The general alarm “battle stations” has various meanings to different men. To the ship’s surgeon of a couple of centuries ago it meant for him to proceed to the cockpit. In this poorly ventilated be- tween-decks space, he and his loblolly boy busied themselves preparing the tubs of sawdust or sand to receive the amputated members, the boiling water or oil to apply to the stumps, and the lint to dust into the bleeding wounds, and laying out their array of compresses, bandages, scalpels, saws, needles, and sutures. Then, in the dim light cast by candles or oil lamps, they awaited the gory procession of wounded who made their own way there or were brought by friends.
In this atmosphere of smoke, dust, sweat and blood, he would whittle and saw, bind and stitch the wounds as best he could. The victims were laid in their bunks to survive or die by their own vitality or lack of it. In view of the present-day meticulous attention to technique and the perfection of instruments, one marvels that any survived the attention of these men, epitomized more or less faithfully by the fictional Dr. Dogbody.
In time the billet of ship’s surgeon gained in dignity and attracted men of greater skill. Their interest in their responsibilities brought certain improvements in their equipment. Sick bays were installed and equipped for their special functions, but the surgeon’s battle station remained much the same, that is to say, any spare space away from but accessible to the gun and navigational decks.
As the design of men-of-war settled into the pattern of light ships and heavy ships, what had by this time become the early Medical Department settled into its definite pattern. The medical facilities on the light vessels were most sketchy and often were no more than a matter of such first-aid measures as the crew could give to each other. As ships grew in size and the crews to man them were increased in numbers, the personnel of the Medical Department also increased. The surgeon’s loblolly boy, who might have been just any willing fellow, became a pharmacist’s mate with a rising standard of training through the years. Later the surgeon was given an assistant.
On the heavier ships, particularly after the use of side and deck armor, the surgeon’s battle station was in some protected space where he was expected to await the arrival of the wounded. Ships had changed, armament and armor had changed, but the surgeon’s station and attitude toward his problem was much the same as before. As ships became heavier, armament more powerful, and armor heavier and tougher, the general idea remained essentially the same. Every possible man was to be protected by the armor. The possibilities of compartmentation and increased watertight integrity were being discussed and given much thought, but as yet access through the ship was little impeded. The damage control organization was being developed. In the beginning it had consisted of the ship’s carpenter and such hands as were free to assist him with the shores and collision mats.
Lieutenant Commander Alvis entered the Naval Reserve in 1941 after practicing medicine in the Pacific Northwest since 1933. He has served with the Fleet Marine Force and at sea in a battleship, and is now in the Medical Corps of the Navy. His particular interest in this subject was stimulated by frequent contacts with British and Canadian medical officers, and discussions of their problems in action.
Representative of this period was the battle bill of the vessel upon which the author is at present serving. In general it established Battle Dressing Stations in the vicinity of Repair Stations. For protection against the entire Medical Department being wiped out by a single “lucky hit,” the personnel was divided into groups. The surgeon’s battle station, as was traditional, was a spot beneath and behind armor in the general vicinity of the sick bay. The sick bay was assigned a spot outside the armor shield as it was not considered so important to protect as were the engineering spaces and the magazines. The surgeon’s assistant and his group of corpsmen took their station in some similar location at some distance from the surgeon’s station.
In principle, certain men were attached to the damage control parties as stretcher bearers. It has been a long-standing custom to use the members of the ship’s band in this capacity. Often a hospital corpsman would be assigned to go with the party and render first aid at the scene. After first aid had been given, the patient was to be transported to the Battle Dressing Station for more complete care. On some ships Collecting Stations were designated. Some battle bills called for a sorting of cases and sending of some to one dressing station and some to another. All this was to take place below armor. Provision for first aid outside the armor was inconsequential as it was expected that there would be few if any persons in exposed positions. When the battle was over it was planned to return to the sick bay and reestablish the Medical Department as a single hospital unit. Some ships made arrangements for an auxiliary operating room behind armor against the chance of the sick bay being wiped out.
