CHAPTER X
Fourth Service Command
Mather Cleveland, M.D., and James J. Callahan, M.D.
Section I. September 1943 to April 1944
The Fourth Service Command comprising the southeastern tier of States--North and SouthCarolina, Georgia, Florida, Tennessee, Mississippi, and A1abama--during 1943 and 1944 hadapproximately 2 million troops in training. To serve the medical needs of these troops, therewere 130 station and 11 general hospitals.
The Fourth Service Command surgeon, Col. Sanford W. French, MC, with headquarters inAtlanta, Ga., had the services of consultants in medicine, surgery, and psychiatry, and inSeptember of 1943 a consultant in orthopedic surgery. Lt. Col. (later (Co1.) Mather Cleveland,MC, was added. At the time, only one other service command (the Fifth) had an orthopedicconsultant.
The training of troops, ground or air, entailed strenuous physical exercise with many fractures.The sports program probably contributed as many fractures as, if not more than, the obstaclecourses. Accidents due to vehicles on and off the post added to this list of injuries to bones andjoints. A large percentage of the surgical cases in all hospitals were injuries of this type and wereunder the care of the orthopedist. Even before casualties began to arrive from overseas, it wasobvious that an orthopedic consultant was required for the large service commands.
Colonel Cleveland's tour of duty in the Fourth Service Command as orthopedic consultantextended from September 1943 to mid-April 1944. During this period, the general hospitals werebeing increased in number and the large station hospital staffs were being depleted to supplymedical personnel for oversea units. In many instances, adequately trained orthopedic surgeonswere no longer available in station hospitals. Elective surgical procedures and major fractures,by directive, were supposed to be evacuated to general hospitals, and orthopedic surgery instation hospitals was confined to first aid, minor fractures, and an enormous outpatient service.
HOSPITALS
Many of the station hospitals in the Fourth Service Command were very small, especially thoseserving a great majority of the smaller airfields. For instance, within a. radius of 50 miles aboutFinney General Hospital, Thomas-
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ville, Ga., there were 5 or 6 small Air Force station hospitals, each completely equipped andstuffed with an average number of nurses and medical officers for the patient load. There werealso large Air Force station hospitals, such as those at Keesler Field. Biloxi, Miss., at GulfportArmy Air Field, Gulfport, Miss., and at Maxwell Field, Montgomery, Ala. These were very wellprovided with nurses and competent professional personnel and rendered a high quality ofprofessional care.
The station hospitals of the Army Service Forces serving large numbers of troops of ArmyGround Forces at the larger training centers, such as Fort Bragg, N.C., Fort Jackson, S.C., FortBenning, Ga., Camp Blanding, Fla., Camp Van Dorn, Miss., and Camp Shelby, Miss., wereenormous and, in the light of experience, were vastly overbuilt and, in time, professionallyundermanned. Four of these hospitals had 4,000 or more beds, and the maximum census, thewriter believes, was never over 50 percent of the bed capacity.
The general hospitals in the service command were almost invariably well equipped and had acompetent professional staff in each instance.
Although the semiautonomous Army Air Forces were actually under Army command, it becameincreasingly evident, during the consultants tour of duty, that the service command consultantswere less and less welcome at the Air Force hospitals. It was impossible not to call attention tothe evident fact that the small Air Force station hospitals were too numerous and too overstaffedwith nurses and physicians, while many of the hospitals serving the Army Ground Forces werelacking sufficient nurses and physicians for the patient load. These personnel discrepanciesconstantly called to one's attention became distasteful, and the service command consultantsfinally visited Air Force hospitals only on invitation. It is to be hoped that in any futureemergency, there will be better distribution of physicians and nurses.
PROFESSIONAL PROBLEMS AND ACTIVITIES OF THE CONSULTANT
The problems confronting a service command consultant in orthopedic surgery were mainly (1)personnel and (2) professional care of soldiers with injuries involving bones and joints. The fieldof military orthopedic surgery was well defined and well recognized in most instances. Anoccasional chief of surgical service considered himself competent to handle the entire field ofsurgery and overrode the judgment and neglected to use the operative skill of his orthopedicchief. This resulted, in one instance at least, in ill-advised elective knee joint surgery.
The problem of having skilled personnel in the proper places was fairly constant. There wereincreasing inroads on the orthopedic services of the various large station hospitals as personnelwere withdrawn to staff new hospitals intended for oversea service. Withdrawn also wereorthopedic surgeons belonging to affiliated hospital units, which had completed their paralleltrain-
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ing with the station hospitals and moved to ports of embarkation. It became evident that most ofthe station hospitals would no longer have trained orthopedic. surgeons to do a definitive type ofsurgery.
