# Doctors Aweigh/Chapter 1

​CHAPTER I
Emergency Call, Pearl Harbor
CAPTAIN HAYDEN SANG in his shower.
The sounds that rose above the gurgle and splash of the plumbing might not have been recognized by many as song, but to the captain's family the sound indicated that to the head of the house all was right with that peaceful, sunny morning of December 7, 1941.
It was one of Hawaii's brightest. Pearl Harbor was unusually full of big ships gleaming in the early-morning sun. Among the eighty-six ships of the Pacific Fleet moored there, there were eight battleships, seven cruisers, twenty-eight destroyers, and five submarines. For days the air had tingled with bugles and with something else, though less easy to define. Not in months had the base been so full and so busy.
Upstairs, in Captain Hayden's quarters, the sounds from behind the shower curtain became staccato: "K—K—K—Katy!" Like most Navy captains, Hayden's musical repertoire was of the vintage of 1918. That particular number was produced in response to a sluice of extra-cold water. Through the chattering of his own teeth he heard, suddenly, the roar of planes approaching and flying low over the quarters. This was immediately followed by a violent explosion.
Let him tell it in his own words:
"I didn't pay much attention to this. The Naval Hospital is ​located alongside the Army Air Base at Hickam Field and across the channel from the Naval Air Station on Ford Island. We had planes flying around most of the time. As we were doing some construction work in the rear of the hospital, dynamite blasts were not unusual. The explosion of three hundred to five hundred pounds of dynamite sounds about the same as the explosion of an air bomb. Then I heard more planes and more explosions. Big ones. They shook the house. Doggone it, that wasn't quite normal. Especially on a Sunday. I jumped out of the shower, threw on some clothes, and started for the window of my room. Just then my thirteen-year-old son, Billy, dashed in.
"'They're Jap planes!' he yelled.
"'Japs?'
"'Sure. Take a look at them.'
"We looked out the window just as three planes went by the second floor of my quarters, only about seventy-five feet away. I could see the features of the men in them. They were Japs, all right."
That was how the Navy's Medical Corps got its call to action at Pearl Harbor. Captain Reynolds Hayden (MC), U.S.N., was commanding officer of the Naval Hospital there. How the Navy answered that call that day and has been answering it all during the progress of the war I shall try to tell as frankly and as fully as naval regulations and circumstances permit.
It was 7:55 a.m. when the first of those black vultures with the crimson ball on their wings swooped down on the Army Air Base, Hickam Field, and on the Naval Air Station on Ford Island, where our big, long-range planes were. In that early hour of the morning a number of ambulant patients were strolling around the hospital grounds, which were one of the beauty spots of Oahu. The first Jap planes zoomed low over their heads, but the fliers were too intent on reaching military objectives, before our anti-aircraft guns could get at them, to bother with these groups.
With the sound of the planes, the explosions of the first bombs, ​and the crackle of our own anti-aircraft batteries sounding all around him, Captain Hayden gave orders to his family to keep inside the house unless it caught fire, and started on the run across the lawn to the hospital.
Waves of enemy bombers, escorted by fighter planes, were swinging in from the southeast to concentrate their attack on the heavy ships in the West, East, and Middle Lochs. It took only a few minutes after the first bomb dropped on the Fleet for the machine guns mounted on the battleships to open fire. Inside another five minutes the anti-aircraft batteries had swung into action. The air was full of the crash of exploding bombs and torpedoes, the roar of ack-ack guns, and the twisted, flaming skeletons of wrecked planes. The harbor was a sea of oil, ablaze in many places, in which terribly charred bodies floated and men made desperate attempts to swim.
Back in the Medical C.O.'s quarters, Billy Hayden flattened his nose against the window and let out an awed, solemn whistle: "Whew! And they call this the Paradise of the Pacific."
On that Sunday morning there were some 500 patients in the Naval Hospital. These were men from the station and sick and injured from the ships of the Fleet then in harbor. The official rating of the institution was 506 patients. Fortunately, the Medical Department was acutely aware of the ultimate significance of the events transpiring in the Pacific. We were keeping a big fleet in the Pacific, and it looked as if we would have to continue to keep it there, and to add to it for some time to come. Pearl Harbor provided the only hospital facilities for this fleet away from the mainland, except for small naval hospitals at Guam, Samoa, and Cavite.
There was no arguing against the fact that we needed enlarged hospital facilities and an abundant supply of drugs and surgical dressings. Although certain powers in authority and the public at large may have objected to appropriations requested for purely military naval expansion, there was always a ready and ​enthusiastic response to the surgeon general's request for funds to provide for an increase in hospital facilities.
