Medicine & War

MILITARY MEDICS: Hahnemann Alumni Recall Fields of Battle

War is a frequent human experience, and medical care is as important to soldiers as their weapons. Despite the many changes in the way wars have been fought, one thing has remained the same -- the need to provide the best possible medical care to those wounded in battle. Hahnemann alumni have done their part in wars over the years. Hahnemann University magazine talked to veterans of three of America's wars -- World War II, Vietnam and the Persian Gulf War -- about their battlefield experiences. What follows are their stories.

Mobility Key in Treating WWII Injured

By Mark E. Dixon

When Carl Tarlowski received his medical degree from Hahnemann in 1940, he planned a nice, quiet surgical practice in his hometown of Trenton, N.J.

World War II changed those plans. Just four years later, Tarlowski found himself working -- in wet clothes, no less -- in a place that was neither nice nor quiet: Omaha Beach during the Allied invasion of Normandy.

"The plan had been for us to set up an aid station 100-150 yards from the front line," recalled Tarlowski, who was soaked when he was pulled under water briefly by the weight of his surgical equipment as he stepped off a landing craft. He didn't get dry clothes for three days.

"But when our lines were moving forward, we didn't bother with that (changing clothes)," he said. "we'd have been left too far to the rear to be of help to anybody."

Instead, Tarlowski worked on wounded soldiers wherever they lay. He received the Silver Star for risking enemy fire to aid the injured when Allied bombs accidentally fell on U.S. troops. The historian of Tarlowski's unit, the 743rd Tank Battalion, believes him to be the war's most highly decorated medical officer.

Now retired and living in Las Cruces, N.M., Tarlowski was one of three alumni -- all veterans of Normandy -- who discussed their wartime experiences with Hahnemann University magazine. Also interviewed were Milton S. Weinberg, M.D. '35, of Port St. Lucie, Fla., and Myer Dashe, M.D. '35, of Reading, Pa.

All three agreed that triage -- sorting casualties according to the seriousness of their wounds -- was the foundation of combat medicine during World War II. This concept requires that the most seriously wounded be treated and stabilized immediately, with the less seriously wounded transferred to the rear. Triage also has a hard-hearted side: when casualties are heavy and medical personnel scarce, patients considered likely to die are given pain medication and treated last.

For front-line surgeons, this meant most operations were simple, said Weinberg.

"We had plenty of belly wounds," he recalled, "but the whole philosophy was, 'Stabilize them and get them back.' "

Depending on the injury, a soldier could pass through as many as 11 levels of triage before being treated, said Weinberg, who served with the Army's 1st Division, known as the "Big Red One."

All combat troops carried a first aid kit containing a dressing and sulfa, a precursor of penicillin. Soldiers who needed expert attention were fathered by "collecting companies" of medics or corpsmen who delivered preliminary care and sent the casualties back to "clearing companies."

The job of clearing companies was to set up field hospitals and triage patients, said Weinberg, who was assigned to the 633rd Clearing Company.

"Behind the field hospitals were the evacuation hospitals and, from there, a whole hierarchy of specialized facilities," he said. "We had hospitals for head wounds, for extremities, everything."

During the Normandy landings, most of those facilities were on ships. As the front moved inland, they moved ashore.

"Transportation became more difficult the farther we got from the beach," said Tarlowski. "In later wars, they had helicopters, but we used ambulances."

Because roads were often rutted or shell-pocked, trips to field hospitals -- usually about five miles behind the front lines -- could take as long as tour hours. Sometimes the injured rode on stretchers laid across a jeep.

Still, survival rates were good.

"Overall, I believe World War II survival rates were well over 90 percent for casualties who came in alive," Dashe said. "In our unit, we had only one man who died, and he was brought in nearly dead."

The pace of medical operations more or less mirrored that of the war, said Dashe. During lulls in the fighting, there was often little to do. Then, one side or the other would attack and the hospitals would be flooded with fresh casualties.

