Pharmacy in World War II: The Military

July 14, 2017July 6, 2017 / Jordyn Redwood / Leave a comment

Sarah Sundin concludes her series today on WWII and the role of the pharmacist. Wasn’t the information amazing? You can find Part I and Part II by following the links.

Welcome back, Sarah!

While researching the military medical system for my World War II novels, I read about physicians and nurses, dentists and veterinarians. But where were the pharmacists? In the civilian world, the physician prescribes medication, the pharmacist purchases, compounds, and dispenses, and the patient or nurse administers. I discovered the wartime military system differed. As a pharmacist I was baffled and intrigued.

On February 14^th, I discussed the role of the pharmacist in the 1940s. On February 16^th, I described the local drug store and how its role changed during the war, and today I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Drug Distribution in the Military

In the US Army and Navy, outpatient prescriptions were filled at base or unit dispensaries, while inpatient orders were filled at hospital pharmacies. Both dispensaries and pharmacies were staffed by enlisted personnel—pharmacy technicians in the Army and pharmacist’s mates in the Navy—under the control of physicians. In 1936, the pre-war Army had forty graduate pharmacists serving as enlisted technicians.

Pharmacy technicians did not need any previous health care background or education. They went through a three-month program based on practical training rather than scientific understanding.

Medical Administrative Corps

For decades, pharmacy organizations had lobbied for a Pharmacy Corps with commissioned pharmacists. Indeed, most nations had similar corps. However, the US Army Medical Department was run by physicians. They thought of pharmacists in a condescending manner as businessmen rather than professionals, and they saw the drug distribution system as adequate.

The Medical Administrative Corps was formed in 1920 as a compromise. The MAC was responsible for administrative duties within the Medical Department, including medication procurement and distribution. In 1936, the MAC was permitted to commission sixteen pharmacists, with future appointments in the MAC restricted to graduate pharmacists.

The number of officers in the MAC increased during the war. In 1943 six hundred graduate pharmacists served as MAC officers—but none of them served as pharmacists.

Options for Pharmacists

Since most draft-age pharmacists had four-year bachelor’s degrees, they were eligible to serve as officers. While physicians, nurses, dentists, and veterinarians were commissioned as officers and placed in appropriate positions, no such guarantee was available for pharmacists.

Upon enlistment, pharmacists could apply for the Army Officer Candidate School, but upon graduation, they could be assigned anywhere. Pharmacists served as infantry officers, artillery officers, and in many other divisions. Even if they happened to be assigned to the MAC, as noted above, they did not practice their profession.

If a pharmacist wanted to compound and dispense medication, his only option was to serve as an enlisted technician, with pay and privileges far below that of an officer.

Fight for a Pharmacy Corps

The American Pharmaceutical Association (APhA) renewed the legislative battle for a commissioned Pharmacy Corps. While the Surgeon General’s office argued that “Army pharmacy was simpler than civilian practice. The department’s three-month pharmacy technician course was sufficient preparation. There was little compounding. Since medications were furnished in tablet form, ‘any intelligent boy can read the label’” (1).

These arguments did not sit well with pharmacists—or with the general public. Dr. Evert Kendig of the APhA argued that “Army pharmacy technicians were given responsibility beyond that legally permissible in civilian life even as the Army misused its professional pharmacists” (1). Several incidents were reported of prescriptions improperly filled by technicians and of blatant physician prescribing errors that would have been caught by a pharmacist. Public opinion tipped the scale, and on July 12, 1943, President Roosevelt signed legislation authorizing the formation of the Pharmacy Corps.

Pharmacy Corps

The Pharmacy Corps was authorized to commission seventy-two pharmacists. However, the military moved slowly. In January 1944, after receiving 900 applications and conducting two-day written examinations, physical examinations, and interviews, twelve officers were commissioned. By January 1945, the Pharmacy Corps had only commissioned eighteen pharmacists. The other officers’ slots were filled by former MAC officers.

The drug distribution system did not change by the end of the war, but the formation of the Pharmacy Corps laid the groundwork for post-war reforms.

Resources:

Ginn, Richard VN. The History of the US Army Medical Service Corps. Washington DC: Center for Military History, 1997. (Accessed February 6, 2011 at http://history.amedd.army.mil/booksdocs/HistoryofUSArmyMSC/msc.html).
Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Her novel Through Waters Deep was a 2016 Carol Award Finalist, won the 2016 INSPY Award, and was named to Booklist’s “101 Best Romance Novels of the Last 10 Years.” Her novella “I’ll Be Home for Christmas” in Where Treetops Glisten was a finalist for the 2015 Carol Award. In 2014, On Distant Shores was a double finalist for the Golden Scroll Awards from both AWSA and the Christian Authors Network. In 2011, Sarah received the Writer of the Year Award at the Mount Hermon Christian Writers Conference.