The hospital at Pearl Harbor grew. One by one, here and there new corridors, outbuildings, and pavilions were provided. Medical stores were built up. In Hawaii, there are no firms manufacturing drugs or medical supplies. All these must come from the United States, and it takes time to get them there.
The value of this foresight is proved by the fact, announced by the surgeon general of the Navy, Rear Admiral Ross T. McIntire, that "at midnight of December seventh there were 960 patients in a hospital whose official rating was 506 patients. And next day nearly 100 more were received who had been temporarily cared for at emergency dressing stations."
A mobile hospital with a capacity of 600 beds had been transported to Pearl Harbor and was practically set up and was functioning on that fateful day, December 7, 1941.
Whatever criticism may be made of our defense program at Pearl Harbor, it must necessarily stop short of the matter of medical preparedness. When it came to taking care of those injured in the raid, we were right on the spot; we were well staffed and well equipped.
Thank God for that!
By the time Captain Hayden got to the hospital, the officer of the day had ordered all hands to their stations. The hospital's three ambulances and all the fire-fighting apparatus were distributed about the grounds, so that in case a bomb were dropped, all the apparatus would not be destroyed at once. The immediate demand was for as many beds as possible for the casualties of the battle then going on. There was no possible way of estimating how many these would be. As ship after ship was hit or set afire, it was all too evident that everything the hospital had wasn't going to be too much. If only it were enough!
The first casualty brought in was a man who had been walking along the road by the hospital with his wife and small child. A ​falling fragment of shell cut off his left arm at the shoulder, with fatal results. Miraculously, the woman and child were not hurt.
All ambulant patients were moved from the wards to hospital tents set up behind the building. A number of men decided for themselves, and without benefit of medical advice, that they were well enough to get back to their ships and into the fight. They didn't stop for uniforms. Some of these men were killed. A few were injured and ultimately turned up at the hospital again. One lanky gunner's mate, who had been under treatment for a fractured rib, got out to his ship in time to help fire his gun before a bursting torpedo shattered both his legs. They brought him back to the same ward and the same bed he had crawled out of an hour before. Through grimly set lips he muttered: "It's just a damned merry-go-round!"
There was constant danger that the hospital itself would be hit. Ten minutes after the raid began, a blazing enemy plane came down on a glide toward the center of the main building. For a minute it looked as if it would make a direct hit. Then it veered off slightly, carrying away a corner of the laboratory roof and half the animal house, to crash on the tennis courts. The pilot had been shot in the head and killed before the crash. The plane had evidently come down out of control.
About eight-thirty came a lull in the raid, when the raiding planes went back to their carrier to reload. During that respite, the first casualties began to turn up at the hospital. For the next three hours, while the enemy came back and renewed the assault, and later, the victims continued to come at an average of three a minute. They were brought to the hospital in every sort of vehicle — ambulances, military and civilian trucks, private cars, and delivery wagons. Civilians co-operated with the Navy in bringing the wounded in under fire. A pool of all vehicles was formed at the navy yard garage and moved up, two by two, to the dock to take on wounded for conveyance to the hospital and to the emergency field hospitals set up in various places.
​The hospital ship Solace was anchored in the harbor. Some of the patients she carried had been transferred to the hospital. The white-painted ship became a mecca for the men swimming about in the oil-covered water. Approximately 141 patients were received on board the Solace. "Many," according to Captain George Eckert (MC), U.S.N., chief surgeon, "were so seriously burned as to be unrecognizable. Those who were conscious tried to mumble their names. But no one whimpered. Their morale was high."
At the hospital, the problem was how to handle such a flood of terribly injured men as quickly and as competently as possible. This was solved by Captain Hayden and his executive officer, who quickly examined each man brought in and assigned him to a place in one of the twelve wards or sent him directly to the operating suite.
Many patients were unconscious, or too badly injured to speak. Forty-seven per cent of all the cases brought to the hospital were burned. Many were thickly coated with fuel oil. Practically all were in a state of shock.
The Navy is a stickler for records. All through a man's career in the service, whether just for a hitch or for life, two careful, up-to-the-minute, detailed accounts are kept of him. One is his service record; the other is his health record. The service record is kept in duplicate. One set goes with him from ship to station, in the keeping of his commanding officer; the other set is kept in Washington at the Navy Department. Whenever anything happens to the man — from an abscessed tooth to a citation for distinguished service — it is immediately written into its appropriate place in his record of health or service.
