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Appendectomies on Submarines

During World War II

by HMC (SS) Phillip J. Chesser, USN (Ret.)
(Copyrights reserved - used by permission.)

 

            In the 1944 Cary Grant Submarine movie Destination Tokyo, the submarine’s enlisted pharmacist’s mate performs an emergency appendectomy on a table in the cramped crew’s mess while the submarine undergoes a depth charge attack. Using bent spoons as retractors, the cook’s best cutlery as scalpels and an inverted tea strainer for ether anesthesia, the pharmacist’s mate successfully completes the operation. Based on real events from World War II, versions of this operation were replayed in made for television episodes of Navy Log and The Silent Service.

            I was an independent duty hospital corpsman – a seagoing paramedic who serves on small ships at sea in the absence of a physician – in the 1960’ and 1970’s and was often asked if would attempt an appendectomy under similar circumstances. I always said no, after which crewmen would invariably protest, “But what if the patient were going to die?” The first time I answered, “Well, if he didn’t die of the appendicitis, he would damn sure die after I finished with him.” This answer was not happily received, so I never gave it again.

            However, I always wondered about the World War II operations. During my student days at the School of Submarine Medicine at the submarine base in Groton, Connecticut, the medical officers and senior hospital corpsmen who instructed me viewed the famous appendectomies with much skepticism. While most did not doubt that the operations had taken place, some had doubts about what was opened and what was removed and all questioned the wisdom of such undertakings on cramped, surgically filthy submarines, especially by amateur surgeons, even during wartime. Most believed the patients to be in more danger from the untrained surgeons than from the inflamed appendices.

            On the basis of my own experience I agreed with them, but I still wondered about the operations, so I spent part of a summer researching the subject: This is what I learned:

            I discovered three operations by enlisted pharmacist’s mates (called hospital corpsmen after 1948), all of which had been performed in the last four months of 1942. The first, which could very well have been the cause of the second and third, was done on the USS Seadragon (SS 194), W.E. Ferrall, Lieutenant Commander, USN, Commanding Officer, on 11 September 1942. The ship’s log for that date has this brief entry: “9-12. Underway as before. 1049. Commenced appendectomy on Rector, D.D. S/2/c. /s/ L.R. Johnson.” Then “1215. Underway as before. 1337. Completed operation. /s/ C.K. Miller.”[1]

            This first operation attracted much attention and was the subject of a Pulitzer Prize winning story by George Weller of the Chicago Daily News, later condensed in Reader’s Digest.[2] Twenty-three year old Pharmacist’s Mate First Class Wheeler B. Lipes was the amateur surgeon. Using the famous spoons, tea strainer, and instruments sterilized in torpedo alcohol, Lipes with some difficulty found and removed young Rector’s appendix. The operation took two hours and forty three minutes.

            Pharmacist’s Mate First Class Harry B. Roby performed the second submarine appendectomy on Torpedoman’s Mate First Class W.R. Jones, aged twenty-two, on the USS Grayback (SS 208), Lieutenant Commander E.C. Stephan, USN, Commanding. Grayback’s log for 14 December 1942 reads as follows: “2252. Submerged to conduct appendectomy on W.R. Jones, TM 1/c. Roby, H.B. PhM 1/c preforming (sic) the operation…. /s/ T.E. Harper.” Then for 15 December, “0200. Operation completed. Surfaced 0225. All ahead standard. 10 kts. /s/ E. Ackerman, Ens.”[3] Roby got a three inch column on page fourteen of the 22 March 1943 New York Times.[4]

            A few years ago I was privileged to speak on the telephone with retired Rear Admiral E.C. “Ed” Stephen, then a witty and robust seventy-eight. He was lavish in his praise of Roby. “You couldn’t find a better man than Roby, “he reported. “He was a lamp salesman at Macy’s before the war, I think. He had great leadership ability.” As evidence of Roby’s leadership ability Admiral Stephan cited Roby’s treatment of downed pilots. On many occasions Grayback and other submarines rescued downed U.S. Pilots and held them on board until they could be off loaded. (Former President George H.W. Bush was one of many pilots rescued by submarines.) Admiral Stephan said that Roby efficiently organized the crew to nurse these pilots.

