Battle casualties from the Philippine Islands

Report is made on experiences with 4,040 surgical battle casualties from the campaign for the Philippine Islands. Detailed analysis of 3,383 of these cases is presented. These were patients who were admitted to a general hospital in Dutch New Guinea. Data are presented concerning the types of injury, the complications, the treatment given in the forward areas, the time interval between injury and operative treatment, the elapse of time between injury and admission to this hospital, the condition of the patients on arrival, the mortality rate, and the causes of deaths. Wounds of soft tissue occurred two and one-half times as frequently as did major fractures. The majority of wounds were caused by small caliber bullets or small fragments of shells or bombs. Minor wounds of entry and exit commonly marked the site of extensive damage to underlying soft tissues and bone. Major amputations had been performed in only 2 per cent of cases. Eighty-four per cent of patients had received sulfonamide therapy from the time of injury until admission to this hospital. Forty-three per cent of patients had received intramuscular penicillin in adequate clinical dosage while en route to this base. Undoubtedly the fact that this high percentage of the wounded were treated by sulfonamide drugs or penicillin as an adjunct to surgery has been reflected in the saving of many lives. Close observation of wounds has provided no evidence that such therapy has resulted in less extensive infection of serious wounds. Cases of hemothorax which had been treated by thoracentesis at regular intervals did not develop complications whereas those which had not been so treated were complicated further by the development of fibrinous hemothorax or empyema. Infections or gangrene due to Cl. welchii occurred in 1.1 per cent of all cases and in 3.6 per cent of all fractures. Thirteen of these battle casualties died in this hospital. The case mortality rate at this station therefore is of 1 per cent.

The introduction of certain military medical methods in this theater has resulted in improved condition of patients and of their wounds on arrival at a general hospital. Innovations in military medical practice during this campaign included availability of whole blood in the forward areas, the assignment to the forward areas of surgical teams comprising the best available professional talent, and the organized efforts of the surgical consultants who advised, demonstrated, and taught in the forward areas. The distances involved in the Southwest Pacific during the campaign for the Philippine Islands necessitated a relatively prolonged period for the patients on the hospital ships. Many patients were evacuated to general hospitals by air but this hospital received only those patients who were brought by ship. The strategic location of general hospitals at points far distant from the United States during this campaign afforded an unequaled opportunity for the application of the principles of reparative surgery.

This analysis of battle casualties reflects the greatest credit upon the work of the medical installations in the forward areas for, in the campaign for the Philippine Islands, emphasis was placed on getting the surgeon to the patient as well as upon the prompt evacuation of the wounded.

The subjects of aneurysm, gunshot wounds of the head, infections and gangrene due to Cl. welchii, secondary suture, and skin grafting will be presented in subsequent publications which are in preparation at this time.^1–4