In the stress and confusion of battle or during such a raid as occurred at Pearl Harbor, there is no time to search a man's health record before attending to his needs. But Navy regulations and sound common sense decree that every effort be made to keep a record of his injuries and the treatment given them, as his continued treatment and future pension claim depend on these records.
​This is one of the times when the metal identification tag, which man in the United States Navy — officer and enlisted man alike — wears about his neck, is invaluable. Here are inscribed the man's name and rating, his blood type — in case blood transfusions are necessary — and the date of his inoculation against tetanus. And, as further proof of identity, the print of his right forefinger. In addition to these data, a man who has been given first-aid treatment at a field dressing station or by a Navy hospital corpsman is promptly tagged before being sent on to the hospital. The tag tells the medical officer, who examines the patient, exactly what first-aid treatment has been given — morphine, sulfanilamide, or blood plasma.
It is enormously important that the first examination of the injured be made by a medical officer of long and extensive experience. Always there is shock to be looked for and guarded against. To send a patient to the operating room while in a state of shock is to court disaster. Abdominal and head injuries need to be wisely appraised. Many head injuries seem slight on casual examination; yet these, if not recognized and properly treated, will result in fatal complications.
All scalp wounds are serious, and sometimes it is a question for the surgeon to decide whether the metallic foreign body should be removed or not. Actually, there is a fifty-fifty chance that the man who has a bullet in his brain will develop epilepsy.
During World War I, Dr. Harvey Cushing improved the surgical technique then followed, with the result that the mortality of head wounds was reduced from 60 per cent to 20 per cent. With the use of sulfa drugs, this mortality rate has now been cut considerably lower.
Naturally, the powers of the entire hospital staff were stretched to the limit on that fateful December 7. "Though occasional shell fragments and machine-gun bullets zipped through our temporary ward building," said Captain Hayden, "all hands were so busy they had no time to think of themselves. Fortunately, nobody was injured."
​For the next three days all hands worked twenty-four hours a day, snatching sleep when they could. In the operating rooms, four operating teams, two teams working at a time in relays, attended to the urgent surgical cases as rapidly as possible. For the next ten days the hospital staff was divided into watches so the work could go on continuously round the clock.
"I was proud of them," said Captain Hayden, "especially of my nurses and hospital corpsmen. Many of these were youngsters doing their first hitch. But they stood their baptism of fire well. As soon as the enemy planes started to roar over and around us, they dashed from their quarters to the main hospital building through a shower of anti-aircraft shell fragments and stray machine-gun bullets. Their first thought was to care for their patients and to get ready for those who they knew would soon be coming. After the raid, all hands worked until they dropped. You never had to keep them at it.
"Our twenty-eight nurses were especially devoted. I will always remember my chief nurse, a frail-appearing little woman who looked as though a good gust of wind would blow her away. But she was made of steel wire. She was everywhere: encouraging, supervising, directing. On Wednesday it was necessary to order her to bed to get some sleep. The staff took great pride in the fact that though we were understaffed for such a great number of serious casualties, we were able to care for our own without any outside medical assistance, except some volunteer trained nurses and 500 flasks of blood plasma from Honolulu."
The staff of the Pearl Harbor Hospital and that of the U.S.S. Solace were cited en masse by the commander in chief, United States Pacific Fleet, for distinguished services during, and subsequent to, the Japanese attack on December 7, 1941! There are combatant units which have been cited for gallantry in action, but this is the first time on record that the entire staff of a hospital or a hospital ship has received that honor.
Among the unsung heroes of that opening battle of the war were ​the hospital's Chinese galley force. Anyone who has lived in the East knows you can kill a Chinaman, but you can't surprise him. His imperturbability equals that of the Great Wall his ancestors built.
The hospital's cooks and mess boys lived up to the traditions of their race. With the great tide of seriously injured patients, slight casualties, helpers, and stray sailors whose ships had been blown up and who didn't know where to go, turning up at the hospital, every inch of space inside and out was crowded. Yet, somehow, by some miracle and the equanimity of the Chinese temperament, those boys served that day, between noon and 3 p.m., 4,500 Sunday dinners. Then they pitched in and produced an equal number of suppers.
Next day they did it again. After that, the hospital was cleared of all except the patients and staff, and the housekeeping settled down to a routine.
Character and habit are what make for morale in any emergency. Sometimes force of habit produces amusing results. When the U.S.S. Arizona was blown up in a world-shattering explosion, the Hayden children ran excitedly to the front door to see. Automatically Mrs. Hayden called after them: "Don't let the mosquitoes in."
One striking difference between the medical picture presented by World War I and the one we are fighting today lies in the enormously increased number of burn cases. As a result of modern warfare, burns have become a major casualty. Of the patients sent to the Pearl Harbor Hospital, 254 were burn cases.