            Admiral Stephan said that Roby performed his appendectomy in Grayback’s control room. Other reports indicated the ward room, but Admiral Stephan said they chose control because there was more space. “You couldn’t stand up in the wardroom,” he said, so they rigged the control room and operated there. Admiral Stephan, then Lieutenant Commander Stephan, administered the anesthesia.

            The third and last reported pharmacist mate performed appendectomy occurred on the USS Silversides (SS 236), Lieutenant Commander C.C. Burlingame, USN, Commanding. The 22 December 1942 log reads, “Underway as before. Course 000 True. Speed full on No. 1&2 Main Engines. Charging batteries on 3&4 M.E. 2152 Made quick dive on course 355 T. Speed 2/3. Moore, T.A. PhM 1/c performed successful appendectomy on Platter, G.M. F3/c. /s/ F.W. Clark, Ens. USN.”[5] Page thirty-four of the 14 February 1943 New York Times has a picture of Moore and Platter along with a two-column, eight-inch story.[6] This story by Robert Trumbull was reprinted in the high school magazine Scholastic of 15 March 1943 under the heading, “Victory Story of the Week.”[7]

            Several years ago I spoke on the phone with Tom Moore, then a drug store pharmacist in Grand Junction, Colorado, about the operation on Silversides. He said he had to operate because they were unable to transfer Platter. They had wanted to take him off by PBY, a seaplane, but were about fifty miles from the Japanese stronghold of Raboul, and Japanese aircraft had been seen in the area all day. Lieutenant Commander Burlingame could not surface and hazard his ship and crew.

            Moore did his surgery in Silversides’s wardroom using first spinal and then ether anesthesia. It took him about four and a half hours, and not long after Platter had been returned to his bunk, the Japanese began a depth charge attack on Silversides.

            Of the three pharmacist’s mates, Moore appears to have had the best background for the emergency surgery. He had worked in the operating room of the Navy Hospital San Diego, and had witnessed many appendectomies there. He had also worked in the operating room of the battleship Maryland, assisting a former Mayo Clinic surgeon who frequently held school on everyone in the Medical Department, especially when he did appendectomies. Moore attended many of these sessions and learned the procedure by heart. Moore says the surgeon once jokingly remarked to him, “If you ever have to do one of these, you’ll know how.”

            Moore volunteered for submarine duty in 1942 and went directly to a submarine from the Maryland. In those days the Navy did not send senior pharmacist’s mates to independent duty school or to submarine medical school. These schools were not established until later. In fact, Moore received his submarine orders the same day he requested them.

            Tight security surrounded submarine operations in those days, so the press was starved for submarine stories. Not able to say much about what submarines were doing but wanting to get good stories to the public about them, Admiral Nimitz had Moore and Platter meet about forty correspondents in Hawaii. The resulting publicity created the legend. A crewman on Silversides had taken pictures of Moore and his patient while Moore operated, and these were widely distributed. Moore laughed that Wheeler Lipes used some of the same pictures to illustrate stories about his surgery on the Seadragon.

            Like Roby and Lipes, Moore was meritoriously promoted to Chief Petty Officer. Moore said he met Lipes later in the war at the new Naval Medical Center in Bethesda, Maryland. By then both had been promoted to Warrant Officer.

            I asked Moore if he ever thought an event such as this would cause such a stir. A thoughtful and soft spoken man, he replied, “No, I didn’t and it shouldn’t have. Many men who did much more important things were never recognized.”