Recent developments in aerial warfare and the defense against it, modern trends in compartmentation of ships, a new evaluation of the importance of watertight integrity have all limited the usefulness and practicability of the type of battle bill just described. The importance of air defense against strafing, bombing, and even torpedo attack has grown by leaps and bounds. The air defense battery has become one marked by the number and variety of its components. We now have the intermediate caliber battery and the automatic weapons, large and small, arranged in banks of guns or singly wherever there is space for the mount and its crew. As a result one finds from 25 per cent to 35 per cent of the entire ship’s complement with their battle stations as exposed as were those of the marksmen in the rigging of a sailing ship.
The essential significance of this to the ship’s surgeon is that he must attempt to calculate the probable casualties before he lays his plans for battle. The likelihood of air attack in almost every naval engagement from this time on means that the greatest number of casualties will occur in this topside group. They are not endangered by air attack alone, but by surface fire as well. The older plan of keeping the medical department personnel behind and beneath the armor with only a trivial detail of first-aid men topside is disproportional to the expected distribution of casualties. On the other hand the more medical department personnel located above armor, the greater the likelihood of their being lost. It need not be pointed out that a wounded doctor only aggravates the problem and reduces the means of coping with it.
It is not alone a question of these topside men being injured that must be considered. One must also consider whether or not they could do anything effective if they were topside during an engagement, or whether they must wait for a definite breaking off of action before they can begin to function. Obviously the work that can be done during action or the momentary lulls will be limited to the more simple lifesaving measures. The increased number of burn cases has been one of the outstanding features of medicine in this war. The shock accompanying this and other injuries need no longer be treated with a lick, a promise, and a prayer. The perfection of the blood plasma package has made it possible to perform lifesaving deeds in any sheltered spot. Already it has been used on fighting ships and in the field under circumstances that ring with heroism.
The matter of breaking watertight integrity and opening armor hatches to permit first-aid parties to come up may be the crux of the situation. Some advocate setting watertight integrity in the armor and absolutely keeping every hatch and door closed until the engagement is won, the ship must be abandoned, or the threat of air attack is completely dispelled, leaving local groups to contend with local situations as best they may. It must be remembered, in this connection, that the threat of air attack may be present for hours on end, making this an inflexible type of arrangement. Others feel that the armor hatches allowing access upward may be opened for short periods. This would permit parties to come up during a lull to assist those already topside.
The older plan of taking the injured to the below armor dressing stations has become impractical. Compartmentation has reached such a stage that now there is hardly space and air enough to contain the repair parties and medical groups in their battle stations. Further, the time required to transport casualties up from one of these cubicles and down into the battle dressing stations is much longer than many damage control officers would care to have armor hatches open.
To attempt to divorce personnel casualties from material casualties is unwise. Injured men and broken equipment are only separate parts of a single problem. They will occur at the same places and at the same time and must be dealt with simultaneously. The surgeon must lay his plans with a full understanding of the problems of the damage control officer and his intentions.
Some compromise must be made between safety and effectiveness. On the one hand, how sad to lose the golden moment of opportunity for saving life by not having sufficient personnel at hand to clear the scene of greatest casualties and quickly apply treatment for shock, burns, and severe bleeding. On the other hand, how tragic to come to the end of an engagement with inadequate personnel to treat the wounded survivors because those who might do so are themselves among the maimed. It appears logical to place sufficient personnel topside to evacuate the wounded to places of shelter from stray splinters and strafing, where plasma may be given, burn treatment started, and wounds dressed adequately. Then when a lull comes to permit opening a hatch, a team trained for treating these conditions further could come up and open their stations, taking their chances from then on with the rest, but still able to do something genuinely worthwhile.
Dispersion of material and personnel.—We come now to one of the great lessons that must be relearned, it seems, with each war. It is the military adaptation of the adage of not putting all the eggs in one basket. This war has already seen the entire medical department of a ship wiped out at one blow. Dispersion of material and personnel is a “must do” matter. The main medical storerooms should be organized so that some of every item is available in each location. The usage of the portable medical chest should be enlarged to a point where every compartment of any size, where wounded may be collected, will have its supply of medical gear. At the end of an engagement these chests scattered throughout the ship may be all that is left of the medical stores. By their appropriate distribution it will be possible to treat considerable numbers of wounded without having to transport either the patient or the stores. This will do much to lessen the confusion and congestion around the dressing stations.
