NAVY MEDICINE January-February 1992 Surgeon General of the Navy Chief, BUMED NAVY MEDICINE VADM Donald F. Hagen, MC, USN Vol. 83, No. 1 January-February 1992 Deputy Surgeon General Deputy Chief, BUMED Chief, Medical Corps RADM Robert W. Higgins, MC, USN From the Surgeon General 1 Emphasis: Health Promotion

Edftor Department Rounds Jan Kenneth Herman 2 Corpsman Climbs 300 Feet in Daring Rescue B. Doughty

Aalletant Edftor 5 NAMI Saves Bends Victim Virginia M. Novinski C. Lee

EdltoMI Alslslant Features Nancy R. Keesee 6 What's a NAMRID? CDR R.L. Buck, MC, USN LCDR J. T Need, MSC, USN

10 NEPMU-7 Supports Operation Provide Comfort LCDR T. W. Sharp, MC, USNR NAVY MEDICINE, Vol. 83, No. 1, (ISSN 0895-8211 USPS 311-G70) Ia pubtillled bimonthly by the De..-nt of the 14 Pacific Duty on the Troopship MS Sommelsdijk Navy, Bu-u of Medicine and Surgery (BUMED 09H~ W.alllnglon, DC 20372-5120. Sacond-claaa poetage paid at CAPT P.M. Ellwood, MC, USNR (Ret.) W.alllnglon. DC. and addltion.l maiHng otlcee. Edited hy D. L Mawdsley, M. n. POSTMASTER: Sand --.changee to fWvy Uedlclne caN of Naval Publlcaliona and ForTq c.r-, ATTN: Coda 301, 5801 Tabor Avenue. Philadelphia. PA 19120. 18 Chronology- WWII: Navy Medicine January-February I 942 POLICY: Navy Uediclne Ia the olllcial publlcallon of the J. Mitchum Navy Medical Depaltmanllt Ia 1..-cled for Madlcal Depart­ ment paraonnel and con1alna profeaalonalinfonnallon rela· live 10 medicine. danllatry, and the atllad haal1h acienca Professional Opinions expraaed are thole of the aulllcn and do not 23 Pyridostigmine Prophylaxis During Warm Water .-ar~~y r~ the official poa111on of the Dapamlent of the Navy, the Bureau of Medicine and Surgery, or any Diving Operations other govwn-1 depament or agency. Trade na-are CAPT J. W. Thorp, MC, USN ueed for identification only and do not r.-.nt an enc1o..... LT D.M. Stevens, MC, USN rnent by the Department of the Navy or the au-u of Medi­ Cine and Surgery. Although Navy Uedlelne rnay cite or CAPT A.J. Dutka, MC, USN extract from directives. authority for action ahould be TJ. Doubt, Ph.D. obllllned from the cited reference. CAPT E.D. Thalmann, MC, USN OISTRIBUnON: Navy Uedleine iadlatrlbuted to active duty Medical Oepartnent personnel via the Standard Navy Dillri­ bullon Uat n.. following dlatribullon ia authorized: one copy To the Editor for each Medical, Dental. Medical Service. and Nurse Corpa 27 Letters from CAPT M.L. Dembert, MC ... LT S.M. Weibert, NC oilier. one copy for each 10 enlilled MediCal ~nt ll*ftbera. ~-10 in~ae or dacr-the number of aHollad copiel should be forwarded to NavyUedicineviathe Notes and Announcements lOcal command. NAVY MEDICINE Ia published from appropriated lunda by 22 Naval Medical Research and Development Command Highlights authority of the au-u of Medicine and Surgery In accord­ 28 In Memoriam: CAPT H.M. Braswell, Jr., MC, USN (Ret.) ... ._ with Navy Publicationa and Printing Aegulallonl P-35. RADM C.B. Galloway, MC, USN (Ret.) The Sec~ of the Navy hu ~ined thai thia publiCa· lion Ia .._..,In the trenaectlon of bualneu required by law of 1he Depatlment of the Navy. Fundi for printing this A Look Back publleallon have baWl approved by the Navy Publlcatlona and Prinl ng Policy Cornmlllee. Artlc..._ lalters. and addr­ 29 Navy Medicine ca. 1919 changee may be forwarded to the Editor, Navy Medicine, Department of the Navy, Bureau of Medicine and Surgery (BUMED 09H). Washington, DC 20372-5120. Telephone (Area Coda 202) 153-1237, 153-1297; Autovon 294-1237, 294·1297. Contribullonl from the field are welcome and will COVER: A diver descends into the "wet pot" at the Naval Medical be publlthed .. apace permits, IUbject to editing and poui· Research Institute in Bethesda, MD, as scientists investigate the effects ble abridgiiWil For aala by the Superintendent of Documenta, U.S. of warm water diving. What they learned directly influenced diving ao-nn-t Printing Office. Washington, DC 20402. operations during the Gulf War. Story on page 23. Photo courtesy Naval Medical Research Institute. NAVMED P-50111 From the Surgeon General

Emphasis: Health Promotion

ast year a major focus for the Navy and the nation manding officers, and officers in charge with appointing a was on health promotion and healthy lifestyles. health promotion program officer to coordinate and pro­ L What we eat, whether or not we smoke or use vide an integrated health promotion program designed to tobacco products, how much we drink, and what we do for reduce morbidity, decrease disability, and decrease mor­ recreation- activities that have always been individual tality due to specific disease or injury risks in defined choices- are rapidly taking on more far-reaching implica­ populations. tions. It is becoming increasingly apparent that our deci­ Seven areas especially targeted for attention are: physi­ sions in these areas affect our health and quality of life, cal fitness and sports, tobacco use prevention and cessa­ and, as a result, also impact on the nation's health care tion, substance abuse prevention, back injury prevention, crisis. More and more organizations, we among them, are stress management, hypertension, and nutrition. looking toward health promotion and preventive medicine With many mandated programs and limited resources, as one way to help curb escalating costs and demands on an commands need to know which areas to emphasize if they already overburdened system. are going to maximize their health promotion efforts. We The military has an advantage over our civilian counter­ have been actively working to help each command deter­ parts, since our beneficiary population is mostly healthy. mine its specific health promotion needs and will continue We must press this advantage and keep them that way. At to do so. By giving health promotion programs the atten­ the beginning of this year I signed out BUM ED Instruction tion and support they deserve, we can fulfill our role as 6110.13 establishing our Health Promotion Program. The subject matter expert, guiding light, and role model as we instruction presents the goal of health promotion as pre­ facilitate health promotion programs within line com­ venting avoidable illness and injury and its task as reducing mands. the impact of disease and injury on the population by Navy leadership is committed to continually improving eliminating individuals' exposure to the risk factors for the quality of life for its members and their families. Health illness. plays a vital part in a person's quality of life, and Navy Our new instruction formalizes and requires what most medicine must take an aggressive and active role in pro­ of our facilities are already doing: providing beneficiaries moting health. with the information and resources they need to maintain a CHARLIE GOLF ONE. healthy lifestyle. This instruction tasks commanders, com- VADM Donald F. Hagen, MC

January-February 1992 Department Rounds

Corpsman Climbs 300 Feet

1n• Daring Rescue

HMCS L" and the radio tower she icture the Super Dome, or any aecended. pro football field: IO? ya~ds P long- 300 feet. Now, 1magme this distance straight up in the air. That is how far the independent duty corpsman of U.S. Naval Hospital Yokosuka, Japan, had to climb to

2 NAVY MEDICINE other bruises and abrasions. HMCS Esther Lee was on duty at the one-person Totsuka Naval Branch Medical Clinic when the phone call came in: "Doc, we need you . . .. Some­ body is hurt and trapped on the tower," said an excited voice. Lee grabbed the rescue bag and headed to the mammoth tower. "You just men­ tally start a checklist of things you need to know," said Lee. "Was he (the victim] knocked unconscious? Is he unconscious now? Is there active bleeding? Generally, is he 'safe?"' When Lee got to the tower she used binoculars to see the patient, but was unable to make a good assessment from the ground. "That's when I made the decision to climb the tower." Was she afraid of heights? "That's the first question (the command mas­ ter chief] asked me. I didn't know, but that wasn't a consideration," she said. "Don't misunderstand, I did not want to climb the tower. But I was not com­ fortable staying on the ground, not knowing what kind of shape he was in." Lee was fitted with a climbing belt and briefed on climbing the tower. At all times, safety was stressed . Indeed, because of the patient's harness and his coworkers' me thodica ll y care ful provide medical assessment and as­ Radio Transmitting Facility, Totsuka, procedures, further injury was pre­ sistance to a member of the Air Force's Japan, on 22 Oct 1991 , when the tacti­ vented. 1849th Electrical Installation Squad­ cal crane rigging used for lowering sec­ After the brief, she began her ascent. ron. tions of the tower collapsed. The "I never looked up. Looking down was SGT Tracy D. Brown, leading his broken section smashed into Brown, not a problem, but I never looked up highly specialized team, was disman­ fracturing his shoulder, breaking one because I didn't want to see how much tling a microwave tower at the Naval of his ribs, and inflicting numerous farther I had to go ," said Lee. She will

January-February 1992 3 never forget the feel of the wind and position. Lee immobilized him, strap­ think, 'I hope I never have to use this. I the view, looking down on to-story ping him in securely, and put a cervical hope I never have to be in this kind of buildings. "You can see a long way collar on him. She started her descent situation."' from up there. You can see all over." to meet the patient and "basically, to She tells junior corpsmen, "If you're When she reached the platform near get out of the way." lucky, you'll spend your whole time in the patient, she quickly attached her She and the ambulance crew from the Navy without rendering life-saving safety strap and remained hooked up the Atsugi Naval Branch Medical support to anyone, but you must be the whole time. She tried to keep the Clinic made a thorough second assess­ prepared ... and, I would add, main­ patient talking, making sure he was ment of Brown. The crew took his vital tain personal physical readiness." She not too "shocky," and to establish his signs and determined that his injuries credits her daily running and active level of consciousness. As part of the were not life threatening. Brown was fitness regimen with helping her climb assessment, she used a knife to cut then taken to the U.S. Naval Hospital the tower with a minimum of effort. open his shirt, checked for open frac­ Yokosuka, where he was admitted. He "After I came down, three different tures and active bleeding, and did as underwent surgery and has since re­ guys came over to shake my hand. good and as thorough an evaluation as cuperated. They said, 'Jeez, Doc! We can't believe was possible. After the ambulance was on its way you did it."' That night she headed "He was doing very well, maintain­ to the hospital, Lee returned to the down to Yokosuka to bowl in the ing his calm, but he was in extreme tower, looked up and thought, "My weekly hospital bowling league and pain, and it would have been impossi­ God, I was up there! Afterward was stopped by to check on Brown. ble for him to climb down," she said. the shaky time," she said. "I still can't Lee visited Brown several times in Based on her assessment, Lee decided believe I climbed up that tower." the week immediately after the acci­ to bring up a Stokes litter (combat­ Lee said later, "I'm glad I was there dent. "She didn't think about the style stretcher) by drawline and have and I'm glad I could be of assistance at obstacles," said Brown, as Lee stood the patient lowered by pulley. a time when I was greatly needed. by. "She has more courage than some Because the platform was so small, Every time you go through EMT of the people I work with, especially the litter was propped up and Brown (emergency medicine technician) since she is not certified to do that type was backed into it from a standing training, in the back of your mind you of work." "I've decided not to get certified," Lee said with a laugh. "You're certified now," Brown commented from his hospital bed. Brown looked up and added, ''Thanks for being there. I don't think I would've made it. ..." Military members- Air Force, Ma­ rine, Army, Navy- trust Navy hospi­ tal corpsmen. They trust the "Doc." Lee said, "Even when you're in a situa­ tion when you're not doing something overtly for a person, the fact that you're there is a comfort." Like all corpsmen, Lee is "standing by, ready to assist." o - Story and photos by Bill Doughty, Public Affairs Officer, U.S. Naval Hospital Yokosuka, Japan.