A mother of three, Sarah lives in northern California, works on-call as a hospital pharmacist, and teaches Sunday school and women’s Bible studies. She enjoys speaking to community, church, and writers’ groups, and has been well received.

Pharmacy in World War II: The Drug Store

July 12, 2017July 6, 2017 / Jordyn Redwood / Leave a comment

We’re continuing with Sarah Sundin’s series on the role of the pharmacist in WWII. You can find her first post here.

Welcome back, Sarah!

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—a personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. On February 14th, I discussed the role of the pharmacist in the 1940s, today I’ll describe the local drug store and how its role changed during the war, and on February 18^th, I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Welcome to the Corner Drug Store—1939

Perkins’ Drugs stands on the corner of Main Street and Elm, where it’s stood all your life. Large glass windows boast ads for proprietary medications and candy, and a neon mortar-and-pestle blinks at you. When you open the door, bells jangle. The drug store is open seven days a week, sixteen hours a day, so you know it’ll always be there for you. To your right, old-timers and teenagers sit at the soda fountain on green vinyl stools, discussing politics and the high school football game. The soda jerk waves at you.

You pass clean shelves stocked full of proprietary medications, toiletries, cosmetics, hot water bottles, hair pins and curlers, stockings, cigarettes, candy, and bandages. You know where everything is—and if you can’t find it, Mr. Perkins or his staff will be sure to help you.

The owner, Mr. Perkins, is hard at work behind the prescription counter with good old Mr. Smith and Mr. Abernathy, that new young druggist Mr. Perkins hired last year. Mr. Perkins greets you by name, asks about your family, and takes your prescription. He has to mix an elixir for you. If you don’t want to wait, he’ll be happy to have his delivery boy bring it to your house. But you don’t mind waiting. You have a few items to purchase, and you’d love to sit down with a cherry Coke.

Welcome to the Corner Drug Store—1943

Perkins’ Drugs still stands at the corner of Main Street and Elm. Large glass windows boast Army and Navy recruitment posters and remind you that “Loose Lips Sink Ships.” The neon sign has been removed to meet blackout regulations. The store is open for fewer hours since Mr. Smith retired and Mr. Abernathy got drafted. Mr. Perkins hired Miss Freeman. Not many people are thrilled to have a “girl pharmacist,” but if Mr. Perkins trusts her, that’s good enough for you. Perkins’ Drugs and Quality Drugs on the other side of town alternate evening hours so the town’s needs are met.

A placard on the door reminds you that Perkins’ Drugs is authorized by the Office of Civilian Defense as a pharmaceutical unit, meaning the store will provide a kit of medications and supplies for the casualty station in case of enemy attack. You pray the town will never need it.

Bells jangle when you open the door. The soda fountain is closed. Mr. Perkins can’t buy metal replacement parts for the machine, the soda jerk is flying fighter planes over Germany, and sugar is too scarce a commodity.

A barrel stands by the door. You toss in five tin cans, washed, labels removed, tops and bottoms cut off, and flattened. Mrs. Perkins at the cash register thanks you.

You pass clean shelves with depleted stocks. Proprietary medications, cosmetics, toiletries, and medical supplies remain, but rubber hot water bottles, silk and nylon stockings, hair pins and curlers, candy, and cigarettes are in short stock—or unavailable. Most of the packaging has changed. Metal tins have been replaced by glass jars and cardboard boxes. You pick up a bottle of aspirin and a tube of toothpaste, double-checking that you brought your empty tube. Without that crumpled piece of tin, you couldn’t purchase a replacement. Tin is too dear.

At the prescription counter, Mr. Perkins greets you by name and asks about your family. Miss Freeman gives you a shy smile and you smile back. There’s a war on and women have a patriotic duty to do men’s work so men are free to fight. Mr. Perkins frowns at your prescription for an elixir. He’s used up his weekly quota of sugar, and his stock of alcohol and glycerin are running low. Would you mind capsules instead? Of course not. Mr. Perkins phones Dr. Weber and convinces him to change the prescription. Mr. Perkins can’t have the prescription delivered—he doesn’t qualify for extra gasoline and he couldn’t find a delivery boy to hire anyway.

You and Mr. Perkins discuss war news as he sets up a wooden block with little holes punched in it, then lines the pockets with empty capsule halves. He weighs powders on a scale, mixes them in a mortar, then fills the capsule shells. After he sets the capsule tops in place, he puts the capsules in an amber glass bottle with the familiar Perkins’ Drugs label.