Practically all these were flash burns, caused by the temporary but intense heat from exploding bombs or torpedoes. These were preponderantly second-degree burns, and many burns covered some 80 per cent of the body surface.
It was immediately noticeable that those parts of the body surface which were covered by any kind of clothing, even the lightest skivvy shirt or cotton shorts, were not burned. When the attack ​occurred, many men aboard ship were below deck and in various stages of undress. At the call of "battle stations," they ran to their stations without waiting to pull on their clothes. Some wore trousers and no shirts. Some were in their underclothes. Others wore only a pair of trunks, or sprang naked from the showers. Those wearing undershirt and trousers were burned only on the arms and face. Those with trousers but no shirts were burned over the entire body above the waist. Those wearing trunks were burned over the entire body except about the hips. This experience has led to the orders, now in force throughout the United States Navy, that at "battle stations" the men shall be fully clothed; and many wear "flash-proof" clothing.
In addition to their burns, numbers of the men had been overboard in water heavily coated with fuel oil, and were covered with it from head to foot. A number of these patients were in a state of shock, even when there was no sign of any physical injury. Those who were burned and covered with fuel oil presented a serious problem. No attempt could be made to remove the oil at the time. Immediate local treatment for the burns had to be applied over the oil.
How to remove fuel oil is a problem for extensive research. The best method found at Pearl Harbor to remove the heavy oil was by the use of a gauze or cotton sponge saturated with mineral oil. Of course this must be done slowly and with all the gentleness possible. The mineral oil leaves a thin film which, however, is not difficult to cleanse away. At least this method is preferable to the old one of using tincture of green soap. Since then some common proprietary preparations have been found to be most useful as detergents.
As soon as possible after their reception at the hospital or aboard the hospital ship all the burn cases were given a tanning process.
Aboard the Solace all the stainless-steel buckets available were collected in the pharmacy. One pound of tannic-acid crystals was added to each bucket of water, and these were distributed to each ​operating room, dressing room, and ward. In the rush, no attempt was made to observe sterile precautions. Dressings were soaked in the solution and placed on and around the burned areas and kept wet for twenty-four hours.
At the hospital, sprays of tannic acid, gentian violet, and triple dye were made up and used continuously. Everything which would spray the solution was put to use. Ordinary Flit guns were emptied, refilled with the medicated spray, and used to spray patients. Even though this tanning process was frequently applied over the fuel oil, a reasonably efficient tanning resulted.
As soon as the necessary cradles could be manufactured, each severely burned patient was placed under a heat cradle, several blue electric lights being used to supply the heat, and the cradles covered with blankets.
Why, one may ask, apply heat to bodies already terribly burned? It should be borne in mind that deaths resulting from burns are produced by shock induced by the burn and the loss of body fluid. Heat helps to prevent this. Treatment of the severely burned continued day and night until they were evacuated to the West coast ten days later.
Only the operating suite had been blacked out before the raid But strict black-out precautions became imperative because another raid might come at any time. Ward work was therefore continued with only the dim light from blued flashlights. This made the care of the injured, especially intravenous administration of plasma, extremely difficult.
In the great majority of war injuries of no matter what kind, the primary cause of death is shock. From the earliest times, surgeons have noted a startling clinical picture which appears in patients following severe injuries or major operations. There is an almost classical group of symptoms — pallor, moist skin, rapid, feeble pulse, and a lowering of blood pressure. These indicate acute failure of the circulation. In other words: shock. Typical shock is seen ​following extensive surgical operations and in the victims of war wounds, burns, industrial accidents, and automobile injuries. It was a common and deadly combination in soldiers during World War I, and caused more deaths than any other single condition.
The term shock was originally applied to this condition when it occurred immediately after an injury. Later, the word came to include states of low blood pressure which might appear some hours after the injury. We now speak of primary and secondary shock. Primary shock generally follows soon after pain or injury. It resembles fainting. It is not due to hemorrhage. Secondary shock develops, insidiously, some hours after injury, burns, or hemorrhage. Its outstanding feature is low blood pressure. It has been found that practically every man injured during battle is in a state of shock, either real or potential. The condition is influenced or caused by hemorrhage, tissue destruction, mental trauma, fatigue, and many other factors. Shock must receive the first attention after hemorrhage is controlled.
