SUPPLEMENT ARTICLE

American Pediatricians at War: A Legacy of Service

AUTHORS: Mark W. Burnett, LTC, MC, USA,a and Charles W. Americanpediatricianshavegonetowarforalmostaslongaspediatrics Callahan, COL, MC, USAb has been a specialty. A decade after Jacobi, Osler, and Forchheimer aTask Force Raider, 6th Squadron, 4th Cavalry Regiment, Combat founded the American Pediatric Society in 1888, pediatricians, or b Outpost Keating, Nuristan Province, Afghanistan; and DeWitt “pediatrists” as they were sometimes called, were serving with the Community Hospital and Health Care Network, Fort Belvoir, Virginia American military on foreign soil. Across more than a century of ser- ABBREVIATIONS vice, the role of pediatricians in armed conflict has often been unclear AAP—American Academy of Pediatrics to military and civilian leaders, fellow physicians, and at times even to MASH—Mobile Army Surgical Hospital members of their own specialty. In a 2003 site inspection of an overseas MEDCAP—Medical Civic Action Program MILPHAP—Military Provincial Hospital Assistance Program US military treatment facility, the assistant secretary of defense for USARV—US Army Vietnam health affairs was briefed about pediatricians. “Why would we need USNR—United States Naval Reserve pediatricians here?” was his reply. Despite the confusion, every major The views and opinions expressed in this article are those of the conflict since the Spanish–American War has witnessed American authors and do not reflect the official policy or position of the military pediatricians serving in a variety of roles. From Cuba to Kan- Army Medical Department, Department of the Army, Department of Defense, or the United States Government. dahar, the beaches of Normandy to Mosul, the century of service con- ’ www.pediatrics.org/cgi/doi/10.1542/peds.2010-3797g tinues around the globe and forms the fabric of the story of Americas uniformed pediatricians today.1–3 doi:10.1542/peds.2010-3797g Accepted for publication Oct 7, 2011 Address correspondence to LTC Mark W. Burnett, Task Force ROOTS Raider, 6th Squadron, 4th Cavalry Regiment, Combat Outpost Keating, Nuristan Province, Afghanistan. E-mail: mark.w. At the close of the 19th century, pediatricians played a very different role [email protected] than in today’s society. Pediatricians were considered specialists rather PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). than primary care providers for children. There were very few pedia- Copyright © 2012 by the American Academy of Pediatrics tricians in America, and they mostly served in large academic centers FINANCIAL DISCLOSURE: The authors have indicated they have or in urban hospitals. Because accurate records of medical specialists fi no nancial relationships relevant to this article to disclose. were not routinely kept at the time of the Spanish–American War, it is unclear how many pediatricians served in the US military during that conflict. Samuel Walter Kelley was one famous pediatrician whose record of serviceis known.Dr Kelley spent mostof his adultlife in Cleveland, where he was a professor of diseases of children in the Cleveland College of Physicians and Surgeons. He worked in Cleveland as both a pediatrist and a pediatric surgeon. He was commissioned as a brigade surgeon with the rank of major on August 17, 1898. After the war, he served as chairman of the Diseases of Children Section of the American Medical Association from 1900 to 1901. In 1909, he published The Surgical Dis- eases of Children, which was the first text of its kind published by an American author.4 He continued his military affiliation as a member of the Association of American Surgeons and later volunteered his serv- ices as a member of the Medical Reserve Corps of the United States Army to both the French and American armies in the World War I, al- though he was barred re-entry upon active duty due to age5 (Fig 1). Dr John Amesse, a future vice president of the American Medical As- sociation from 1943 to 1944 and a charter member of the American Academy of Pediatrics (AAP), served during the brief period of fighting in Cuba and in the Philippine Insurrection that followed as an assistant surgeon in the Marine Hospital Service—the forerunner of the US Public

PEDIATRICS Volume 129, Supplement S1, February 2012 S33 Downloaded from www.aappublications.org/news by guest on September 29, 2021 activities for which their specialized Dr Edward Clay Mitchell, a busy pedia- training was unsuited.”8 trician in Memphis, Tennessee, was Dr Phillip Moen Stimson, soon to be appointed commanding officer of Base recognized nationally for his work in HospitalNo.57inRheims,France,where contagious diseases, joined the US he served in the Army Medical Corps in Army Medical Corps in 1917 after com- the rank of colonel. He later established pleting his residency at the St Louis the first American military hospital in Children’s Hospital. He recalled that “In Paris and gave lectures on pediatrics at the United States Army in the World the Sorbonne. For his efforts in France, War, pediatrists were enrolled in great he was awarded the French Croix de number, but comparatively few had op- Guerre with Palm medal. Returning to portunities to work on the contagious the United States, he resumed his pe- diseases.”9 diatric practice and became a charter Dr Stimson served initially with the member of the AAP. He later served as British forces in Flanders and was its president and as the chairman of the Pediatric Section of the American FIGURE 1 wounded in action when a piece of shell Medical Association.12 Dr Samuel Kelley. fragment hit and dented the brim of his helmet.He is thought tobeone of the first Two other future founding members American medical officers wounded and presidents of the AAP served in the Health Service. He later served as the in World War I. After his recovery, he “War to End All Wars.” Phillip Van Ingen first health officer in Havana during the served with the British 25th Stationary enlisted as a captain shortly after the American occupation of Cuba.6 At least Hospital in Rouen, France, and finally declaration of war by the United States 2 other practicing pediatricians, Dr with the American Red Cross Military in 1917. By war’s end, he had been Charles Boyton of Atlanta and Dr Everett Hospital in Paris. He later authored A promoted to lieutenant colonel serving Hawes who “served in the U.S. Marine Manual of Common Contagious Diseases, in France and Italy in command of Field Hospital Corps as an Assistant Surgeon,” one of the classic infectious-disease Hospital No. 331, receiving La Croce al also took part in the conflict. A rising texts of the time until its final edition Merito di Guerra from the Italian gov- star in pediatrics, Dr John Howland, in 1956.10 ernment for his meritorious service.13 served as an Army physician shortly A number of other pediatricians stood Dr Borden Veeder, a St Louis pediatri- after his medical school graduation out for their individual service. Dr John cian who was on staff at the Washington from New York University. Howland Amesse continued his wartime service University Medical School, deployed worked on the hospital ships that begun in the Spanish–American War by with Base Hospital No. 21, becoming the brought troops suffering from typhoid ’ ’ serving as a lieutenant colonel in the hospitals commander by wars end fever from Cuba to New York. A decade Army Medical Corps. He first com- (Fig 2). Dr Veeder would later direct the later, Dr Howland created the first full- manded Base Hospital No. 29 organized wartime efforts of the AAP as one of its time university clinical department in by the Medical School of the University presidents during World War II, then go pediatrics in the United States at the of Colorado, then was transferred to on to become editor of the Journal of Harriet Lane Home at The Johns Hop- 14 Base Hospital No. 15 in France where he Pediatrics during the postwar years. kins Hospital in Baltimore.7 served until the war’s end.6 Major One of his staff physicians and fellow James H. McKee, a pediatrician from pediatricians at Base Hospital No. 21, PEDIATRICIANS AND “THE GREAT Philadelphia, became one of this Captain Hugh McCulloch, would later WAR” country’s first military flight surgeons go on to be the founding editor of Pe- When the next generation of Americans serving in the United States Army Air diatrics.15 sailed off to fight in the trenches of Service. After the war ended, he also Two other pediatricians who were soon Europe in World War I, pediatricians became one of the first Americans to fly to be nationally known, Dr A. Graeme again went with them. Remembered one from coast to coast, with a squadron Mitchell and Dr Rustin McIntosh, served critic at the start of the World War II: “In commanded by Colonel “Hap” Arnold, early portions of their medical careers the First World War, many of the pedia- who was later to become the only during World War I. Dr Mitchell, soon tricians were used indiscriminately in 5-star general in the history of the Air to publish one of the preeminent texts the Army in all sorts of medico-military Force.11 on pediatrics, Diseases of Infants and

