{"id":15555,"date":"2018-12-04T11:00:02","date_gmt":"2018-12-04T16:00:02","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=15555"},"modified":"2024-10-21T10:59:28","modified_gmt":"2024-10-21T14:59:28","slug":"detailing-michael-debakeys-war-years-puzzle-pieces","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2018\/12\/04\/detailing-michael-debakeys-war-years-puzzle-pieces\/","title":{"rendered":"Detailing Michael DeBakey\u2019s War Years: Puzzle Pieces"},"content":{"rendered":"

By Sanders Marble ~<\/em><\/p>\n

In November 2017, I was fortunate to get an NLM Michael E. Debakey Fellowship in the History of Medicine<\/a> to explore his wartime service and contributions. Like many, I knew he had been in the Army in WWII and wanted to find out more about what he had done.<\/p>\n

\"A<\/a>
Michael DeBakey (front row, far right) with U.S. Army surgical consultants in North Africa, ca. 1943
Courtesy of Katrin DeBakey<\/em>
National Library of Medicine Profiles in Science<\/a><\/figcaption><\/figure>\n

What I am finding is patchy, yet illustrative. First, a thumbnail of DeBakey\u2019s service: he was not yet a nationally-known surgeon\u2014he was 34 years old and a junior faculty member at the Tulane Medical School. He joined the Army in 1942, was briefly a surgeon at an Army hospital in Mississippi, then for the rest of the war (and into 1946) was at the Surgeon General\u2019s Office (SGO) as a staff officer in the Surgical Consultants Division.<\/p>\n

The Army ran a very large medical system and wanted to be both effective and efficient, so getting the right people in the right places, and providing good advice and control were important to those goals. The Surgical Consultants Division was a major element of that. (There were also medical consultants, and other varieties, but as a surgeon DeBakey was in Surgical Consultants.) DeBakey was part of that, but he was also the youngest, lowest-ranked member, although he was promoted during the war. Since the Boards were relatively new and residencies far less structured than now, the consultants evaluated doctors\u2019 credentials and capabilities. Throughout the war they also worked on policies\u2014for surgeons this involved whom to operate on and what techniques to use. The consultants also played a role in communicating, both to doctors (such as attending medical meetings) and the public through mass media. And they consulted on Army policies on what surgical capabilities were needed at the various steps in the treatment chain.<\/p>\n

\"Photograph<\/a>
Army policy on limiting surgical operations, 1942
Courtesy U.S. Army Heritage and Education Center<\/em><\/figcaption><\/figure>\n

So far, we know DeBakey spent much of the war at an important place in the Army medical system. But how do we find out what he was doing? Here, we run into problems of process and records. Policies were all officially issued by The Surgeon General, some sent out over his signature, some over the Chief of Staff of the Army\u2019s signature<\/a>, and doubtless some over other signatures\u2014but they were not signed by DeBakey. Correspondence from the SGO could be channeled through a liaison officer or some control element\u2014for instance, almost all Army correspondence with the National Academies of Science (which ran Advisory Committees to the Surgeons General of the War and Navy Departments and U.S. Public Health Service) was from Lt. Col. Roger Prentiss, presumably because he was coordinator of research and development at SGO. These procedures mask an individual\u2019s role.<\/p>\n

\"A<\/a>
Letter from Dr. Loyal Davis to Dr. E.H. Cushing of the National Academy of Sciences, mentioning DeBakey and others working on trench foot, 1943
Courtesy National Academy of Sciences<\/em><\/figcaption><\/figure>\n

In a large organization, many individuals can be involved. What is a particular individual\u2019s role\u2014did they start something? keep something moving through hurdles and amid distractions? get the final version approved? Which of those roles is the most important, or even provable? Human nature being what it is, if something important was done, many will claim to be important in the behind-the-scenes work. For some things, we can be confident who was (or was not) involved. For instance, DeBakey would not be involved in internal medicine, aviation medicine, dental, and other areas. But many things would come through Surgical Consultants Division, and knowing what DeBakey worked on is (so far) haphazard. He apparently worked on policy about treatment for trenchfoot, about treatment of the wounded, and about when to operate for pilonidal cyst\/sinus. Given his post-war involvement with vascular surgery, and the high profile of care for the wounded, those first two items got attention, while data-driven analysis of minimizing surgery for pilonidal cysts got little attention. They were important to the Army\u2014tens of thousands of soldiers developed pilonidal cysts or sinuses, and data analysis showed that early surgery caused extra time in hospital, away from duty. Thus telling surgeons not<\/em> to operate was in the Army\u2019s interests.<\/p>\n

The way records are kept can also mask individuals. Official records tend to be focused on the organization, and final results, rather than an individual\u2019s work and the many steps along the way. A final policy is (or should be) a record, while the routing slip attached to the front of a report is not a record. Thus the National Archives has the annual reports from 1944 and 1945 of the Surgical Consultants Division, which contain information about the organization’s work. There are other documents about DeBakey\u2019s war years, for instance in the National Library of Medicine, at the Uniformed Services University of the Health Sciences, at the Countway Library, at the National Academy of Sciences. These are fragments\u2014letters to colleagues, and other informal mentions.<\/p>\n