It is well for the surgeon to go over the ship compartment by compartment and check off how many men are in each space at general quarters. Where there is any collection of men and any chance that one might be left able to help his mates a first-aid box or gun bag should be provided with the gear for emergency first aid.
To have an operating room in the sick bay and an auxiliary surgery below armor is well but is not enough. A careful study of the ship must be made for spaces that may be converted to makeshift surgeries. Provisions for emergency lighting should be made at all such stations. The availability of fresh water if mains are broken should be considered. Gravity feeding tanks may be installed overhead for emergency supplies to tide over until the water supply can be restored.
The available stretchers should be strategically placed and appropriately distributed. The Army litter is too wide to pass through some quick acting watertight doors. Many of the engineering spaces do not permit the convenient use of either the Stokes or Army litter. For these spaces the Robertson litter or the Weber zipper suit are much better solutions. An ingenious sling made from the standard Navy hammock has been described which could be used in many tight corners.
Gas decontamination stations must be arranged so they can be reached without contaminating the entire ship. The material to be used for decontamination should be located at the station so there will be no delay- in setting up this function.
Personnel should be trained to a high degree of proficiency in emergency first-aid measures, from the captain to the youngest seaman. The hospital corpsmen should be trained to do many things not ordinarily considered to be within their scope. Many of them are capable, with proper training, of being developed into “apprentice physicians.” Such training will be most appreciated in the hours following an engagement when the medical officer can leave orders with an easy mind for routine techniques to be followed. The stretcher-bearers can be trained to a degree of proficiency in general first aid that will increase the number of effective treatments much beyond that of the capacity of the medical department personnel. Certain ones who have the knack and the interest can be used after an engagement as “assistant corpsmen” for many routine nursing duties. It is well to lay out a standardized plan of treatment for the common conditions and adhere to it through the hectic period immediately following an engagement. Later there will be time and opportunity to individualize treatment.
It is not enough that corpsmen and stretcher-bearers should know where their battle stations are located and how to give first aid. They should be familiar with the routes of access to all spaces adjacent to their station, and better still be familiar with the plan of the entire ship. Inasmuch as they are apt to find themselves with repair parties at scenes of fires and gas-filled chambers, they should be trained in the use of the rescue breathing apparatus and in fire fighting.
Battle station assignments will disperse the medical department personnel at general quarters. In addition, in combat zones they should sleep at their stations against the chance of a surprise attack and a “lucky hit.” Just as the gunnery and engineering departments establish different watches for various conditions and anticipated developments, so should the medical department. This does not mean that the virtue is in the number of men kept awake, it lies rather in the distribution of the men. The medical department, more than others, must conserve its reserve strength and the alertness of its personnel for use during and after battle.
The ship’s surgeon should be familiar with the general mission and purpose of his type of ship. In addition he should be informed on the anticipated conditions to be encountered on a specific mission. This knowledge may be sufficient reason for modifying the general plan of his department.
How then can the ship’s surgeon offer the best battle bill for his ship?
(1) He must know his ship, its mission, its chances of survival in battle and its intricate structure. (2) He must train the personnel. This includes first-aid training in the more important lifesaving measures for the entire ship’s company. The hospital corpsmen and stretcher-bearers should be brought up to the peak of their ability and sorted over for their adaptability to the roles they will play. (3) He must make an estimate of probable casualties as to location, numbers, kind, and seriousness. (4) He must provide material for routine care and for battle conditions. This latter implies a wide dispersal of material anticipating the loss of some. The extra quantity needed to maintain a widespread and generous distribution of first-aid gear must not be underestimated. If the nature of his ship renders special types of casualties likely in greater than usual proportions, it will be reflected in the greater amount of material for treating these. As an example, the anticipated greater number of burns on a tanker would require a larger store of tannic acid jelly than would be required on a transport. (5) He must familiarize himself with the general plans of the damage control officer.
When an abundantly adequate supply of material is aboard and properly distributed, when the personnel of the medical department have been trained in their medical and auxiliary duties, when the ship has been studied from stem to stern, truck to bottoms for available space, routes of access and probable locations and kinds of casualties, when the damage control organization and plan is understood, then and not until then the ship’s surgeon is in a position to offer the best medical battle bill for his ship.