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freely. In this time period before the American involvement in the war, they were even able to visit German military hospitals. From a German officer, the group learned of imminent German plans to usepoison gason the battlefield.Making their way through Holland and secretly back to England, Davison reported this information to the British authorities, but the threat was not acted upon. Ten days later, the Germans used chemical weapons successfully for the first time at Ypres, Belgium. Dr Davison returned toandgraduatedfromJohnsHopkinsin 1917. He returned to France as a first FIGURE 2 Dr Borden Veeder (second from left, front row). lieutenant with the American Expedi- tionary Force serving for the remainder of the war.20 Children, served with the American the Duke University Medical School, as In the presidential address before the Expeditionary Force in France and well as one of the nation’s most well Twelfth Annual Meeting of the AAP in Germany, finishing the war in the rank known pediatricians, may be the most Chicago on November 7, 1942, then- of major.16 Dr McIntosh, who would go incredible of the wartime doctors’ president Mitchell remarked that “The on to be a long-term director of the tales. Davison won a Rhodes Scholar- history of World War One records great Columbia-Presbyterian Medical Center ship in 1912 and entered Oxford’s accomplishments by the medical pro- in New York City, served for 3 months Merton College as a medical student in fession and certain specialist groups. on the front lines with the 5th Marines 1913. At Merton, he became a friend of The contributions of pediatricians, how- before the war ended. He was then Sir William Osler and was often a guest ever, not as individuals, comprise an assigned to a translation bureau of at his home for dinner. With a letter of unwritten chapter in that history. Fu- the American Commission to Negotiate introduction from Osler and a year of ture historians may be able to pass on Peace.17 medical school under his belt, Davison to posterity a better record of achieve- Detailed recordsof wartimeexperience was given a position at the American ment on the part of the pediatric group ”21 wereleftbyotherpediatricians.Captain Red Cross Ambulance Hospital in Neu- of this era. Sadly, no complete record Marshall Pease joined the American illy, France. Over the course of his of pediatricians serving in the military fl Expeditionary Force in April 1917 with 6-week winter vacation of 1914–1915, he during this con ict was ever compiled, a group of fellow physicians from the worked his way from being an orderly to and much of the story has been lost New York Post Graduate Hospital. His being a wound-dresser to being an forever. letters home and the tales they con- anesthetist. PEDIATRICIANS IN WORLD WAR II tained were later chronicled in book Taking a leave from classes at the end of form, including his care of a French his vacation, Davison accompanied a The world was again engulfed in war child dying of tuberculosis.18 In a letter volunteer medical group to go to Serbia two decades later, and America mobi- to his old college newspaper, the Beloit and care for patients during the worst lized its resources for its seemingly Alumnus, he reported that “meningitis, typhus epidemic of modern times. Trav- inevitable involvement. There was dis- diphtheria, pneumonia, dysenteries, and eling back through Italy and Austria, he pute as to how pediatricians could best the many other infectious diseases, some was later detained and interrogated serve their country. Several of the of which are rare and some of which are when his group reached the German founding members of the AAP and feared, call for much investigation and border. Allowed to leave with 2 soldiers a number of past presidents were vet- instant action.”19 as guards, Davison and his other Amer- erans of military service in World War I. The story of Wilburt C. Davison, who was ican colleagues were able to slip their Not all believed that their medical ex- to become the founder and first dean of escorts and travel through Germany pertise had been used wisely in that

PEDIATRICS Volume 129, Supplement S1, February 2012 S35 Downloaded from www.aappublications.org/news by guest on September 29, 2021 conflict. The pre–World War II Army had ourselves as to what the pediatrician meeting the terrible situations which no pediatrician serving on active duty. can do to help. On every side we find the warfare of today brings to the chil- Care was provided to dependent chil- colleagues in other special fields, as dren of a nation at war or overrun by the dren in the local community or in some surgery and its subspecialties and enemy.”22 instances by Army general practi- psychiatry, organizing to give their best Also recognized were the problems of tioners as a part of their additional knowledge to the new army which is human migrations that the war was duties. being developed and to prepare tech- causing, both for service members and One potential role for pediatricians be- nically for a war we do devoutly hope for wartime plant workers and their came clear as soldiers were inducted will never take place. The early days of families. An article in the Journal of into the Army and exposed to a range of American participation in the World Pediatrics in winter 1941 summed up infectious diseases. In an address be- War in 1917, when army medical pre- the problem: “Migration of families has fore the Tenth Meeting of the AAP in paredness was quite a different thing increased very greatly, with all its Memphisin1940,WorldWarIveteranDr than it is today, found many pedia- concomitant hazards to the health and Philip Stimson discussed what he had tricians entering army service, and welfare of children ....Idonotneed to witnessed in his time in the service in name after name of men of the older tell you what life in a trailer camp that war: “It is not widely known that group comes to mind, who served in means to children or to their mothers fi fi mumps, measles, scarlet fever and the eld, or with eld ambulances and when a one room trailer becomes their diphtheria between them caused a loss hospitals, both abroad and at home. permanent family dwelling place. . . . of almost six and a half million days of Not a few rose to positions of respon- Add to this the withdrawal of physi- availability of United States soldiers in sibility....Whileincaseofwar,anum- cians, including pediatricians, and the the last World War. . . . In fact, in 1918, ber of pediatricians will enter military civilian population to enter the Army or the speaker was on duty at a British service either for the element of ad- Navy, and the situation becomes still hospital for Contagious Diseases at venture, or in order to maintain a cer- more difficult to handle.”23 tain necessary self-respect arising from Rouen, in France where at one time At the AAP’s annual meeting in Boston, the dictates of their emotions, clear, he had soldiers from eleven different a “Symposium on the Role of the Pedi- hard, unemotional thinking leads defi- nations as his patients in a single large atrician in National Defense” was held ward for mumps.” nitely to but one conclusion. The trained pediatrician has a much more impor- in October 1941, just 2 months prior to In discussing the American experience, tant function in the warfare of today the attack on Pearl Harbor. Dr Stimson “ “ he related that Boys who have grown than military service with the army or remarked that It seems advisable to up in backwoods districts, on farms, or navy. It has been demonstrated clearly try and have pediatricians spared from fi in other rural communities have usu- in the last year that war today is a total being used as regimental medical of - fi ally never been exposed to any such war, involving the civilian population as cers, hospital supply of cers and the infections, and when thousands of these much as the troops in the field. To win like in the present emergency, but ra- fi rural young men are rst massed to- a war, it is as essential to maintain the ther to keep them available to support gether in army camps, contagious dis- morale and health of the civilian pop- civilian needs. Men especially trained fi eases are apt to be very common. ulation as it is to maintain the health of in contagious diseases and in the eld Therefore, in 1918 some army camps the troops or to care for the wounded of nutrition could be of value to the ”8 actually had relatively 100 times as after battle. Here, we sincerely believe is armed forces . . . . many cases of a disease as did other the field in which the pediatrician, be- Dr Davison, at that time the chair of army camps. It is in the hospitals of cause of his particular training and pediatrics at Duke University, spoke such camps where pediatrists can be sphere of work, can be of most service. from experience on how pediatricians ”9 useful. It is along these lines that our thoughts could fit in the national defense pro- An anonymous editorial published as should be directed and our organization gram. In his article “Reduction of the lead article of the February 1941 be pointed. The problem of the child and Communicable Diseases among Troops issue of the Journal of Pediatrics sug- child health has been a major one in and Children during National Defense gested that AAP members should serve every country so far involved in the war. Program” published in the American their country in a different manner. “In The pediatrician with his store of tech- Medical Association’s new journal War this time of national organization for the nical knowledge relating to child health Medicine, Davison commented: “One in defense of American life and freedom, and welfare can best help the nation as every 133 in the military services (of the question is frequently asked among a whole by directing his efforts toward the United States in WWI) died of