By the spring of 1943, directives had been issued to transfer all major orthopedic problems,including elective surgery, to the general hospitals of the command. The 2 original generalhospitals in the command were increased, during late 1943 and early 1944, to 11, and anadequate orthopedic section was provided for each of these hospitals. In sonic instances, well-trained orthopedic surgeons were left. in some of the larger station hospitals, but the scope oftheir professional work was curtailed. For the most part. the directives were complied with, andmajor orthopedic problems were handled in the general hospitals.
During the authors 7 months as orthopedic consultant for the Fourth Service Command, hevisited time 11 general hospitals, all of the large Army station hospitals, and many of the smallerones, approximately 60 hospitals in all.
A separate report was rendered on each hospital. Reports on class 1 hospitals at posts, camps,and stations were submitted to the Commanding General, Fourth Service Command, throughtime commanding general or officer of the installation. If the hospital was located on aninstallation of the Army Air Forces, the report. was submitted to the commanding general orofficer of the airbase. Reports on general hospitals surveyed were submitted to the CommandingGeneral, Fourth Service Command, attention Chief, Medical Branch.
These reports were thorough. All orthopedic patients were seen and problems were discussedfully with the chief of section. The X-ray department, physical therapy, rehabilitation, anddisposition of patients were reviewed. The operating rooms were inspected, and anesthesia,nursing, and personnel were commented upon. A hospital with a large orthopedic service orsection might take 2 or 3 days to survey. At the end of such a survey, very complete data wereavailable on which to evaluate the orthopedic care afforded in that particular hospital or medicalinstallation.
Colonel Cleveland considered his chief function to be teaching and the interpretation of thevarious directives related to medical care. The term "inspection seemed to connote a snoopingand, perhaps, an effort to find fault. A consultant had to be fair and kindly, but he could notescape occasionally finding conditions which required warning or even reprimand throughproper channels. The consultant needed to "walk softly but carry a big stick." He could onlyadvise; the command surgeon could implement the advice if he saw fit. A consultant who hopedto be invariably popular was, above all, foolish.
Personnel allotments for a service command headquarters carried no specific position or rank formedical consultants. It was Colonel Cleveland's considered opinion that, since time ArmedForces are constructed on a basis of rank and are thoroughly rank conscious, consultants should have had rank
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equal to or higher than that of the commanding officers of all medical facilities they were calledupon to visit.
Occasionally, the consultants of the Fourth Service Command were sent out as a team to surveya trouble spot for the service command surgeon. In one instance, one of this service command'snewly opened general hospitals received undue and unwarranted publicity by a radiocommentator because of the confusion that attends any new staff which is overwhelmed by thearrival of a large number of patients. A complete survey of the hospital was made, all patientswere seen, and some semblance of order was instituted. Additional orthopedic personnel wereprovided. Many of the patients admitted to this hospital could have been disposed of at thestation hospitals, a majority by return to duty.
On another occasion, all the consultants were sent together to Stark General Hospital,Charleston, S.C., to see the first casualties returned from North Africa. The wounds of theextremities with long-bone fractures had at this time all been treated by the closed-plastertechnique--a method later abandoned. Many of the amputees had protruding bone ends visible inthe stump due to failure to utilize skin traction on the stump. Stark General Hospital wastransformed into a debarkation hospital and the casualties were shipped from this point to thegeneral hospitals nearest the homes of the returnees.
The relationship between the four consultants--medical, surgical, orthopedic, and psychiatric--inthe command surgeon's office was cordial and helpful. Mutual problems were freely and fullydiscussed. The surgical consultant and orthopedic consultant frequently, on separate tours orconsultations, noted and brought to each other's attention problems affecting the surgical serviceor the orthopedic section of various hospitals.
It was a pleasure to serve under Colonel French and on his staff with Col. I. Mims Gage, MC,Col. F. Dennette Adams, MC, and Col. (later Brig. Gen.) William C. Menninger, MC. The staffmade a constant effort to see that the sick and wounded of the Fourth Service Command receivedsuperior care. It was believed that, on the whole, they did receive such care.
MATHER CLEVELAND, M.D.
