Medicine, World War II
MEDICINE, WORLD WAR II
The purpose of military medicine during World War II was the same as in previous wars: to conserve the strength and efficiency of the fighting forces so as to keep as many men at as many guns for as many days as possible. What transpired between 1939 and 1945 was a cataclysmic event made worse by the nature of the weapons the combatants used. The use of machine guns, submarines, airplanes, and tanks was widespread in World War I; but in World War II these weapons reached unimagined perfection as killing machines. In every theater of war, small arms, land-and sea-based artillery, torpedoes, and armor-piercing and antipersonnel bombs took a terrible toll in human life. In America's first major encounter at Pearl Harbor, the survivors of the Japanese attack could describe what modern warfare really meant. Strafing aircraft, exploding ordnance, and burning ships caused penetrating injuries, simple and compound fractures, traumatic amputations, blast injuries, and horrific burns, to name just a few. Total U.S. battle deaths in World War II numbered 292,131 with 671,801 reported wounded or missing.
Conserving fighting strength and enabling armies and navies to defeat the enemy also meant recognizing that disease, more than enemy action, often threatened this goal. For example, during the early Pacific campaign to subdue the Solomon Islands, malaria caused more casualties than Japanese bullets. Following the initial landings on Guadalcanal, the number of patients hospitalized with malaria exceeded all other diseases. Some units suffered 100 percent casualty rates, with personnel sometimes being hospitalized more than once. Only when malaria and other tropical diseases were controlled could the Pacific war be won.
The military's top priority organized its medical services to care for battlefield casualties, make them well, and return them to duty. The systems developed by the army and navy worked similarly. In all theaters of war, but particularly in the Pacific, both army and navy medicine faced their greatest challenge dealing with the aftermath of intense, bloody warfare fought far from fixed hospitals. This put enormous pressure on medical personnel closest to the front and forced new approaches to primary care and evacuation.
army medics and navy corpsmen
The most dramatic and demanding duty an army medic or navy hospital corpsman could have was with army infantry or Marine Corps units in the field. Because the Marine Corps had always relied on the navy for medical support, corpsmen accompanied the leathernecks and suffered the brunt of combat themselves. Many of them and their army counterparts went unarmed, reserving their strength for carrying medical supplies.
Army medics or navy corpsmen were the first critical link in the evacuation chain. From the time a soldier suffered a wound on a battlefield in France or a marine was hit on an invasion beach at Iwo Jima, the medic or corpsman braved enemy fire to render aid. He applied a battle dressing, administered morphine and perhaps plasma or serum albumin, and tagged the casualty. Indeed, one of the lingering images of the World War II battlefield is the corpsman or medic crouched beside a wounded patient, his upstretched hand gripping a glass bottle. From the bottle flowed a liquid that brought many a marine or soldier back from the threshold of death. In the early days of the conflict that fluid was plasma. Throughout the war, scientists sought and finally developed a better blood substitute, serum albumin. Finally, in 1945, whole blood, rich in oxygen-carrying red cells, became available in medical facilities close to the battlefield.
If he was lucky, the medic or corpsman might commandeer a litter team to move the casualty out of harm's way and on to a battalion aid station or a collecting and clearing company for further treatment. This care would mean stabilizing the patient with plasma, serum albumin, or whole blood. In some cases, the casualty was then evacuated. Other casualties were taken to a divisional hospital, where doctors performed further stabilization including surgery, if needed. In the Pacific, where sailors, soldiers, and marines were doing the fighting, both navy and army hospital ships, employed mainly as ambulances, provided first aid and some surgical care for the casualties' needs while ferrying them to base hospitals in the Pacific or back to the United States for definitive care. As the war continued, air evacuation helped carry the load. Trained army and navy nurses, medics, and corpsmen staffed the evacuation aircraft.
World War II brought about many advances in medicine. The military moved quickly to reduce the impact of malaria and other tropical diseases. Personnel trained in preventive medicine attempted to control malaria-spreading mosquitoes by spreading oil on breeding areas and spraying DDT. Physicians, medics, and corpsmen dispensed quinine and atabrine as malaria suppressants.
Advances in combat surgery saved countless lives. Surgical removal of dead or dying tissue—debridement—reduced the danger of infection as did the delayed closure of wounds. Surgeons skilled in orthopedics preserved limbs that in previous wars would have been amputated.
For the first time, miracle drugs—the sulfas and penicillin—were widely used to combat infection. By the last two years of the war, penicillin was also being mass-produced in the civilian community.
Not all wounds are physical. In a previous era, the psychologically wounded suffered from "nostalgia" during the Civil War, and "shell-shock" in World War I. In World War II this condition was termed combat exhaustion or combat fatigue. Although the World War I experience of treating men at the front had been successful, military psychiatrists and psychologists at the beginning of World War II had to relearn those lessons. Nevertheless, the care givers soon recognized that given a respite from combat, a safe place to rest, regular food, and a clean environment, 85 to 90 percent of patients could again become efficient warriors. The more psychologically damaged received therapy in military hospitals.
By 1945 the war had left a decided impact on the practice of medicine, with implications both for the military and civilian communities. The combat theaters were testing grounds for medical evacuation procedures, the use of blood substitutes, advanced surgical techniques, new miracle drugs, preventive medicine practice, and the treatment of psychiatric disorders.
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Jan Kenneth Herman