"Those were the times when we operated until we dropped," said Dashe, who served with an experimental frontline unit, the 3rd Auxiliary Surgical Team.

"We had four doctors, four nurses and four enlisted men," he recalled, explaining that his unit and another like it leapfrogged over each other so that one was always close to the front.

"The whole idea was to save lives by reducing the time a wounded man had to wait for treatment."

Dashe, an anesthesiologist at the time, administered local anesthetic to most wounded soldiers before they went to the surgeons. More seriously wounded soldiers were put under with ether for surgery.

The front-line concept suffered a setback, he said, when a bullet came through a tent wall and killed a female nurse. Shortly thereafter, all female nurses were ordered to the rear.

"All we had left were the corpsmen," Dashe said. "I trained three of the to replace the nurses and they did very well."

The military provided little training for combat medicine. After arriving in England in early 1943, Dashe spent about 18 months visiting English hospitals where he "looked around." One highlight was meeting the author of a textbook he had used at Hahnemann.

After the war, Weinberg served with the occupation forces, and wondered at one point whether he would ever get out of the Army.

"Army policy was to have one medical officer for every 200 enlisted men," he said. "Well, they had one medical officer for every 51 enlisted men and they didn't want to let me go because 'What if...?' " Weinberg's congressmen eventually helped get him out of the Army.

In 1952, during the Korean War, Tarlowski got a letter from the Army.

"They wanted to 'see me,' but I didn't answer their letters," he chuckled. "After being bombed and shot at by the Germans -- and even, a couple of times, by the Americans -- I didn't want to press my luck."

After the war, Dashe returned to his hometown of Reading, where he practiced general medicine before retiring in 1987. Weinberg practiced general medicine and gynecology in Jackson heights, N.Y., until 1979. Tarlowski moved to New Mexico in 1956 to become county health officer and later student health director at New Mexico State University. He retired in 1977 and "never" thinks about the war.

"Actually, that's not true," he said. "About once a year, I get a letter from a former enlisted man, thanking me for treating him.

"All those guys are now grandfathers, of course."

Injury, Death Powerful Memory For Vietnam Vets

During the Vietnam War, all U.S. soldiers were issued flak jackets -- cumbersome garments that fastened up the front and were intended to protect against enemy fire and shell fragments.

Trouble was, the things were uncomfortable, recalled James O. Finnegan, M.D. '64.

"Some guys didn't button them up," he said. "They'd walk around with the front wide open, especially during the warmer months. Of course, that exposed all their vital organs: heart, lungs, belly.

The result -- major penetrating chest injuries -- was predictable, said Finnegan, who served from October 1967 to October 1968 with the 3rd Marine Division. It was a year that included the Tet offensive, during which Finnegan performed surgery in a bunker in the besieged U.S. garrison at Khe Sanh.

For each of the three alumni who discussed their Vietnam experiences with Hahnemann University magazine, injury and death remain a powerful memory.

Among the many Hahnemann alumni who served in Vietnam were Col. Charles Lipton, M.D. '64, chief of surgery at Cutler Army Hospital, Ft. Devens, Mass.; Finnegan, chairman of the Department of Surgery at Crozer-Chester Medical Center, Upland, Pa.; and Lloyd Tom, M.D. '60, who is in private orthopedics practice in Yorba Linda, Calif.

"On the one hand, it was the single, most glorious experience in my 28 years of practice," said Lipton, who commanded a mobile medical company that treated casualties in the field.

"I salvaged more people, under worse circumstances, in a shorter time period than I ever have since.

On the other hand, the experience also disgusted Lipton.

"After the Tet offensive, we knew there was just no way of winning that thing," he said. "And, yes, it was discouraging to see our guys go out and come back in all shot up."

Tom sometimes felt "like (one of) Custer's men at the Little Big Horn. Our stations were overrun twice and the enemy was in the area."

He served two years with the U.S. Public Health Service as part of the "pacification" program that included forced relocation of Vietnamese civilians from outlying hamlets to fortified villages.

"We were hoping to 'win their hearts and minds,' " said Tom, "and to prevent them from shooting at us. We failed on both counts."

