CHAPTER IX
Third Service Command
Walter D. Wise, M.D.
ASSIGNMENT, ORIENTATION, AND EARLY ACTIVITIES OFSURGICAL CONSULTANT
Lt. Col. (later Col.) Walter P. Wise, MC, was ordered to duty as surgical consultant to the ThirdService Command and the Military District of Washington in August 1943. Previous to thistime, he had been serving as medical director of Selective Service for the State of Maryland withthe rank of lieutenant colonel. Rumor had had it that assignment as a surgical consultant carriedwith it the rank of colonel and that Colonel Wise would not be assigned to the area in which helived. As noted, however, he was assigned to the mid-Atlantic area of the eastern seaboard, andhis rank of lieutenant colonel remained unchanged until July 1944 when a promotion to the rankof colonel was received. Following this promotion, Colonel Wise was able to carry out his dutiesmuch more efficiently, to act with more. authority, and to command the respect due a surgicalconsultant.
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, hadpresented before the American Surgical Association a paper dealing with the duties of a surgicalconsultant which proved to be a great help. Additional assistance was available throughcommunication 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 knowwhat functions the position of a surgical consultant entailed and had not been informed ofColonel Wise's appointment, the situation was at first embarrassing and this consultant's dutieswere rather vague for the first few weeks. He visited the nearby smaller hospitals and madereports 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 werereceived 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 surgicalconsultants 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 generalhospital, disposition boards, and, perhaps more important, about the weaknesses of some of theservices in this particular hospital. After the month of training, Colonel Wise's routine workbegan with visits throughout the Third Service Command and the Military District ofWashington which were continued until after V-J Day.
At the time of Colonel Wise's appointment there was as yet no medical or neuropsychiatricconsultant in the Third Service Command, and no orthopedic consultant was ever assigned. Thevast 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 Leadbetterof 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 thesurgical consultant with great benefit to the patients, the orthopedists, and the surgicalconsultant. Eventually, the medical and neuropsychiatric consultants were appointed. The threeconsultants--surgical, medical, and neuropsychiatric--visited all of the medical installations inPennsylvania, Maryland, Virginia, and the District of Columbia. They also met most of the shipscoming in to Newport News, Va., with sick and wounded and accompanied the patients on thetrain to McGuire General Hospital, Richmond, Va., where they were sorted for distribution toappropriate centers (fig. 32). Before McGuire General Hospital was opened, some shipments ofwounded 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 staffswere not permitted to do major-grade surgery except in emergencies, needed much moresupervision and more frequent visits. The regional hospitals occupied an intermediate positionin the type of surgery which was permitted and in the talents of the staffs. In correcting anyinadequacies in the regional and station hospitals, Colonel Wise always had the full cooperationof the Office of the Surgeon General.
With one or two exceptions, there was little or no evidence of use of political influence in thehospitals of the Third Service Command. Friendships of long standing, however, or ties newlymade among the medical officers of the Army of the United States and the U.S. Army createdsonic tenseness and at times inefficiency. In one important hospital, there was a staff thatcontained several friends of civilian days, and there was a group from one large city who hadworked together at home. Some of these had received assignments by the commanding officer ofthe hospital which were not strictly based on merit, with some bad results. The consultant wasslowly 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 informationand sent representatives from both the Surgical and Medical Consultants Divisions, and thesituation was remedied.
A situation that seemed to the surgical consultant to need improvement was the occasional lackof ability on the part of the Regular Army medical officer to give proper value to theprofessional qualifications of an outstanding temporary medical officer commissioned in theAUS (Army of the United States). This resulted in some inequities not conducive to goodservice. Likewise, some of the highly trained surgeons of the AUS would not or could notassume administrative responsibilities demanded by the Army. It was in such situations that theconsultant could be of great value. He, too, was of the AUS, however, and sometimes went downto defeat at the hands of an occasional hospital commander who had been trained to adhere torigid 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 hospitalsand in the general hospitals. Some of this talent was, of course, ordered overseas; some remainedfor the duration; and some had already returned from overseas. Other talented surgeons camelater. Not all who deserved commendation can be mentioned, and it may be wrong to name anyfor fear of unjust omissions. It would seem lacking in appreciation. however, not to mention thehigh type of work done by such men as James Barrett Brown and Bradford Cannon in plasticsurgery; Rettig Arnold Griswold, John C. Lyons, John Owen, and Leslie E. Bovik in generalsurgery; T. Campbell Thompson, Henry F. Ullrich, George O. Eaton, Leonard B. Barnard, andSims Norman in orthopedics ; Brian B. Blades in chest surgery; and M. Elliott Randolph inophthalmology. Each of these surgeons had associates of ability. Outstanding help was given theregional 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-raymachines, and physiotherapy equipment. When Germany was defeated and the end of the warseemed in sight, many temporary wartime medical officers gave consideration to this plethora ofArmy hospital equipment and the dearth of it in civilian hospitals. Remembering that thisvaluable material had already been paid for by the public, they wondered if it could not be madeavailable at reasonable rates to the civilian hospitals at the close of the war. Suggestions alongthese 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 tokeep the Zone of Interior hospitals manned with capable surgeons. The consultant had little or notime for supervision of the deteriorating surgical work because he was kept at service commandheadquarters trying to find replacements for officers being let out. Unfortunately, the dischargeof patients from hospitals could not keep pace with the discharge of medical officers. Thesigning of the armistice stopped surgical admissions to a tremendous degree, but it did not speedup the healing of the cases of osteomyelitis of the femur nor did it provide the needed plasticsurgery in those previously wounded or burned.
SUMMARY OF ACTIVITIES
There were many incidents outside of the routine duties of the consultant which served to keepup his interest and to be stimulating. Among these was the recognition of the dangers ofPentothal sodium (thiopental sodium) as an anesthetic agent and a report of these findings to theOffice of the Surgeon General, with the resulting directive from that Office as to the proper useof the drug. Another was attendance at a very secret conference dealing with Japanese balloonswhich were being sent on the stratospheric air currents and which had landed in considerablenumbers in the Northwest and also in the north-central region of the United States. There weremany 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 besttreatment for ill or injured members of the Armed Forces and any others treated in servicecommand 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 wardrounds, conferences, and journal clubs; helped arrange for speakers: and tried to see that newprocedures of merit were not neglected, while trying to discourage procedures that had been triedand found wanting or did not justify further trial. In this he was aided a great deal by formalmeetings and discussions at installations within his service command and by many meetingsarranged by the Office of the Surgeon General and held in Washington or commands withinreasonable distances.
COMMENT
The sudden expansion of the Army Medical Corps and the rapid establishment of the manyoversea and Zone of Interior hospitals and other medical units was necessarily a great drain onmedical 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 theattempt to get the most advantageous disposition of available men. These efforts, in turn, wereaccompanied by disappointments here and criticisms there. Though the ideal could not bereached, nevertheless the surgical service received by the patients was, all things considered, of ahigh order.