S36 BURNETT and CALLAHAN Downloaded from www.aappublications.org/news by guest on September 29, 2021 SUPPLEMENT ARTICLE infectious disease. Judging by the ex- president-elect and war veteran Borden special training. If a pediatrician for- perience of the last war, the best and Veeder summed up the consensus gets in a few years of Army medicine all most efficient way of utilizing a pedia- feelings in his remarks at an AAP lun- of the pediatrics he has learned to date, trician is as a medical officer in the cheon in summer 1942: “The first duty it does not speak well for his mental field of infectious disease. Training in of the medical profession in a war such ability or interest in the specialty.”25 pediatrics does not fit the physician for as this, whose outcome will determine By late fall 1942, 162 of the 1496 mem- any other type of military duty unless oursurvival,istothemilitaryforces.... bers of the AAP were serving in the as a mess or lab officer . . . . Therefore, Some sixteen months ago, almost a military, along with “many pediatricians whether pediatricians serve as medi- year before Pearl Harbor, before either who are not yet eligible to the Academy cal officers with troops or practice as you or I or anyone else knew what was who are now in the Army or Navy.” Dr civilians with children, they must con- in store for us, an editorial was drafted, Edward Clay Mitchell, Great War vet- cern themselves with the reduction of approved by the Editorial Board, and eran and outgoing president, pledged communicable diseases, or preventive published in the February, 1941, issue “to offer the services of pediatricians ” pediatrics. of The Journal of Pediatrics which stated to our country with no restrictions.”21 “To reduce this incidence of infectious that warfare today was a total warfare From June 1942 until June 1947, the diseases in troops, pediatricians would and that the pediatrician would prob- Journal of Pediatrics, then the “Official recommend the adoption of the pre- ably be of more value in civilian life Organ for the American Academy of ventive measures which have been than in service. None could foresee at Pediatrics,” published a monthly to bi- found to be efficacious in children. that time the extent to which this world monthly listing of AAP members in the Some of these precautions at present madness would reach. Today the situ- service. Never before and never since are being used in the Army and Navy, ation is different. I am sure, although has the AAP been so forthright with its but more of them should be applied. I have not consulted with them, that support of its members serving in the To be specific, as soon as a recruit is the group who thought as I did then, military. AAP dues were not to be inducted into service he should have would agree that our first essential assessed against fellows while they Schick, Dick, tuberculin and Wassermann duty is to win the war and that only an were on active duty and for 1 year after tests, be vaccinated against smallpox overwhelming military force can their release from the service. Fellows andbeinoculatedwithtyphoid- bring this about, and all else must be in the military could continue to receive paratyphoid vaccine and tetanus subordinated.” the Journal of Pediatrics for a dis- toxoid. . . . Alternate recruits should A second speaker, Major Robert Bier, counted annual fee of $5.00 per an- receive influenza vaccine in order that member of the AAP and an assistant in num. Candidates for examination for data on its immunizing value may be the Medical Division of the Office of the American Board of Pediatrics could collected.” SelectiveService,addedtheseremarks: substitute 1 year of military service for Dr. Davison closed his treatise with this “The Army is in dire need of thousands 1 of the 2 required years of pediatric recommendation, “During the last war, of additional physicians to serve in practice or continued study. Brig Gen J.M.T. Finney served as con- their forces, and a somewhat smaller For the first time in its history, the an- sulting surgeon and Brig Gen W.S. number is needed by the Navy ....It nualmeetingoftheAAPwascancelledin Thayer as consulting physician. Per- would appear to be unwise for any fall 1943 “in order to help the railroad haps in the present emergency, a con- young physician, especially for the pedi- transportation problem brought about sulting pediatrician who has had atrician,toattempttostartpractice.... by the war and the shortage of physi- experience in preventing communica- There are a few permanent stations cians in civil life.” Dr Veeder’s presiden- ble diseases should be appointed. In where the attending physician is called tial address, published in the December the light of the figures on the frequency upon to care for children of the post, issue of the Journal of Pediatrics, up- of children’s diseases in the Army and but the needs in this respect are either dated the situation of pediatricians in Navy during the last war, this sugges- filled or so small as to be discounted. the war effort. “Pediatrics, we must re- tion is not as foolish as it may seem.”24 For all practical purposes, there will be alize, is not a medical specialty closely By 1942, in the aftermathofPearlHarbor no pediatricians in the Army. Many of related to military medical efforts. De- and America’s declaration of war on the younger pediatricians in practice spite the fact that there is no particular the Axis powers, any hope that pedia- and postgraduate training have com- place for the pediatrician as a pediatri- tricians could choose their assignments plained that if they go into the Army for cian with the Armed Forces, 310 Fellows in the military had disappeared. AAP several years, they will forget their of the Academy, nearly 22 per cent of our

PEDIATRICS Volume 129, Supplement S1, February 2012 S37 Downloaded from www.aappublications.org/news by guest on September 29, 2021 membership are in the service. This is a the 12th Surgeon General of the United the executive officer then commander high figure when we consider that only States.28 of the 309th Medical Battalion, which between 3 and 4 per cent of our mem- Other pediatricians played more sub- was attached to the 84th Infantry Di- bership are under 35 years of age, and stantial roles during the war. Captain vision during the Battle of the Bulge. 35 per cent are in the 35 to 45 year George Lyon served as the chemical After the war, Dr Geppert had a distin- age group. There are, of course, many warfare officer on the staff of Com- guished career in Army pediatrics. He more pediatricians than this in service, mander, United States Naval Forces, establishedthefirstpediatricserviceat as over 2,100 pediatricians have been Europe. He was “chiefly responsible for an Army hospital at Brooke Army Hos- certified by the American Board of Pe- the training in defense against chem- pital in 1946. He later served as theater diatrics. A very large portion of the 600 ical warfare of the Naval forces orga- consultant in pediatrics, Armed Forces odd certified by the Board and eligible nized in the United Kingdom for the of the Far East, then after stints as chief to Academy membership but are not assault on North Africa, and organized of pediatrics at Walter Reed and again members are in service. Of the men in the program of instruction for all Naval at Brooke, he retired from the service service, a few have been assigned to personnel engaged in the operations in 1964.32 contagious disease and sanitary ser- against the coast of France.” He was One of the most recognizable names in vice, and a very few are actually prac- awarded the Bronze Star by the com- military pediatrics is that of Ogden ticing pediatrics in Army and Navy mander of United States Naval Forces, Bruton. In 1940, he was conscripted as camps. Letters from all over the world Europe, for his efforts.29 Dr Harry Gor- a reserve officer to serve 1 year in the have crossed my desk from pediatri- don served as the assistant chief of the expanding peacetime Army. His con- cians doing a wide variety of medical Medical Service and was in charge of scription launched a 21-year career in military duties. Even if pediatrics is a the tropical disease section of the the Army that took him around the specialty that does not fit directly into sprawling 3000-bed Harmon General world, from Washington, DC, to Germany the medical picture of military organi- Hospital near Longview, Texas. Dr Gor- to Panama and to Hawaii. In 1946, he zation, there has been ample demon- don went on to serve on the editorial became the consultant to the Army stration of the spirit of the physician board of Pediatrics and to publish Surgeon General for pediatrics andwas whose medical work is with children, more than 100 papers in neonatology tasked with improving the health and and we can look with pride on our as- and developmental pediatrics.30 Dr safety of the infants of “war brides” as sociates who have entered service.”26 Horace Hodes served as the officer in they made their passage to the United The roles that individual pediatricians charge of the Virus Laboratory, US Na- States from Europe. The importance of played in the war effort were quite val Medical Research Unit No. 2 in Guam. this mission was made even more ur- varied. Some pediatricians had small In Guam he did seminal work with gent as an epidemic of diarrhea sick- roles in the conflict but later went on to Japanese encephalitis and later in ci- ened 19 and resulted in the death of prominence nationally. Dr Benjamin vilian life was a part of the research 6 infants on the US Army transport ship fi 33,34 Spock, rejected for Army service due to group to isolate the rst known cause of Zebulon B. Vance. a previous pneumothorax, joined the viral diarrhea in humans, now known as In spring1948,againat thebehest of the Navy in 1944 and served as a psychia- rotavirus.31 Army Surgeon General, Dr Bruton trist at military hospitals in the United In this conflict, the first female pedia- inspected the pediatric care facilities of States until 1946. During his free time in tricians served on active duty in the the US Army in occupied Germany and the service, he wrote what was to be- military. Dr Anna Hays and Dr Joyce Austria. Returning to the United States, come one the best-selling American Hartman both served as lieutenant com- Dr Bruton led the efforts to create the books of all time, The Common Sense manders in the United States Naval Re- Army’s first pediatric training program Book of Baby and Child Care, published serve (USNR). Dr Marion Josephi finished at Walter Reed. It was during his time at in 1946 just in time for the postwar her career as a commander in the USNR. Walter Reed that he published his land- baby boom.27 Dr Julius Richmond vol- Several other physicians served whose mark work on the disease that now unteered his efforts and served as a names,butmaybenotwartimecareers, bears his name, Bruton X-linked agam- flight surgeon stateside in the Army Air are familiar to members of the Section maglobulinemia, based on observations Forces Training Command from 1942 on UniformedServices of the AAP.Dr Leo he made in the care of a “military de- until 1946. He later was appointed as Geppert was commissioned as a sec- pendent.” the first director of the national Head ond lieutenant in the US Army in 1941. Much of the historic record of the pe- Start program and went on to become During the war, he served as both diatricians who bravely served in World

