Battle Field Angels (7 page)

Balch, Boone, and others shared their space with countless slugs, frogs, horned beetles, and brown rats. Lice-ridden rats scurried across sleeping soldiers and contaminated food supplies. Sometimes nearly the size of a house cat, these varmints feasted on the eyes and fingers of unburied fatalities. Lice transmitted trench fever that caused chronic leg pain. Soldiers’ clothes were steamed at delousing stations, but the eggs that survived in a uniform’s seams hatched quickly with the help of a soldier’s body heat.

The military medical corps fought an incessant battle against disease in World War I. Although vaccinations controlled smallpox and typhoid, other microscopic enemies were formidable. Trench foot—the development of blisters, open sores, and infection from standing in mud for prolonged periods—was widespread. The worldwide influenza pandemic of 1918 devastated the American Expeditionary Force. Soldiers suffering from influenza occupied 193,000 of the 275,000 military beds available in Europe. At one point, a British military hospital of 40 medical officers and 40 nurses admitted 600 influenza-stricken soldiers a day. The cramped, cold, muddy trenches were as unsanitary as the Civil War’s overcrowded army camps.

Doctors, corpsmen, and medics confronted another formidable enemy: shell shock. Known as “nostalgia” during the Civil War, shell shock became more prevalent during World War I because of monthslong warfare. For weeks at a time, soldiers endured filthy, stinking trenches overrun with vermin. They lived within range of constant enemy artillery. They saw their friends lying face down in a bomb crater or buried in the wall of a trench after being coated with chloride of lime. Amidst this nonstop barrage of disease, noise, and death, many soldiers developed spasms or tics. Other symptoms of shell shock included delusions, sudden phobias, deafness, stammering, and tremors. Military doctors in the rear tried hypnosis, electric shock, massages, drugs, isolation, and rest. Some men recovered, while experimental treatments failed others who committed suicide or deserted. The British Army recorded eighty thousand shell shock casualties in World War I, equivalent to the total population of modern-day Sioux City, Iowa.

Meanwhile, surgeons faced new and far more complicated battlefield wounds than their predecessors had seen in earlier wars. During World War I, 70 percent of the wounds were from shrapnel and secondary missiles such as wood shards and even bone, resulting in horrific mutilation. Sometimes the wounded could not be evacuated from the battlefield for several days. By the time they reached field hospitals, they were weak from loss of blood, shock, hunger, and dehydration. Maggots or pus sometimes filled their wounds. If a medic had packed a belly puncture wound with dressing, fecal material often poured out of a perforated intestine when a surgeon removed the dressing days later.

Although debridement had replaced amputation as the primary surgical weapon against infection, shock remained a primary killer in combat surgery. World War I surgeons knew that quickly replacing blood and body fluids was vital to warding off shock. Karl Landsteiner had discovered blood types in 1901. But surgeons had no way to store donated blood for more than twelve to eighteen hours for use by the wounded. Early in the war, vein-to-vein transfusions from a donor to a recipient lying next to him were attempted. If the donor’s blood was the wrong type, however, there was a chance the recipient would die from a transfusion reaction.

The primary duty of corpsmen and medics in mud-filled trenches was more fundamental: keep soldiers functioning and firing at the enemy.

At Belleau Wood, Lieutenant Weedon Osborne and Captain Donald Duncan were among the one thousand eight hundred Americans who died in battle. German artillery had found the only naval medical officer killed in action during World War I. Osborne posthumously received the Medal of Honor, and in 1919, the U.S. Navy named a destroyer the USS
Osborne
.

Surgeon Orlando Petty survived the destruction of his dressing station near Lucy-le-Bocage. His heroism that day earned Petty the Medal of Honor, Distinguished Service Cross, Silver Star Citation, the French Croix de Guerre, and the Italian Croce di Guerra. After the war, Petty taught at the University of Pennsylvania, and, in 1931, he became Philadelphia’s Director of Public Health. He died the following year at the age of fifty-eight.