You buy a few War Bonds. Your wages are higher than ever with the war on, and with all the shortages there’s nothing to buy. Besides, War Bonds are a solid financial investment and your patriotic duty. On a poster by the counter, a smiling pilot leans out of his plane and reminds you: “You buy ‘em. We’ll fly ‘em. Defense Bonds and Stamps.”

Mr. Perkins thanks you for your purchase, and you thank him for his service. War or no war, you know Perkins’ Drugs will always be there for you.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Pharmacy in World War II: The Pharmacist

July 10, 2017July 6, 2017 / Jordyn Redwood / Leave a comment

I’m so pleased to have Sarah Sundin back. This week, she’ll be discussing the role of the pharmacist on several different fronts during WWII. I’ve found this information absolutely fascinating!

Welcome back, Sarah.

As a pharmacist, I found much about my profession has changed, but some things have not—the personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. Today I’ll discuss the role of the pharmacist in the 1940s. On February 16^th, I’ll describe the local drug store and how its role changed during the war, and on February 18^th, I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

The Profession of Pharmacy in the 1940s

Although the term of druggist has been abandoned by the profession—please do not use it in your contemporary novels—in the 1940s, the terms of pharmacist and druggist were interchangeable. The 1940 US census counted over 80,000 pharmacists. The majority worked in retail pharmacy, with only 3000 working in hospitals. In fact, less than half of hospitals had a pharmacist on staff.

A cornerstone of pharmacy had always been compounding, the practice of mixing a prescription from raw ingredients. Pharmacists made creams, ointments, elixirs, suspensions, capsules, tablets, suppositories, and powder papers. Only pharmaceutical grade ingredients could be used, approved by the USP (United States Pharmacopoeia) or the NF (National Formulary). Every pharmacist owned a copy of the USP guide—the 11^th Edition (1937) or 12^th Edition (1942). The USP guide provides chemical data on each substance. By the 1940s, pharmacists compounded less—about 70 percent of prescriptions were filled with manufactured dosage forms.

In the 1940s, the pharmacist was a vital member of the community. Often viewed as more accessible than physicians, pharmacists were relied upon for health information and the treatment of minor ailments.

Education and Licensing

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955, and did not become mandatory until 2000. Therefore, in World War II, pharmacists were addressed as “Mr.” or “Mrs.” or “Miss.”

In 1942, sixty-eight colleges of pharmacy operated in the United States. In addition to general education requirements, pharmacy students also studied pharmacy, pharmaceutical chemistry, pharmacognosy (deriving pharmaceuticals from raw substances, such as plants), pharmacology (the effect of a drug on the body), and business. To increase the chance that a student would finish his degree before being drafted, most colleges of pharmacy adopted a year-round, three-year program during the war.

Each state had its own licensing requirements and examinations, and there was no reciprocity between states. For example, a pharmacist licensed in California had to take a new set of examinations if he moved to Michigan.

Manpower Shortage

In a nation of 130 million, over 11 million would serve in the armed forces during the course of the war. This produced a manpower shortage on the home front, and pharmacy was not immune. As a class, pharmacists were not exempt from the draft, but local draft boards could declare individuals as “necessary men” if their enlistment would negatively affect the health of the community. During World War II between 10,000-14,000 pharmacists served in the military. Due to this loss, approximately 15 percent of drug stores closed during the war. The west coast was hard hit when all Japanese-American pharmacists were forcibly interned.

However, more opportunities opened for women as colleges and employers actively recruited them. While less than 5 percent of pharmacists in 1940 were female, the percentage of female pharmacy students rose above 15 percent during the war.

Effects of the War

Due to store closures, the average store filled 13 percent more prescriptions than before the war. This increase in workload was balanced by depletion of other goods due to rationing and shortages. In addition, citizens were encouraged to take better care of their health so they could contribute to the war effort, which led to an increase in physician visits. Overworked physicians dispensed fewer drugs from their offices and sent more patients to pharmacies. As a result, the average drug store enjoyed an 80 percent increase in sales during the war.

Pharmacists dealt with shortages of ingredients and medications. A serious shortage of quinine, used to treat malaria, led the military to collect the majority of the nation’s quinine stock. Also, shortages of alcohol, sugar, and glycerin taxed the ability of pharmacists to compound. Each pharmacy received a ration of ten pounds of sugar a week for compounding purposes.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

United States Pharmacopoeial Convention. The Pharmacopoeia of the United States of America, Twelfth Edition. Easton PA: Mack Printing Company, 1 November 1942.
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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Sarah Sundin: WWII US Army Hospitals Part 3/3

February 3, 2017January 28, 2017 / Jordyn Redwood / Leave a comment

This is Sarah’s final installment on WWII Army Hospitals. I’d like to thank Sarah for all her hard work on these terrific posts. Click the links for Part I and Part II.

