American Surgeons at Musgrave Park Hospital in World War II: Surgical Giants.

JOURNEY TO IRELAND

The U.S. Army 5th General Hospital[1, 2] was activated on 3 January 1942 at Fort Bragg, North Carolina 3 weeks after Germany declared war on the United States. Five hundred patient beds were to be sited at “Musgrave Park in the environs of Belfast”. The former boys’ reformatory was occupied at that time by the 31st General Hospital of the British Army.

The 5th General Hospital embarked from New York on 19 February 1942. Seven Medical Officers, 28 Nurse Officers and 14 Enlisted Men were placed on various ships of the convoy but the remaining personnel were assigned to a single ship. This vessel, the American Legion, broke down in the Atlantic and subsequently returned to Halifax, Nova Scotia. The detached 7 Medical Officers (including Lt. Col. Ted Badger, to be Chief of Medicine at Musgrave Park) arrived in early March of 1942. The U.S. Nurse Officers were distributed between the 31st General and the 10th Station Hospital and the 136th Medical Regiment of the U.S. 34th Infantry Division, which had arrived in January 1942[2, 3]. On 12 May 1942, the main body of the 5th General Hospital arrived at Musgrave Park. Key personnel are seen in Figure 1. Some of the U.S. personnel were stationed at Carrickfergus and commuted2. On May 20, I[1] attended the handover ceremony from British to US occupancy at Musgrave Park[1]. Within a fortnight, 12 wards were open and Musgrave Park was ready to care for 400 patients. By June 1942, this capacity was exceeded and Lt. Colonel Thomas Lanman became CO of an additional unit, Waringfield, a former British Emergency Medical Services (EMS) Hospital 20 miles from Musgrave Park (Table 1A). Peak patient census of 1,500 was reached that August (Table 1B).

Fig 1

The Fifth General Hospital in Belfast, 19424 First row, left to right: Saxon, Kendall, Badger, Keeler, Matron Major Sinclair, Lanman and Zollinger. Second Row: Strock, Emerson, Brewster, White, Dunphy, Pratt, Wenzel and Quigley. Third Row: Simeone, Saunders, Baldwin, Hazard, May, Smedal, unidentified, Cavanaugh, Freedman. Fourth Row: Hill, Burchenal, Cogdell, Dimmler, Light and Carney. Top: Tanner. Warren.

TABLE 1A.

United States Army Forces in Northern Ireland stations of units, United States Army Hospitals functioning in Ulster3 in 1942

Location	County	Dates	Unit
Musgrave Park	Antrim	21 May-25 Nov 1942	5th General Hospital (V Corps)
Waringfield	Armagh	June 1942-	Detachment, 5th General Hospital
Waringfield	Armagh	1942	Detachment, 2nd General Hospital
Irvinestown	Fermanagh	19 Sep 1942-28 Dec 1943	160th Station Hospital (250-bed) (V Corps)
Ebrington Barracks (Londonderry)	Londonderry	19 May 1942-	10th Station Hospital

TABLE 1B.

United States Army Forces in Northern Ireland stations of Units, Army Medical Units suited for Medical and Surgical Therapy[3]