Fortunately, today we can afford to wait and let shock be relieved before operating. I remember during World War I, when I was commanding officer of the Naval Hospital at Brest, we used to make every effort to operate on our surgical cases as soon as they were brought in to us; if possible, within the "golden period" of six hours after the injury. We believed, as the profession did then, that after that period infection was practically certain to set in, cutting down the chances of recovery. Today the sulfa drugs have extended the traditional "golden period" from six hours to from three to four days. The first time this miracle-working new drug was tested severely in a vast number of cases during conditions of war was at Pearl Harbor. "The experience," Captain Hayden said, "completely demonstrated that the free local use of sulfanilamide powder in wounds permits us safely to select the best time to operate on these patients."
All severely wounded patients also received sulfanilamide by mouth, in routine dosage, for from several days to a week after ​injury. In severe cases, this was a necessary adjunct to the local use of the drug.
The discovery of the "sulfa drugs" and the discovery of the use of blood plasma are the two greatest advances in war surgery since anesthesia and antisepsis were given to the world. They have put into our hands better, surer means of saving the wounded from infection and from the fatal effects of shock than those of us who served in the military hospitals during World War I ever expected to see.
The best field preventive of shock is blood plasma. It should be given to all seriously wounded patients as soon after injury as possible; certainly within from five to ten minutes after they are received at the first casualty clearing station. Transfusions of plasma, given at this time, do more to cut down the mortality from shock than any other single factor we have at hand today.
Today every ship in the United States Navy carries a large supply of dried blood plasma. Liquid plasma, ready for immediate use, is a must in every naval hospital. Every hospital corpsman, at battle stations, carries a first-aid kit which contains syrettes of morphine to be administered to all gravely injured and a supply of blood plasma and sterile needles for prompt intravenous therapy.
Blood plasma is human blood from which the blood cells have been removed. It has the advantage over whole blood in that it does not require typing. Also, it can be given on the field more rapidly and easily than whole blood can be transfused. The powdered plasma has only to be regenerated by the addition of distilled water, which does not have to be warmed prior to injection.
In preparing the dry plasma, the blood is processed and the plasma separated, dried, and packed in compact, waterproofed containers, ready for instant use. Liquid plasma has been transported without refrigeration from Washington to California and to Cuba for use by medical officers stationed there.
In cases where there has been considerable hemorrhage, whole blood must be administered. But even in these cases it is often wise ​to begin with plasma until time permits a more careful study of the patient.
There is probably no service which the civilian can render to the fighting forces so valuable as the gift of blood.
Before the raid on Pearl Harbor, both the Army and the Navy medical officers there thought that they had sufficient dried plasma on hand for any emergency. The Naval Hospital had 500 units. A unit of plasma is 250 cc. But no one had any conception of the enormous number of severely burned cases the Medical Corps would be called upon to treat, nor the tremendous amounts of plasma that would be required for these cases.
A call was sent to the Honolulu County Medical Society in the need for plasma. Their Medical Preparedness Committee, with the aid of the Chamber of Commerce, had established a plasma bank just six months before the raid occurred. By November the blood bank had attained its goal of 200 flasks of plasma. In response to appeals by the Army and Navy, seventy-five flasks were sent to the Army's Tripler General Hospital, forty-five to the Naval Hospital, and eighty flasks to Queens Hospital for civilian use.
In view of the urgent need, a radio appeal for blood donors was broadcast. The response to this was dramatic and overwhelming. For two weeks donors were bled at the rate of fifty an hour, ten hours a day, seven days a week. Every available doctor and nurse in the islands was called upon to assist. Men and women waited in line for hours to donate their blood: society women and defense workers; laborers from the docks and plantations; passengers and crews from vessels in port and, when they were able, soldiers and sailors on liberty. The question most commonly asked was, "How soon can I come again?" In these two weeks of continuous work over five thousand pints of blood were obtained for plasma: 2,500,000 cc. This answered the need until more plasma could be obtained from the mainland.
One of the vitally important lessons learned at Pearl Harbor was the necessity for hospitals or any medical activity in areas ​to enemy attack to scatter their stocks of reserve medical supplies and personnel as widely as possible.
Mobile Base Hospital No. 2 had been landed at Pearl Harbor in November. The buildings on the hill were a little more than half completed. A hundred casualties were sent up there and cared for. Naturally, the most serious cases were sent to the main naval hospital. Another temporary field hospital, staffed by medical officers and equipped with material taken from ships damaged during the raid, was set up in the large main room of the Officers' Club in the navy yard.
Immediately after the raid, plans were drawn up and carried through for setting up emergency hospitals and stores of supplies all over the reservation. A number of these were built underground. The same arrangements were carried out at Midway Island, and only just in time. When the enemy struck there, and the hospital was the first building hit, medical equipment was safe underground.