HMCS LM visits SGT Brown at U.S. Naval Hospital Yokosuka.

4 NAVY MEDICINE NAMI Saves

Personnel control and monitor conditions Inside the hyper­ Bends Victim baric chamber.

11 After the first treatment, I a patrol craft and medical personnel ing the hyperbaric system is to support literally felt we saved his administered medical treatment. physiology training, operational fly­ life," said HMCM(DV) Simultaneously, NAMI was contacted ing, and Navy diving operations. Wayne Shurtz, Naval Aerospace Med­ and after an on scene evaluation by However, military members, their ical Institute's (NAMI's) senior diving Dr. Stephen O'Connell, NAMI's Duty dependents, and retirees suffering medical technician. HMCM(DV) Hyperbarics Medicine Advisor, the from DCS and air gas embolism as a Shurtz was referring to a recent case of patient received treatment in the result of sport diving may be brought decompression sickness (DCS), or the NAMI's recompression chamber. to the recompression chamber for "bends" that had been successfully "It was an actual case of life or treatment also. In life- and limb­ treated in NAMI's recompression death," said HMCM(DV) Shurtz. "If threatening situations, other members chamber. he hadn't gotten to us in time, he could of the public sector may receive treat­ DCS is caused by the formation of have died. The first treatment was ment. Before receiving treatment, inert gas bubbles, usually nitrogen, done to squeeze or recompress 'the potential civilian patients are evalu­ within the body's tissues. Rapid lower­ bubbles,"' added HMCM(DV) ated to determine the bona fide nature ing of ambient pressure, such as during Shurtz. Squeezing the bubbles is of the emergency. ascent in flying or diving, leads to an accomplished by bringing the patient Qualified Navy divers and diving increase in dissolved nitrogen reaching to 165 FSW for 30 minutes in the medical personnel comprise the staff a threshold level and appearing as chamber, and then by putting him on for the recompression chamber. Geo­ bubbles. A recompression chamber is 100 percent oxygen at 60 FSW for4 or graphically, the NAMI recompression a steel vessel where the internal pres­ more hours. "Some significant prog­ chamber is the only such facility from sure can be increased in equivalent feet ress was made after the first treat­ Mobile, AL, to Panama City, FL, of sea water (FSW) or pounds per ment," HMCM(DV) Shurtz replied, capable of treating DCS or embolism square inch causing the bubbles to be "but the patient still had a great deal of resulting from diving. o recompressed. leg weakness and numbness, indicat­ - Story by Claudia Lee, Naval Aerospace The patient, a retired Navy lieu­ ing extensive spinal nerve damage," he Medical Institute, Pensacola, FL 32508. tenant commander, was brought to continued. To treat the nerve damage, NAMI on a Saturday afternoon after the NAMI hyperbaric medical team, A view inside the chamber following a he had been doing a series of recrea­ with the assistance of divers from both treatment session shows the built-in tional dives in the Gulf. "Immediately the Naval Air Station Port Operations breathing system hoses and masks, after his last dive, he noticed he had and the Naval Aviation School Com­ hearing protection, and fire retardant difficulty with balance," said mand Training Tank One, conducted bedding. HMC(DV) Don Ortiz, a NAMI diving 10 additional similar treatments, medical technician. "He was standing exposing the patient to higher concen­ in the back of the boat, and fell trations of oxygen than would be pos­ unconscious into the water," con­ sible breathing 100 percent at sea level. tinued HMC(DV) Ortiz. His compan­ Following nearly I 0 days of treatment, ions, one of whom is a practicing HMCM(DV) Shurtz said the patient Pensacola physician, quickly pulled was functioning at about "99 percent him out. Recognizing the seriousness capability." of his condition, they contacted the This is truly a success story for Coast Guard by radio and under the NAMI, which trains thousands of guidance of the Coast Guard they aviators and air crew personnel each sailed for shore. Upon reaching shore, year. NAMI's primary mission regard-

January-February 1992 Features

What's a NAMRID?

CDR Richard L. Buck. MC, USN LCDR J ames T. Need, MSC, USN

6 ---·NAVY MEDICINE PERU

Lima @

ight years have elapsed since infectious disease to military and the establishment of the Naval civilian personnel in Peru, NAMRID E Medical Research Institute De­ was born into and is still serving a tachment (NAMRID) in Lima, Peru. unique role. (See Navy Medicine, July-August When first established, N AM RID 1984.) NAM RID, a component of consisted of a single room in the major Naval Medical Research Institute, Peruvian Navy Hospital, "Centro Bethesda, MD, functions under the Medico Naval," and was manned by auspices of the Naval Medical five U.S. Navy personnel. NAMRID Research and Development Com­ now consists of two separate labora­ mand and is the only U.S. Navy re­ tories: the main facility in Lima con­ search facility operating in South sisting of two modern structures of America. The result of an outstanding 32,938 square feet and a supporting cooperative relationship between the laboratory in Iquitos, at the head­ • I U.S. Navy and the Peruvian Navy, waters of the Amazon River. Pres­ J NAMRID has also established itself as ently, the staff includes I I U.S. Navy an important asset to the U .S. scientists and administrative staff and Embassy in Peru, and the Peruvian more than 50 Peruvian scientists, mil­ Armed Forces and civilian commu­ itary physicians, and technicians. nity. Dedicated to conducting research Peru is an ideal location to carry out to assess the medical threats posed by infectious disease research since jun-

Top left: NAMRID's microbiology lab. Left: Mr. Irving Phillips, virologist dis­ cusses retroviruses in NAMRID's virology lab.

January- February 1992 7 NAMRID Publications 1984-1991 (Grouped According to Subject Area)

Medical Entomology Parasitology Effectiveness of permethrin-treated military uniform fabric Parasitosis intestinales identificadas mediante examen de against human body li ce. Sholdt et a l. Milit Med. heces en tres grupos de poblacion del Peru. Kilpatrick et al. 1989; 154(2):90-93 . Bot Sanit Panam. 1986; 100(4):412-4 16. Lyme disease in South America? Need & Escamilla. J Infect An epidemic of oroya fever in the Peruvian Andes. Gray et Dis. 1991 ; 163(3):68 1-682. a l. Am J Trap Med Hyg. 1990;42(3):215-221. Annotated list of ticks (Acari: Ixodidae, Argasidae) Diffuse cutaneous leishmaniasis acquired in Peru. Franke reported in Peru: distribution, hosts, and bibliography. Need et al. Am J Trap Med Hyg. 1990;43(3):260-264. et a l. J Med Entomo/. 199 1;28(5):590-597. Efficacy a nd Toxicity of sodium stibogluconate (pentos­ tam) in the treatment of Peruvian mucosal leishmaniasis. Microbiology Franke et al. Ann Intern Med. 1990; 11 3( 12):934-940. Spurious sulfamethoxazole-trimethoprim resistance of Sal­ Dermatobia hominis en caruncula ocular: reporte de un monella typhi. Escam il la et al. J Clin Microbial. caso en lquitos, Peru. Seminario & Colan. Diagnostico. 1986;23( I ):205-206. 1991;26(6 -5):95-96. Evaluation of blood clot cultures for isolation of Salmo­ Global distribution of a variant of the circumsporozoite nella typhi, S. paratyphi-A, and Brucella melitensis. Escamilla gene of Plasmodium vivax. Kain et al. J Infect Dis. et al. J Clin Microbial. 1986;24(3):388-390. 1991 ;99(7):208-2 10. Urine and Faecal lgA response during natural acquired Antibody response of humans to the circumsporozoite pro­ infection with Campylobacter jejuni. Lane et a l. Lancet. tein of Plasmodium vivax. Franke et al. Infect lmmun. 1987: 1141. 1991 ;59(8):2836-2838. Penicillinase-producing Neisseria gonorrhoeae in various Malaria por P.falciparum en madre de dios. Gonzales et al. seaport cities o f Latin America. Escamilla et al. Sex Transm Diagnostico. In press. Dis. 1988;15(3): 14 1-1 43. Antibody response to the circumsporozoite protein of Plas­ Nontoxigenic 0 I Vibrio cholerae in Peru: a report of two modium vivax in natural infected humans. Franke et a l. Am J cases associated with diarrhea. Batchelor & Wignall. Diag Trap Med Hyg. In press. Microbial Infect Dis. 1988; I 0: 135-138. Prevalence of antibody to the variant repeat of the circ um­ Estudio sabre portadores cronicos de salmonellas en mani­ sporozoite protein of Plasmodium vivax in Peru. Franke eta I. puladores de alimentos de Ia ciudad de lquitos. Rojas Garcia Am J Trop Med Hyg. In press. et a l. , 1988. Alkaline phosphatase-conjugated oligonucleotide probes Virology for enterotoxigenic Escherichia coli in travelers to South Hepatitis A in children. Kilpatrick & Escamilla. Am J America and West Africa. Oprandy et a l. J Clin Microbial. Epidemiol. 1984; 124( 1): 111-11 3. 1988;26( I ):92-95. Marcadores serologicos de hepatitis vira l B en pacientes Aeromonas: studies of invasiveness in the modified remov­ drogadictos del hospital Hermilio Yaldizan. Faran et al. Psi­ able intestinal tie adult rabbitdiarrhea(Ritard) model. Pazza­ coactiva. 1989;3( 1):6 1-74. glia et al. Adv Res Cholera Rei Dis. In press. Facto res de riesgo para infeccion par virus de hepatitis Ben Diarrhea and intestinal invasiveness of Aeromonas strains personal hospitalario. Llanos et al. Rev Gastroent Peru. in the removeable intestinal tie rabbit model. Pazzaglia et al. 1990;9:24-28. Infect Jmmun. 1990;58(6) 1924- 1931. Hepatitis B in a highly active prostitute population: evi­ Campylobacter jejuni versus E. coli in developing coun­ dence for a low risk of chronic antigenemia. Hyams et a l. J tries: How accurate are prevalence estimates? Pazzaglia et al. J Infect Dis. 1990; 162:295-298. Infect Dis. 1990; 162:570. HTLV-1 coinfection in a HIV-1-infected Peruvian popula­ Transient intestinal colonization by multiple phenotypes of tion. Phillips et al. J Acquired Immune Def Syndromes. Aeromonas species during the first week of life. Pazzaglia et 1991 ;4(3):30 1-302. al. J Clin Microbial. 1990;28(8): 1842-1846. Dengue epid emic: Peru, 1990. Colan et al. Morb Mort Etiology of diarrhea among American adults li ving in Peru. Wkly Rep. 199 1;40(9): 145-147. Pazzaglia et al. Milit Med. 1991 ; 156(9):484-487. lnvestigacion operacional de prevencion del S l DA en pros­ Etiology of childhood diarrhea in northern coastal Peru. titutas del Callao, Lima-Peru, 1988-89. Alarcon et al. Rev Pazzaglia et a l. Milit Med. In press. Peru Epidemio/. 199 1;4( 1) :16-25. Hospital case-control study of Aeromonas-associated diar­ Comportamiento sexual y seroprevalencia del virus de Ia rhea in Peruvian infants: high frequency of co-infecting en­ immunodeficiencia humana tipo I en varones homosexuales teropathogens. Pazzaglia et a l. J Clin Microbial. peruanas. Caceres et al. PAHO Bull. 1991;111(3):218-230. 1991;29(6)1 151-1156. Paratyphoid fever outbreak in Peruvian Navy personnel. Pazzaglia et a l. PAHO Bull. In press.