US Army Hospitals in World War II—Part 3

Ruth squatted beside his cot. “Have you ever flown before, Corporal?”

“No, ma’am. A man’s meant to stay on the ground.”

“How long did it take you to get to England?”

“Almost two months, ma’am, zigzagging around them U-boats.”

“Mm-hmm. Well, tonight you’ll have dinner in New York. You may change your mind about flying.”

a-memory-between In my novel A Memory Between Us, the heroine becomes a flight nurse, pioneering medical air evacuation. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you’ll need to understand how patients were evacuated from the battleground to the hospital and perhaps taken stateside.

In my first post, I discussed the chain of evacuation. In my second post, I discussed more details about mobile and fixed hospitals, and today I’ll cover evacuation of the wounded.

Manual Transport

On the battleground, medics or fellow soldiers could manually carry a wounded man further to the rear for aid. Methods included the supporting carry (walking side-by-side), the arms carry, the saddleback carry (piggy-back), and the fireman’s carry.

Litter Transport

American litters were made of canvas stretched over aluminum or wood poles with stirrup-shaped feet to keep them off the ground. A litter could be carried by two people, but a litter squad consisted of four men, to rotate if traveling long distances and to assist over obstacles. Ideally, litter transport was only used for short distances, but in mountainous or forested or swampy terrain, litter transport was the only available means. Mules were often used in the Mediterranean Theater to carry litters in rocky, mountainous terrain.

Motor Transport

Ambulances were used to transport patients, usually from an aid, clearing, or collecting station to a field hospital, or for transport further to the rear. Ambulances could carry seven seated patients or four patients on litters.

Water Transport

Jeeps were often used, both on the battleground and to transport further to the rear. Rugged and maneuverable, jeeps could cover terrain inhospitable to ambulances. With litter brackets, a jeep could carry two patients. Armored divisions also used light tanks to transport their wounded.

During an amphibious landing, the best way to handle the wounded was to send them back on departing landing craft, which carried them to hospital ships off-shore. Patients could be removed from danger and transported quickly to get needed care.

Hospital ships were used offshore after an invasion to care for the wounded before field and evacuation hospitals could be set up. They also transported patients who needed long-term care to general hospitals further to the rear. Another use of hospital ships was to transport to the US any patients who needed long-term convalescent care or those who qualified for a medical discharge. They carried several hundred patients and delivered full medical care, but transport took a long time and carried the danger of enemy attack at sea.

Rail Transport

Hospital trains were used within theaters of operation to transport patients from one hospital to another. They were used in the continental US, Britain, continental Europe, India, and North Africa. They could carry several hundred patients with excellent medical care.

Air Transport

Medical air evacuation was new and revolutionary, but by the end of the war, it proved successful. Planes can traverse inhospitable terrain or dangerous seas—and quickly. At the front, the wounded were gathered at collecting stations at airfields. C-47 cargo planes carried 18-24 litter patients or a higher number of ambulatory patients further to the rear. A team consisting of a flight nurse and a surgical technician cared for the patients in flight. The larger C-54 cargo plane was used for trans-oceanic evacuation. Danger still existed, both from the inherent risks of flight and also because the planes carried cargo and couldn’t be marked with the Red Cross.

Resources for Research

Office of the Surgeon General. Medical Field Manual: Transportation of the Sick and Wounded. Washington, DC: US Government Printing Office, Feb. 21, 1941 (available free on-line at http://www.ibiblio.org/hyperwar/USA/ref/FM/index.html ). Please note the date—some of the material, especially about air evacuation, became quickly outdated.

For better information on air evacuation, please see:

Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Washington, D.C.: Office of the Surgeon General, USAF, 1955.
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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 17th, 2010.***

Sarah Sundin: WWII US Army Hospitals Part 2/3

February 1, 2017January 28, 2017 / Jordyn Redwood / Leave a comment

This week, I’m pleased to host author Sarah Sundin as she shares some of her wonderful research that served as the backdrop for her Wings of Glory Series. You can find Part I here.

US Army Hospitals in World War II—Part 2

Ruth passed precise military rows of the hospital’s Nissen huts. Redgrave Hall stood to the west, but she headed south across the road the ambulances used and entered a lightly wooded meadow and another world. How could one family own so much land?

If Ruth had resources like that, she wouldn’t be in a fix.

a-memory-between In my novel, A Memory Between Us, the heroine serves as a US Army nurse based in England. If you’re writing a novel set during World War II, you may need to write a scene set in a military hospital, and you’ll need to understand Army hospitals.

Last post, I discussed the chain of evacuation, today I’ll discuss more details about mobile and fixed hospitals, and on the next post, I’ll cover evacuation of the wounded.