Section II. 1944 and 1945
GENERAL DUTIES OF THE CONSULTANT
The consultant's general duties were twofold as follows: (1) To supervise the overallprofessional care of the sick in hospitals of the Army Service Forces in the service command,and (2) to evaluate professional personnel and make recommendations for their assignment infurther detail, the orthopedic consultant, Lt. Col. James J. Callahan, MC, provided overalldirection and supervision of the orthopedic services in each medical treatment facility, conductedregular rounds of orthopedic wards, maintained liaison with the Professional
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Service in the Office of the Surgeon General and the other members of the service commandmedical section, evaluated professiona1 personnel assigned to orthopedic services within theservice command, and made recommendations regarding assignment and transfer of personnel.Professional papers were submitted to the consultant for his approval for publication by theMedical Department. After reviewing these papers, he forwarded them to the Office of theSurgeon General. It was the consultant's purpose to encourage by precept the highest level ofprofessional care of patients and the general improvement, with respect to professionalinformation and skill, of the officers assigned to the orthopedic services, he had to be availablefor professional consultation concerning orthopedic cases. It was expected of the orthopedicconsultant that he make suggestions for the correction of deficiencies in service.
It may go into the record that, in Colonel Callahan's personal experience as an orthopedicconsultant, he always received the fullest cooperation of the service command surgeon, who was,first, Col. Sanford W. French, MC, and, later, Brig. Gen. Robert C. McDonald. Both officersalways gave a sympathetic ear to suggestions. Most observations were discussed with thecommanding officer and chief of services at each hospital, and corrections or suggestions weremade at the time of discussion. The commanding officer and the several chiefs of services inevery instance gave the most constructive cooperation.
Area Served
The orthopedic consultant served as adviser to the service command surgeon and, through him,advised the appropriate branch in the Office of the Surgeon General. The services of theorthopedic consultant of the Fourth Service Command were available to the 40 hospitals inoperation at the close of 1944 in that command. Ten were general hospitals, of which three--Kennedy, at Memphis, Tenn., Lawson, at Atlanta, Ga., and Northington, at Tuscaloosa, Ala.--were designated as special centers for neurosurgery as well as orthopedic surgery. LawsonGeneral Hospital was, in addition, an amputation center: and Northington General Hospital wasalso a plastic center where specialists performed plastic surgery. A creditable achievement maybe recorded here because of the many corrections of deformities and disfigurements whichenabled restored patients to be returned to society and even to duty.
The Fourth Service Command did not have its own vascular center; thus, all vascular surgerycases had to be transferred out of that command.
The remaining seven general hospitals were Battey, at Rome, Ga.; Finney; Foster, at Jackson,Miss.; Moore, at Swannanoa, N.C.; Oliver, at Augusta, Ga.; Stark; and Thayer, at Nashville,Tenn. All the general hospitals had qualified orthopedic surgeons who were certified by theAmerican Board of Orthopedic Surgery.
Stark General Hospital was the receiving hospital for the Fourth Service Command. There,patients were received from overseas; casts were changed or removed; wounds, dressed; newcasts, applied; and the patients were made
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generally comfortable before they were transferred for definitive treatment to hospitals close totheir homes. The staff at Stark General Hospital did a superior service under pressingcircumstances of great numbers of patients passing through in rapid turnover.
PROGRAM OF SPECIFIC DUTIES, 1944
During 1944, the orthopedic consultant visited each medical treatment facility in the FourthService Command at least once and in most instances twice. During these visits, ward roundswere made with the chiefs of the various services. The work of the several sections wasreviewed, the quality of clinical records was assessed, and patients presenting special problemswere examined on a consultative basis. The consultant was also called on to discuss currentmedical problems with the officers. Those consultations and general open forums contributedimportantly to professional progress, for each of the officers had an opportunity to voice hisopinion and to acquire knowledge from the other officers or the visiting consultants. Thisapproach helped to unify the system of treatment, so that medical care to the patient wasinevitably improved.
A further duty of the consultant was to attend meetings of the different medical dispositionboards in order to facilitate the disposition of cases and at the same time to insure thatdisposition was made in accordance with existing instructions of the War Department.
It was required of the consultant that he supervise decisions to operate so as to eliminateunnecessary operations in cases in which disability existed be fore induction. It was in thisregard, for instance, that recurrent dislocations of the shoulder and recurrent injuries ordislocations of semilunar cartilages-- particularly in those cases in which there was a severeatrophy revealing a long history of injury--were accurately screened before surgery waspermitted. It. was evident in this type of condition that the patient would not return to active,duty. Limitations were never imposed on any type of reconstructive surgery that might yield thebest possible functional result. Treatment, however, had to be planned with a view to thepatient's ability to return to duty whenever this was at all a possibility.
