00:00:00.109 - 00:00:22.920

Four. While we were at that, we received orders to go to Red Park near in East Anglia to transfer and, and take over the hospital unit of the two 31st station hospital, an advance party left in February and the main unit was transferred on March 6th.

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Now on that day, 1000 heavy bombers raided Berlin. And that evening, we received over 24 air fresh casualties removed from those bombers as they returned. And we jumped into an active experience that continued unabated until B E V E day. Uh over a year later, the

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very next day, two bombers crashed and there are units and a group of personnel gathered around to watch the affairs. At which time the bombs exploded. And we received over 35 casualties immediately from that experience, many with blast injuries to their lungs. In addition to all

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types of, of uh injuries to body and extremities. Only three days later, we were inspected by uh a group of generals who had come over at the behest of major general of the Air force who was displeased with the medical care which he had been receiving

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from the station hospitals in the area. As a matter of fact, that was the reason we were sent down to L A is distress or the care that the station those were giving. And there was a great deal of agitation at that time for the Air

00:02:07.360 - 00:02:29.570

Force to have its own medical units. And so only uh five or six days after we arrived in Red Grave Park, we were inspected by uh the surgeons are uh General Grant who was the uh Air Force. Uh surgeon General General Hawley, who was the commanding

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officer of the Medical Forces in the European theater. And general who came to determine first of all whether we were adequate to take care of the Air Force guys place. And second of all, to determine whether or not the Air Force should have its own medical

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service. So distressed was general grow with the service he had been receiving. We didn't realize quite what the cause for that inspection was, but we were pleased to learn later that they had decided that we were adequate to take care of their CASS. And I don't

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believe the Air Force continued their demands that they have their own medical service there. Now, we as a general hospital uh receive transfers from the state hospitals in the vicinity. Uh direct casualties from the 2nd and 3rd units of the eighth Air Force. And we operated

00:03:30.220 - 00:03:48.600

a busy outpatient department for all these trips in the area as well as operating a hospital and we were extremely busy from that day on until, until we were inactivated and sent back to the States because even after V E day, although we did not receive

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any more acute casualties from the heavy farmers, we were receiving all kinds of casualties who were transferred back to the, uh, from the frontline hospitals in, uh, in Germany, uh, as well as, uh, the care we were giving to all the troops in the area. Ok.

00:04:15.639 - 00:04:37.079

While we were at Red Grave Park, we had a vast experience in traumatic surgery. And I wrote a summary of that which was published, uh detailing our experience in over 1000 fresh battle casualties from the Air Force. They were received within five hours of their wounding

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and uh a number of uh injuries throughout all parts of the body. I think it's interesting to note that of those over 1000 cases, we had a mortality rate of less than 1%. It was 4/10 of 1%. Actually, I think another interesting observation was the high

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number of class organisms recultured from the wounds. Uh The castro organisms are the ones that cause gas gray green, which is a Federal Organization organism. Um We cultured the wounds from all of our injuries at the time of the breed. And that work was done by

00:05:26.339 - 00:05:52.700

Leonard scholar who had entered our laboratory service. And he found that in over 40% of the excised tissue in mount pathogenic organisms were present. Yet we only had two cases of gas ary, both of which had major arterial injury. Attribute that to the fact that the

00:05:52.709 - 00:06:17.350

breed was thorough and the use of. So. No, and I think we did, we have penicillin. Yes, we received penicillin in about early 43 we're using it with our battle casualties. In fact, most of the penicillin that was being produced, the early part of the war

00:06:17.359 - 00:06:35.760

was sent exclusively for use of the troops. I remember how crude it was, it was a dark green material, most of it made by commercial solvents corporation. And I remember it had no cocaine in it and it was a terror to receive it. It was like

00:06:35.959 - 00:06:53.739

a hot wasp thing and we had to give it about every four hours and we thought that 10,000 units at that time was a big dose. I think it also should be mentioned, Connie that Leonard Skyler who did all of that bacteriological work with us bacteriologist

00:06:53.750 - 00:07:13.140

at the time. And later after the war came to Duke and graduated as one of our better known medical graduates. That was one of the good things that came out of the war when Leonard scholar had been unable to get into medical school previously. And after

00:07:13.149 - 00:07:35.570

our experience with him, we were able to manager and he has become a leading medical practitioner in the New York area. There were a number of good things that, well, I think before we leave those wounds, it would be worth mentioning the primitive conditions under which

00:07:35.579 - 00:08:01.880

our heavy bombers worked. They were all driven. They were not pressurized. They operated at elevations of over 40,000 ft. They weren't pressurized nor was oxygen available except through mass through masks which they had to wear all the time. There was no heating of the, of the

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aircraft and they had to wear the heavy suits in which each had electrical heating elements to keep them warm. And if during an injury, anything happened to the heating element in their suit or anything happened to the oxygen supply, which was linked to the oxygen mask.