8 NAVY MEDICINE gle, desertlike coastal plains, and high­ With the encouragement of the Latin American naval forces. In land populations and climates can be Peruvian Navy, each branch of the August 1990, the UNITAS-sponsored surveyed. Consequently, nearly every Peruvian Armed Forces has physi­ Humanitarian and Civic Assistance tropical disease known to affect man cians and technicians assigned for Program in Peru had to be canceled at can be studied somewhere in Peru. Re­ periods of 1-3 years. Another impor­ the last moment due to security con­ search involving the following subject tant area has been providing assistance cerns. NAMRID willingly offered to areas is presently being conducted: in their H IV screening program. Last work with the Peruvian Navy to re­ epidemiology, microbiology, parasi­ year, NAMRID tested over 7,700 sam­ schedule the project. The project was tology, virology, and medical ento­ ples for HI V from the Peruvian Armed successfully carried out by N AM RID mology. Specific projects include Forces, of which over two-thirds were staff (Peruvians and Americans) and different aspects of malaria, leishman­ for their blood bank screening pro­ Peruvian Navy personnel in March iasis, dengue, hepatitis, human immu­ gram. NAMRID is also the reference 199 I, in numerous small villages in the nodeficiency virus (H IV), human t-cell center for all of Peru for confirmatory lquitos area. lymphotrophic virus, diarrheas, barto­ testing for HI V. By providing this All that NAMRID has accom­ nellosis, Lyme borreliosis, and rickett­ essential assistance in the national plished is even more impressive when siOses. HIV program, NAMRID has become considered against the backdrop of When one measures the success or rapidly integrated into the Peruvian extreme political and economic tur­ failure of a research facility, the bot­ medical community. moil which have plagued Peru in the tom line is quality publications. Over N AM RID has also been active in last decade. Politically, while the the past 8 years, 36 journal articles direct "fleet" support activities. The country made a transition from one have been published or accepted for detachment has lent its expertise to democratically elected civilian govern­ publication and an additional II U.S. cooperative efforts with Peru at ment to another last year, the increase manuscripts are presently under jour­ the Santa Lucia Peruvian Police Base in terrorism and its associated violence nal review. The subjects of these arti­ in the Upper Huallaga Valley. This have been marked. Nonetheless, cles are varied (see box) and the base, in the heart of the coca produc­ NAMRID has continued its collabo­ publications have been accepted by ing area, is a major focus of the U.S. rative efforts in Lima and other areas such prestigious journals as the Annals antinarcotics effort in Peru as the of the country while complying with of Internal Medicine, Journal of Infec­ Upper Huallaga Valley produces over necessary security recommendations. tious Diseases, Journal of Clinical 60 percent of the coca product that Economically, several years of Microbiology, and Infect ion and enters the United States. NAMRID hyperinflation have wreaked havoc on Immunity. Most importantly, the arti­ teams have been sent to Santa Lucia the local economy (inflation in 1990 cles are very military relevant. They five times in support of U.S. efforts, was over 7,500 percent- the highest in include the first published account most recently in December 1990, at the Peru's history). There is great fluctua­ that the World Health Organization's direct request of the Deputy Chief of tion in prices both in services and recommended treatment for severe Mission (U.S. Embassy Lima) to goods. This has meant extraordinary mucosal leishmaniasis is ineffective, investigate the threat of dengue fever difficulties in projecting local costs for and an article on clinical and labora­ and in April 1991 , to investigate the more than I month at a time. The 99+ tory aspects of Peru's first dengue out­ potential of a cholera outbreak. percent of obligation rate NAMRID break estimated to have affected more NAMRID personnel have also de­ achieved in FY90 is truly remarkable than 150,000 people in one city alone. veloped a proposal, presently under given this economic chaos. NAMRID's collaborative and consideration by the U.S. Embassy Considering the political and eco­ training role in the Peruvian medical Lima, to conduct a complete disease nomic conditions in Peru much has community is also extensive. During threat assessment in the Upper Hual­ been accomplished in the first years of 1990, NAMRID staff made 25 formal laga Valley. NAMRID also recom­ NAMRID's development. Yet, presentations of their work at scien­ mended and subsequently coordinated because of these problems, even more tific conferences and meetings in Peru a preventive medicine assist visit by the remains to be done. With the con­ and the United States, reaching a total Navy Environmental Health Center, tinued cooperative relationship of the audience of over 2,300 persons; 52 Norfolk, VA. This close collaboration Peruvian Navy, NAMRID will pro­ Peruvians received technical labora­ between a Navy medical research facil­ ceed to carry out its mission. o tory training for periods of 1-6 ity and Navy preventive medicine has months; NAMRID staff actively col­ benefited both groups and has been laborated with more than 20 Peruvian most appreciated by the U.S. Embassy Dr. Buck was Officer-in-Charge of U.S. scientists; and NAMRID sponsored a Lima. NAMRID, Lima, Peru, until July 1991 and is now at the Navy Environmental Health Center, 2-day tropical medicine conference Other "fleet" activities include sup­ Naval Station, Norfolk, VA 235 11. Dr. Need is attended by over I 00 Peruvian medical port of UNIT AS efforts, an annual Head of the Entomology Department, U.S. personnel in the city of Piura. exercise betwee n United States and NAMRID.

January-February 1992 9 NEPMU-7 Supports Operation Provide Comfort

LCDR Trueman W. Sharp, MC, USNR

ollowing the Gulf War, Navy CTF medical staff. Its mission was were trapped on steep mountainsides preventive medicine personnel threefold: first, to carry out the assess­ with little water or food. Few had ade­ F had a unique opportunity to ment of the refugee situation as quate clothing or shelter. Diarrheal assist in refugee relief during Opera­ initially planned, then to implement disease was rampant and often compli­ tion Provide Comfort, the U.S. mil­ medical relief efforts for the refugees cated by dehydration, malnutrition, itary's effort to deliver emergency aid and finally, to establish a medical sys­ and exposure, particularly in the very to Iraqi Kurds fleeing the Iraqi army. tem for troops involved in the opera­ young and old. Measles, usually the In early April 1991 , the U.S. Euro­ tion. main killer in refugee situations, pean Command (EUCOM), ordered By this point, the plight of the threatened. to provide emergency relief to Kurds Kurdish people along the Turkey-Iraq The CTF medical staff clearly had along the Turkey-Iraq border, asked border was desperate. Of the estimated much to do, particularly in preventive U.S. Navy Environmental and Pre­ 1.5 million Kurds who fled northern medicine, which is the basis for acute ventive Medicine Unit No. 7, Naples, Iraq, approximately 500,000 escaped refugee relief along with public health. Italy, (NEPMU-7) to provide two into the high mountains along the It consists of performing rapid epide­ members for a nine-person assessment Turkish-Iraqi border. Mostly city miologic field evaluations and setting team. The team was to spend 10-14 dwellers, they drove north as far as up surveillance systems; providing days assessing medical needs of the they could along the few poor roads, proper food , water, shelter, and Kurds. abandoned their vehicles and walked clothing; establishing decent sanita­ NEPMU-7 assigned CDR Don on, some for as long as 4 days. The tion systems; administering appro­ Thurston, MSC, USNR, an environ­ Kurds eventually encountered Turkish priate vaccinations; and instituting mental health officer (EHO), and troops and ended up "camping" in suitable basic mediCal care. LCDR Trueman Sharp, MC, USNR, large conglomerations of people along Troops involved in Operation Pro­ an epidemiologist, to the team which the Iraqi side of the border in obscure vide Comfort were in areas with also included logistics personnel, areas like Isikverin, Cukurga, Yekmal, numerous disease threats. For exam­ another epidemiologist, an EUCOM Princikin, and Yesolova. ple, malaria is indigenous to much of physician assistant, and the U.S. Army This region, much like parts of the the region, and diarrhea and hepatitis Seventh Medical Command. southwestern United States, is very are highly endemic. Shortly after convening at the Com­ beautiful but remote, rugged, and CDR Thurston and LCDR Sharp bined Task Force (CTF) headquarters harsh. In April, snow still lay on the spent 2 weeks in Incirlik setting up for Operation Provide Comfort in ground, and the temperature dropped refugee relief and establishing preven­ lncirlik, Turkey, the team became the below freezing at night. Many Kurds tive medicine policies for the troops.

10 NAVY MEDICINE CARE photo by Nancy Blum A Turkish relief worker for CARE, the international relief and development organization, pauses in the midst of lsikverin, a camp in Turkey where 160,000 Kurds camped after their flight from Iraq in April 1991.

This was a demanding and hectic task, Profiles [DISRAPs]) was used to zone. LCDR Sharp worked with a but the Navy specialists were well pre­ assess health risks to personnel in the team from the Centers for Disease pared. NEPMU-7's many firsthand area. This information, particularly Control (CDC) on a number of public experiences in Africa and the Middle related to malaria prevention, was health programs for the mountain East proved to be vital in understand­ accurate and useful. refugee camps, such as vaccination ing the health threats the region pre­ The CTF subdivided into two task campaigns, nutrition programs, sur­ sented for both the refugees and the forces: Joint Task Force Alpha (JTF­ veillance systems, basic sanitation, troops. A) and JTF-Bravo. JTF-A, head­ and treatment protocols for diarrhea The Navy Environmental Health quartered in Silopi, Turkey, had and respiratory infection. Subse­ Center's "Refugee Medicine Library," cognizance over southern Turkey, quently, efforts shifted into the JTF-B a comprehensive collection of articles including the mountainous border region as the refugees returned from and books on refugee medicine com­ areas. JTF-B, headquartered in the mountains. CDR Thurston then piled for Operation Desert Storm and Zahku, Iraq, had cognizance over the assisted military and international brought along by the NEPMU-7 team, rest of northern Iraq. CDR Thurston agencies in planning refugee camp proved to be invaluable. Many of the served as the preventive medicine offi­ sites in northern Iraq and then in de­ refugee relief policies established were cer (PMO) for JTF-B, and LCDR livering public health in these camps. based on these references. The Navy Sharp served as PMO for JTF-A. Although there were outbreaks of Preventive Medicine Information sys­ Refugee relief operations centered cholera and measles, and an unex­ tem (i. e., Disease Risk Assessment first on the border areas of the JTF-A plained syndrome of fever, rash, and