THE ORTHOPEDIC SERVICE AND SOME ASPECTS OF THERAPY
Back wards. - Some of the general hospitals had organized back wards (wards for backdisorders) collectively controlled by the orthopedic surgeon, the neurosurgeon, thephysiotherapist, and the roentgenologist. When the many cases in these wards had beenreviewed, it was decided to have a consultation with all the ward personnel. Each case was againreviewed and examined individually. At the conclusion of the examination of all the patients, itwas decided that a back ward was not a wise method of grouping back cases. The patientsdiscussed their symptoms with one another and found them
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similar, although the findings were often different; thus, subjective symptoms increased. Theback wards were as a consequence disbanded. Disbanding these wards did not eliminate theproblem, however, because so many cases had been diagnosed as disk syndromes or as positivefor a disk finding. The disk had become a too popular diagnosis. Certainly, disk cases occurred,but not so commonly as the diagnoses had been made: moreover, it was believed that when theydid exist, treatment should be conservative. Patients were thereafter placed in traction. Manywere placed in plaster of paris casts. Many others were manipulated either with or without a castapplication. The number of operative disks was substantially reduced. On the other hand, whenthere were definite indications for surgery--that is, when the patient did not respond toconservative care--the orthopedic surgeon assisted the neurosurgeon. If congenital deformitiesexisted in the vertebras or if there were beginning arthritic changes, then stabilization, eitherwith cortical and cancellous bone or cortical bone alone, enabled the patient to have restored tohim a stable back. Those patients who had fusions performed were in a large measure relieved ofpain but those who did not have a fusion done frequently complained of the same painpostoperatively. Even though the patients thus operated on would usually have to be dischargedbecause of disability, an effort was made to restore them so that they could return to gainfulemployment.
Physical therapy under orthopedic service. - The Surgeon General placed physical therapyunder the orthopedic service, which was an excellent idea inasmuch as the orthopedic servicefurnished most of the patients for the physical therapy unit. The close cooperation between thechief of physical therapy and the chief of orthopedics in a hospital meant better and quickerrehabilitation of the patient. More than half of the patients in most of the hospitals were underorthopedic care. For that reason, it was suggested that the chief of physical therapy make roundswith the orthopedic ward surgeon to permit frank discussions in evaluation and choice oftreatment.
Complete rounds innovation. - In point of fact, a logical suggestion was adopted pertaining tocomplete rounds. Each time the consultant visited a hospital, he saw every patient in the ward.Thus encouraged the, younger officers, improved the morale of the patient who then felt that hewas given the benefit of consultation, as he was, and confirmed each chief of service in hisjudgments or helped him to resolve his doubts in difficult cases.
Amputations and rehabilitation. - Lt. Col. Edward C. Holscher, MC, who was in charge of theorthopedic and amputation service at Lawson General Hospital, guided commendably theprogram instituted at the hospital in which, for example, every effort was made to preserve theinvolved joint, which was usually the knee joint. Conservative treatment, to be sure, as always,depended on careful evaluation so that the patient's life would not be endangered. Efficienttraction, careful plastic repair, early physical therapy, and rehabilitation in all its facets allconstituted care of such superior quality that many of the amputees could be reclassified andreturned to duty.
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The formation of a large rehabilitation center at Daytona Beach, Fla., called the WelchConvalescent Center, significantly relieved that phase of the workload at the general hospitals.As soon as a patient was ambulatory, he was transferred to that large installation where care wasgeared exclusively to the problems of rehabilitation. There the will to get well was an activeforce. Under the direction of Maj. Newton C. McCollough, MC, the section on orthopedicsprovided superior care. As the service command consultant on an inspection visit, ColonelCallahan made the opportunity to examine every patient. Major McCollough and the consultantdiscussed individual problem cases to determine appropriate disposition regarding transfer to ageneral hospital or a specialty center for definitive care or for further surgery.
Prevention of fractures by proper fitting of boots and socks. - A program was developed atFort Benning to correct avoidable deficiencies in the wearing of boots and socks. First to beconsidered were the shoes and socks of the parachutists of the airborne divisions. Each soldierwas measured for correct size of socks and boots. Many had been wearing socks that were tooshort and boots that were inadequate. This malpractice was evidenced by the number of needlessinjuries to feet and the number of fractures of the leg and ankle. The boots were designed withdouble straps which would not remain in the slot intended for them; frequently the straps wouldcatch in the shroud of the parachute, throwing the foot, As a result, typical fractures ofparachute jumpers were observed--fractures of the ankle and of the head of the fibula, as well asknee joint injuries. That defect in the boots was corrected.