            I asked Admiral Stephan what had brought him to consent to Roby’s surgery. In his good natured and salty voice he replied, “Hell, I didn’t know anything about medicine. Roby was a good man. I had to rely on his judgment.” I would have liked to have been able to ask the same question of Lieutenant Commander W.E. Ferrall, Commanding Officer of the Seadragon. Being the first submarine skipper to say yes, he might have unwittingly started the practice of submarine pharmacist’s mates doing emergency appendectomy surgery. In the Navy Log episode the Chief Pharmacist’s Mate tells his captain that a successful appendectomy has been done on the Seadragon. One can reasonably assume that Seadragon’s appendectomy had probably been widely discussed in the submarine force before Roby and Moore did their operations on Grayback and Silversides.

            In these three cases the patients survived without complications and returned to duty within a few days. All the pharmacist’s mates were promoted to Chief, and Roby was awarded the Navy and Marine Corps Medal.[8] Then, as abruptly as they had started, the operations apparently ceased. Moore said he heard of six such operations, but I found no evidence of any more after December, 1942, even though World War II and submarine patrols continued in the Pacific for three more years, as did the morbidity of appendicitis.

            Because the appendectomies were apparently confined to a four month period early in the war, I believe that someone with knowledge of submarine conditions called a halt to the operations by enlisted pharmacist’s mates, but I found no directives prohibiting the surgery. Indirect evidence, however, indicates that Navy medical leaders made efforts to stop them.

            I have direct testimony from Moore about the attitude of his Squadron Medical Officer. “He gave me hell,” Moore said. In his Silent Victory: the U.S. Submarine Victory against Japan, Clay Blair writes that the Squadron Medical Officer was “appalled” by Lipes’s surgery.[9] Another high ranking medical officer also remarked, “While this had a happy ending, it is hoped that this success on this occasion will not encourage others to take unnecessary risks.”[10] Writing about the same subject in Sink ‘em All, Vice Admiral Charles A. Lockwood, USN (Retired) says, “I was surprised and disappointed to find that the Squadron Medical Officer to a ‘dim view’ of the matter. According to him the patient had a better chance of survival if kept packed in ice and put on a starvation liquid died…. Perhaps this was true, but we got the ‘Doc’ promoted (to Chief Petty Officer) anyhow.”[11]

            Other evidence of efforts to discourage the operations appears in the Science News Letter for 22 January 1944 in an extract from the U.S. Naval Medical Bulletin News Letter of January, 1944. The extract is titled “Sulfa Drugs Save Sailors” and is sub headed “Instead of having makeshift appendectomies performed on board ship, surgeons advise special holdover treatment until professional aid is available.”[12] The papers quoted here advise the use of sulfa drugs to stem the infection process in much the same way physicians now use antibiotics, and they present case studies showing sulfonamide effectiveness in the non-surgical treatment of acute appendicitis. They also discuss the difficulty of accurate diagnosis, noting in one instance that sea sickness may mimic appendicitis.[13]

            Science News Letter notes, “The public may be thrilled by stories of enlisted personnel performing appendectomies on shipmates at sea when no medical aid is available. Physicians and surgeons in and out of the Navy, however, deplore such action.”[14]

            In their U.S. Naval Medical Bulletin paper entitled “Appendicitis in the Navy,” Lieutenant Commanders (MC) USNR F. Glen Irwin and Gaines L. Coates write, “We believe more lives will be lost through surgery performed by unqualified persons than would be lost through a policy of delay of surgery, using proper treatment during the delay period,”[15] and in “Chemotherapy and the Management of Acute Appendicitis” (previously cited) in the same issue of the U.S. Naval Medical Bulletin, Doctors Berkley and Watkins write, “The postoperative complications which one encounters in base hospitals as sequelae of appendectomies done at sea emphasize the serious additional risk and hazard associated with the relatively simple procedure when performed under unfavorable circumstances.”[16]

            It is clear then that the Navy’s medical establishment was properly concerned about unqualified personnel doing surgery at sea under any circumstances and apparently took action to end these adventures. Even qualified physicians, it seems, were discouraged from doing these procedures at sea, all though “at sea” seems overly broad. Large vessels such as battleships, cruisers, and aircraft carriers were properly equipped and staffed.