January-February 1992 11 Kurdish refugees at Camp Cukurga

eventually death occurring in young wanted to provide fresh fruits and good and in the end there were only a children, diarrhea and its complica­ vegetables from unsafe local sources. few suspect cases. Unfortunately, tions remained the main health prob­ The rapid deployment to this remote there were some traffic and mine acci­ lem for refugees. Both CDR Thurston area presented food handling and dents, but probably fewer or no more and LCDR Sharp worked on out­ waste disposal issues. Gastroenteritis than would be expected in any opera­ break investigation and control.{l) was an ever-present problem, and dur­ tion of this complexity. Aside from the Several military and volunteer med­ ing a 6-week period in Silopi an aver­ gastroenteritis, there were no other ical groups participated in Operation age of 100-200 persons with the illness disease occurrences. Provide Comfort. Among those were were seen at sick call each week. HM I Navy PMTs proved to be excellent Navy medical personnel from the Walker and H M2 Savageau worked assets in the field. Because of their Navy Mobile Construction Battalion extensively with the U.S. Marines and extensive training, they were flexible 133 and the 24th Marine Expedition­ Army and various international mil­ and able to adapt to unique and unpre­ ary Unit. Two Navy preventive medi­ itary personnel on such field issues. dictable tasks that arose. They solved cine technicians (PMTs) from Despite all these problems, there unusual problems in the refugee arena NEPMU-7, HM I Jerry Walker and were a number of positive aspects of as well as in the fi eld for troops. HM2 Brian Savageau, also joined the the mission. For one, morale was high Although the overall mission could CTF staff, and medical administrative and an esprit-de-corps developed be deemed quite successful, some support personnel arrived from Naval among the participants. Operation problems surfaced and important les­ Hospital Naples, Italy, and Rota, Provide Comfort demonstrated that sons were learned. For one, those Spain. the military, with its organization, attempting to do refugee relief often Security was a major concern equipment, training, and manpower, lacked the necessary supplies and re­ throughout the operation, particularly could effectively provide acute relief in sources. As a result, the measles vacci­ in JTF-B. Ultimately, a combined refugee or disaster situations that nation program was delayed, food force (including international military international relief agencies may not relief supplies were unsuitable, and air units) of more than 10,000 troops be able to. drops were inappropriate. The lack of joined the effort. The troops had a The efforts of U.S. military person­ resources to perform fie ld evaluations multitude of field preventive medicine nel are unquestionable and saved and disease surveillance meant that it concerns. As in Operation Desert many li ves. Preventive medicine was frequently unclear exactly what Storm, providing potable water was a efforts impeded disease in troops, heat the health problems were in the var­ constant challenge, field sanitation illness was minimal, and no cases of ious camps. Thus, grossly exaggerated was rudimentary, flies and mosquitoes hepatitis were reported. Malaria and ill-informed press reports of chol­ were prevalent, and local commanders chemoprophylaxis discipline was era and other epidemic diseases fre-

12 NAVY MEDICINE military or not, can be quite dis­ organized. Operation Provide Comfort was a ve ry interesting and successful mis­ sion, and the Navy was fortunate to p a rt icipate. Many of the lessons learned will be discussed at presenta­ tions and workshops on refugee relief at the next Navy Occupational Health a nd Preventive Medicine Confe rence, to be held in the spring of 1992. The recently formed Navy Epidemiology Board will focus on the overall ques­ tion of how best to use Navy preven­ tive medicine teams. Now that many realize that the mil­ itary can perform emergency relief commendably, it is in cumbent upon Navy medicine to learn from this expe­ rience and prepare even better for fu ture relief efforts. quently disrupted relief operations. A issues, such as the proper use of oral Reference nutritional emergency resulting from rehydration salts, the appropriate use I. Public healt h consequences of acute dis­ the rampant diarrhea and dehydration of antibiotics to treat diarrhea, and the placement of Iraqi citizens- March-May 199 1. was not readily recognized, and criti­ id entification and treatment of upper Morb Mort Wkly Rep. J uly 5, 1991;40(26):443- cal feeding programs for malnour­ respiratory infec tions. 446. 0 ished children were never satisfactorily Some problems are attributable to implemented. Most military personnel the difficulties inherent in a n evolving, Dr. Sharp is stationed with the Navy Environ­ sent to treat refugees had not been unplanned triservice field operation. mental Preventive Medicine Unit No.7, Naples, briefed on important refugee medical In addition, relief operations, whether Italy, FPO New York 09521.

A refugee child Is vaccinated against measles In the Yesolova camp.

January-February 1992 13 wYII +50th ~ Pacific Duty on the Troopship MS Sommelsdijk

CAPT Paul M. Ellwood, MC, USNR (Ret.) Edited by Dean L. Mawdsley, M.D.

he inspiration for this account his medical internship at Stanford­ Saipan, ca. August 1944* came as my wife Mary Lou, Lane Hospital in 1924-25. On Sunday afternoon I was dele­ T Dr. Paul M. Ellwood's daugh­ After completing his education, Dr. gated to take the boys (30 American ter, and I went through a 25-year-old Ellwood worked on tropical diseases crewmen aboard the Sommelsdijk) to accumulation of household items as in Montgomery, A L, for the Rocke­ the Marine baseball diamond for a Dr. Ellwood prepared to move to a feller Foundation. Completing this game. This particular diamond was retirement community. Among the assignment, he returned to California selected because the trip there was contents was a long forgotten manu­ where he worked for the California through some areas of unusual inter­ script on time-toned paper. With diffi­ State Department of Health in Berke­ est. First we began to notice cement culty we commenced reading what ley from 1926 to 1929. fireplaces standing alone beside char­ turned out to be a series ofessays writ­ Dr. Ellwood opened his first office coal and debris, mute evidences of ten by Dr. Ellwood during his eight in Oakland, CA, in 1929, and con­ burned out cottages. Considerable voyages on MS Sommelsdijk between tinued in this general practice during vegetation, however, was growing and 1942 and 1944. Although the essays the depression years of the 1930's. As almost obliterating these signs. Grad u­ were neither dated nor titled, it was he became established, the Japanese ally there appeared more and more possible to put them in chronological attack on Pearl Harbor changed piles of concrete and stone and irregu­ order. Taken together as a single docu­ every thing. larly shaped blocks of masonry with­ ment, the account may resemble a In August 1942, Ellwood enlisted in out roofs and with much less diary, but it is not; the keeping ofdia­ the U.S. Navy and was appointed vegetation. "Yes," somebody said, ries was forbidden by wartime regula­ lieutenant commander. He entered "this was formerly the town ofG [Gar­ tions. But for a minimum of editorial active service on 8 Oct 1942 and apan]." Now not a building with a roof notes in brackets, Dr. Ellwood's reported for duty at Mare Island and not a soul living there, but here a account is in his own words. Naval Hospital, where he remained shrine, there some old rusty machin­ Paul Murdock Ellwood was born in until assigned as assistant medical ery, and there a block away, the tower Elkhart, IN, on 6 Mar 1900, the son of officer to MS Sommelsdijk on 15 Dec of a former temple or church, and here an architect. He attended local public /942. He soon became the vessel's a well-constructed building of blue schools and the University ofChicago. senior medical officer and made nine stucco on a corner, appearing to be the He received his medical education at voyages on the troopship before being

Rush Medical College in Chicago, relieved at Leytefor return to Califor­ *It was not until 10 August that ADM Ray­ where he graduated in 1924. He then nia in March /945. Following are mond A. Spruance announced the capture and went west to San Francisco, CA, for excerpts from Ellwood's "essays." occupation of the island to be completed.

14 NAVY MEDICINE home of some well-to-do person, quite where already square platforms were gallon cans with a sort of valve gadget near the center of town. And then we emerging. This one said "Housing Unit between. These appeared to be cook­ came to that famous mill- now a mass umber One." Near this was another ing or dishwashing devices burning of tangled pipes, machine shop lathes more prominent one in Japanese, no diesel. The tents had dirt floors and and presses, rusted and knee deep in doubt saying the same thing. cots and were not very commodious. rubble; walls and stacks with thou- Few had platforms. The road was very sands of piercing wounds, large and muddy and slippery; an approaching small; huge tanks and boilers with the Unknown Location, 13 Oct 1944 heavy truck almost slid down on top of same evidences of systematic, com­ The other day I hitchhiked up to a us as we passed. I knew these boys plete, ruthless destruction. The whole Marine camp. The road was muddy were going out of their way but they plant must have covered nearly a city from the recent rain and I carried an were very kindly and soon deposited block. overnight bag. I was picked up by an me at the OD tent of the hospital. Out of town we came upon those Army colonel who was soon stopped The hospital also consisted entirely hundreds of amphibious tanks, most by a junior officer in another jeep who of tents for the most part without of them lined up in neat rows with the complained that some other colonel wooden floors. The patients had cots paint in fairly good shape-some with had ordered an activity placed at the but were without sheets, pillows, or turrets, some without. Here and there, exact site where some other officer had mattresses. T he tent floors were however, one would see completely ordered another activity. My driver covered with fairly firm coral, a rather rusted or with tracks off and laying colonel complained that, "We have so recently acquired luxury, replacing the very much a victim askew in the break many bosses here we hardly know mud. Yes, the orderly knew where the water half submerged, and there in one where we're at." We rode about 2 miles camp was I was looking for and soon plot were perhaps a dozen similarly over a well-surfaced dirt road where showed me a nice new terrain map. An irrevocably wrecked tanks. Soon we considerable tra ffic was coming and officer very graciously indicated that came to a set of tents and crude shops, going. The area was alive with activity evidences of reconstruction and reha­ with numerous areas of permanent

bilitation, work progressing on this and semipermanent camps and struc­ Photos courtesy Dr. Dean Mawdsley huge mass of American first-line beach tures being built. Soon the colonel taking weapons.... said, "I turn off here" and I hopped Soon we were at the diamond, a nice out. level spot, with a substantial backstop I started walking and sliding along .... On one side was a group of Gen. the road and began to see many things Grants [tanks] most of them appar­ I should very much liked to have inves­ e ntl y intact. Some of the boys tigated further but remembered the explored and found shells and guns, warnings about booby traps, unex­ etc., left just as if the operators had ploded missiles, and wandering J aps gone to lunch, though actually they no and decided to continue on my way. doubt had stood for several months. Some of these were sharp pointed Dense foliage almost hid them. projectiles about 5 inches in diameter As the game went on, a truckload of scattered about the ground, empty cas­ brown people, some with red tags ings approximately 2Yz feet long, and passed. Later, two two-wheeled carts some o ld wrecked trucks. Two boys in drawn by oxen and driven by the a jeep soon appeared and very courte­ brown people jogged along. Then two ously picked me up. They looked to be squat brown men came up, crunched marines but didn't exactly know where behind the backstop and watched the the place was I wanted .... game. Both had red tags. They were Soon we were through the moun­ unwatched and unguarded. tainous section and could see the A heavy rainstorm came but the ocean on the other side of the island boys continued to play in wet and and groups of green tents here and slippery mud. Finally the game ended. there spread out over the landscape for As we returned the same sights passed miles. We stopped and asked a sentry in review. Two others of significance where so and so was. He didn't know were noted, one a large level plot with but could direct us to the hospital. As many, many white wooden crosses, the we passed several camps we noted Marines were buried there. Another cooking areas with what appeared to sign fronted another large level space be rows of stove pipes on top of 10 LCDR Paul M. Ellwood, MC, USNR