00:08:24.089 - 00:08:47.559

It was a address that they would have to get an oxygen bottle which would last only temporarily. And we had many cold injuries suffered because of failure of their heating elements and their suits. We also had many sudden high altitude deaths from ania because of the

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freezing up from the saliva that would occasionally in condensation in their mask. I think we used to see quite a few injuries that were just from the environment flying from 25 to 30,000 ft as they did in temperatures down to 60 below zero. I think it

00:09:07.229 - 00:09:28.969

also should be noted that these men all wore flex suits, uh which protected their body and chest injuries were minimal, I expect because of that. Although we had many chest injuries that had their injury, the point of injury on their arm or in the neck. We

00:09:28.979 - 00:09:48.809

had abdominal injuries where the point of injury was in the products or in the thigh. We had super injuries and there was many, now there were many good things that came out of our experience. I think one of the greatest ones was the need for blood

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banking services because whole blood was absolutely essential to combat shock, uh, for our patients. Now, the American Army was hopelessly. American surgery in general was hopelessly deficient in the banking of blood and, and, and the American Army knew nothing about it. So Ivan Brown was delegated

00:10:15.349 - 00:10:35.299

as soon as we got overseas to visit these British units and bring us up to date on, on, on blood banking. And we had because of him, uh the superior blood banking service of the whole American American army right in our hospital. I, you want to

00:10:35.309 - 00:10:56.710

tell us a little bit about, I think you're giving me too much credit because I only brought back what the British already do in something else you may not recall because of their generosity in making it so easy for us to steal from them. When we

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couldn't get our own material. They arranged for me to steal some of their equipment so that we could start a bank. And then of course, you know, everything in the army had to be accounted for. So it took quite a quite a bit of maneuvering so

00:11:10.750 - 00:11:30.789

that they would have this material on a certain platform that when an ambulance came along we could pick it up. Well, we got this British equipment, the British bottles, some of the British chemicals for making the anticoagulant. I remember, I remember how we had to distill

00:11:30.799 - 00:11:53.919

our own water using an old laboratory, a chemical laboratory still to make up our intravenous solutions and particularly in making these blood bottles. But it worked amazingly well. We kept blood in those days for 21 days just as they do. Now, the bottles were a little

00:11:53.929 - 00:12:17.250

bit smaller than they are now about 410 CC per unit. But it worked exceedingly well. And we used our own personnel, we used our own enlisted personnel and officers and people from the nearby bases as donors. And I must say that I think a large share

00:12:17.260 - 00:12:37.250

of the great success we had with some of our real acute casualties that were bled out when they arrived was because of sen's maintenance of that very good blood bank that we had. And as you say, the only the only hospital, blood bank of any American

00:12:37.260 - 00:12:54.359

hospital that I know of in the e all the other units received their blood later in the war, sent over from overseas. And you remember too, county at the outbreak of war, they thought they could solve the whole thing with the plasma and the Red Cross.

00:12:54.369 - 00:13:16.599

They had a big plasma program, millions of units drawn and sent overseas as dried plasma. We very quickly learned that you could sustain a patient through his arrival in the hospital by replacement with plasma. But before the treatment was completed and particularly any operative treatment, one

00:13:16.609 - 00:13:38.369

needed whole blood. And then of course came the great tragedy of the serum hepatitis that most of this plasma was infected with, that led to very tragic results some 6 to 8 weeks later. But that of course is another story. I think there can be no

00:13:38.380 - 00:14:00.890

doubt that the low mortality in our care of these acute casualties came from the fact that we had an unlimited supply of blood because of what I did. And I think it also should be noted that when Ivan returned to America after the war, he was

00:14:00.900 - 00:14:23.450

instrumental in setting up the blood bank at the Duke University Medical Center and in making innumerable contributions to the whole field of blood preservations and so on. A matter of fact, those were his early contributions in the field of surgery. Uh The uh uh don't you

00:14:23.460 - 00:14:42.429

think that uh also that one of the things that we learned during war? And as I remember uh was one of the contributions of war medicine was the whole concept of uh the central supply operation. I'm glad you brought that up. I because in the matter

00:14:42.440 - 00:15:03.104

of uh of blood banking, let me ask you what kind of tubing did you use? Well, of course, it was all, uh, old, uh, uh, rubber tubing. Uh, sort of, how did you, uh, all we had no disposable equipment such as we have now, we didn't

00:15:03.114 - 00:15:19.770

have plastic tubing, all of the tubing for the intravenous sets and all of the tubing for the blood sets and all was all rubber tubing. Well, not only that, not very good rubber either. Well, tell us about the whole concept of central supply, uh which uh

00:15:19.780 - 00:15:43.609

was developed in the army and in our unit guards through your interest and which we also brought back to do. Well, I think the, I think the credit for the uh the central supply development really goes to uh two people. Uh Sergeant Blair Fly, who had