The Public Health Service was assigned to treat casualties among civilians -- "people who happened to get in the way of the war." In reality, Tom said, many of the civilians were enemy soldiers.

"I believe those of us who experienced the death and destruction of the Tet offensive felt to some extent that a part of us also died spiritually in Vietnam," Tom said.

Finnegan also experienced the Tet offensive, as chief of a survival team that treated more than 3,000 casualties during the three-month siege at Khe Sanh. When the Viet Cong offensive began, the three surgeons and 26 corpsmen in Finnegan's unit worked in tents ringed with sandbags.

"By the time we were a month into it, that set-up was blown away," said Finnegan, recalling estimates that the Viet Cong fired 3,000 artillery and mortar rounds a day into the garrison. Many of the corpsmen were wounded.

As an alternative, bunkers were dug by the Navy Seabees and covered with heavy steel plates ordinarily used for temporary runways. These bunkers were secure against anything except a direct hit.

"Our biggest problem was getting the wounded -- once we had them stabilized -- out of there to the base hospital," said Finnegan. "The only way to do this was with helicopters, and they were nice big targets."

Early in the siege, casualties were evacuated on fixed-wing aircraft. The end of the runway eventually fell into enemy hands, however, and the slow-moving planes were prime targets of hostile fire.

Subsequently, only helicopters were allowed to land at Khe Sanh. They could come in at treetop level, avoiding some enemy fire, said Finnegan. On the other hand, each chopper could accommodate only three or four wounded, as opposed to the dozens a plane could carry.

"That meant a lot of choppers coming and going," he said, "and a lot of running back and forth under fire to get them loaded."

Officially, the corpsmen were assigned to load casualties aboard helicopters. But the surgeons felt they should share the risk, and took turns as well, said Finnegan.

"Once, when I was running to a chopper, a shall burst right behind me," Finnegan said. "It wasn't close enough to do any real damage, but I've got a small scar that I've never been able to live down."

Basic surgical procedure and pace in Vietnam were like that of other wars. Patients were triaged and evacuated by a medical staff that paced feverish activity with stretches of idleness.

However, Lipton remembered being surprised at the wealth of technology available in a combat situation.

"We had some monitoring equipment that some of the biggest universities didn't have," he said. "I saw that stuff for the first time and was just amazed."

In retrospect, Lipton thinks all the high-tech medical gear was made practical by the fact that Vietnam's military hospitals seldom moved.

"It wasn't like World War II where you always had a front to keep up with," he said. "In Vietnam, we were hunkered down with the war going on all around us."

But during the Persian Gulf War in 1991, the emphasis was again on World War II-style mobility, said Lipton, who rode into Iraq in the back of an ambulance.

Thanks to helicopters and technology, casualty survival rates in Vietnam were well over 90 percent. Lipton estimated that, of those who reached the triage area alive, 98 percent survived.

"The speed of evacuation meant we saw soldiers who had horrible wounds and, in previous wars, would never have made it in alive," said Finnegan.

Tom said the medical staff in Vietnam did have one luxury that he doubts will ever again be available to wartime physicians: a ready supply of blood free from the AIDS virus.

"Vietnam happened in the pre-AIDS era and a lot of our blood came from sources that if harvested today we would consider questionable," he said. "I know a lot of it came from the Philippines and Japan, but I don't know how it was gathered." some patients received as much as 30-40 units of blood, he recalled.

In a future war, Tom predicted, blood screening procedures would be quickly overwhelmed and physicians might be forced to use untested blood. This situation was not a problem in the Persian Gulf War, because of the lengthy buildup and relatively small number of casualties.

"Their choice will be to have the patient die immediately, or to risk a small chance of AIDS infection later," Tom said.

Lipton and Finnegan agreed in theory, but said hepatitis was statistically a larger problem than AIDS in blood transfusions.

"The criteria will include not only the number of casualties, but the rate at which they arrive," observed Finnegan, who said casualties arriving two or three at a time would put no particular strain on the system.