            In 1942 when pharmacist’s mates Lipes, Roby, and Moore were the only medical authorities available to submarine skippers in difficult situations, it is not surprising that such heroic, if ill advised, procedures were attempted; and there were no directives, as far as I have been able to determine, that specifically prohibited these procedures by pharmacist’s mates. The Manual of the Medical Department for 1939 says “pharmacist’s mates are not offered as substitutes for physicians, but they should be men of such training judgment, and experience that the commanding officer of a vessel without an attached medical officer may rely on them for … first aid and detailed management of the sick and injured.”[17]

            A reasonable man would conclude from the above that to the Medical Department of the U.S. Navy, appendectomies were clearly beyond the competence of pharmacist’s mates. Later editions of the Manual of the Medical Department use much the same language, and even though I never went to the Manual for guidance on the subject, I always knew for all of my years on independent duty, first on diesel submarines and then at the end of my career on a Gearing class destroyer, that appendectomies were far beyond my capabilities.

            Still, crewmen always asked the questions.

Bibliography

Associated Press, “More Submarine Surgery,” New York Times, 22 March 1943, p.14

Berkley, William L., and Harry C. Watkins, “Chemotherapy in the Management of Acute Appendicitis,” U.S. Naval Medical Bulletin, January, 1944, p.3.

Blair, Clay. Silent Victory: The U.S. Submarine War against Japan, New York: J.B. Lippincott, 1975.

Irwin, F. Glenn, and Gaines L. Coates, “Appendicitis in the Navy,” U.S. Naval Medical Bulletin, January, 1944, p.10

Lockwood, Charles A. Sink ‘em All. New York: E.P. Dutton, 1951.

Ship’s Deck Log, U.S.S. Grayback (SS 208), 14 December 1942.

Ship’s Deck Log, U.S.S. Seadragon (SS 194), 11 September 1942

Ship’s Deck Log, U.S.S. Silversides (SS 236), 22 December 1942.

“Sulfa Drugs Save Sailors,” Science News Letter, 22 January 1944, p. 54.

“Surgery in a Submarine,” Reader’s Digest, August, 1943, pp. 59-61.

Trumbull, Robert. “Pharmacist’s Mate Operates on an Appendix in a Submarine,” New York Times, 14 February 1943, p. 34 

Trumbull, Robert. “Victory Story of the Week, ‘Operation Successful,’” Scholastic, 15 March 1943, p. 2.

U.S. Navy. Manual of the Medical Department, 1939, Chapter 5, Paragraphy 607.

 _____________________________________________________________________________________________________________

       Author’s Navy Career at a Glance
 
Entered the Navy 23 June 1954; went through boot camp at NTC Bainbridge, Maryland
Attended Hospital Corps School
Naval Hospital, Pensacola, Florida
Naval Dispensary, Green Cove Springs, Florida
USS Magoffin (APA 199)
USS Pickaway (APA 222)
Attended Clinical Laboratory and Blood Bank School at the Naval Medical School, National Naval Medical Center, Bethesda, Maryland
Staff technician, Bethesda, Maryland
USS Glacier (AGB 4)
Attended Submarine Medical School and Basic Enlisted Submarine School at Groton, Connecticut
USS Runner (SS 476)
Naval Hospital, Portsmouth, Virginia
USS Sabalo (SS 302)
USS Medregal (SS 480)
Grossmont College, El Cajon, California, as part of ADCOP (the Associate’s Degree Completion Program)
USS Tiru (SS 416)
USS Joseph P. Kennedy, Jr. (DD 850)
Submarine Medical Research Laboratory, Groton, Connecticut
31 August 1973; Transferred to the Fleet Reserve (Retired after twenty years)