Location	County	Dates	Unit
Breandrum (Enniskillen)	Fermanagh	1942	109th Medical Battalion (less two collecting companies (34th Infantry Division)
Ballymoney	Antrim	3 March-3 May 1942	53d Medical Battalion (V Corps)
Balmoral	Antrim	-27 Nov 1942	1st Section, 1st Platoon, Company A, 63rd Quartermaster Laundry Battalion
Balmoral	Antrim	8 Nov 1942-28 Feb 1943	1st Platoon, Company D, 94th Quartermaster Bakery Battalion (V Corps)
Belfast	Antrim	13 May-1 July 1942	Section, 4th Medical Supply Depot
Belfast	Antrim	1942	Company A, 63d Quartermaster Battalion (Laundry)
Brownlow House	Armagh	1 June 1942-	Headquarters, V Corps
Castlewellan	Down	May 1942	Headquarters, 1st Armored Division
Castlewellan	Down	1942	Headquarters, Combat Command B, 1st Armored Division
Castlewellan	Down	1942	Headquarters, Artillery Command, 1st Armored Division
Castlewellan	Down	1942	141st Signal Company (1st Armored Division)
Celtic Park (Enniskillen)	Fermanagh	13 Jun-14 Dec 1942	Headquarters and Headquarters Company (Less Maintenance and Service Platoons), 109th Quartermaster Battalion
Celtic Park (Enniskillen)	Fermanagh	19 Jun-14 Dec 1942	Maintenance Platoon, Headquarters Company, 109th Quartermaster Battalion
Drumdarragh House (Doagh)	Antrim	1942-9 Jan 1943	53d Medical Battalion (less Companies A and B)
Lisgoole Abbey (Enniskillen)	Fermanagh	1942	One collecting company of 109th Medical Battalion (34th Infantry Division)
Prospect House (Carrickfergus)	Antrim	1942	Companies A and B, 53d Medical Battalion
Tollymore Park (Bryansford)	Armagh	11 June -31 Oct 1942	47th Armored Medical Battalion (1st Armored Division)

With a hepatitis epidemic raging, U.S. Army nurses from New York's Columbia Presbyterian's 2nd General Hospital near Oxford were transferred to Musgrave Park under the supervision of Bernice Sinclair, Matron of the 5th General. These U.S. Army Nurse Officers traveled to Stranraer by train and after a rough and slow crossing landed at Larne where “almost all of the nurses were seasick”[5].

MEETING THE U.S. SURGEONS

At the welcoming party for officers of the 5th, Major, later Sir Benjamin Rycroft[6, 7] introduced me to Major Robert Zollinger (Fig. 2, Fig. 3) and Captain Bert Dunphy (Fig.3). Rycroft said that he rode Sir John Milne Barbour's horses with my mother, Nancy. Zollinger said he knew that Barbour was President of the Royal Victoria Hospital. Zollinger added that he had made a living with his pony and trap delivering and selling milk for half-pennies a pint[8]. At a dinner party at our house, Major Zollinger met my pony and vowed to look after him if I had to return to England. Max, later Lord Rosenheim[7] greeted Zollinger, with whom he had become acquainted while Rosenheim was a physician at Massachusetts General Hospital, when Bert Dunphy and Robert Zollinger were surgeons at the Peter Bent Brigham, a hospital made famous by Cushing and Cutler[9, 10, 11, 12], where Matron[2] from 1917 to 1937 was Carrie Hall (Fig. 4)[13].

Fig 2

1942 letter stating that Major Robert Zollinger had been appointed to the British Medical Research Council War Wounds Committee. Photograph courtesy of the Robert M. Zollinger MD Collection, Spec.199301. Zollinger, Medical Heritage Center, Health Sciences Library, The Ohio State University.

Fig 3

Elliott Carr Cutler and his two protégés, Majors Robert M. Zollinger and J. Englebert (“Bert”) Dunphy, just outside Musgrave Park. All would receive an Honorary FRCS (Eng). Photograph courtesy of the Robert M. Zollinger MD Collection, Spec.199301. Zollinger, Medical Heritage Center, Health Sciences Library, The Ohio State University.

Fig 4

Carrie M. Hall, Founder and Director, Peter Bent Brigham Hospital School of Nursing, 1912-1937. Oil on canvas by Emil Pollak-Ottendorf (1864-1950), presented 1934. Dimensions 91 x 61 cm. From the collections of the Brigham and Women's Hospital, Boston, MA. Photography by Mainframe Photographics, Inc., Boston, MA.