"If you suddenly must treat 100 severely wounded guys who are in danger of bleeding to death, there will be pressure to bypass the screening procedure. And there may well be some cases of AIDS or hepatitis resulting from the emergent and necessary use of partially screened blood."

Hahnemann Reservists See Varied Gulf War Assignments

During the Persian Gulf War, 16 military reservists who work or study at Hahnemann were involved in assignments that took them to locations as distant from each other as Bordentown, N.J., and the Persian Gulf state of Bahrain. One thing they have in common is that all arrived home safely.

Their co-workers, fellow students and friends know who they are. For the rest of us, Hahnemann University magazine asked these reservists to describe where they went, what they did and what they think about it now.

Sabrina Anderson, third-year medical technology student

Anderson is a medical supply specialist with an Army Reserve unit in Chester, Pa. During the war, she was assigned to an optical lab in Germany where she operated a lens-grinding machine that turned out eyeglasses for the military. Anderson was called up in December 1990 and didn't return to Philadelphia until this past June.

Although her primary mission was to free active-duty soldiers for Gulf assignments, Anderson still felt that she had been to war. "There were bomb threats and we followed wartime procedures," she said. "There was a feeling that anything could happen."

Now, Anderson is looking forward to graduation, and getting out of the reserves. She has decided military life is not for her.

"The war experience changed my outlook on life and the military. Adjusting to normal life when I returned was difficult, as it was for many of my fellow soldiers. But I do know for sure that if another war is in the future, I definitely won't be there."

James Betancourt, nursing care assistant, 15 West

Betancourt is a medic with a reserve unit based at the Willow Grove (Pa.) Naval Air Station. After being called up in September 1990, he worked for two months at an Air Force hospital in Virginia and was then sent to an air tactical hospital in Oman, a small country just east of Saudi Arabia.

"If the ground war had gone on for a while, we would have been rotated forward, closer to the battlefield," said Betancourt. "Since it ended so quickly, we never moved and never even saw any casualties.

"The United States got 90 percent of what it went in for, but I think we left a few loose ends," said Betancourt. "I hope we don't have to go back but, of course, I'll go if they call me."

Paul Carter, first-year physician assistant student

Carter, a hospital corpsman with a reserve unit at the Philadelphia Naval Base, spent two months at a fleet hospital near the Saudi Arabian town of Al Jabail.

This hospital received the most U.S. casualties, said Carter, because the area is remote and was judged relatively safe from Iraqi attack. He worked on a casualty receiving team that included three corpsmen and a nurse.

As casualties arrived, Carter and the other corpsmen took the patient's vital signs and checked for wounds while the nurse administered medication and inserted catheters. A surgeon circulated among several such groups, treating the most seriously wounded first.

"We had everything from gunshot wounds to burns and head trauma suffered in airplane crashes," Carter said.

"It was exciting to do the job I had been trained for. But, on the whole, I think the war caused a lot more problems than it solved."

Stephen Cleghorn, critical care technician, CTICU

Cleghorn spent the war in California, assigned to the First Marine Division at Camp Pendleton. The unit was scheduled to ship out for Saudi Arabia on March 28, but that order was cancelled in mid-March.

If his unit had gone into battle, Cleghorn would have been responsible for treating the wounded. As it was, he spent much of his time treating sprains and fractures suffered by reservists during training.

"We had an obligation to support Kuwait but, if it hadn't been an oil nation, I doubt we would have shown that much support. I wasn't pleased to be activated, but I'd do it again if called."

Christopher Hand, research laboratory supervisor, Neurosurgery

During the War, Hand was assigned to the Philadelphia Naval Hospital, where his reserve unit was responsible for receiving casualties.

Hand's unit also had the difficult duty of notifying next-of-kin if a family member were killed or wounded on active duty, to expedite payment of benefits and funeral arrangements.

"Fortunately, we didn't have to do any of that," said Hand. "The war was over so quickly that our services weren't needed."