It was Maj. Roy Ciccone, MC, who classified the fractures incurred and collaborated in bringingabout the needed corrections in apparel.
Multiple operations of the knee. - At the beginning of the war, many operations of the kneewere performed without enabling the soldier to return to duty. Instead, certificates of disabilityfor discharge had to be issued. Later, a program was instituted whereby the men were betterscreened in the first place. Those operated on were given appropriate preoperative andpostoperative exercise and rehabilitation opportunities; thus, the numbers that had to bedischarged were greatly reduced. This curtailment of surgery did not apply to those who hadreceived injury in line of duty, although the new exercise and rehabilitation measures, undercomplete supervision, benefited them as well.
Many of the cases of internal derangement of operative knees had been the result of insufficientcare in evaluation before operation. There were, for example, two cases of arthrotomies inwhich no pathologic condition had been observed. An occasional soldier had been operated onfor an internal derangement of the knee, although the condition had existed before induction.Inasmuch as half the orthopedic surgery at Fort Benning at one point concerned internalderangement of the knee, the opinion was submitted that each case be more carefully consideredand evaluated. It had been true, moreover,
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that soldiers who were operated on for internal derangements of the knee were allowed out ofbed in less than a week after the operation. Rehabilitation was retarded and not hastened by suchearly weight bearing. Many distended, swollen, painful knees were observed as a result of tooearly weight bearing and early ambulation.
Recurrent dislocations of the shoulder. - Again, many cases of recurrent dislocations of theshoulder had existed before entrance or induction into the service. With the rigors of militarytraining, dislocations were bound to recur. Early operations to correct these conditions had notbeen successful, so that the soldier's had to be reclassified for limited service or discharged. Astime and experience progressed, it was realized that it took at least 6 to 12 months before suchpatients could be returned to useful service. The number of operations thereafter authorized wasgreatly reduced. Surgical correction was attempted only when the prognosis gave reasonablejustification.
Fusion operations on the spine. - Fusion operations on the spine were authorized only whenthere was an unequivocal indication for the procedure. Backaches from conditions that hadexisted before induction into the service were rarely considered an adequate indication forsurgery.
March fractures. - Anther change that was instituted concerned fractures incurred duringmarches, designated march fractures. It was concluded that it was better not to transfer patientswith march fractures to general hospitals because, by the time the diagnosis was made, thefracture was well on its way to healing. Two or three weeks of rehabilitation or of limited dutywould enable the soldier to resume active duty.
Traction for simple fractures of the femur. - In the treatment of fractures of the femur, anorder had been issued to place the extremity with simple small fractures of the femur in traction.That was wise, for the alternative measure of placing the leg in plaster-although it affordedgood immobilization-it did not give an opportunity to examine the limb for the presence ofthrombophlebitis or phlebothrombosis. Neither did the plaster-encased leg permit early activephysical therapy, including massage, muscle contraction, and movement of the knee and ankle--an essential motion. These difficulties, for example, were characteristically observed in fracturedfemurs evacuated from overseas in plaster spicas.
Many orthopedic surgeons were under the impression that casts represented the optimum intreatment, so that it was necessary in making rounds or visits to the hospitals to explain theadvantages of the traction and to insist that the order be executed. Deformities had frequentlybeen found in those cases in which the fracture had been immobilized in a body cast. Traction,either skin or skeletal, resulted in fewer deformities and fewer cases of shortening; moreover, itfacilitated the dressing and care of wounds.
Open fractures and skin grafts. - There were many cases of open fractures of the shaft of thefemur or of the tibia with a loss of bone substance in which skin grafts had been performed, askin dressing had been applied, and
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the leg had healed. Exercise had been ordered to keep the adjoining joints active so as to increasecirculation and restore muscle tone, Later reconstructive surgery reinforced the shallow ornarrow bone and resulted in excellent weight-bearing surfaces. This treatment certainly obviatedthe need for many amputations and prevented permanent disabilities in time weight-bearingextremity. The policy of saving what tissues remained so that something could be added to thepreserved number was worthwhile as it gave a well-functioning limb as an end result.
