how the chaos of ships under attack complicates the delivery of casualty care. We also learn a lesson or two about medical preparedness.

I mentioned last week that I depended on on-line sources for these postings; in particular, the Battle Reports of the Commanding Officer of USS Yorktown(1), sunk at Midway, and Commander Destroyer Squadron SIX (TF 17.4)(2). These reports, written just days after the events they portray, are as raw as they are economical in words.

The medical paragraph in the Yorktown report is especially informative:  the initial bombing attack on Yorktown resulted in the near-destruction of battle dressing station 5 in the wardroom annex. Personnel there “were badly shaken but were not otherwise injured… These personnel proceeded to the flight deck and hangar deck to assist wounded there.” In the following torpedo attack, battle dressing station number 4 was flooded and destroyed. I could find no comment about medical personnel injuries or deaths.

Shrapnel caused the vast majority of injuries among the 55 men who went on to require hospitalization. Many patients experienced severe penetrating shrapnel wounds; these cases required blood transfusions and plasma administrations, most if not all administered in the battle dressing stations. 60 men received minor wounds or rope burns from sliding down ropes into the water.

Yorktown survived the initial attacks. Severely wounded men were prepared for surgery, and the operating room activated. Within minutes, however, torpedoes hit the ship. All lights and communications went down, and the ship immediately developed a heavy list. When the Captain issued “abandon ship” orders, medical personnel immediately commenced evacuating the casualties. This process was made almost impossible because ladders leading from sick bay were damaged so that stretchers could not be used to lift patients out of the hold. Slippery decks and the ship’s list made it impossible to carry stretchers, so men were reduced to sliding them across the deck, or bodily man-handling casualties. Rescues below the main decks had to be carried out in pitch-black darkness, perhaps with the aid of flashlights only.

Lifeboats on the high side of the ship could not be launched, so wounded men were lowered over the side in straps from other ships, or onto life rafts, or into the water, and picked up later.

Destroyers Balch, Benham, Russell, Anderson, Morris, Hughes, Hammann (she sank quickly when two torpedos struck her as she lay along side Yorktown providing engineering support to salvage efforts) and Bidell provided rescue operations, and it fell to the medical departments aboard these small ships to care for about 2270 survivors. Claude M Lee, Jr, LT (jg), MC, USNR and his assistants aboard USS Balch cared for 544 survivors. “His all night occupation with the operative and surgical care of injured men, his forethought in providing adequate and special medical supplies and in training of personnel to handle this particular emergency” came in for special commendation from ComTaskFor17.4.

Few medical “lessons learned” find their way into these after action reports. The Destroyer Task Force commander did point out that “[t]horough instruction and stationing of officers and men for rescue work is essential”. It makes sense: once the fighting is done, or when a ship can no longer be fought, the combat work of officers and men is done. The emphasis now shifts to rescuing survivors, and this should be almost an “all hands” operation, with all hands trained to properly carry it out.

Another lesson is not stated in these reports, but I think this has significance in today’s naval activities. Big naval units (translate this “aircraft carriers” in the U S Navy) are the big targets, too. They are also well supplied with sophisticated medical and surgical personnel and equipment. But if one of these big targets is successfully attacked, use of these medical assets may be compromised or lost, and casualty care then falls to smaller rescue ships – destroyers- whose medical “kit” often consists of a senior hospital corpsman and one or two junior assistants. These ships need to have their medical staffs – and their medical equipment and supplies – beefed up significantly when combat is anticipated. I believe that the US propensity to depend upon helicopter evacuation of casualties can’t be depended upon in the chaos of naval battle because the airspace may be dangerous from enemy action, or too full and too confined around an aircraft carrier for orderly and rapid evacuation of something like 2500 or 3000 casualties.

We should learn and apply these lessons now, lest they have to be re-learned in future naval battles.

(1) Buckmaster, E. (Commanding Officer, USS Yorktown): Report of Action for June 4, 1942 and June 6, 1942, 18 June 1942, http://www.history.navy.mil/docs/wwii/mid7.htm, accessed 7, 8, 15 June 2012.
(2) Sauer, E. P. (ComTaskFor17.4), Japanese Torpedo Plane Attack on U.S.S. Yorktown During Battle of Midway, June 4, 1942 — Report of, June 12, 1942, http://www.history.navy.mil/docs/wwii/mid8.htm, accessed 7, 8, 15 June 2012.
 

©2012 Thomas L Snyder