Although Hand volunteered for duty in the Middle East, he was not sent because his two brothers had already been called up. Military policy forbids entire families from being sent to a war zone.

Hand spent his time visiting at least 40 of the 115 Delaware Valley hospitals which had previously agreed to accept military casualties.

"We pulled out too early," said Hand. "The fact that Hussein is still in power proves we didn't accomplish a thing."

Morris Kerstein, M.D., Edgar J. Deissler Professor and Chairman, Department of Surgery

Kerstein, a rear admiral in the Naval Reserve, was commander of the task force responsible for mobilizing 14,000 "medical-type" reservists. These included physicians, dentists, nurses, corpsmen and administrators. Approximately 6,000 of those reservists were sent overseas.

"We determined who was called up, verified that their training was appropriate for their assignment and arranged supplementary training where needed," said Kerstein. "We also verified that their wills were made, arranged their transportation and even got uniforms for a few people," he said.

It was also Kerstein's office which decided to fill stateside needs with reservists, freeing active-duty personnel for Gulf assignments. In a major conflict, he explained, the military would simply close military hospitals in the United States and send their personnel overseas.

Kerstein's Navy service dates back to Vietnam, where he served from 1965-67 as a surgeon. He also served for two months as a surgeon with the Marines in Beirut in 1983, operating daily on both U.S. and Lebanese casualties. Kerstein left Lebanon 10 days before the bombing of the Marines' barracks.

"The war was well-managed and the results were predictable. We're fortunate we didn't have any more casualties than we did. The U.S. government decided it was the appropriate thing to do and I certainly won't disagree."

Gregory Maxwell, pharmacy technician

Maxwell, a reservist based at the Willow Grove Naval Air Station, was called up in February 1991. He worked until July as a pharmacy technician at the Bethesda (Md.) Naval Hospital. this allowed active-duty personnel to go to the Middle East.

"I had hoped I would be assigned to a hospital ship," said Maxwell. Still, his experience at Bethesda may have been a professional turning point. Because military hospitals grant staff members more responsibility than civilian hospitals, he had the opportunity to supervise the pharmacy and administer solutions to patients. At Hahnemann, his job focuses almost exclusively on mixing intravenous solutions and antibiotics.

Maxwell now hopes to become a pharmacist and plans to attend the Philadelphia College of Pharmacy.

"The war separated a lot of families, but it was a necessary evil," said Maxwell. I'm glad the reserves got an opportunity to prove they could do a job."

Lynn Catherine Newmuis, mental health worker, Mental Health Services Prison Division

Newmuis is a Navy veteran with five years of active service, plus nine years in the reserves. In peacetime, she is attached to the Navy's regional contracting center in Philadelphia, where she handles paperwork required to obtain services for Navy ships.

Newmuis was called up for two weeks in late January 1991 and assigned to a naval base in Naples, Italy, where many other reservists were sent for training and security briefings. Newmuis' unit was sent to Bahrain in April, but a health problem kept her at home.

"The war taught us a lot about our state of readiness. Specifically, it taught us that a lot of people weren't prepared to go," she said. "Still, I'm glad it was over quickly, with few casualties, and our goal was accomplished."

Joseph Rondinelli, administrative director, Clinical Laboratories

Rondinelli was a pilot in the Air Force Reserve and, after his call-up in August 1990, flew C-f Galaxy transports between Saudi Arabia and various points in the United States and Europe. He flew 425 hours and carried more than three million pounds of cargo, including tanks, trucks, bombs, troops and -- on one flight -- 44 tons of matches.

"It was just long hours," said Rondinelli, who has since retired from the reserves. "We'd often get up and didn't go to sleep again for 18 to 20 hours." The planes never rested, however: As Rondinelli and his crew headed for bed, another crew was climbing into their seats.

It's unfortunate that the war happened, but the issue had to be resolved. I'm optimistic that the end of the Persian Gulf War is the beginning of a lasting peace for the region."

