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The eventful day of Sunday, December 7, 1941, dawned on a quiet, peaceful and beautiful morning. I was up early (5:45a.m.) in order to operate upon a case of acute appendicitis. In the operating room at The Queen's Hospital much noise was heard from sirens and the booming of guns, but it was thought by all present that we were being treated to an early Sunday morning "alert." On leaving Queen's to attend a lecture by Dr. Moorehead at the Mabel Smyth Bldg., numerous people were found clustered about the entrance to the hospital, watching the sky. Dr. Arnold, being among those present, said that the view from the roof was startling and it looked to him as though all hell had broken loose; that much smoke was pouring out of Pearl Harbor and that depth charges were throwing water high in the air--all of which suggested to him that something more than a practice was going on. On reaching Mabel Smyth Bldg., Dr. Hodgins was encountered and he stated in his usual no uncertain terms that it was the real McCoy, since he had seen two battleships over on their sides when he left his home at the Peninsula a short time previously.
Dr. Moorhead was lecturing to a handful of medicos and he later told me that he had started his lecture by a quotation from scripture, "Be ye also ready, for in the hour that ye know not, the Son of man cometh." (St. Matthew, chapter 24:42.)
I had scarcely become seated when the door was thrown open and Dr. Jesse Smith announced that surgeons were wanted at Tripler General Hospital immediately. With Dr. Moorehead in my car we dashed out School Street and turned down Middle Street, but soon found our progress halted by a long line of confused traffic. Remembering the back entrance to Fort Shafter, I turned around and headed in this way but was abruptly halted by a sentry who said we could not pass. Dr. Moorhead said, "Oh, yes we can." He hauled out his purse and exhibited some sort of identification card reputedly declaring him to be a Colonel in the medical reserve corps - perhaps it was membership in the Rotary- at least it produced results and we encountered no further interference. On reaching the hospital we were directed to surgery which was on the second floor of the main building. While changing our clothes Dr. Moorhead remarked that he had been placed on the inactive list of the Army, but it looked as though this status was going to change abruptly.
The operating rooms at this particular spot were three in number--one large room with three tables, and two smaller ones with two tables each. Dr. Moorhead took up his station in the large operating room where he carried on all day long, except at not infrequent intervals when he was called to one of the six other tables to act as consultant. His mature judgment, quick decisions and cool headedness, example and encouraging remarks contributed immeasurably to the attempts of all to do the best surgery possible to so many terrifically wounded under such trying conditions.
It immediately became evident that we were attempting to do blitz surgery in a location and in a manner that was entirely inadequate. First, the operating rooms were on the second floor and they had one common entrance, and the passageway and connecting halls quickly became cluttered with the seriously injured, and there was no place to put them except on the floor. There was no place to segregate the patients who needed surgery immediately from those who first needed treatment for shock, there were not enough instruments, and suture material, and sterile supplies were soon exhausted. Patients were brought directly to surgery without having their clothing removed and without having any preliminary cleaning up of their wounds. Thus it became necessary for surgical teams to waste much of their valuable time doing the work that should have been done by orderlies and nurses. Much of the transporting of patients from where they had been deposited on the floor on stretchers to the operating table had to be done by the surgeons, and this was a large factor in contributing to their near exhaustion by the time evening arrived.
I put in a call to Queen's Hospital for instruments, and also succeeded in getting Dr. Fennel, who was at home, on the wire, and told him of our desperate need for plasma. He put in a speedy appearance, arrived with a large clothes basket filled with plasma and apparatus for giving it. He spent the remainder of the day treating shock and acting the part of a glorified orderly.
The officers of the regular Army, who on our arrival were already attending the wounded, were gradually replaced at the operating tables as the civilian doctors arrived. They took up the equally important tasks of selecting cases for surgery, for the evacuation of the wounded to and their care on the wards, arranging for X-rays, for replacing supplies and the multitudinous other duties for which their military training and familiarity with the hospital best suited them.
Many of the injured had multiple injuries, and as more help arrived it not infrequently happened that two or three doctors would be engaged on a single individual in widely separated parts of his anatomy. As the day wore on greatly needed supplies became available. Much of it I learned later came from the Red Cross, some from local doctors' offices--such as instruments--and the remainder from supplies of the Army which apparently were abundant but had been overlooked during the confusion accompanying the unexpected arrival of such great numbers of wounded.
I arrived at the Hospital between 9:00 and 9:30 in the morning and some of us, including Drs. Halford, Stevens, Burgess, Bowles, and myself left about 9:30 p.m. We left because other doctors were available to take our places, most of the seriously injured who needed immediate attention had been cared for, and last but not least, because our usefulness at the moment was almost nil because of exhaustion. Those of us whom I have mentioned were taken home in a military car in absolute blackness. The driver had orders to keep all windows closed, and being a good soldier he complied to the point of our near suffocation. I arrived home about midnight, too tired to move or to sleep.