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War II has departed with the memories the citation read, “rendered extremely 13 and 14 October 1943 . . . during an of those of the “Greatest Generation.” valuable service in the treatment evac- attack by an infantry regiment over the There are a few who served whose uation of wounded personnel, frequently Volturno River . . . Captain Connell fol- heroic wartime exploits have been doc- facing great danger in the performance lowed the infantry across the river and umented. Dr William Wallace, a future of such duty. His courageous devotion to by his own ingenuity organized routes driving force in the expansion of the duty, tireless efforts and high profes- of evacuation of battle casualties. All Rainbow Babies and Children’s Hospi- sional skill contributed materially to the through the attack which lasted two tal in Cleveland, served 4 years as an success of the Okinawa campaign and days Captain Connell supervised the infantry battalion surgeon and took were in keeping with the highest tradi- proper function of new routes and part in the North African Campaign, tions of the United States Naval Service.”37 constantly reconnoitered to improve, the invasion of Sicily, the landings in The most highly decorated pediatrician shorten or hasten the evacuation, even Normandy, and the Army’s final push in- to ever serve in the US military was Dr though the routes were under enemy to Germany.35 Saul Krugman, who would John Connell (Fig 3). Dr Connell grew fire. He made several trips across the go on to be one of the most well-known up in Iowa and then graduated from river which was still under enemy ob- pediatric infectious disease physicians Washington University in St Louis in servation and heavy artillery and mor- in America, joined the US Army Air Corps 1937. He joined the National Guard as a tar fire. Undoubtedly the ingenuity and in June 1941. He served until 1946 as medical officer and then entered active perseverance of Captain Connell, and a flight surgeon earning the Bronze duty in the Army Medical Corps in 1941. the calm and courageous manner he Star. In one 13-month period alone, from By 1943, he had become the comman- performed his duties, saved the lives of August 1944 until September 1945, Dr fi “ ” many battle casualties and was in- fl ding of cer of Company C, 109th Med- Krugman ew more than 115 000 miles strumental in their being evacuated — ical Battalion, which was then attached mostly aeromedical evacuation mis- more quickly from the front lines . . . .” sions.36 The August 1946 issue of the to the 34th Infantry Division. ’ Journal of Pediatrics gives an account After the Allied Invasion of Italy, German Captain Connells service in the battle of the Bronze Star awarded to Lieuten- forces had set up defensive positions came to an abrupt halt in the early af- ant Harold A. Rosenberg of the USNR. south of Rome, the southernmost along ternoon of October 14, when his Jeep ’ The citation was made for “meritorious the Volturno River forming the so-called ran over a land mine near D Annun- services in connection with operations “Volturno Line.” In 2 short days, Captain ziata, Italy. Suffering a concussion as against the enemy as a medical officer Connell’s actions would earn him the well as a left frontal bone fracture, attached to a Marine Air Base in the US military’s third-highest award for Captain Connell was evacuated back to Ryuku Islands, during the period April 5 valor, the Silver Star. The citation for the United States where he became one to June 7, 1945.” Lieutenant Rosenberg, his award tells the story: “In action on of 13 pediatricians of World War II to be awarded the Purple Heart. He served out the remainder of the war stateside, being promoted to the rank of major. Dr Connell went on to have a long and distinguished career in pediatrics. He helped to found what would become the RockyMountainPoisonandDrugCenter because of his “concern about acci- dental aspirin deaths.” He was also involved in the work in designing the original Denver Developmental Screen- ing Test. Dr Connell worked his way up to become medical director at Denver Children’s, then later served as the di- rector of pediatrics at the then Denver General Hospital. Remembered by friends and family alike as a quiet and FIGURE 3 humble leader who let others flourish, Captain John Connell. he died in 2003 at the age of 93. Most of

PEDIATRICS Volume 129, Supplement S1, February 2012 S39 Downloaded from www.aappublications.org/news by guest on September 29, 2021 his colleagues knew little about his war The World War II era was a pivotal time almost all specialties. One aspect of service, and even fewer knew about his for American pediatrics. Pediatricians this program, important to all pedia- heroic actions in the dark days of fall had proved their worth on the battle- tricians, is that in the event of another 1943.38 field,andtheirabsenceathomeshowed mobilization the consultants who have There is no accurate count of how many theirimportanceinAmericanmedicine. been appointed to the Surgeon General pediatricians served with the Army, Commented Deputy Surgeon General in pediatrics will have a strong voice in Army Air Forces (the predecessor of of the Army George Lull: “In the Army the adequate utilization and assign- ”43 today’s Air Force), and Navy in World there was no need for such special- ment of pediatricians. Likewise, Navy War II. On July 1, 1940, there were 1562 ists as obstetricians, gynecologists military pediatric residencies were physicians in the United States with or pediatricians. Let it be said of this created as the American military needed fi board certifications from the American group, however, that they volunteered to remain of suf cient size to meet the Board of Pediatrics. The AAP reported to do anything they could for the war new challenges of the Cold War. Fami- ∼100 of its members in the Army effort.”39 The mass migration of the lies and children had become a part of Medical Corps by fall 1941. By fall 1942, American populace during the war the US military landscape worldwide, and military pediatrics was here to the number of AAP pediatricians in coupled with the departure of the ma- stay. the military service had risen to 162 jority of pediatricians under the age of of a total membership of 1500, and 45 for the service left a gap of care for by January 1945 this percentage in- the children of those who had newly KOREA joined the military and for the families creased to 355 fellows of the 1740 in Less than 5 years of tentative peace of those who worked in the defense total membership. The pages of the were shattered in the early morning industry. A portion of the care was Journal of Pediatrics listed the names hours of Sunday, June 25, 1950, with the provided to more than 230 000 infants of 453 pediatric members of the AAP invasion of South Korea by the forces of under the age of 1 by the Emergency who served in the military during the communist North Korea. Again, Ameri- Maternal and Infant Care program, course of World War II: 304 were listed can pediatricians were at war in a dis- 40 as having served in the Army, 127 in the known as EMIC. This care allowed the tant land. In the drawdown of the Navy and Marine Corps, and 5 as having enlisted in the lowest ranks of the military and its medical services fol- served in the Army Air Forces. For 17 military to receive subsidized care for lowing World War II, this was a conflict serving members, no service of record their children, often provided by the for which America was ill prepared. few overworked civilian pediatricians was listed. This is at best a partial Summer 1950 saw the Army Medical who remained. Commented one physi- count, as those who interrupted their Corpswoefullyundermanned.TheEighth cian: “Before EMIC, many parents did pediatric training, as well as those who Army, which staffed medical units in not know that a pediatrician was not a had completed their training, but were both Japan and Korea, had only 156 foot doctor.”41 The old adage, “if the not yet diplomates of the American physicians assigned, although they had Army wanted you to have a family, it Board of Pediatrics, were not included an authorized strength of 346 doctors. would issue you one,” was passing by in the list. Data collected on the ∼52 Of the total number of physicians the wayside. 000 physicians on active duty with the present, 13 had completed an intern- Army in January 1944 showed 21 741 In 1943, the Army opened up its first ship or a portion of their residency in with specialty qualifications of some pediatric ward at Brooke Army Hospi- pediatrics. The majority of the remain- sort. Of this number, 963 (4.4%) had tal.42 In the December 1948 issue of der of the physicians had only a year- some training in pediatrics with 320 Pediatrics, the new “Status of Pediat- long rotating internship of training listed as having “Outstanding Ability” rics in the United States Army” was beforetheywerethrustintotheconflict. or “Superior Training” in pediatrics with outlined: “Pediatricians who served in Hospital staffs were depleted in Japan the ability to perform pediatric duties the armed forces during the war will as physicians were quickly transferred without supervision. Another 386 had be interested to learn that pediatrics to staff the 8054th Evacuation Hospital recently completed pediatric training, as a specialty has been given recogni- as well as the 8055th Mobile Army Sur- with the final 247 including those who tion by the Army Medical Corps. With gical Hospital (MASH), 8063rd MASH, had finished a pediatric internship and the inauguration of residency training and 8076th MASH. At one point in late 1 year of residency or those who were in Army General Hospitals it became summer 1950, all of the medical offi- general practitioners with a “demon- apparent that pediatric experience cers, with the exception of the com- strated ability” in pediatrics.39 was essential to adequate training in manding officers of the hospitals, were