January-February 1992 15 he would help. His name was Dr. Gardner. He explained that a few Motorship Sommelsdijk weeks previously there had been some 200 dengue cases in their hospital (500 beds) and at present there were some MS Sommelsdijk was 492 feet 7 ing, defending the Free World from 25 diphtherias. He insisted that it inches long with a 62-foot beam. Axis tyranny. In pursuit of this would be impractical for me to try to Her net tonnage was 5,517 and cause, the Dutch government in walk to the other camp a nd so called a deadweight tonnage II ,887. The exile leased the ship to the United jeep ambulance to take me over. The vessel's two diesel engines devel­ States for the duration of hostili­ latter was an ingenious affair, a jeep oped 8,400 horsepower, giving her a ties. In August 1942, Sommelsdijk with the right side fixed with a frame to top speed of 16 knots. With a fuel arrived at the Moore Drydock support two stretchers double deck oil capacity of I, 768 tons, Som­ Company in Oakland, CA, for con­ style. The driver sat in front in the melsdijk had a range of 23,040 version to a troop transport. usual way on the left and the longitudi­ miles. Manned by a crew of 53, as As a troopship Sommelsdijk nal seat behind him was sufficient for originally designed, she carried 12 sailed for thefirst time in May 1943. two attendants. We jogged a long, I in passengers. Sommelsd(jk had During it s stay in the Pacific one of the places fo r the attendants. It accommodations for I ,493 troops Theater, San Francisco. CA, must be pretty rough ridin' for in her wartime configuration as a remained its home base. Although patients, but nevertheless they must troop transport. she transported a variety of military get there. Somme/sdijk was built in units, Seabees frequently domi­ We stopped abruptly and the driver Odense. Denmark in 1939 for the nated her passenger list. Som­ inquired, "Where is the 2nd Regimen­ Holland-Amerika line fo r its pas­ melsdijk made nine voyages to the tal Aid Station?" "Right there," a voice senger and freight trade between Pacific before returning to New said. We looked up and there stood an New York and the Dutch East York for repairs. After leaving the open tent canopy affair with a little Ind ies. In May 1940, as the Nazis yard, the ship made three voyages sign in front which said "Sick Call 0830 overran Ho lland, Somme/sdijk and to Europe to return victorious and 1800." another Dutch freighter, Noordam, troops to the United States. I jumped out a nd ha lf stumbled up were in Singapore. In order to In 1946, Sommelsdijk was the incline and inquired for Dr. avoid the Japanese juggernaut, released from further service as a Mcinnes. In an adjoining tent a little these ships departed Singapore and troop carrier and 5 months later the further back I met Dr. Me and intro­ took a long, devious course around Dutch government returned her to duced myself as one of the doctors of Sumatra, Australia , New Zealand, the Holland-Amerika Line which the Sommelsdijk which had taken him and Pitcairn Island. returning reconverted the vessel to he r origi­ to New Zealand. He remembered and through the Panama Canal to Balti­ nal state. was very cordial. I showed him my bag more in early February 1942. Following nearly 20 years of and immediately indicated that the Sommelsdijk, like Dr. Ellwood. postwar service, Sommelsdijk was purpose of my visit was social and in had a new and more important call- scrapped in La Plana, Spain. the interest of trading. Did they have a nything? Yes, they might have some­ thing. Nearly all the stuff had pre­ viously been traded for food. One of the fellows had a nag and they had so me Japanese money a nd some J apa­ nese medical supplies. Dr. Me had to attend an officers school himself, but he would turn me over to hi s assistant, Dr. Richardson. And could I stay to chow? Yes, I would be glad to, but would they not like to come to the ship and have some real chow for a change. 1\o, they couldn't do that tonight. All right, I would stay if transportation could be a rranged fo r my return to the ship. It could be arranged. Dr. Richardson, in green fatigue clothes, took me immediately to the

16 NAVY MEDICINE supply tent. Low and behold, there were almost as many cases of Japanese medical supplies as there were Ameri­ can. The doctor started showing cap­ tured bandages, ampules, splints, instruments, lab supplies, and then pharmaceuticals and scales, etc. A small autoclave and filter affair with a crank had not been figured out but it appeared to be an apparatus fo r either just filtering water through porcelain (hardened staylike material) o r for fil­ tering and heating- a combined oper­ ation. Not only did Dr. R keep showing me this stuff but constantly kept giving me samples of everything. I was sure intrigued and came away with a real collection. We then went to their hospital tent, the front portion of which housed a field operating table. 'This," he said, is Sommelsdljk trades with the natives, P.l., December 1944. Japanese and is superior to ours because it has this small attached ing o n the center post. One of the first lance). The driver had a rifle and the instrument table which makes the points of conversation concerned the boy by the tailgate a 45 pistol. I sat whole table much more stable. I could lack of mosquitoes and insects which between. It was rugged going and the see it was an ingenious affair.... was directly the result of some very fellows said, 'They got one of our We walked into a crude screened tricky aeroplane distribution of DDT. lieutenants and a couple of men the building with long crude tables and It was a big plane, a C-47, and it came other night, they were on patro l. " benches, sat down, and as the officers over at treetop or less and scared After bouncing and sliding around came in, I was introduced. The meal plenty of people. Dr. Me told of the about lh hour the driver said, "I always consisted of canned bully beef made amphibious tanks which bore the feel better after I get past that banana into patties, canned white beans, brunt of the entire landing, the turret grove." A little further on we came on canned cold tomatoes, bread, butter type coming ahead, protecting the to the main road, but the driver had a substitute, peanut butter, jam, coffee, plain type carrying personnel, 35-40 to chunk of mud fly up and hit him in the water, and cake with a canned berry a tank or carrying vehicles. The ten­ eye. We had to turn off and let some of topping. There was catsup for the sions could be readily felt as the tanks this wash out with tears before we beans and meat. There was very little were fairly vulnerable. "Some outfits could go further. It was still raining. grumbling about the food although it came ashore D-1 day," said Dr. Me, We came to one entrance but the was mentioned that fresh meat had not "What did they do?" "Prepared the driver said, "I can't go in there or we'll been served for several weeks. way and reconnoitered." "Some fun I get shot, that's the seaplane base." We The colonel sat at the head of the bet." backed out and started the other way. table and seemed quite interested in It was beginning to rain and ar­ Soon we were at the dock. Fortu­ our ship. He spoke of another ship on rangements were made for me to nately, we were permitted to drive o n which the troop commander insisted leave .... to the dock and I finally clambered up o n cleanliness and he told how enthu­ The doctor gave me some J apanese the gangway with my "fortunes of siastically he cooperated as the ship stuff and so did a corpsman. In turn I war." Joe at the top yelled, "Almost "scarcely had a fly or cockroach doled out the stuff I had brought in the got you a Japanese rifle today. Had the aboard.... " bag to trade-a box of cigars, a I fellow down to 20 but he wouldn't After dinner we walked over to Dr. pound and a 2 pound box of fancy come down any further." Me's tent where we met four or five candy, an Evans cigarette lighter and a other doctors and dentists .... bottle of fluid, and a fairly decent pipe. (To be continued in the March-April The tent appeared fairly comforta­ The latter I gave to the corpsman. The issue.) ble with platform floor, army cots with boy with the flag decided he didn't nets, table in center and small stools or wish to trade. boxes to sit on, regular gasoline camp When I was fitted into a poncho, we Dr. Mawdsley, Dr. Ellwood's son-in-law, lantern for light, field telephone hang- climbed into the jeep (another ambu- resides in Hillsborough, CA.

January-February 1992 17 Chronology ~""""------lww~~ .... II + SOttt ~ Navy Medicine January-February 1942

Jennifer Mitchum

18 NAW MEDICINE Just across the bay from the Cavlte Navy Yard, Naval Hospital Canacao, P.l., was the largest Navy medical facility west of Pearl Harbor when the Jap­ anese closed It down and imprisoned its staff in January 1942.

lames still raged at Pearl Har­ Guam, co nsisting of about 400 Navy, women, and children; "we even had a bor when Japanese fighters and 155 marines, and 308 Guamanians, Caesarean section by way of vari­ F bombers swarmed over the fought hard but were outnumbered ety."(4) Philippine Islands, Wake, Guam, and and lacked the weaponry needed to On 15 Jan 1942 the nurses and other the British possessions of Hong Kong suppress the Japanese force.(l) Fol­ prisoners boarded the Argentina and Singapore devastating Allied air lowing several air raids, .J apanese Maru, a merchant ship, that would and sea forces. In the Philippines, troops landed at 0330 on I 0 Dec and take them to J apan. Not allowed to Army airfields were pulverized as Jap­ headed fo r the government headquar­ take additional clothing, the group anese bombers caught American fight­ ters at Agana. arrived in Japan shivering in the frigid ers and B-1 7 bombers "wingtip to The firing ceased by dawn and by temperature. wingtip" on the ground. When they 0830, the Japanese had seized USNH were through, more than half the U.S. Guam. "I think the bitterest moment No Rescue for the Philippines Army Air Force had been destroyed. of my life came at sunrise when, stand­ The main assault on the Philippines Outgunned U.S. military personnel ing in the door of the hospital library, I came 2 days after the initial attacks on did their best to counter the J apanese saw the Rising Sun ascend the flagpole 8 Dec. Approaching Clark Field from attack and, although our forces could where the day before the Stars and the north, Japanese air power returned not stop the enemy onslaught, their Stripes had proudly flown," said unopposed a little after noon on 10 efforts slowed them down, prolonging Leona Jackson, one of five Navy Dec. The force divided north of the surrender of the islands. nurses stationed at USN H Guam and Ma ni la. Part of it took Nielson and On Wake, marine and naval person­ captured when the island fell.(2) The Nichols Fields and Camp Murphy, the nel totaling slightly over 500, per­ enemy then set up a headquarters in other attacked the Cavite avy Yard. formed admirably, holding the islands the hospital. "They thought that if the For over 2 hours, more than 50 planes until 23 Dec 1941 with scarcely any air Americans came over to retaliate they flew back and forth over Cavite "at power. During the first raid alone. all wouldn't fire on the hospital," added leisurely tempo and in graceful curves, but 4 of 12 G rumman Wildcat fighters J ackson.(J) at 20,000 feet elevation beyond ra nge were destroyed . Subsequently, two Shortly after the landings, casualties of the 3-inch antiaircraft guns, the m ore planes were lost in missions. A began pouring into the hospital. Navy bombers releasing at will."(5) medical facility near the airfield was medical personnel were allotted one In way of medical treatment, several badly hit a nd several corpsmen were ward for tending patients as the Japa­ station hospitals and dispensaries among the fatalities. By the surrender nese utilized the rest of the hospital existed throughout the islands as did 2 days before Christmas, a new medi­ facility. " It was probably the most two main military medical facilities: cal station was operating in two under­ a mazing ward I'll ever see," declared the S ternberg Army H ospital in ground magazines. nurse J ackson adding, "we had war Manila and USNH Canacao, located Similarly, the small garnson on casua lties there, and native men, on the south rim of Manila Bay, adja-

January-February 1992 19 yard. It was really a s hocking scene."(8) Within that time, medical personnel received and treated approximately 500 casualties of w hi ch 100 were treated in the surgical ward with -- merely a 50 kw unit lighting the operating rooms, halls, and part of the ward.(9) Many of the injured civilians received emergency treatment and were sent to the Caridad School build­ ing where Philippine Public Health

Wtke hland _,.. doctors had set up a hospital. . Personnel transferred patients to the Sternberg Army Hospital in ,.: .. Manila as the Japanese pushed inland. Monholllolonds In addition, a small team of doctors, n urses, and hospital cor psmen