00:15:43.619 - 00:16:01.809

been an employee of Duke and whom we took with us, the unit became the sergeant in charge of central supply and he just did an outstanding job of developing and maintaining that unit that supplied the operating room that supplied all the sterile goods and gauze and

00:16:01.820 - 00:16:22.820

trays for the entire hospital. And remember at times, we were up to 1400 beds with him was Lieutenant Mary Copeland who was the nurse in charge. And I think that probably if credit had to be given to two people in the unit who did as much

00:16:22.830 - 00:16:40.909

as anyone else, it would have to be to Blair Flynn and Mary Copeland for just, we never won it. Can you remember a time when I agree with you that they were the ones who did it? But the stimulation and the direction came from you. And,

00:16:40.919 - 00:16:57.369

uh, and, and when we got back to Duke you were, you did the same thing for us there. What about the Kenny? What about the, what do you think uh uh from the standpoint of uh surgical treatment? Uh that was new that we learned during the

00:16:57.380 - 00:17:18.969

war that we didn't know before and some of the surgical contributions that uh well, what surgery mean to me, I'm sorry to say that many of our uh procedures then would be prim. Now, I refer particularly to our vascular surgery. Although we did vascular surgery, we

00:17:18.979 - 00:17:42.119

did it under conditions that would be recognized as much prim now because we had no vascular clamps. We had no sedge needles. We would do our arterial sutures with french needles and ordinary soap and, and we would have to control vessels with tapes. Although we did

00:17:42.469 - 00:18:01.640

our surgery, it was not, uh would be considered more affirmative now. But still, but still, I think it's quite remarkable. I remember one case that you did of reattaching a left subclavian artery that had been taken off by the base of a shell and though it

00:18:01.650 - 00:18:23.469

may have been primitive, it did work. Oh, that was a horrible experience. But we saved this officer's life. I don't think we ought to talk about that. Particular case perhaps. What about decortication? Well, we did learn how to take care of chronic chronic fibro thorax or,

00:18:23.479 - 00:18:43.974

or clotted hemothorax, which we really didn't understand in civilian life. And I think we learned it possibly from the experience in the Mediterranean Theater where Paul Sanger made contribution, another new president, which it was to the fact that uh that when into the cavity and the

00:18:44.574 - 00:19:05.260

hex occurred, there was uncertainty about how it should be treated. Uh If it was left in place, the blood was left in place. It so often simulated an in response with the deposit of fiber on the chest wall and on the floor of the lung which

00:19:05.270 - 00:19:24.819

entrapped the lung in its collapsed position and, and, and circle the chest wall. So chest didn't move. And the patient was left with a huge mass of crowd of blood and fiber in a oral space with a collapsed lung that he couldn't, couldn't use and couldn't

00:19:24.829 - 00:19:47.199

be expanded. Then was introduced the, the procedure of decoration, which meant that the thorax was open and we decorticated or removed that fibrous scar from the lung so that it could expand. We removed the fiber scar from the chest wall so that it could move and,

00:19:47.209 - 00:20:07.949

uh, and that we did learn and burned back. Yes, I think though there's one other thing Kenny that you should recall because now the days with all of the interest in cardiac surgery, I think that we should recall the three cases that you did of removing

00:20:07.959 - 00:20:33.280

shell fragments from the human heart with those primitive instruments and with no Sweded down needles. I remember them very vividly. And I also remember that all these three soldiers lived without infection or without any. The one, the one was, I think, extremely interesting because he had

00:20:33.290 - 00:20:48.800

a shell fragment in his heart which didn't show in an ordinary x-ray at all. He had, had an X ray made. He was an officer who had stepped on one of these anti personnel bombs which flew up and exploded at his chest level. And one of

00:20:48.810 - 00:21:03.270

the fragments entered his chest and entered his heart. And he had an X ray made in the in the field hospital before it was transferred to us, which did not show a foreign body. And we had an x-ray made, which did not show a foreign body

00:21:03.280 - 00:21:23.439

because the motion of the heart blurred the image of the foreign body and it showed only one on one, a very rapid exposure. Uh x-ray plate was made, but it was beautifully visible under fluoroscopy when it described a circle with each heartbeat. Well, we, we took

00:21:23.449 - 00:21:45.569

that out but uh and two others but well, and of course, the those were the first real uh heart operations. Uh uh those in the of course, others were doing them too with, with the Harvard unit who had, by the way, uh one of our radiologists

00:21:45.579 - 00:22:06.510

working with him who was one of the 65th originals. Uh Arthur Joyce did was his radiologist uh who had gone overseas with us and later went with, with the Harvard Unit. But so I think there were, there were some contributions made. Could you give us a

00:22:06.520 - 00:22:13.530

capsule summary of the, you mentioned the fact that our battle casualties were only.