S40 BURNETT and CALLAHAN Downloaded from www.aappublications.org/news by guest on September 29, 2021 SUPPLEMENT ARTICLE physicians whose residency training completely useless; except maybe the now 72 hrs since I wrote the last par- had been interrupted. ‘keep your head down’ and ‘wear a hel- agraph; 72hrs of which I spent only ByOctober1950,thenumberofpartially met.’ When I resumed training in pe- 8 hours in my sleeping bag. We just trained pediatricians serving in Korea diatrics at Yale, ultimately as chief participated in another bloody but in Army units was up to 18. What could resident, we taught pediatric residents ‘successful’ attack. Things were worse a pediatric intern or resident new to to do cut downs, and tracheotomies.” than I have ever seen . . . .” Korea expect to be doing? For some, the (W. Nyhan, MD, personal communica- Dr Nyhan closed his letter with an assignment meant working in a dis- tion, 2009) apology for having lost a copyof a paper pensary away from the front lines, for A letter from Dr Nyhan to a pediatric that he and his colleague were working others working in a hospital, caring for colleaguebackatYaletellswhatlifewas on: “In the process of our last attack the wounded and for those with disease like as a physician on the front lines of it disappeared along with a camera, andnon-battle-relatedinjuries.Formost, the Korean War. “Geographically, I don’t razor and all of my clothes . . . judging the assignment meant working at a know where I am. I do know that I’m from where we were when I last saw Battalion Aid Station forward of the well into North Korea and about as far my bag, the Chinese may be reading surgical hospitals. Their primary duties north as any United Nations troops my paper.”45 there would be “to provide first aid, have gotten at this particular time. Young doctors were changed forever by resuscitation measures such as the Medically, I’m in as bad a spot as one their experiences in the war. Robert establishment of adequate respiratory can get. I’m what is known to the Army Endres served in Korea from 1951 to exchange, shock therapy, before and as a Battalion Surgeon—there is one 1952 after completing a rotating in- during evacuation, the alleviation of to each Battalion of troops—and I’m ternship. He was the chief medical of- pain and apprehension, the institution in a Battalion Aid Station. This is the ficer of a dispensary attached to the of antibiotic therapy and the adminis- furthest forward of the Army’s medical 110th Replacement Battalion. For 3 tration of the routine tetanus toxoid installations and we are the first to see months in summer 1951, he served in booster injections, the necessity for casualties off the line. Our position now the combat zone near Inchon, and then timely, early evacuation and distribu- is about a mile from the front but we’re his work slowed as the fighting moved tion to appropriate surgical or evacu- very mobile. Two days ago we were on to the north. His unit’s chaplain had ation hospitals.”44 One of these young the line itself. A crazy job for a pedia- started an orphanage in Inchon in an aid station doctors was Dr William trician—but this is a crazy Army. One of attempt to care for some of the hun- Nyhan, soon to become a well-known my aid men, a corporal, has a Master’s dreds of children who needed food, name in pediatrics. His residency in Degree in Engineering and another a clothing, and shelter (Fig 4). He asked pediatrics at Yale was interrupted by Bachelor’s in Music Composition. The Dr Endres to “see the sick kids when I a 13-month tour of duty in Korea. Re- Army is so full of such incongruities had finished up with my troops,” and members D. Nyhan: “I joined the 5th that I find it hard to complain.” the young doctor obliged. Although he Regimental Combat Team, and imme- “We see so many badly wounded—very had a residency in surgery lined up diately after I arrived there we were badly wounded men every day that it’s upon his return to the United States, Dr in a furious fire fight. I was battalion difficult to complain at all. I hated the Endres enjoyed caring for the children surgeon for the first battalion. I don’t Army throughout (my time in) Texas so much that he changed his residency think I slept at all my first night with the and on my rapid journey over here, but to pediatrics, eventually enjoying a ca- outfit. There was a lot more of that as even that passes in this sort of work. reer as a pediatrician in Tulsa, Oklahoma we kept moving forward. Ultimately we One can only hate war here. No one (R. Endres, MD, personal communica- got to a stable position and spent the wants to be here—not even the Chi- tion, 2009; Fig 5). winter with our troops on connecting nese I’ve seen. It’s just heartbreaking Creative ideas were put into place to fill high hills and the enemy on the next work. Living is primitive, but not bad the depleted ranks of Army physicians group of hills north. My life went from yet. We all dread the arrival of winter. who had been deployed to Korea. In acute care of battle wounds to general The Army is on the move forward—has September 1950, Operation NavMed was practitioner trying to keep the troops been since I arrived. So we don’t stay in launched to furnish 570 Navy physicians healthy, with of course some acute care one place for more than a day or so. We to serve in Army hospitals and clinics of wounded soldiers, but much less. I sleep on the ground—there is a tent for worldwide, including Korea. After a day was impressed that the training the patients, only rarely for us. It depends of in-processing, these doctors were Army gave us during basic was virtually on the load.” Continuing he writes: “It is given “three days of intensive Army