Gilt..rt lolonclo : ... assumed temporary duty at Sternberg . \ to help care for the patients. As the enemy continued to gain ground, the hospital relocated several times, the first time to the Sternberg Army Hospital. "It was not until I) _, around m id night or after when some of the PT boats, which were new out there, came to take us to Manila," said The American possessions of Wake, Guam, and the Philip­ nurse Danner about the transfer.(/0} pines were early targets of Japanese aggression. From there, the hospital moved to the Estado Mayor, a group of old wooden buildings about a block from cent to the Cavite Navy Yard. Several Most medical supplies were moved Sternberg that once housed an infan­ missiles fell within the navy yard de­ from the dispensary to this location. try battalion. Within days, it moved stroying the dispensary but sparing the Casualties began streaming into the again, this time to the Philippine hospital. As Cavite burned uncontrol­ station shortly after the first wave of Union College at Balintawak on the lably, personnel tha t had been enemy bombers had passed. The sta­ northeastern outskirts of Manila, and assigned to the dispensary relocated to tion was hit in the midst of the bomb­ then fi nally to the Santa Scholastica other medical posts throughout the ing. Personnel then loaded patients College in Manila after General yard. Some joined the Canacao staff into trucks and headed fo r USNH MacArthur declared Manila an open while others worked in various field Canacao. city on 26 Dec. and dressing stations. "We came out from under the build­ Upon arriving at Santa Scholastica Med ical personnel in the field with ing and there was the navy yard, a ll College, Navy medical personnel the Marines not only cared for flattened out, black smoke coming up found Navy, civilian, a nd a few A rmy wounded but also took up a rms. "We everywhere." recalled Dorothy Still patients that had been left behind by counted 80 bombers go right over us. Danner, one of II avy nu rses the previous occupant, the Army Med­ We couldn't reach them but we kept assigned to USN H Canacao and even­ ical Center. Those few patients were them from getting down too low. They tually captured in Manila.(7) She and added to the Navy medical rosters. In said we got two of them," recalled other nurses had taken refuge under an attempt to consolidate all blue­ Ph M2c Ernest .1. Irvin, USN, who was the nurses quarters at the onset of the jackets and marines in one place, hos­ serving with "C" Battery of the Third raids. As the sound of enemy bombers pital personnel searched area Manila Battalion Fourth Marines across receded, Danner and her colleagues medical facilities for Navy and Marine Bacoor Bay. a mile south of the Cavite rushed back to the hospital to find it Corps patients that may have been avy Yard.(6} inundated with patients. 'They were brought there during the series of air One facility best shielded from the on the floor. There were Filipino raids. aerial attack was a medical station women and children and some men By New Year's Day 1942, 27 doc­ beneath the naval prison at the yard. and our own people from the navy tors, II nurses, and 104 hospital corps-

20 NAVY MEDICINE men at USNH Canacao, awaited CONUS pharmacist mate, died at Cavite Navy occupation of the city by Japanese In CONUS, the Navy Medical Yard and the other three at USNH expeditionary forces. The following Department was busy finding ways of Canacao. day, the enemy occupied Manila and increasing patient capacity at hospitals seized the hospital. They questioned and organizing security and emer­ References CAPT Robert G. Davis, MC, com­ gency measures in case the mainland I. Karig W. Kelley W. Baule Report, Pearl manding officer, about the storage of came under fire. To meet the demand Harbor to Coral Sea, p 107. firearms on the hospital compound for more hospital beds, new buildings 2. Karig W, Kelley W. p 109. 3. Ibid .. p 109. and then searched his safe . By 7 Jan, were going up and a plan of expansion 4. Ibid .. p 109. the Japanese occupied the entire hos­ and / or renovation was underway at 5. Morison SE. The Rising Sun in the pital and posted guards at the gate. existing facilities. Some sites such as Pacific 1931-April 1942. p 171. Throughout January and February USNH Bainbridge, MD, and USN H 6. Irvin EJ. Wartime reminiscences of they returned to "inspect" the hospital, Bethesda, MD, were ready for com­ PhM2c Ernest J . Irvin. USN. 7. Danner DS. Wartime remi niscences of confiscating hospital supplies on missioning and opened o n 4 Feb and 5 LCDR Dorothy Still Danner, NC. USN. almost every visit. They took the hos­ Feb, respectively. X. Ibid. pital's stock of quinine and several USNH Bethesda, MD, opened as 9. Davis RG . Jo urnal, p I. other items including iron beds and part of the National Naval Medical 10. Danner. mattresses, pillows, linen, mosquito Center, Bethesda, replacing the aging II. U.S. Navy Medical Departmel!l Admin­ istrative History 1941-1945: Narrative History. nets, pajamas, and hospital vehicles. faci lity at 23rd and E Streets in Vol!, chaps I-VII I, p 9 of chap II . Following Japanese orders, medical Northwest Washington, DC. In addi­ personnel began transferring patients tion to the hospital, the new medical Bibliography in pairs to a hospital the Japanese had center housed the U.S. Naval Medical Danner DS. Wartime reminiscences of set up in an elementary school. This and Dental Schools. LCDR Dorothy Still Danner, i'\C, USN. transfer went on almost daily. On a Training was also a major concern. BUMED Archive>. Davis RG. J ournalS Dec 1941 to 7 Sept 1945. few occasions larger numbers of pa­ The Surgeon General directed that all BUMED Archives. tients were transferred as well as Dental Corps officers become profi­ Irvin EJ. Wartime rem iniscences of PhM2c members of the hospital staff. In addi­ cient in administering first aid­ Ernest J. Irvin, US:-<. BUM ED Archives. tion, the Japanese requested medical treating burns, shock. and hemor­ Karig W, Kelley W. Baule Report: Pearl Har­ histories on all patients and ordered rhage; disposing of the dead; and bor to Coral Sea. New York: 1-arrar & Rinehart Inc; 1944. patients and staff members to fill out performing other duties customary to Kentner RW. Journal. BUM ED Archives. questionnaires disclosing name, rate, the Medical Department. Morison SE. The Rising Sun in the Pacific age, religion, next of kin, birthplace, To provide training for hospital 1931-April 1942. Boston: Little Brown & Co; and education. corpsmen, construction began on a 195 I. site west of USN H Great Lakes in Sep­ Patton WK. Bilibid account of captivit y at Mani la, PI , 1942-1945. J ournal. BUMED Navy Medicine at Sea tember 1941 for a Hospital Corps Archives. Medical personnel also served school. The school officially opened The History of/he Medical DeparJmem ofJhe within the fleet aboard noteworthy on 14 Feb. U.S. Navy in World War II: A NarraJive and vessels including USS Canopus, USS Pictorial Volume. Washington, DC: Govern­ USS USS ment Printing Office; 1953. Houston, Marblehead, KIA UniJed States Naval Chronology, World War Pecos, and USS Oahu. As part of the As medical personnel a imed to pre­ II. Prepared in the Naval History Division. fleet, Navy medical personnel dis­ serve lives during battle, several gave Office of the Chief of Naval Operations, Navy played bravery and skill as they up their own. At sea, in the Atlantic Department. Washington, DC: Government attempted to save as many lives as pos­ theater, two doctors were killed in Printing Office; 1955. sible during heightened moments of action (KIA), one aboard USS Trux­ U.S. Navy Medical Departme/11 Administra­ Jive History, 1941-1945: Narrative Hiswry. Vol baftle. When Canopus was hit the ton and the other aboard USS Jacob I, chaps I- VIII. Unpublished typescript. second time on 5 Jan, stretcher parties Jones. Three pharmacist mates a lso BUM ED Archives. began boarding the ship "almost be­ died, one each on USS Truxton, USS U.S. Navy Medical Deparrmem Administra­ fore the dust had settled" and carried Pollux, and USS Jacob Jones. Three live Hislory, 1941-1945: Organizational His­ 15 wounded men to dressing stations pharmacist mates were also killed as tory. Vol II, cha ps X- XV I. Unpublished typescript. BUMED Archives. CJ ashore.(/ I) Similarly, the 18 corpsmen part of the fl eet in the Pacific theater aboard Houston, which later received aboard USS Pope, USS Shark, and a Presidential Unit Citation for its ser­ USS Peary. Additionally, four medi­ Ms. Mitchum is special assistant to the Com­ vice, were occupied with routine or cal personnel were killed during the 10 mand Historian. Bureau of Medicine and emergency medical functions. Dec raid on the Philippines. One, a Surgery (09H), Washington, DC 20372-5120.

January-February 1992 21 Naval Medical Research and Development Command Highlights Bethesda, MD

• New Labeling Technique for Stem Cell assess the effects of high intensity glare on visual per­ Replacement Therapy formance. The artificial eye which is interfaced with a Stem cell therapy is the mainstay of successful bone high resolution color image processor, is comprised of a marrow transplantation. However, it has been difficult dual lens system, variable aperture, and scaled anterior to grow stem cells in culture and to prove that func­ and posterior chambers. The artificial eye allows tional blood cells collected from patients actually researchers to vary, with known degrees of freedom, derived from therapeutically infused stem cells. Re­ parameters of the human eye such as the refractive searchers from the Immune Cell Biology Department at power of the cornea and lens, lenticular and corneal the Naval Medical Research Institute, Bethesda, MD, transmittance, pupil size, as well as the fluids filling the developed a new method that combines the use of two chambers. Current research is calibrating and validat­ bone marrow growth factors, stem cell factor and ing the artificial eye against human data over a safe G-CSF (granulocyte colony stimulating factor), and range of glare intensities. Studies to date demonstrate interleukin-3, a cytokin, to stimulate the division of that the glare spread function in the artificial eye closely isolated stem cells from rhesus monkeys. Cell labeling approximates the human glare spread function was done with a retrovirus containing a gene for resist­ observed with emmetropic and ametropic observers. ance to the antibiotic, neomycin. Studies showed that Future studies will assess the transient effects associated the lethally irradiated rhesus monkeys recovered with with damaging glare intensities in addition to evaluat­ culture grown labeled stem cells (CD34 + cells). The ing high risk agile laser eye protection. normal levels of new red blood cells, white blood cells, and platelets occurred as early as 2 weeks postirradia­ tion/ therapeutic transfusion with CD34 +cells. All cells * * * were derived from CD34 +cells because all white blood • Trypsin Detection and Quantitation cells were resistant to neomycin. Human stem cell Using the BAPNA-in-Agar-Gel replacement therapy trials will commence shortly at Researchers at the Naval Dental Research Institute, NIH. This therapy has the potential to save the lives of Great Lakes, IL, developed a quantitative assay for countless military casualties if future conflicts include measuring trypsin and trypsinlike enzyme activities the use of chemical or radiological weapons. In the using N -a-benzoyl- D L-a rgi ni ne-p-ni troanilide civilian sector, this new technique for manipulating (BAPNA). Both cultured oral microorganisms and stem cells will help advance blood cell reconstitution human subgingival plaque can be screened and evalu­ therapies for cancer patients. The novel method of ated for trypsin activity. Thus far, use of the BAPNA­ growing stem cells in culture will allow the therapeutic in-Agar system has revealed positive reaction by trypsin replacement of the patient's own stem cells, decreasing and several gram-negative oral microorganisms asso­ the risk of transplantation rejection as well as the risk of ciated with adult periodontal diseases. Applied clini­ infection from nonself stem cell donors. cally, the test will help identify patients undergoing changes in disease status and will be useful in monitor­ * * * ing the success of therapeutic measures. Exploratory tests with subgingival plaque samples indicate the • Assessment of High Intensity BAPNA-in-Agar system can serve as a rapid, simple Laser Exposures method for detecting microbial trypsinlike activity. NMRDC-sponsored researchers at the Naval Air For additional information on these or other medical Development Center, Warminster, P A, designed and R&D projects, contact NMRDC Code 04 at Commer­ fabricated an enlarged (X14), scaled artificial eye to cial (301) 295-1468 or Autovon 295-1468.