The following morning and for several subsequent days I dressed hundreds of wounds. A corps of civilian nurses was recruited and they went ahead down the wards getting dressings open for inspection; another group followed and redressed the wounds. Many of the dressings had become adherent, especially on amputation stumps, and where a large part of the soft tissues had been torn away. Unfortunately, at the time they were dressed in surgery no sterile vaseline gauze or other similar preparation was available, and dry gauze was applied to the sulfa coated wounds. Many anesthesias, pentothal sodium frequently being given intravenously, were necessary at the first dressing.
For several mornings after the Blitz the civilian doctors did a number of more elective types of surgery, mostly for removal of foreign bodies. I operated upon one individual for an arteriovenous communication in which a missile had injured the common carotid artery and jugular vein and had lodged in the neck. He was semiconscious at the time but it was thought advisable to see if anything could be accomplished, since the outlook seemed hopeless from infection and secondary hemorrhage. All involved vessels were ligated and the foreign body removed, but unfortunately the patient died some time later. Numerous rather bizarre injuries were encountered. In one individual a missile had struck the mid portion of the chin, completely fracturing the lower jaw, driving all the canine and incisor teeth deep into the muscles beneath the floor of the mouth. The wound was debrided, coated with sulfa powder, the mandibular fragments wired into place, and the skin fairly well approximated. Several days later the result looked promising.
Being interested in chest surgery, I was called in to see a number of chest injuries. One such injury stands out as being the most dramatic that I had witnessed in my twenty-seven years of surgical experience. The individual. if I remember correctly, had received a number of penetrating wounds of the chest some hours previously. He was emphysematous form the top of his head to the soles of his feet, and his skin everywhere seemed so tense that it was likely to burst. He was deeply cyanotic and evidently near the point of suffocation. He was clutching at his throat, thrashing about the bed, and in a voice that was growing rapidly weaker was imploring those standing about for help. A needle into the pleura did not reveal a tension pneumothorax and gave no relief. We were all nonplused for the moment but it suddenly dawned on me that his mediastinal structures were undoubtedly being compressed. A slash with a scapel across the neck just above the manubrium gave spectacular results. Frothy fluid in great quantities squirted out and ran down over the chest in a continuous stream. The patient immediately experienced relief. His respiration became regular, his cyanosis cleared up and he expressed thanks for the help he had received. Due to the urgent need of other seriously wounded this case was not seen again by me, but I was told he died some time later as most cases of mediastinal emphysema do, due to the location and seriousness of their injuries. However, I am sure the immediate sequence of events following the incision in the neck will remain in the memory of those present as a most dramatic episode.
In the midst of our efforts to take care of the wounded we were reminded that the normal surgical emergencies must be taken care of as well. Dr. Straub and I removed two acutely inflamed appendices occurring in soldiers during the first few days after the Blitz. One must not lose sight of the necessity for provision being made to handle less dramatic though equally important afflictions that befall the human race in time of bombings.
Dr. Moorhead on his arrival from the mainland spoke of a foreign body detector that he had used successfully, and that he had brought along with him. He stated that with this instrument he had been able to locate and remove in a policeman, injured in an explosion at the New York World's Fair, many pieces of metal that otherwise would have presented a very difficult problem. That the record for posterity may remain straight, I would like to record that this instrument was unpacked several days after December 7 and subsequently used, but with how much success I do not know.
I have been asked to include in these comments a statement as to what method was used in assigning the civilian doctors to various stations in the event of an attack. The County Medical Society early in 1941 elected a Preparedness Committee of seven members, consisting of Drs. Arnold, Judd, Withington, Pinkerton, Larsen, Faus and Strode. Dr. Arnold, as Chairman, appointed Dr. Judd to investigate the needs of the Army for aid from the civilian doctors in case of attack, and I was appointed to assign doctors to the various hospitals in the city. We pooled our assignment and worked on the problem as a whole. Before the Blitz surgical teams were appointed that would be available for Tripler and for Schofield hospitals, and for use in the field, and other teams were assigned to the various hospitals in the city. Due to the sudden acute need of surgeons at Tripler the morning of the 7th, these assignments were not adhered to, and the men responded to the call that seemed most urgent.
While the Blitz of December 7 caught almost everyone off guard and resulted in a terrific loss of men and munitions of war, I feel sure it served a very useful purpose both nationally and locally. No act could have reacted so quickly to silence the isolationists and the pacifists and to unite the Nation as one for the common purpose of avenging Pearl Harbor. The civilian medical profession of Hawaii learned very quickly many things of vital importance in adequately caring for a large number of suddenly seriously wounded individuals, and I am sure if we are called upon again in such an emergency we will not be found wanting.
(Signed) J. E. Strode, M.D.
June 3, 1943.
Medicine in Hawaii: The World War II Experience
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