Mobile Hospitals

Field hospitals (400 beds) and evacuation hospitals (either 400 bed or 750 bed) arrived within a few days of an invasion and followed the army, staying about thirty miles behind the front. They were close enough to treat patients quickly and send them back to the front quickly as well.

These hospitals relied on mobility. They usually used canvas tents, but also used schools, barracks, hospital buildings, hotels, Mediterranean villas, and an Italian stadium. A few days before a move, the hospital stopped admitting patients and evacuated their current patients to other hospitals. They packed their equipment and personnel into trucks, advanced, set up, and were ready to admit patients within hours.

When ambulances arrived, triage officers sent patients to pre-op, medical, shock, or evacuation wards as needed. Surgical teams worked twelve hours on, then twelve hours off.

In the European Theater (England, France, Belgium, Germany), the field hospitals stayed closer to the front, with the evacuation hospitals further to the rear. In the Mediterranean Theater (North Africa, Sicily, Italy, southern France), field hospitals and evacuation hospitals were often used interchangeably. Both theaters practiced “leapfrogging” as the front advanced—hospital A would pass hospital B, then hospital B would pass hospital A. This reduced the frequency of moves.

Fixed Hospitals

The station hospitals (250, 500, or 750 bed), general hospitals (1000 bed), and convalescent hospitals (2000 or 3000 bed) were set up far from the front to keep patients safe from danger, but also to keep them in the theater, which made it easier to return the soldiers to duty. In England before D-Day, field and evacuation hospitals waiting for the Normandy invasion functioned as station hospitals to care for patients.

In each theater of operations, fixed hospitals operated in what was called the “Communications Zone.” In the European Theater, the COMZ was originally in England, then as the Allies approached the German border, the COMZ extended to include Normandy and Belgium. In the Mediterranean Theater, Morocco served as the first COMZ, then Algeria. When the Allies invaded Sicily and Italy, North Africa was the COMZ, and as the front advanced, the COMZ was established in the Naples area of southern Italy. In the Pacific, fixed hospitals were first established in Hawaii and Australia, then followed into secured regions.

Fixed hospitals moved less often and occupied more permanent facilities. American units used some standing hospitals in host or occupied countries, but most were a collection of Nissen huts, 20-ft by 40-ft corrugated tin semi-cylinders. In England, these hospital complexes were often placed on estate grounds, and had concrete floors, flush toilets, clean water, and were heated by coal-burning stoves. In the Mediterranean and Pacific, facilities were more primitive but improved over time. In these theaters, mosquito netting was draped over the beds to prevent transmission of malaria.

Fixed hospitals in the Zone of the Interior (continental United States) enjoyed the benefits of modern buildings and facilities. However, shortages of medication, equipment, and personnel were always a problem.

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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 15, 2010.***

Sarah Sundin: WWII US Army Hospitals Part 1/3

January 30, 2017January 27, 2017 / Jordyn Redwood / Leave a comment

I’m so thrilled to have author Sarah Sundin here this week. If you’re looking for information surrounding WWII, check out all of her posts. Recently, she did a series on WWII nursing. They’re an excellent resource.

US Army Hospitals in World War II—Part 1

Lieutenant Doherty wrote on the clipboard while the mercury rose, and Jack glanced around the Nissen hut, which was like a giant tin can sawed in half. Four coal stoves ran down the aisle, with ten beds on each side, only eight of which were occupied. Jack didn’t mind the extra attention.

In the Wings of Glory series, my B-17 pilot heroes keep getting injured and hospitalized. If you’re writing a novel set during World War II, your soldier characters may need treatment, and you’ll need to understand how and where patients were hospitalized.

sarsunwoundsol Today I’ll discuss the chain of evacuation, on December 15^th, I’ll discuss more details about mobile and fixed hospitals, and on December 17^th, I’ll cover evacuation of the wounded.

The Chain of Evacuation

Wartime medical treatment occurred on muddy battlefields under fire, tent hospitals only miles from the front, and sterile stateside hospitals.

A complex chain moved patients to where they could best be treated. At all points along this chain, decisions were made regarding when to treat, when to return to duty, and when to evacuate further to the rear.

Organic Medical Units

These units were attached to combat units and followed them into battle.

Battlefield: Medics performed first aid and moved the wounded to the aid station, often under fire.

Battalion aid station: About one mile from front. Physicians and medics adjusted splints and dressings, administered plasma and morphine. Soldiers reported to the aid station for treatment of minor illnesses or mild combat fatigue.

Collecting station: About two miles from front, near regiment command post. Further adjustment of splints and dressings, administration of plasma, treatment of shock.

Clearing station: About four to ten miles from front. Treated shock and minor wounds. Grouped patients in ambulance loads for transport to field hospitals.