PEDIATRICS Volume 129, Supplement S1, February 2012 S41 Downloaded from www.aappublications.org/news by guest on September 29, 2021 in children with cystic fibrosis. The new- found colleagues spent days off at the orphanage setting up a “state-side hospital.” Working with the local Ma- sonic Lodge, the Children’s Hospital at Pusan, later to become the Pusan Child- ren’s Charity Hospital, the first children’s hospital in Korea, was born47 (Fig 6). Sadly, almost nothing about the service of pediatricians, pediatric interns, or residents were included in the pages of the Journal of Pediatrics or the AAP’s new journal, Pediatrics. No listing of those who served was ever published, nor was any mention of their service made during the yearly address of FIGURE 4 the AAP president. Dr Grover Powers, a Orphanage in Inchon, Korea. contributing editor to Pediatrics, did briefly mention how pediatric interns were doing in his 1953 essay “Some pediatrics at the Children’s Hospital of Observations on Pediatric Education”: Pittsburgh where he would eventually “One can acquire in a year of organized, become the medical staff president, he focused experience under inspiring was given 3 weeks’ notice to report to guidance in several aspects of one duty and was soon off to Korea. While discipline, high standards, sharp cri- stationed in the city of Pusan, he served tiques and the ability to accurately and as a “Port Surgeon” in a dispensary. intelligently appraise, relate and apply Recalled Dr Mermelstein: “One night a data in the humane practice of medi- Korean Medical Advisor came to my — FIGURE 5 cine probably the most tender and dispensary, telling me that they needed Dr Robert Endres. sensitive are of human relations, these a doctor as one of the children was verities are never out-of-date! Physi- dying at the orphanage on the hill. We cians so trained and conditioned are orientation, which covered Army Med- got to the orphanage and the child had prepared to meet the exigencies of fu- ical Service in the field, and in fixed a diphtherial web in the back of his ture responsibilities in much wider hospitals; radiologic defense, military throat.” Dr Mermelstein performed a fields of medicine; I have noted this too correspondence, law and courtesies; tracheotomy on the child, though he many times to have doubts of its es- medical supply procedures; military had never done one before as a resi- sential validity eg effective battalion preventive medicine and neuropsychi- dent. In looking around the orphanage, surgeons in World War II and in Korea atry; and legal and personal affairs.” he saw what he described as “an irri- after ‘straight’ pediatric training.”48 Nearly 10% of these physicians were table museum of chronic pediatric dis- pediatricians or pediatric residents orders.” Fortuitously, Captain Giulio VIETNAM whose training was interrupted. Ac- Barbero, who had recently completed cording to the July 1951 issue of the his pediatric residency at Children’s For the first time in any American con- Military Surgeon, which detailed the Hospital of Philadelphia, was also in flict, pediatricians were deployed to operation, “This project was a complete Pusan. Dr Barbero, who during the war be used as pediatricians during the success, the entire group of Navy offi- served as the chief of laboratories of Vietnam War. They arrived early during cers was pleased and satisfied as they an Evacuation Hospital, as well as the the American involvement, initially to departed for their new duties.”46 chief medical officer of the 8228th care for the children of those American Dr Howard Mermelstein was one of MASH, would go on to become one of advisors stationed in Saigon. It is un- those Operation NavMed physicians. In this country’s early pediatric gastro- clear how many military pediatricians fall 1950, after starting his residency in enterologists and do pioneering work filled these positions.

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reasonable degree of ongoing care to the children. Vaccinations could be given and the nuns (most orphanages were Catholic Church affiliated) could keep some records of which children re- ceived them. Infectious skin diseases responded especially well to antibiotics plus proper cleansing with soap and water.”50 The Army’s deployment of pediatricians to Vietnam to serve as pediatricians was started with the establishment of the Civilian War Casualty Program. As the conflict grew in size, the numbers of civilian casualties began to mount. Directive Number 40-14 (MACV-66, sec. 3a) stated: “Vietnamese civilians in- jured by an instrumentality of the FIGURE 6 Armed Forces of the United States are Dr Giulio Barbero (left) and Dr Howard Mermelstein (right) examine a young Korean boy affected with authorized complete emergency care, arthritis of the hip. including hospitalization when neces- sary. Care is authorized to be continued until the patient’s condition is stabi- As American involvement grew, so Action Program (MEDCAP) I was a pro- lized sufficiently to permit discharge or did the number of pediatricians and gram in place from January 1963 until transfer to a civilian hospital or to a pediatricians-in-training who served. June 1967. In this program, American civilian facility for convalescence.” From 1954 until 1974, the so-called medical personnel advised the South Brigadier General Andre Ognibene com- “Berry Plan,” named after its creator, Vietnamese Army in how to provide mented on the roles Army pediatricians Dr Frank Berry, who served as assis- medical care to the medically under- played in Vietnam: “By 1968, all US Army tant secretary of defense for health served of their country. It is unknown Vietnam (USARV) hospitals accepted affairs, gave graduating medical stu- how many pediatricians participated Vietnamese civilians on a space-available dents 3 different options of service. The in this program. The more familiar basis. Pediatricians initially were as- first choice was to join their service of MEDCAP II involved medical elements of signed to these facilities, but pediatric choice immediately after their intern- all services providing outpatient care care never developed beyond a small ship year. After their 2 years of oblig- via mobile medical clinics, usually sim- effort for a limited number of patients. atory military service, they could then ple medical treatments with little op- Before the assignment of pediatricians continue on with their residency train- portunity for follow-up care. Beginning to hospitals, care had been provided by ing. A second option would be to elect in 1965, with increasing American me- an internist-surgeon team and, when to fulfill their military obligation after 1 dical infrastructure in Vietnam, this available, a general medical officer with year of residency, then return to com- sortofcarewasoftenattractivetothose some pediatric training. At the peak of plete their residency after their ser- whowantedtohelpthelocalpopulation, assignment in 1969, six pediatricians vice. A third option was to complete but it proved frustrating with organi- were assigned to USARV hospitals, as their residency training and then serve. zational and logistical problems. An in- large a complement as the dermatol- The Berry Plan meant that pediatricians volved physician discussed one manner ogy commitment. Their caseload was and pediatricians-in-training would be of care that did work. “I believe that the small, and their time was best spent found serving in the military throughout care provided in the Orphanages was assisting the internist in adult care. the Vietnam era.49 significantly better than in other ven- Most pediatric care was provided in the The American military was involved in ues. Even if there was no firm schedule outpatient setting by MEDCAP; indeed widespread humanitarian aid pro- for revisits, if they occurred on a regu- most Vietnamese families were reluc- grams during the conflict. Medical Civic lar basis it was possible to provide a tant to release their children for care