A month after the battle at Belleau Wood, the Aisne-Marne Offensive in July 1918 became the turning point of the war on the Western Front. It set the stage for a major Allied counteroffensive the following month. By that point U.S. troops were fully deployed in Europe. America’s manpower and mechanized resources helped turn the tide against Germany after four years of war on the European continent.

Corpsman John Balch kept treating wounded soldiers out in the open at Aisne-Marne. A few months later, on October 5, 1918, Balch again defied death by establishing a critical advance dressing station under brutal shellfire. More than 900 of the 2,300 Marines fighting the Germans suffered casualties in that attack. Many survived because of Balch’s willingness to die if it meant saving the lives of wounded Marines. Balch received the Medal of Honor and an honorable discharge in 1919. In 1942, he reenlisted in the Navy, and retired as a commander eight years later. John Balch died in 1980, at eighty-four years of age.

Surgeon Joel Boone also survived the assault on Soissons in the Aisne-Marne Offensive and received the Medal of Honor for his valor. Boone became the personal physician to Presidents Warren Harding, Calvin Coolidge, and Herbert Hoover. He commanded naval hospitals later in his career, and represented the medical corps during Japan’s surrender ceremony aboard the USS
Missouri
in 1945. Vice Admiral Boone died on April 2, 1974, at the age of eighty-five. He was buried in Arlington National Cemetery.

Their valor typified a fundamental shift in the scope and role of America’s military medical corps. Doctors, corpsmen, medics, and even dentists had joined the troops on the front line. Army medical personnel received 265 Distinguished Service Crosses, and two stretcher bearers were awarded the Medal of Honor. The Navy’s 331 medical personnel who accompanied the Marines were given 684 citations for bravery. Six earned the Medal of Honor. The corpsman became the most decorated rank in World War I.

An estimated 60 million men fought in World War I. More than 7 million were killed, 19 million were wounded, and 500,000 suffered amputations. On average, 900 French soldiers and 1,300 German soldiers were killed every day during the course of four years of war. In just one day in 1916, the British Army suffered 60,000 casualties. By contrast, America’s relatively short participation produced 53,000 battle deaths, 200,000 wounded, and 63,000 noncombat fatalities, nearly all from disease.

The human devastation drove home both old and new lessons in battlefield medicine. World War I surgeons confirmed that nearimmediate debridement improved a wounded soldier’s chances of survival. American doctors, corpsmen, and medics also adopted the French method of treatment called
triage
, literally meaning “to sift or sort.” They learned to assign each wounded man to one of four groups: those who were beyond help; casualties needing immediate treatment; wounded who could wait for treatment; and those with minor injuries. It was the critical first link in a chain of progressive battlefield care that became the basis for casualty care in future wars.

When an American soldier fell wounded in a trench or field during World War I, stretcher bearers—sometimes nicknamed “body snatchers”—carried him as far as several hundred yards through enemy fire to a dressing station. Some stations were little more than medics with first aid packs huddled in a ravine. Others could handle as many as two hundred patients but were equipped with only a single operating table for the most critical abdomen, chest, and severe-fracture wounds. Ambulance drivers stood nearby, ready to take the more seriously wounded to field hospitals about five miles behind the front. Although that usually placed the field hospitals out of range of most artillery, churches commandeered closer to the battlefield for use as field hospitals made easy targets.

Mechanized transportation revolutionized battlefield evacuation. Ford ambulances were prized for their ability to plow through mud. Wounded soldiers who needed more comprehensive care were driven another twenty miles to the rear to evacuation hospitals established along railroad lines. These generally were operated by the American Red Cross, which had created and mobilized university-based hospital teams prior to the war. Their ability to train together in the United States and be ready for deployment to Europe as a single unit on a few weeks’ notice ultimately saved thousands of lives. The Red Cross dramatically increased hospital capacity, which became critical in a war of unprecedented scale.