Faith Thomas, R.N., staff nurse, 19 East

During the war, Thomas served as an assistant charge nurse in an intensive care unit at a naval hospital near Al Jabail, Saudi Arabia. the hospital treated 8,000-9,000 patients, most of them ambulatory. Fewer than 700 people were actually admitted.

"Some of the injuries were just tragic," said Thomas. "We had a number of Senegalese -- part of the multinational force -- who were in a plane crash. Only a few survived, and those people who did were pretty broken up."

While not pleasant, the experience was an education in how the reserves function during a war, she said. Previously, Thomas had never been involved in a conflict, although she served three years on active duty with the Navy and has been in the reserves since 1985.

In peacetime, Thomas is an administrator in the office which oversees Navy hospitals in New Jersey, Delaware and southeastern Pennsylvania. She's based at the Philadelphia Naval Hospital.

"I really can't say whether the war was right or wrong," she said. "I wish it hadn't happened, but I went because it was my job, and I'll go again if the need arises."

Matthew Toms, R.N., staff nurse, 19 West

Called to active duty in October 1990, toms spent two months at a naval hospital in Portsmouth, Va., where most patients had been admitted for ailments unrelated to the war.

"We did get in a number of people from Saudi Arabia with gastrointestinal complaints, mostly diarrhea," said Toms, a member of the Naval Reserve. "Someone suggested the cause was sand flea bites, but we were never sure."

The presence of Toms and other reservists at Portsmouth freed that facility's regular staff for duty at fleet hospitals and on hospital ships. As at Hahnemann, he served as a nurse, but with extra responsibilities.

"One of our assigned duties was to supervise the corpsmen who performed a majority of the nursing care," said Toms, who helped run a 24-bed ward. He was released from active duty in December 1990.

"War is never a good thing, but at least it ended quickly and with minimal casualties," said toms, recalling early estimates of tens of thousands of allied casualties. "The bad thing is that it's not really over. As long as Saddam Hussein remains in power, Iraq will continue to be a trouble spot."

Susan Weilminster, R.N., staff nurse, 16 NT

The Persian Gulf conflict did little more than change Weilminster's commute to work. Rather than drive to Hahnemann, she drove to Ft. Dix, N.J., where she helped establish a medical staging facility.

In a major conflict, U.S. casualties would have been flown to the facility before being transferred to hospitals closer to their homes or bases.

"If it had been a full-fledged war, we would have been busy little bees," said Weilminster, whose Air Force Reserve unit was activated in January 1991. "Instead, they began deactivating the unit as soon as it became obvious e weren't going to get any patients."

The staging facility was closed in March, but Weilminster was kept on active duty until August to help perform physicals on returning military personnel.

"I'm ready to do whatever I have to, whether I agree with the cause or not. Anyone who can't do that shouldn't be in the military."

Lauren Williams, first-year medical technology student

Williams is a medical supply specialist whose Army Reserve unit is based in Folsom, Pa. Called up in December 1990, she was sent to Germany where she worked as a medical supply specialist.

"We inventoried all the supplies and made sure they got sent where they were supposed to go," said Williams, who described the position as similar to that of a shipping clerk.

"I just hope there isn't another one," she said of the war.

Richard Wine, R.N., staff nurse, 17 NT

Wine is a hospital corpsman based at the Willow Grove Naval Air Station. He was called up in January 1991 and sent to the Naval Air Hospital at Patuxent River, Md., where he served for 60 days -- "very safe, secure and thankful."

No casualties arrived at the Maryland hospital, which would have served primarily as a rehabilitation facility. Wine counseled patients and assisted in several surgeries. And, because he was among the senior enlisted personnel, he was assigned administrative responsibilities which he normally doesn't carry at Hahnemann. He arrived home in late March.

"I was pleased that the gulf veterans were accepted so much better than the Vietnam vets," said Wine. they gave up a lot and deserve some recognition."

Hahnemann University magazine / Spring 1992

Mark E. Dixon

757 Upper Gulph Road

Wayne, PA 19087-2022

USA

610-971-0649

dixon_mark@verizon.net