PEDIATRICS Volume 129, Supplement S1, February 2012 S43 Downloaded from www.aappublications.org/news by guest on September 29, 2021 in USARV hospitals.” Consequently, after internist, and himself as the pediatrician. was that of Lieutenant Commander 1969, medical consultants urged that After training in tropical medicine was Frederick “Skip” Burkle. In 1968, after pediatricians not be assigned to USARV provided by the Army at Camp Bullis, completing a senior residency in pedi- hospitals. By the end of 1971, the abor- Texas, they were off to Vietnam. He took atrics, Dr Burkle was assigned as a tive pediatric program in USARV hos- his written pediatric board examination general medical officer with the Third pitals had ended.51 in Saigon and then became familiar with Marine Division. Seven miles south of One additional program that used pe- the real-world problems of pediatrics the Demilitarized Zone in the village of diatricians as pediatricians was the in Asia—malaria, tuberculosis, plague, Dong Ha, more than 85 000 refugees Military Provincial Hospital Assistance and the traditional methods of child had gathered, displaced from areas in Program (MILPHAP). In a letter to the care such as cupping, coining, and the northern and western Quang Tri prov- editor published in the November 1966 application of cow dung to the umbili- ince and from the fighting around Khe issue of Pediatrics, Lieutenant Com- cal cord stump. Marine guards pulled Sanh. At the Dong Ha Combat Base, the mander Wesley Boodish described security while they worked in the pro- 110-bed Third Marine Division Memo- what it was like to be on a MILPHAP vincial hospital. rial Children’s Hospital, an integral part team. “I head a 16 man Navy medical A vivid memory of Dr Jacobson’sisof of Delta Med’s Casualty Receiving Facility, team situated in Quang Tri . . . there are being invited to dinner by the local was opened to the refugee population now 21 of these military medical teams mayor shortly after his arrival in coun- “to help check the rising numbers of in South Vietnam—Army, Navy and try. The main course was presented childhood deaths and serious disease.” Air Force—each consisting of three with a complete chicken head bobbing It was the only health facility for a prov- doctors, an administrative officer, and up and down in the broth—the mayor ince population of more than 300 000 twelve corpsmen. It is perhaps not well proclaimed that this was for the spe- residents. publicized that the military is involved cial guest. Finding no way to escape, Dr In a classic case of “mission creep,” in such a large role, not only in pro- Jacobson prepared for the worst, only Lieutenant Commander Burkle’s job in viding medical care to the civilian to be surrounded by gales of laughter Vietnam became that of a full-time pe- population, but also in upgrading the by his hosts who were pulling a favor- diatrician, working alongside a handful capabilities of the Vietnamese to care ite practical joke on the newcomer of other Navy general physicians and for their own. Certainly here is a per- (J. Jacobson, MD, personal communica- surgeons, often while under fire. One fect opportunity for the young pedia- tion, 2009). Dr Kilpatrick’sexperiencein of Dr Burkle’s most memorable cases trician to combine his military service Hoi An was similar but reflected the also serves as a cautionary tale for with the practice of medicine in South changing environment of the sur- those working overseas: “A five day old East Asia.” Dr Boodish went on to de- rounding countryside. Despite the infant was passed across the wire after scribe the challenges: “After working at fact that he worked in civilian clothes, the hospital was closed for the night. the hospital for a short time, it was he remembers that they “took a lot of The infant was septic and apneic. I used apparent that despite my newly ac- incoming rounds and often had to head what I had (back then we only had quired ‘F.A.A.P.,’ I would have to cease to for the bunkers.” With a year of pediat- sulfa, penicillin and chloramphenicol) think of myself as primarily a special- ric internship, he had to grapple with —I had to have colleagues send me ist. Not only have I and the team had complicated cases of osteomyelitis, the ‘new’ Ampicillin from Yale Medical to grapple with and teach elementary tuberculosis, Salmonella, and diph- Center plus ‘steroids’ that were then concepts of hygiene, disease, and treat- theria. Recalls Dr Kilpatrick: “We went experimental. The infant was failing ment, but I have had to break out long there to teach the Vietnamese western rapidly so I decided to do a double forgotten skills in obstetrics, surgery, medicine, but we learned a lot from volume exchange transfusion—used orthopedics and anesthesia. Pediatrics, them.” (G. Kilpatrick, MD, personal at times before antibiotics were dis- in fact, despite a heavy case load, has communication, 2009) covered. I had two Marines donate formed only a small part of my time.”52 Although the total numbers of pedia- fresh blood and did this exchange . . . DrJedJacobsonandDrGerryKilpatrick tricians and pediatricians-in-training with pulses of antibiotics ....About half were two other physicians who served who served in Vietnam is unknown, it way through the whole night’s slow in the MILPHAP program in the small can be safely said that the vast majority exchange the infant began to cease the town of Hoi An, south of Da Nang, in still served in general medical capaci- apneic spells and gained strength. . . . 1967–1968 and 1969–1970, respectively. ties—usually taking care of adult ser- The next morning the mother showed Dr Jacobson’s team had a surgeon, vice members. One unique experience up with a small gray coffin . . . believing

S44 BURNETT and CALLAHAN Downloaded from www.aappublications.org/news by guest on September 29, 2021 SUPPLEMENT ARTICLE for sure her child was dead. She fell to military personnel had fathered some mostly consisted of sick call and caring the floor and hugged my legs. Thinking of the children, and with the reluctant for heat injuries. In February 1991, the this might be what I needed to get more agreement of South Vietnam’s totter- unit moved to within sight of the sand kids in (we were in a Viet Cong con- ing government, then-President Ford berms that separated Kuwait and Saudi trolled area), the whole event came announced: “I have directed that C-5A Arabia. Final preparations were made back to haunt me. It was passed quickly aircraft and other aircraft especially for the attack that was to come.56 around Quang Tri Province that I had equipped to care for these orphans By this time, other pediatricians had ‘ ’ fl ’ taken out all the evil spirits and put in during the ight, be sent to Saigon. Its joined Dr Naylor in the desert. A total of ‘ ’ – ” fi good spirits . . . for the next 3 4 days I the least we can do. Tragically, the rst 31 Navy pediatricians served during the was overwhelmed with adults (in par- US Air Force transport plane, carrying Desert Storm/Desert Shield operations. ticular an insistent village chief with 243 Vietnamese infants and children, Dr Charles “Chuck” Morton, a devel- ‘ chronic complaints that I remove all crashed, killing 130 including at least opmental pediatrician fresh out of ’ his blood and give him new blood )... 78 children. The next day, more than training, deployed to Saudi Arabia in they walked out in disgust when I told 1000 infants and children, including 40 support of forward Air Force oper- them it would not work . . . even my of the crash survivors, made their way ations. Unfortunately, no record exists Vietnamese translator was threatened out of Vietnam for Clark Air Force Base of the total number of other Air Force because they thought he was not trans- in the Philippines. At Clark, hundreds pediatricians who deployed during this lating their demands accurately to me! turned out to help care for the children conflict, though it is known that some Lots of lessons learned—especially not on their stopover. Temporary “surro- served with evacuation and large area to go beyond what is culturally repro- gate mothers” assisted Air Force nurses support hospitals. Thirty-six pediatri- ducible” (F. Burkle, MD, personal com- and pediatricians in the care of these cians and a resident who had vol- munication, 2009; Fig 7). often ill and malnourished children. unteered to take a leave of absence Some required care in the ward and Dr Burkle was working at the hospital during his third year of training were intensive care unit before they could when it was severely damaged during deployed from the ranks of Army safely make their way to the American a siege in October 1968, re-injuring active-duty pediatricians. Another 25 mainland and eventual adoption at lo- many children already in the hospital pediatricians deployed from the Army cations around the world (K. Manney, from previous wounds. The hospital, in Reserves, part of the largest activation ’ “ fi personal communication, 2009).54,55 Burkles words, a tting Memorial to of medical reservists since the Ko- the men of the 3rd Marine Division who rean War. Of the 37 active-duty Army died serving the people of South Viet- THE PERSIAN GULF WAR pediatricians, 34 were men and 3 nam,” was destroyed by advancing The summer of 1990 brought a new were women. Twenty-nine were gen- North Vietnamese forces in 1972.53 challenge to the pediatricians of the eral pediatricians, and 8 were sub- fi A nal bittersweet pediatric experience American military—desert warfare. specialists.57,58 took place with the end of US military Saddam Hussein’s invasion and an- Pediatricians served a wide variety of involvement in Vietnam in 1975. Oper- nexation of Kuwait first brought about roles during the conflict. Lieutenant ation Babylift took place between the the American defense of Saudi Arabia Commander Naylor was the first 4th and 19th of April and involved the known as Operation Desert Shield, fol- American medical officer into Kuwait airlifting of more than 3000 infants and lowed by the expulsion of Iraqi forces City with the Marines. Heading in he children out of the country. American from Kuwait known as Operation recalled that “outside the skies were Desert Storm. black from smoke generated by oil Lieutenant Commander Gordon Naylor fires burning on the horizon. Even was likely the first pediatrician to de- though the sun was covered, I told one ploy to the region. Ten days after the of the guys I was with that I feel like this invasion, Dr Naylor shipped out of Camp is hell.” Although his battalion did not Pendleton, California, with an infantry suffer a single death during the con- battalion of the First Marine Division. flict, he did witness some horrific in- Thefirst3monthsofhistourwerespent juries: “It was not a happy experience in the desert of Saudi Arabia with his for me. But in a lot of ways, that time FIGURE 7 battalion, which was then the closest to was the best time for me. I was doing Dr Burkle with his memorable patient. the border with Kuwait. His work there what I knew how to do best.”56 Five of

