Preface
Prevailing United States Army doctrines in 1942 held that a combat forcecould best be supported by activating methods and procedures generally known atthe outbreak of war. Exception was made for new developments which were expectedto emerge from an intense scientific effort in this country, specifically thatfostered by the Office of Scientific Research and Development, with the adviceof the National Research Council. Otherwise, combat in the field was pictured ascalling for the replacement of personnel and supplies and a reasonable modicumof skill in the adaptation of standardized procedures to specialized situationsas they were encountered. It was not generally understood that experience in thefield could point the way toward immediate and radical changes of methods andequipment and that quick footwork in making these changes spelled survival. Tobe sound, changes of this type required as much factual evidence as could beassembled.
As a consequence, no provision was made for the collectionand analysis of surgical evidence so that corrective measures might be devisedby those on the spot when confronted with unexpected happenings. The idea ofsending out skilled observers to identify new problems and solve them then andthere was not entertained. In fact, such an idea smacked of the academic and wasdismissed by the stern reminder that medicine was on the march to help fight awar-not to indulge in research.
Interestingly enough, it was the combat components thatpointed the way by the utilization of the services of experts to observe andreport on the performance of machines of war. Many were the "bugs"that remained in new tanks, planes, and missiles, and these defects wereconstantly being ironed out. Precise and scientific measurement of noveldevelopments by the enemy required alert and expert intelligence. One recallsthe encounter with magnetic mines that threatened shipping in the NorthAtlantic. Combat commanders and their conventional military staffs cannot beexpected to solve such problems unaided and, in fact, may not even be able todefine them in terms that can lead to a solution elsewhere. The same may be saidof 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 needfor surgical evidence to guide their daily work. Some of the first compilationsof the records of patients who had disappeared into the evacuation stream weremade as follow up studies by members of the 2d Auxiliary Surgical Group. This waspartly because the surgical teams had periods of inactivity that could bedevoted to such pursuits and partly because of the wise insistence
of their commanding officer, Col. James H. Forsee, MC, onmaintaining duplicated and full clinical records. It could have been so easy tolet down standards and be too busy to keep records adequate for analysis.
The theater from which the greater part of this volume has originated wasalso fortunate in the assignment of affiliated hospital units from leadingteaching hospitals with chiefs of surgery who insisted on the maintenance ofhigh standards. A professor of surgery from Oslo, after 3 weeks in the forwardarea of the Fifth United States Army in Italy, said: "You are holding tothe standards of university clinic surgery under fire and in tents with mudfloors."
Finally, the small group of peripatetic officers who were identified asconsultants were not deployed with the mission of commissars or gauleiters. Theywere searching for surgical evidence by direct observation and discussion. Theachievement 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 thethread that binds them is mine own."
Of course, the Mediterranean Theater of Operations provided a favorableenvironment for such undertakings. It was an experimental laboratory not onlyfor 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 woundsurgery be carried on within a framework of inquiry, for this theater was theproving 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.