Mobile Hospitals

These hospitals were assigned to a theater of operations, and could be packed and moved quickly.

Field Hospitals: Within thirty miles of clearing station—were supposed to receive the wounded within one hour of injury. Surgery was performed for the most severe cases.

Evacuation Hospitals: Treated illnesses and less urgent surgical cases. Patients could be reconditioned here to return to the front.

Fixed Hospitals

These hospitals were set up a safe distance from the front, either in the theater of operations or stateside.

Station Hospitals: Usually attached to a military base, designed to treat illnesses and injuries among personnel stationed at that base.

General Hospitals: Large facilities where patients received long-term treatment.

Convalescent Hospitals: Designed for rehabilitation.

Resources for Research

Cosmas, Graham A. & Cowdrey, Albert E. The Medical Department: Medical Service in the European Theater of Operations. Washington, D.C.: United States Army Center of Medical History, 1992.

Wiltse, Charles M. The Medical Department: Medical Services in the Mediterranean and Minor Theaters. Washington, DC: Office of the Chief of Military History, Department of the Army, 1965. (available free on line at http://history.amedd.army.mil/books.html)

Condon-Rall, MaryEllen & Cowdrey, Albert E. The Medical Department: Medical Service in the War Against Japan. Washington, D.C.: United States Army Center of Medical History, 1998.

Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Washington, D.C.: Office of the Surgeon General, USAF, 1955.

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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 13, 2010.***

Sarah Sundin: WWII Nursing Part 3/3

December 16, 2016December 3, 2016 / Jordyn Redwood / Leave a comment

This is Sarah’s final installment concerning her research into WWII nursing. I want to thank Sarah for all the great information she provided. I know I learned a lot. What was one interesting thing you learned?

Click the links for Part I and Part II.

US Army Nursing in World War II—Part 3

“Lieutenant Holmes is going into anaphylaxis.”

Harriet’s elfin face blanched. “Oh no. Thank goodness Dr. Sinclair is on the ward.”

“Not yet.” Ruth grabbed a tray and put two sterilized syringes on top.

“So—so why are you already getting the meds?”

“I want to be ready when he comes. I can’t waste any time.” One vial of adrenaline.

“But he hasn’t ordered them yet.”

Ruth leveled a look at the girl. “I know the treatment for anaphylaxis.”

“That—that’s presumptuous of you. You’ll make the doctor angry.”

Ruth pulled a vial of morphine. “I don’t care about the doctor’s feelings. I care about my patient’s life.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty, serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. On November 26th, I discussed the training the nurses underwent and rank in the Army Nurse Corps. And today I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Uniforms

On the job, nurses wore a white ward dress with the white nurse’s cap. They were also issued a set of “dress blues,” a dark blue service jacket and a medium blue skirt, a white or blue shirt, black tie, black shoes, and a dark blue garrison cap or service cap. This uniform is pictured on the cover of A Memory Between Us. A dark blue cape lined with red and an overcoat were also used for outdoors wear. Starting in July 1943, the blue uniform was replaced with an olive drab service jacket and skirt and cap, khaki shirt and tie, and brown shoes—but implementation was slow and sporadic.

In combat areas, white ward dresses and skirted suits were absurdly impractical, but the Army was slow to provide appropriate clothing for women. In 1942 during the early campaign in North Africa, the women resorted to wearing men’s fatigues and boots—in men’s sizes. In time the nurses were issued WAC (Women’s Army Corps) field uniforms and the popular Parson’s field jacket, as well as easily laundered seersucker ward outfits, both dresses and pantsuits.

Nursing Practice

On the ward, the nurse was assisted by a male medic, an enlisted man. Some men had serious problems taking orders from women, and some didn’t. In stateside hospitals, Red Cross nurses’ aides also served. Physicians entered the Medical Corps with the rank of captain and only male physicians were admitted to the Corps. As was typical in the 1940s, the physicians expected unquestioning, speedy obedience from nurses.

For the writer, it’s important to remember this was long before our disposable, single-use, universal precautions era. Syringes were made of glass and were sterilized in bichloride of mercury before reuse. Gloves were washed and reused—and holes were even patched. Improvisation was the rule, especially in combat areas, and nurses used their creativity and imagination to turn trash into useful items.

Resources

http://history.amedd.army.mil/ANCWebsite/anchome.html (The official website for Army Nurse Corps history.)

Sarnecky, Mary T. “A History of the U.S. Army Nurse Corps.” Philadelphia: University of Pennsylvania Press, 1999. (A comprehensive history with a thick section on WWII).