PEDIATRICS Volume 129, Supplement S1, February 2012 S45 Downloaded from www.aappublications.org/news by guest on September 29, 2021 the Army pediatricians also served in had the opportunity to treat children civilian care in future conflicts; there- Battalion Aid Stations, the nearest while deployed.57 Dr James Brien, an- fore, every hospital unit should have at medical facilities to the front line, and 7 other pediatric infectious disease spe- least one pediatrician. Pediatricians were awarded the Combat Medical cialist, was assigned as an internist to should be identified in doctrine as Badge for performing medical duties the 41st Combat Support Hospital. After having a role in Refugee/Host Nation while engaged with the enemy. Twelve the fighting stopped and the casualties population care of infants and children Army pediatricians were placed in me- slowed, he traveled multiple times to a who are injured, displaced, diseased, dical clearing companies. Colonel Rus- Kuwaiti refugee camp, seeing hun- or malnourished by war.” Also men- sell Steele, a pediatric infectious dreds of children on the tailgate of a tioned in the after-action reviews was disease specialist, served as a field pickup truck60 (Fig 8). Captain Carolyn the need to have a course for providers surgeon with a medical clearing com- Sullivan, serving with the Third Ar- in “Third World Medicine and Princi- pany, then was transferred to an mored Division, saw her workload go ples of Refugee Care.”62 This recog- Evacuation Hospital where he provided up dramatically after war’s end. As her nized need was acted upon by Dr Julia infectious disease consultation for division’s only pediatrician and female Lynch, who had deployed in support of much of western Saudi Arabia and physician, she was sought out for care the Kurds in northern Iraq in Operation Iraq.58 Dr Andre Muelenaer Jr, a pedi- by the large numbers of internally dis- Provide Comfort, and Dr Clifton Yu to atric pulmonologist and activated re- placed and refugee women and chil- create the Military Medical Humani- servist from Duke University, helped to dren. Her work was made more difficult tarian Assistance course. First offered provide medical care for 3000 soldiers by the fact that she had supplies pri- in 1998, this course has provided hun- and 22 000 Iraqi prisoners of war in a marily to treat war trauma rather than dreds of military physicians with a camp in northeastern Saudi Arabia.59 noncombatants.61 background in humanitarian care and Colonel Donald Person served as the After-action reviews from a conference can trace its roots to those pediatri- only pediatrician known to have de- conducted in Phoenix, Arizona, in July cians who toiled in the heat of Iraq and ployed as a pediatrician with the 312th 1991 were filled with references to Kuwait in the aftermath of the Gulf War. Evacuation Hospital near Hafar al Batin, pediatricians and the lack of pediatric Saudi Arabia (D. Person, MD, personal supplies in Desert Shield and Desert THE GLOBAL WAR ON TERROR AND communication, 2009). Storm. “Pediatricians should be lo- BEYOND Twenty-two of 32 Army active-duty cated at each Military Treatment Facil- ThetragiceventsofSeptember11,2001, pediatricians who responded to a ity where children may appear for care. meant that American military pedia- postwar survey reported that they had It is obvious that hospitals will provide tricians were again heading overseas. The pace of deployments started slowly as few medical elements entered Af- ghanistan during the first months of hostilities. The first Army pediatrician wasinneighboringUzbekistaninspring 2002 with the first pediatricians arriv- ing in Afghanistan by summer of that year. Dozens of pediatricians of all 3 serviceshaveservedinavarietyofroles and settings in Operation Enduring Freedom. A great deal of their work involved humanitarian care, as Afgha- nistan after the fall of the Taliban reg- imen had one of the highest infant and child mortality rates in the world. The contributions of military pedia- tricians in Operation Iraqi Freedom have been much more extensive. As of FIGURE 8 summer 2011, well over 250 Army pe- Dr Brien on a MEDCAP. diatricians have deployed to Iraq and

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Kuwaitinsupportofthewareffort,from young pediatricians recently graduated from residency to subspecialists, pro- gram directors, and department chairs at the Army’s largest medical centers. Many have had multiple deployments, including both Afghanistan and Iraq, with some deployments lasting nearly 500 days in duration. Almost one-third of all Army pediatricians deployed in support of both operations have been women. Twenty-eight Navy pediatri- cians, 14 Navy pediatric interns, and more than 2 dozen Air Force pedia- tricians have also been deployed to the FIGURE 9 region. Military pediatricians have also Dr Karla Au Yeung, one of the growing number of female pediatricians who have served in Iraq and Afghanistan. done humanitarian work in the southern Philippines as well as in the Horn of Africa nation of Djibouti as a part of operations in the Global War on Terror (Fig 9). Military pediatricians have been in- volvedinalllevelsofcareinAfghanistan andIraq.Manyhaveagainfunctionedas battalion surgeons: Serving in that role, thefirst2uniformedphysicianstoenter Iraq after the initial invasion were Army pediatricians.3 Others have served as brigade and flight surgeons, on hospi- tal ships, and as hospital commanders. During the “surge” operations in Iraq, a chief physician of the Air Force’s 332nd Theater Hospital in Balad, then Iraq’s busiest military medical facility, was a pediatrician (Fig 10). And for the first time a general officer, Brigadier General FIGURE 10 James Reynolds, who served as the General David Petraeus with Colonel Martin Ottolini, then chief physician at the Air Force Hospital in commander of the Second Medical Bri- Balad, Iraq. gade from 2004 to 2005, was a pediatri- cian serving in wartime. looking at pediatric patients who were (C.W.C.) remarked that “there were pe- The need for pediatric care has been hospitalized in Army treatment facili- diatric patients in every hospital visited recognized during these conflicts. Brig- ties in Afghanistan and Iraq from in Iraq and Afghanistan during my tour adier General George Weightman, who December 2001 until December 2004 with Coalition Forces Land Component was the senior medical officer in the- found that 1012 (4%) of the patients Command (CFLCC) and the 3rd Army.” As ater during the initial phase of the war hospitalized were children. Because of of this writing, the numbers of children in Iraq, commenting on lessons learned the almost complete lack of medical who have been hospitalized in US mili- said that there “was the need to have infrastructure in Afghanistan, the pe- tary treatment facilities in Iraq and more pediatric-trained physicians and diatric patients there occupied 25% of Afghanistan is now well past the 5000 pediatric supplies to treat children the hospital bed space as there was no mark. who were injured during the fighting. place to transfer them to once they had The pediatric requirement at the hos- We’re going to see kids.”63 A study been stabilized.64 One of the authors pital in Bagram, Afghanistan, was so

PEDIATRICS Volume 129, Supplement S1, February 2012 S47 Downloaded from www.aappublications.org/news by guest on September 29, 2021 critical that it prompted modifications being “over there” themselves recog- misunderstanding regarding the role of the manning document for the hos- nized the stresses that repeated and of pediatricians. In 2009, when one of pital. It has been staffed with an Army extended deployments have put on the the authors (M.W.B.) was in the pro- pediatrician or family medicine special- military family. Several of them created cess of deploying, he was asked by ist since 2004 and is currently billeted the Military Child and Adolescent Cen- a neurosurgeon he had just met, “ with rotating Air Force pediatricians. ter of Excellence at Madigan Army What the hell is a pediatrician going ” When pediatricians are not available, Medical Center in Tacoma, Washington. to do in Afghanistan? Despite this, assistance has been provided through pediatricians remain cornerstones of resources such as the Hostile Envi- Despite pediatricians having served American military medicine in peace- ronments Life-Saving Pediatrics (HELP) in the US military for more than time and in war. And as long as the CD created by a team of military pedi- a century and pediatrics being one of nation defends its peace on the world’s atricians or via on-call “store and for- the Army’s most deployed specialties frontiers, pediatricians will serve along- ward” telemedicine consultation for in the current conflicts, it is not unusual side her service members in harm’s challenging cases. Finally, pediatricians to continue to encounter confusion and way.

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