Osteomyelitis and skin grafts. - Chronic osteomyelitis following open wounds was observedoften, because of the program of treatment of open or compound wounds. At first the cases wereprotracted, but later, after the wound had healed or at least had begun to granulate, either earlygrafting was done or a skin dressing was applied. Because of the early skin dressing, the woundremained clean. Operation was performed early in such cases with a full thickness graft orpedicle graft. The entire program was well worth the time and effort as it reduced the morbidityand saved many an arm on leg that might otherwise have been lost.
To be sure, it was discovered early that the antibiotics were helpful, but they were not whollyresponsible for the improved results Antibiotics could not substitute for good debridement, skincoverage, or dressing in cases of chronic osteomyelitis or cases of large open wounds.
Massive bone grafts. - If the skin graft had fulfilled its purpose of a closed clean wound, thenthe consideration for definitive treatment was in order. Thus it was that large defects were soonclosed with bone grafts. Many were successfully accomplished because of the clean wound andbed furnished by the skin graft; otherwise, in cases of large defects, it would have beennecessary to amputate. In many instances, this important procedure prevented regrafting and theunnecessary loss of precious bone. Dr. John Flanagan at Kennedy General Hospital wasresponsible for some of the excellent surgery of these massive bone grafts which saved manyarms and legs.
Regrettably, a bone bank was not available at that time. Bone from such a bank could havebridged the defect without sacrificing the patient's own bone and would have permitted thepatient to be ambulatory early, without the risk of fracturing the good member at the donor site,
Hand surgery. - Hand surgery centers were established with the initial instruction given by Dr.Sterling Bunnell to all the officers from the general and regional hospitals. The benefits of thisexperience in how to salvage as many hands and fingers as possible and in making tendon andnerve grafts carried over into civilian life, Many hands which would otherwise have been uselesswere saved and rehabilitated. That effort represented the first time that emphasis was placed onthe specialty of hand surgery.
The braceshop. - An important facet of the orthopedic organization was the braceshop. Most ofthe braceshops were in charge of civilian bracemakers who worked commendably for long hoursin the performance of their duties and
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in instructing Army personnel. Their trainees were able to produce professional braces andcalipers. Many of the military trainees have carried the skill of bracemaking over into civilianlife from the Army where they had performed so essentially in an auxiliary service vital tosuccessful orthopedics.
Miscellaneous observations. - It was interesting to observe in the orthopedic clinics how manysoldier's had objective symptoms, how many subjective, and how many had symptoms entirelywithout foundation. Of all symptoms recorded in the clinics, foot disorders represented about 70percent; knee disabilities, about 15 percent; and backaches, from l5 to 20 percent. Theseproportions varied, to be sure, particularly in regional hospitals with large numbers of trainees.At Moore General Hospital, at one time, there were 40 cases of self-inflicted gunshot wounds.
It was interesting that there were so few cases of thrombophlebitis or phlebothrombosis amongthe vast number of injuries treated in the Fourth Service Command.
At Lawson General Hospital, there were four cases of temporary paralysis as the result of usingthe pneumatic tourniquet--three in the lower extremity and one in the upper. All patientsrecovered.
The large prisoner-of-war camp at Camp Forrest, Tenn., presented many serious orthopedicproblems. Lt. Col. Clarence W. Hullinger, MC, was in charge, with the assistance of Maj.Ernest Dehne, MC, and other surgeons. Their program was notably efficient. Col. Mims Gage,the service command surgical consultant, and the Orthopedic consultant frequently visited CampForrest for review purposes and, on occasion, participated in surgical procedures to rehabilitatepatients. Colonel Gage's advice and constant vigilance for complications were noteworthy. Theclose cooperation between the surgical service and the orthopedic service was largely due to hisinterest.
All the commanding officers and personnel of the hospitals in the Fourth Service Commandperformed excellently during the writer's term as consultant. It was the exercised aim of all togive each injured serviceman the best possible result in the shortest possible time. To furtherthat end, the best available professional personnel were invariably assigned to the positions ofchiefs of services. As a consequence, during his tenure Colonel Callahan enjoyed the fullestcooperation of certain chiefs of orthopedic surgery who have not been credited in previousreports, such as Lt. Col. T. Campbell Thompson, MC, Lt. Col. Frank G. Murphy, Lt. Col. EverettI. Bugg, Jr., MC, Dr. I. William Macklis, Lt. Col. Saul Ritchie, MC, Lt. Col. Edward Parnall,MC, Lt. Col. Harold C. McDowell, MC, and Maj. F. Bert Brown, MC.
JAMES J. CALLAHAN, M.D.