Tomblin, Barbara Brooks. “G.I. Nightingales: the Army Nurse Corps in World War II.” Lexington: University Press of Kentucky, 1996. (A wonderful history, including all theaters, full of personal stories).

Brayley, Martin. “World War II Allied Nursing Services.” Oxford: Osprey Publishing, 2002. (Detailed information on military nurses’ uniforms).

http://library.uncg.edu/dp/wv/ (The Women Veterans Historical Project—a vast collection of oral histories, letters, photographs, diaries and other treasures).

http://history.amedd.army.mil/books.html (Prepare to get lost…this website contains dozens of on-line historical medical texts, from detailed—800 page!—books describing medical services in each theater, to period textbooks used for neuropsychiatry to infectious disease to orthopedic surgery).

***This blog originally posted 11/29/2010***
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sarahsundin2 Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 2/3

December 14, 2016December 3, 2016 / Jordyn Redwood / Leave a comment

We’re continuing our three part series with historical author Sarah Sundin about her research into WWII nursing. You can find Part I here.

US Army Nursing in World War II—Part 2

Ruth hugged her knees to her chest, her dark blue cape tented around her against the gray chill.

Where would the money come from? Promotions were meager in the Army Nurse Corps. All the nurses were second lieutenants except the chief nurse, a first lieutenant. At twenty-three, Ruth was too young and inexperienced to become a chief nurse.

She’d always solved her own problems, but now she longed for advice, and she kept thinking about Major Novak.

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. Today I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Recruitment and Training

The American Red Cross served as the traditional reserve for the Army Nurse Corps. On October 9, 1940, the ANC called the reserves to active duty, to volunteer for a one-year commitment. At first there was no formal military training for nurses. On July 19, 1943, the first basic training center for nurses opened. Training centers were located at Fort Devens, MA; Halloran General Hospital, Staten Island, NY; Camp McCoy, WI; and Brooke General Hospital in San Antonio, TX. The nurses trained for four weeks, learning military courtesy and practices, sanitation, ward management, camouflage, the use of gas masks, and map reading. They also drilled and underwent physical training.

To train the increased number of nurses needed during the war, Congress authorized the Cadet Nurse Corps on July 1, 1943. The government paid for women to attend civilian nursing programs in exchange for service in the Army Nurse Corps upon graduation. The women in this accelerated program (two and a half years instead of three) had their own special cadet uniforms.

Rank

Nurses entered the ANC as second lieutenants, and the vast majority of them stayed at that rank. The chief nurse of a hospital was usually a first lieutenant, but sometimes a second lieutenant or a captain. The highest rank in the ANC was held by the superintendent of the ANC, a colonel.

Even so, nurses held “relative rank.” They held the title, wore the insignia, were admitted to officers’ clubs, and had the privilege of the salute, but they had limited authority in the line of duty and initially received less pay than men of similar rank. On December 22, 1942, Congress authorized military nurses to receive pay equivalent to a man of the same rank without dependents, and on June 22, 1944, Congress authorized temporary commissions with full pay and privileges.

One of the main reasons nurses were granted officer status was to “protect” them from the great crowd of enlisted men, and—it was often thought—for male officers to keep the women for themselves. The Army had rules against fraternization between officers and enlisted personnel.

***This blog originally posted 11/26/2010.***

********************************************************************************************* sarahsundin2 Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 1/3

December 12, 2016December 3, 2016 / Jordyn Redwood / Leave a comment

Redwood’s Medical Edge is pleased to host historical author Sarah Sundin who has done extensive research regarding nursing during WWII.

US Army Nursing in World War II—Part 1

“I love this smell, don’t you?” May said.

“Bichloride of mercury?” Ruth laughed and shook water from a pair of gloves. “Only a nurse would like this smell.”

May rolled syringes in a pan of the blue green disinfectant. “In the orphanage I had no control over my life, but with soapy water and a stiff brush, I could scrub away the smells and pretend I lived in a castle.”

Ruth draped the brown latex gloves over a clothesline to dry before being sterilized. “Cleanliness may not be next to godliness, but it beats back the demons of poverty.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting at first, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

Combat produces injuries. Injuries require treatment. If you write a novel set during World War II, you may have to write a medical scene—and you’ll want to get the details right about your nurse characters.

During World War II, 57,000 women served in the US Army Nurse Corps (ANC), 11,000 in the Navy Nurse Corps (NNC), and 6500 in the Army Air Forces. More than two hundred nurses died serving their country.

Today I’ll cover requirements to serve in the Army Nurse Corps. On November 26th, I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Requirements

To serve in the Army Nurse Corps, women had to be 21-40 years old (raised to 45 later in the war), unmarried (married nurses were accepted starting in late 1942), a high school graduate, a graduate of a 3-year nursing training program, licensed in at least one state, a US citizen or a citizen of an Allied country, 5’0”-6’0,” have a physician’s certificate of health and a letter testifying to moral and professional excellence.