Late nineteenth-century advances in civilian medicine became evident in military hospitals during World War I. X-rays, discovered in 1895, were utilized for the first time, typically on soldiers with multiple wounds in order to help surgeons determine which were most serious. Advances in diagnostic bacteriology enabled surgeons to ascertain when it was time to close a gaping wound with a skin graft without fostering infection. For decades, surgeons unknowingly had been closing infected wounds prematurely, ignorant of the bacterial origin of infection. By 1917, one battle that produced twenty-five thousand wounded soldiers generated only eighty-four cases of gas gangrene. Progress also was made in the war against shock. Intravenous saline transfusions became common in military hospitals, and blood transfusions on the battlefield were introduced on a limited basis.

These advances led to dramatic increases in wound survivability. Surgeons Orlando Petty, Joel Boone, and others returned 78 percent of wounded soldiers to the front after hospitalization. Only 6 percent died—less than half the 15 percent mortality rate of the hospitalized wounded in the Civil War. Wound survivability also was attributable to the first comprehensive battlefield evacuation system implemented in war. By the end of the war, 21 hospital trains had carried 197,000 wounded men to treatment. The United States had nearly 7,000 ambulances at its disposal in Europe and had built 333 hospitals with more than 275,000 beds.

Disease remained America’s deadliest enemy. Pneumonia and influenza killed more young men than the enemy, while typhoid, diphtheria, malaria, smallpox, and measles accounted for fewer than one thousand deaths. The first large-scale use of the tetanus antitoxin reduced a fatality rate of 90 percent in the Civil War to less than 1 percent in World War I, despite battle conditions that had greatly increased the potential incidence of tetanus.

Both offensive and defensive armor led to the advent of reconstructive surgery on a large scale during World War I. Steel helmets inadvertently contributed to devastating facial ricochet wounds. Glancing strikes by bullets slammed the steel edges of helmets into foreheads, cheeks, and eyes. Early in the war, surgeons were ill equipped to handle these critical facial wounds. Some of these soldiers were transported lying down, and died from suffocation. Later in the war, prosthetics, such as eyeglasses built into fake cheeks and atop handcrafted noses, developed into a subspecialty practiced by those who cared for the wounded when they returned to America. Thousands of maimed soldiers benefitted.

Once again, however, the military medical corps had vastly underestimated the traumatic casualties that a major war would produce. New killing technology had overwhelmed peacetime advances in medicine. In some hospitals, one doctor was assigned to as many as two hundred fifty wounded soldiers. Frontline treatment for the slightly wounded was so inadequate that many were forced to occupy badly needed beds in field hospitals. Convalescent hospital capacity fell well short of the demand that was created by American casualties.

That lack of preparation led to military medicine’s principal accomplishment in World War I: administration and organizational development. In only eighteen months from the start of U.S. involvement in World War I, the Army Medical Department grew to more than 336,000 personnel, including approximately 25 percent of all American physicians. The Red Cross was incorporated into this expansion, as the equivalent of reservists responsible for base hospital operation. In addition, the fledgling development of mobile field hospitals became the precursor to acute-care mobility, which would prove invaluable in the future. That mobility would prove critical more than thirty years later when warfare emerged from the trenches to span thousands of miles across the Pacific Ocean.

World War II: The Pacific

T
he wail of the air raid siren froze the work detail on the deck of the submarine. Exposed topside on the USS
Sealion
, the knot of sweat-soaked men in blue dungarees squinted into the noonday sun. They swept the blue sky for specks that might grow into Japanese bombers, even though for two days they had jumped at sirens that had yielded nothing. Pulses quickened when the drone of enemy aircraft washed over them. Several sailors glanced over at another sub, the USS
Seadragon
, and a minesweeper, the USS
Bittern
, alongside to see if their crews also had been caught in the open. All three ships were lashed together at the Machina Wharf at Cavite Navy Yard in the Philippines on December 10, 1941.