22 NAVY MEDICINE Professional

Pyridostigmine Prophylaxis During Warm Water Diving Operations

CAPT J.W. Thorp, MC, USN LT D.M. Stevens, MC, USN CAPT A.J. Dutka, MC, USN T.J. Doubt, Ph.D. CAPT E.D. Thalmann, MC, USN

ne important goal of scientists Background the effects of pyridostigmine. at the Naval Medical Re­ Troops deployed to the Middle East At the time, research had not been 0 search Institute (NMRI), Be- were exposed to extremely high done to study these problems, and the thesda, MD, is to develop recommen­ temperatures and to the risk of attack required information was not availa­ dations for guarding the health and with chemical weapons. They carried ble in the literature. Fortunately, safety of our troops, while improving pyridostigmine packets to use if pro­ resources at NMRI were optimal for their ability to complete their mission phylaxis was required against possible conducting this type of work with under a wide range of environmental exposure to chemical warfare with short notice. The original query conditions. Generally, operational nerve agents. The question from the arrived on 27 Aug 1990. NMRI's planners can define the requirements fleet was, "Will the prophylactic use of investigators provided their answer that generate these research programs pyridostigmine affect the diver's abil­ before 15 Oct 1990. Table I outlines far enough in advance to allow several ity to complete his mission?" the course of events from the time of months or years to plan and execute Through its influence on the auto­ the initial request until the report was each program. Occasionally, however, nomic nervous system, pyridostigmine completed. Of course, research on they need immediate information to could have adverse effects upon ther­ several other projects had to be sus­ deal with a hazardous situation. That moregulation, exercise tolerance, pended during the study. type of situation arose last year with equilibrium, and cognitive perform­ To ensure that the study design the deployment of troops for Opera­ ance. With the doses used for chemical would truly reflect operational situa­ tion Desert Shield. Investigators at warfare prophylaxis, these negative tions, and to obtain supplies such as NMRI were tasked to define how well effects had not been experienced by clothing and rations that would be divers could work in hot water while pilots and others tested in hot, dry used in the fleet setting, the investiga­ taking pyridostigmine as protection environments, nor by patients who tors maintained close liaison with against exposure to chemical weap­ receive the drug to treat myasthenia operational groups during the study. ons. The information was required gravis. The diver, however, is exposed Within days of receiving the initial "immediately." to a hot, wet environment where heat request, NMRI's investigators met This report describes how that task stress may differ substantially com­ with representatives of the Bureau of was accomplished, and illustrates how pared to dry environments. Addition­ Medicine and Surgery and contacted NMRI responds quickly to meet the ally, some divers breathe 100 percent Explosive Ordinance Disposal and Navy's needs. The bibliography pro­ oxygen (02) and face the risk of sei­ Naval Special Warfare commands to vides more detailed information about zures from oxygen toxicity. The bibli­ obtain more information about the the research plan and the results of the ography contains a more detailed field conditions that might be study. discussion and list of references about encountered.

January-February 1992 23 .....

Schematic of Man-Rated Chamber Complex (MRCC) at NMRI.

The investigators would have pre­ fe rred to study several different aspects of the problems described, TABLE 1 such as the relative effects of breathing Background: Pyridostigmine and Diving air vs. 0 2, the effects of different temperatures from 90 to 1 10° F, and the effects of different levels of exer­ 27 Aug Message from CINCPACFLT tion. There was no time to accomplish all of those goals, however. They 29 Aug Phonecon CINCPACFLT and NMRCD decided they could obtain the most Meeting at BUMED useful information by comparing the Phonecon NA VSPECWARCOM effects of pyridostigmine vs. placebo upon the ability of divers to perform 31 Aug Planning meeting at DMD, NMRI: intermittent exercise in hot water Literature search (94° F) while breathing 100 percent 0 2 Research plan at the depth of 20 feet of seawater Reply to message (FSW). They would have to wait until some other time to design more elabo­ 5 Sept Message CINCPACFLT: rate studies to answer other questions. Define conditions Literature search completed Study Design Ten Navy divers participated as sub­ 10 Sept Research protocol approved jects to measure changes in thermal and hydration status, exercise and 11 Sept Reply to message sent cognitive performance, manual dex­ terity, and visual adaptation in chang­ 14 Sept First research test conducted ing ambient light. Each subject completed two 7-hour 12 Oct Message to sponsors with answers to questions exposures in NMRI's Man-Rated Chamber Complex (MRCC)- one after taking a 30 mg pyridostigmine

24 NAVY MEDICINE to obtain these items. During each exposure, sensors were in place to monitor rectal and skin temperature, heat flux, a nd heart rate. Cognitive performance was measured by use of the PAB. Exercise perform­ ance was evaluated by measuring heart rate, ventilation, oxygen consump­ tion, and indirect calorimetry while the diver worked on a cycle ergometer. Blood and urine sa mples were obtained to evaluate hydration status. Q Other functions were evaluated peri­ \ 1 odicall y during the exposure: ( I) man­ Divers during "dry phase" drank 1 liter of water per hour. ual dexterity~mcasured by the time Diver on right is demonstrating the grip strength test. required to assemble nuts a nd washers on a bolt, (2) visual adaptation to changes in ambient light ~ measured tablet three times daily for 2 days and load. During that period, the di vers by the a bility to read letters w hen the other after taking a placebo three a lso learned how to complete the com­ ambient lighting was increased or times daily for 2 days. Drug and puter-ass isted Performance Assess­ decreased, (3) diver perception o.lheal placebo were administered in balanced ment Battery (PAB) used at N M R I to stress and exertio n ~ measured with fashion and the study was performed evaluate changes in cognitive function. number scores, and (4) hand grip double blind. Heat acclimation was maintained by strength ~ m easu r ed wi th a hand Before any exposures, each diver spending alternate days in the environ­ dynamometer. was heat-acclimated 90 minutes per mental chamber between exposures. During the exposure, the d ivers day for 5 days in NM R l's environmen­ Each diver ate Meal Ready to Eat were at rest for4 hours breathing air in tal chamber. During the 90 minutes in rations for 2 days and wore desert one chamber of the M RCC that was the chamber, the temperature was kept camouflage attire during the exposure heated to a temperature of 100° F. Var­ at 100° F, while the diver pedaled a to simulate field conditions. Opera­ ious tests were conducted as described cycle ergometer at a moderate work tional groups were generous in helping above. For the next 3 hours, the divers were immersed in the wet pot of the M RCC, performing exercise on a cycle ergometer with the water tem­ perature at 94° F. During immersion, the chamber was pressurized to the equivalent of 20 feet of seawater. Dur­ ing the first 2 hours of immersion, the ergometer work load was kept rela­

tively low (oxygen consumption (Y02 ) = 1.0 L / min, or equivalent to fin swim­ ming at 0.6 knot) with repeated peri­ ods of 30 minutes of light work followed by 10 minutes of rest. During the last hour of immersion the divers completed three periods with each period having 5 minutes of light work, I 0 minutes of moderate work (Yo2 = 1.8 to 2.0 L / min, or equivalent to fin swimming at 1.0 knot), and 5 minutes of rest.

Divers during "dry phase." Note computer terminals for test­ Results ing with the PAB. Divers are breathing into the spirometry For both the drug and placebo con­ circuit to measure respiratory volumes and oxygen ditions, the divers were able to com­ consumption. plete the work. At the end of exposure,

January-February 1992 25 38.50 ,------. Discussion Accomplishment of the fleet tasking illustrates the fl exibi lity and respon­ -e- PYR ----tr- CON siveness required to provide useful 38.00 information to NMRI's sponsors. A 2 major reason that the project suc­ 0. 2 ceeded is that N MRI's investigators w 1- 37.50 enjoy a close working relationship _j with their sponsors, e.g., personnel at <{ the Explosive Ordinance Disposal and u1- w Special Warfa re Commands, NA V­ a: 37.00 SEA, and others. This relati onship was crucial for understa nding the problem and designing the best pro­

36.50 L______..______..__ __ .J.__ _ _ +-----'----__J__-____J tocol to a nswer the question. It wo uld 0 60 120 180 240 300 360 420 have been impossible to conduct the research wi thout this liaison, because EXPOSURE T IME (MIN) much of the gear used had to be obta ined with the help of the sponsors. Figure 1. Rectal temperature (mean ± SEM) measurements The experience of completing this during dry exposure and immersion. Comparison of drug task has had the additional be nefit of (PYR) vs. placebo (CON) for 10 subjects. helping N M Rl's scientists become rectal temperature was increased by but it should be noted that all divers even more aware of the needs of the I° C with no difference between condi­ were well hydrated before exposure operational avy. This understanding tions (Figure 1). The increase in rectal started, a nd each diver consumed 4 stimulated new ideas for research to temperature was similar to that expe­ liters of water during the first 4 hours lea rn more about the diver's ability to rienced when running on a warm day; of exposure. Visual acuity, grip work in warm water. it never a pproached a level that would strength, and m otor coordination be considered dangerous to the indi­ were unaffected by condition or by Bibliography vidual. For all groups, the ability to exposure to heat. Heart rate (Figure Doubt T J . Dutka AJ . Pyridostigmine a nd complete the PAB was decreased by 20 2), ventilation, and oxygen consump­ warm water diving protocol 90-05: I. General to 40 percent after exposure to heat, tion also were unaffected by condition. outline. Naval Med ical Research Institute Tech­ nical Report No. 90-95. 1990. with no difference between conditions. More detailed information is available Hyde D. Weinberg R P. Stevens OM. Doubt Hydration status was well maintained, in the bibli ography. TJ. Pyridostigmine a nd warm water diving pro­ tocol 90-05: II. Thermal effects. Naval Medical Research Inst itute Technical Report No. 90-96, 150 1990. "'t T ho mas JR, Schrot J , Ahlers ST, Thorton 140 MO, Dutka AJ , Armstrong OW. Kowalski KR. Shurtleff D. Pyridostigmine and warm water z diving protocol 90-05: Ill. Cognitive effects. ::i 13C _!_ Naval Medical Research Institute Technical '(/) I- Report No. 90-97. 1990. < 120 ew Doubt TJ, Roberts JR. Taylor NAS, Wein­ w berg R P, Holmes NE. Pyridostigmi ne a nd warm I-< 11 0 IY water diving protocol 90-05: IV . Exercise and I- ventilation. 'aval Medical Research Institute IY 100 w< Technical Report No. 90-98, 1990. I Stevens O M. Hyde D. Haberman KJ, Thorp JW, Doubt T J . Pyridostigmine and warm water diving protocol 90-05: V. Hydration status. 80 Naval Medical Research Institute Technical Report No. 90-99, 1990. o 70 0 30 60 90 120 150 i 80 Drs. Thorp, Doubt, and Thalmann a re on IMMERSION TIME (MIN) staff a t the Naval Medical Research Institute, Bethesda, MD. Dr. Dutka is head of neurology Figure 2. Heart rate for PYR and PLA during immersion. at the Nat ional a va l Medical Center, Increases in heart rate correspond to work periods. Bethesda, a nd Dr. Stevens is an EENT resident at the same facility.

