To the Editor:—
I read with appreciation and interest the recent special article by Dr. David B. Waisel, “The Role of World War II [WWII] and the European Theater of Operations [ETO] in the Development of Anesthesiology as a Physician Specialty in the USA.”1I would like to comment on three assertions made in the article based on my father's personal experiences as a staff officer with the 24th General US Army Hospital in the ETO during WWII, 1943–1945. These three assertions included the following: (1) predominately physicians and some nurses were trained as wartime anesthetists in the US and England in 1943 and 1944; (2) military physician–anesthetists were deployed in the ETO primarily after late 1943; and (3) and Dr. Henry K. Beecher was primarily active in behind-the-lines training of US physician–anesthetists in the US and England in 1943 and 1944. 1
In fact, designated dentists, nurses, generalist physicians, and, physician–specialists with limited wartime skills, particularly obstetricians and pediatricians, received anesthesia training at US institutions both before and after the outbreak of WWII. My father, Major Abram H. Diaz, D.D.S., USA, joined the US Army in 1937 as a dentist and oral surgeon and was further trained as a maxillofacial surgeon and dentist–anesthetist at the Walter Reed Army Hospital in 1942 and 1943. In addition, my uncle, an obstetrician, received further training in abdominal and thoracic surgery and anesthesia at the Mayo Clinic. In July 1942, they and others were mobilized in New Orleans, Louisiana, as the 24th General US Army Hospital, under the command of Colonel I. Mims Gage, a general and thoracic surgeon trained by Dr. Alton Ochsner. The chief physician–anesthetist of the 24th General was Major George B. Grant, a professional anesthesiologist and early member of the American Society of Anesthesiologists and a respected colleague of Drs. Gage and Ochsner. Dr. Grant directed two professional nurse–anesthetists and all of the multiskilled physician– and dentist–anesthetists in the 24th General's anesthesia department and trained many more “nurse”–anesthetists in the ETO throughout WWII (E. D. Matthews, personal interview, June 17, 2001).
Besides Dr. Grant, no other formally trained anesthesiologists served in the 24th General (E. D. Matthews, personal interview, June 17, 2001). My father, a dentist, administered head and facial blocks and neuroleptanesthetics that combined craniofacial blocks with pentothal and morphine, both as a surgeon and as a dentist–anesthetist. Nitrous oxide, which was favored by dentists for neuroleptanesthetics but supported combustion, was not uniformly available in the ETO, especially in forward-area hospitals, like the 24th General. Explosive volatile anesthetics were also not available. 1My uncle, an obstetrician, also performed regional anesthetics in the ETO, both as a surgeon and as a physician–anesthetist. The 24th General Hospital had a distinguished wartime record in the Mediterranean and participated in two massive amphibious assaults, the North African invasion and the Italian invasion. Thus, many nurses, dentists, and even physician–specialists, particularly obstetricians and pediatricians, served as anesthetists and assisted professional physician–anesthetists, like Dr. Grant, in the ETO in WWII. As an anesthesiologist, I have had the privilege of administering subsequent anesthetics to WWII veterans treated by both my father and uncle in the ETO, 1943–1945.
The first 24th General Hospital was established in Bizerté, Tunisia, in the spring and summer of 1943. This hospital was composed of tents for staff housing and recovery wards and temporary buildings for laboratories, specialty units, and prisoner-of-war quarters. The staff of the 24th General treated the heavy casualties experienced by the US Army during the early part of the North African campaign. The Tunisian 24th General Hospital was dismantled in early 1944 in anticipation of the Italian invasion. The second 24th General Hospital was established in an abandoned cigarette factory in Grosseto, Italy, north of Rome on the Mediterranean Sea, and on the parallel with the fiercely defended German defensive lines anchored at Montecassino on the Adriatic side of Italy. The Italian 24th General Hospital provided expert specialty care for all allied soldiers serving in the Italian campaign until the end of WWII. Some of the most experienced medical officers in the 24th General were then sent to the Pacific Theater of Operations for additional military service after the end of the war in the ETO in the spring of 1945. Thus, there were indeed many highly experienced physician and nonphysician anesthetists, not previously trained in British or US northeastern noncombatant hospitals serving in forward-area hospitals in the ETO before late 1943.
In an interview with one of the few surviving veterans of wartime service with the 24th General in the ETO, Edward D. Matthews, M.D., a retired internist, recalled a personal visit with medical and postsurgical rounds made by Dr. Henry K. Beecher to the Tunisian Hospital in 1943 (E. D. Matthews, personal interview, June 17, 2001, and letter to the author, June 20, 2001). Both Dr. Matthews and Dr. Grant provided postoperative critical care to surgical patients. After WWII, Dr. Grant was credited with establishing the first postoperative recovery room in the USA at the original Ochsner Foundation Hospital, located in the former US Army Camp Plauché in New Orleans, Louisiana. 2This first recovery room also functioned as an intensive care unit for patients undergoing endotracheal anesthesia and was modeled on similar units established for postoperative patients at the 24th General Hospitals in Tunisia and Italy (E. D. Matthews, letter to the author, June 20, 2001). 2Thus, Dr. Beecher not only trained physician–anesthetists in the US and England, but also personally visited with staff and patients at forward-area hospitals in the ETO, many of which came under enemy air and artillery attack (E. D. Matthews, letter to the author, June 20, 2001). 1In addition, Dr. Beecher encouraged physician and nonphysician US Army anesthetists to use endotracheal anesthetics for thoracoabdominal surgery, to explore new combinations of regional and intravenous anesthetics for wound management, and to design unique areas for intensive postoperative care, such as early postsurgical recovery rooms, now contemporary intensive care units (E. D. Matthews, personal interview, June 17, 2001, and letter to the author, June 20, 2001).