Pregnancy was the main cause of discharge from the Army Nurse Corps, or as the women called it, PWOP (Pregnant WithOut Permission). To discourage pregnancy, the Army had a cumbersome process to gain approval for marriage. Other methods to prevent pregnancy included careful placement of nurses’ quarters, discouraging drinking, and encouraging the women to socialize in groups. The second main reason for discharge was “neuropsychiatric,” what we call combat fatigue nowadays.

Remember that gender and race discrimination was still rampant in the 1940s. Male nurses were not allowed in the ANC during World War II, and only a limited number of African-American nurses. Despite a large number of black registered nurses in the United States, fewer than five hundred were allowed to serve, and then only to care for black patients or for prisoners of war.

***This post originally published 11/24/2010.***

********************************************************************************************* sarahsundin2 Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Author Question: Nursing 1940’s

September 23, 2015July 21, 2016 / Jordyn Redwood / Leave a comment

Anonymous Asks:

First and foremost, I have to say that I am in love with Medical Edge. I’ve been spending a lot of time on it lately because I enjoy studying medicine and also because I am starting to do research for my novel. It’s set in 1939 through to 1943. I have three questions for you.

One of my main characters is a nurse in Sioux Falls, South Dakota. I want to be able to write her doing her job correctly. I was wondering what kind of equipment they used, how they used it, and for what illnesses (No need to be extremely specific here, I think). Also, what would her responsibilities be within the hospital? Would she rotate through all the wards or do/did nurses have particular specialties like physicians?

Jordyn Says:

Thanks for your compliments on my blog! Glad you find it helpful.

Nursing in your time frame of 1939-1943 would have looked a lot different than it does today. They definitely wore uniforms and caps. Doctors would have been formally called “Dr. Smith” versus using first names like we do now (although not in front of patients).

Nursing work was viewed as inferior to the physician meaning—you do what the physician says. Now, a nurse’s input is more respected. Doctors and nurses realize they can’t work separate from one another.

Nurses likely didn’t specialize then like we do now and there was likely not a lot of physician specialties either as there weren’t any intensive care units or emergency departments until the 1970s. Equipment would have been non-existent like the heart monitors and stuff we now use. Read through this info to get a general feel of how the floors or “wards” would have been split up.

This link is from Britain but would probably have some cross-over to the US. Here is a linkto some personalized stories from people who nursed during your time frame. I would read through these for the 1930’s and 1940’s to get a feel for what their jobs were like.

Thisis also from the UK but should provide some insight.

Question:

Another one of my main characters goes off to fight in the war. How severe would an injury have to be for him to be discharged? Presently, I have a situation designed where he is aiding a family out of a bomb shelter; there is an unexploded shell nearby, and a child accidentally kicks rubble at it and sets it off. Big boom, main character loses part of his leg and half of his body is burnt. I’m also thinking that he loses his hearing. Would this be plausible?

Jordyn Says:

I would search military discharge related to a medical condition two ways. One—what medical conditions are prohibitive for military service and those conditions that would lead to discharge.

I found this list, but you could probably find more and if it’s the 1939-1942 time frame it may be different than those that cause discharge in these times.

The injuries you list related to the bomb blast are realistic and I think would be enough to cause his discharge from the military as well.

I contacted a cousin of mine who serves in the medical corp of the military and he said to look at AR 40-501 which is the standard of medical fitness. Basically, if you couldn’t do what’s listed than you could be discharged from service. He did say that there are personnel who are still serving who have amputated limbs.

Question:

Lastly, my nurse has a patient, a woman in her 40s or 50s, who she loves with all her heart. I want this patient to die. What would be a good way to kill this woman off? I need her to have been in the hospital for around four years. I also want to have her weak but able to speak with my other characters. What’s a good malady for this situation?

Jordyn Says:

This kind of criteria would mean the character would need a chronic illness that’s debilitating. You could look into multiple sclerosis, Lou Gehrig’s Disease, Huntington’s Chorea or some of the autoimmune disease like Lupus or Sarcoidosis.

These diseases fall on a spectrum (more MS and the autoimmune diseases) but Lou Gehrig’s Disease and Huntington’s Chorea lead to neuromuscular wasting, etc that does lead to death and there is currently no cure.

In that time frame you’re looking at you’d have to determine if they were able to diagnose these diseases. To do that you could Google search “When was Lou Gehrig’s Disease discovered?” That should get you in the ballpark to know if the medical community knew about whatever disease you chose for your time frame.

Keep in mind—it would be highly unusual for someone to be hospitalized for four years straight.