26 NAVY MEDICINE To the Editor

PTSD I am a member of 2d FSSG (the only Navy female nurse I am writing a letter to you regarding the article by CDR forward) and was utilized by both Medical Battalion as Sampson, ''Treating the Psychologically Wounded War­ well as Headquarters and Service Battalion (in the Group rior" which appeared in the July-August 1991 issue of Aid Station) for the DSC. I moved forward to AI Khanjar Navy Medicine. I applaud CDR Sampson for presenting a to assist with the nursing care in the Navy-Marine Corps concise and informative overview on the psychiatric dis­ Trauma Center. I was assigned to the prisoner of war ward order known as post-traumatic stress disorder (PTSD). as the night nurse. During the 4 days of the ground war and The only area of his article which I think was inadequately 3 days following I was one of the nurses who provided presented was the section on medication. He seems to direct care to the Iraqi prisoners of war. It was my observa­ downplay the valuable role medications have in treating tion that in working with the prisoners of war that they PTSD. He says they can be useful in treating certain readily assisted one another, whether it was to refill water serious symptoms. I feel this is misleading. Selective psy­ cups or to get the attention of one of the staff because a chopharmacology can be effectively tailored to treat a wide prisoner of war patient needed assistance. variety of symptoms including sleep disturbances, refrac­ The Nurse Corps officers assigned as charge nurses for tory depression and anger, persistent flashbacks, persistent the wards were all ENSs, LT JGs, or LTs. There were two anger and hypervigilance, and/ or significant distress on nurses assigned to each 30-36 cot ward, one for the 12- reexposure. hour-day shift and one for the 12-hour-night shift. The Mild or moderate PTSD symptoms can be debilitating only exception was in the intensive care unit which staffed to the patient's intrapsychic understanding of and coping at least two nurses on each shift. There were approximately with the world around him. Appropriately prescribed psy­ 5-6 corps staff on each shift for each ward. The corps staff chotropic medications- which reduce the severity or the was augmented by the Dental Corps on many wards. The presence of one or more of the spectrum PTSD majority of care rendered was by the Hospital and Dental symptoms-can contribute significantly to the patient's Corps. The Nurse Corps officers' role was to supervise, working through of the traumatic events and putting the teach, and assist the corps staff in the care of the prisoner of past in its place while living a better present and hoping for war patients. In my entire time covering 6 months, 10 a better future. I refer CDR Sampson and others to an moves, and working with a variety of personnel in Navy excellent article entitled "New Approaches in the Pharma­ medicine, 1 never heard concerns from anyone about pro­ cotherapy of Post-Traumatic Stress Disorder" by J. Silver viding care to prisoners of war if the U.S./ Allied troops et al. in the October 1990 supplement to Journal of Clinical were no longer among the incoming wounded. Psychiatry 51:10, pages 33-38. Prior to my present tour with 2d FSSG, I was assigned as Flight Nurse/ Nurse Corps Officer at Diego Garcia. In CAPT M.L. Dembert, MC this position I managed, cared for, and interfaced with the U.S. Air Force in patient medevac movement. In any medevac the prisoners of war are moved after U.S./ Allied Nursing Care of Iraqi POWs casualties. At AI Khanjar the flight deck was dirt. Due to The following information is in response to CDR Van the rains during the ground war, the soil structure was Nest's article entitled "Nursing Care of Iraqi Prisoners of subject to bog holes. This was somewhat like quicksand. War" in the July-August 1991 issue of Navy Medicine. The U.S. Air Force could not jeopardize a C-130 on the The Navy-Marine Corps Trauma Center at AI Khanjar, flight deck that potentially could be stuck in the mud. Due Saudi Arabia, was a combination of BOTH 1st FSSG to the rain the prisoner of war patients could not be moved (Camp Pendleton) and 2d FSSG (Camp Lejuene) medical as quickly as many would have hoped. In a 36-hour period personnel. The garrison assets of both 1st and 2d FSSG the prisoner of war patient census went to 150 before were involved, as well as over 200 Navy Medical Depart­ medevac movement could be reinstituted. ment personnel who were TAD from Navy medical treat­ In closing, I would like to commend the Hospital Corps ment facilities. The personnel who were TAD augmented and Dental Corps staff. These men and women did a the Medical Battalion of BOTH 1st and 2d FSSG in the myriad of jobs from setting up tents, caring for patients, Direct Service Command (DSC), which was the support and standing watches. Their "can do" attitude and profes­ unit for the forward Marine Divisions. CDR Brown, sionalism was instrumental in all aspects of the Navy­ MSC, was the commanding officer for the Navy-Marine Marine Corps Trauma Center at AI Khanjar, Saudia Corps Trauma Center, which was Medical Battalion for Arabia. the DSC. Within the Navy-Marine Corps Trauma Center LT S.M. Weibert, NC there were three letter companies, with all personnel under the Medical Battalion of the DSC.

January-February 1992 27 In Memoriam Dr. Galloway studied at the Naval War College, New­ port, RI, served as a staff medical officer to the Second CAPT Harold M. Braswell, Jr., MC (Ret.), died of pan­ Marine Division, and participated in the Saipan and creatic cancer on 21 Dec 1991 in Paradise Valley, AR. Okinawa operations. Subsequently, he commanded the Dr. Braswell was born on 17 Aug 1924 and was a native Medical Field Research Laboratory, Camp Lejeune, NC, of Bonham, TX. He graduated from Louisiana State Uni­ and the Naval Medical Research Unit #3, Cairo, Egypt, versity and received his M.D. from the University of respectively. He assumed duty as commanding officer of Arkansas. He completed his internship and residency at the Naval Medical School, National Naval Medical Cen­ the University of Chicago clinics and at the Naval Aero­ ter, Bethesda, MD, from August 1956 until December space Medical Institute, Pensacola, FL, respectively. In 1958, when he was assigned to BUM ED as Assistant Chief addition, he was conferred the Master of Public Health for Research and Military Medical Specialties. In July Degree by Tulane University. I 963, he reported as commanding officer of the National Dr. Braswell began his military career during World Naval Medical Center, Bethesda, and se rved as such until War II in the Army Air Corps. He served in Europe with he retired I Feb 1965. the 8th Air Force as a radio operator and gunner before RADM Galloway was awarded the Legion of Merit; joining the Navy. Bronze Star Medal; Yangtze Service Medal; Marine Corps During his naval career, Dr. Braswell served as senior Expeditionary Medal; American Defense Service Medal, medical officer and flight surgeon at sea on the aircraft Fleet Clasp; American Campaign Medal; Asiatic-Pacific carriers USS Randolph and USS Saratoga. During the Campaign Medal; World War II Victory Medal; Navy Vietnam conflict, he saw action in the Gulf of Tonkin off Occupation Service Medal, Asia Clasp; National Defense, the coasts of North and South Vietnam, while embarked Korean, and United Nations Service Medals. on Saratoga. In addition, he served as senior medical officer and flight surgeon in both the Atlantic and Pacific * * * Fleets, at Naval Air Squadrons ashore and afloat, and at Statement of Ownership, shore-based naval medical activities. Management and Circulation In 1982, CAPT Braswell retired from the Navy and tRBqwed bv 39 u sc. 3685) entered private medical practice in Paradise Valley, AR. NA.VY MEDICINE 30 Sept 1991 8 Annu• U"I>IC '!CI\·0~ roc• CAPT Braswell was awarded the Navy Commendation $8 . 00 Oomest.1c Bi monthly $10. 0 0 Foreign Medal; Navy Unit Commendation; Meritorious Unit G Cnm~:>lel t '-'.,'"'11 A ~r 1nol to:no""n OHc:•toon 1Suur 0" (;,..Ill)', Sui•r<~tf!li liP ~ 4 Ci>J.'J I\tttP""""• ' NA VY MEDICINE , De p artme nt of the Navy. Bureau of Medicine t. Surgery (09H) Commendation; Army Good Conduct Medal; American, 2300 E St ., N. W., Washi ngton, DC 20372- 5120 ~ Cl)mP'-'' M•~"'ll .t.~ eu ol ,,.. He•d-•1• •• ol Otnt rll Busmus 6fl>e•• ~I '"'" f>Wiotl'l.,. ( \'of. JWUII~'' Departme nt of the Na vy, Bureau of Med i c ine & Surg f' ry (09H) European, and Republic of Vietnam Campaign Medals; .2300 8 St., N.W., Washing ton, DC 20372 - 5 120 World War II Victory Medal; Army of Occupation & F., ...... ,.l.rn!Comp~ot1tM I"lllr1Mf . Ed!OI', ..w1 MM~ag.on(lfdllOI (1'ltd iltlfl ,\jLST \OTHW...A! f>.,o,ll'lot< ,...,,,. -.tC.-pi~" ,\W.t"'' .idd''">' Depa rtment of the Navy, Bureau of Medicine & Surgery (09H) (Europe) and National Defense Service Medals; and the 2300 ESt. , N.W. , Wa~h i ngton , DC 20372-51 20 Ed·lcw •\ ,,,.,-c,"''IW'r/OI~> - tuitJ•u• '"~ " H •"'"" "'"" o4,h •• ,.. , .,..,. , • h. ~"' l!'<••aof tor""'"'t>!">I• """'"""''""' """""" ' "'l'llllld4rrn~•"!fti" "'dm.:W./--,..-n_""'"'"' lt .... .,. J,.,,, I"''"" ' W."• failure 28 Jan 1992 after a lengthy illness. , .• '~"' c """""'T"''a/..Jfi"" 111 ...- a..J1 IW ft""· lfrh, ~·~-''"" n ,..bl,>lln/1>1" "'"'!''"~' '"""''''"''"" fl •IJ rlt<-.. M<~"'""" - "',,., Commissioned an ensign, he joined the Navy 3 June None 1930 and completed his internship at the Norfolk Naval

Hospital, Portsmouth, VA. He then returned to the Uni­ !i ~o• Co.-.pletoon b~ '--•ol ~ O•~ruat'Oftl AU11'0hztd To ~~~ 11 Spec •~ Altn rD~Itf Stm01t 4N 1],./1, TM PUt ~oe l~nC UOI'I. a nd I\Onpon t nd tkt t xe -..p t 1 111~1 IQI Federel n<:Otnt U x P""IXIH' <(lk,J. · - • versity of Michigan for postgraduate work in syphilis [K! ~"'.... <~o;,;~!'~!~..";'.ng 111<"""'~.-.J /IWNI>Jic l '"~ " 'k"""-' •lf'b•""'"'' --I "''"'"f~ kllh '~" ...~ •• - .... ~ · .

b,.nt lndN~tuttOf ( ~ttula< on Avt' ''" No Cop"' Eaeh ln..,. o ....,,. A~rua• NQ Co~n ql S"''i'- u ..... before reporting as medical officer to USS Panay on China IS..•t~>t.,...... , , '"" '"''N' udr} Ptt!Ctti"'Q I 1 M

Station in October 1931. A loti - -.a Coo--ti 1\rl I'•~•• lt-1 124 , 772 20 ,300 20,300 6 fl'.wta'IOorRe•w.. tedC,cul•tiOII Dr. Galloway served as liaison officer with Memorial 1 SuesthrO<.Ig~tlt:Nu.,...;c •mt

Brazil, as well as medical officer of the U.S. naval operat­ I t:ertify that the st atements made by me above &•e correct and complete

ing base there. f>S Fotm 3526 '"""'""' 1'1'>1

28 NAVY MEDICINE A Look Back

Navy Medicine ca. 1919

Nurse provides bedside Instruction at Hospital Corps school.

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