At the welcoming party, Benjamin Rycroft played our landlord's piano. Rycroft said he preferred George Gershwin, but would take requests. Tom Quigley asked for the “Mountains of Mourne”. Tom had appeared in Repertory Theatre in Cape Cod with Jimmy Stewart and Henry Fonda[12] and said that he would sing “Mourne” solo, but we should sing the chorus. We did with feeling—casualties had been coming in from the U.S. 1st Armored Division's training “in the place where the dark Mournes sweep down to the sea”[14, 15].

By 1942, John Englebert Dunphy already had an unusual career[11, 12, 16]. One stunt involved masquerading as Dr. Wycoff, a pompous Englishman. Dunphy read a paper entitled “The Protopathic Blood Iodides of Primiparous Women of Northern India”. At the end of this speech to a serious Harvard University Dining Club, still unrecognized by the audience, the toastmaster, who was in on the secret, asked if there was any discussion. There being none, the toastmaster asked the speaker if he had seen any changes since the 1920s. ‘Wycoff’ then criticized the U.S. flag, medicine in the USA, and most everything to do with the audience. Only then was he recognized by a prominent member of the Harvard Faculty[16]. Not surprisingly, he failed to gain an internship there.

Professor S. Burt Wolbach gave Dunphy a Fellowship in Pathology at Harvard, and later recommended Dunphy for a delayed Surgical Internship under Robert Zollinger as Chief Resident but commented: “Needs a strong hand. Beware of his leprechaun.”

Zollinger admitted that supervising Dunphy was hard work, commenting: “Greatest job leading that young man.” Later, when accused by Zollinger of embroidering their stories, Dunphy replied, “It's my leprechaun, I picked him up working for you, where ‘the Mountains of Mourne sweep down to the sea’”. “My foot,” was Zollinger's response.

Amongst the senior nursing staff were Matron Carrie Hall (Fig. 4) and Matron Bernice Sinclair (Fig 5), a 1924 graduate of the Peter Bent Brigham Hospital School of Nursing and an instructor at her alma mater for over a decade. She served as hostess and guide to such visiting dignitaries as Clementine Churchill, Massachusetts Senator and later U.N. Ambassador Henry Cabot Lodge, Jr., and Eleanor Roosevelt[13, 17]. President Clinton gave a U.S. Presidential Citation to Bernice Sinclair for her service in World War II and afterwards in her native state of New Hampshire [17].

Fig 5

Major Bernice Sinclair with General George S. Patton, Jr. (far left), preparing to present medals. Colonel Sinclair received the U.S. Legion of Merit in 1945. Photograph courtesy of the Cocheco Times, Weirs, New Hampshire[17].

In December 1942, 549 patients were flown or shipped to the United States and the 5th General Hospital staff were flown to Odstock near Salisbury, a new specially constructed facility. Three hundred and sixty-one remaining Musgrave Park patients were transferred to the U.S. 10th Station Hospital (Table 1A). From May 21st to Christmas 1942, the U.S. 5th General Hospital at Musgrave had cared for 7,487 patients[2].

INTO EUROPE

After D-Day a German bullet holed the crossbar of Zollinger's Normandy cot. A strong odour led to commotion and cries of ‘poison gas’. The bed crossbar had shattered a bottle of Worcestershire sauce. Bert Dunphy repeatedly embroidered that happening almost to the level of a World War I gas attack.

On another occasion, just after the breakout from St. Lô, Zollinger and another colonel were riding in a jeep. It was raining hard. The canvas top was up. They were spotted and stopped by the commander of the newly deployed Third Army, General George S. Patton, Jr., himself. “Did they not know they were willfully disobeying his personal orders—all the tops down all the time, whatever the weather, for identification? This gross disobedience might lead to courtmartial or friendly fire. Dunphy asked Zollie why he had not acted like Matron Helen Coghlan[18, 19]. She had taken General Patton by the scruff of his neck in Sicily and thrown him out of the U.S. Army's 93rd Evacuation Hospital. Her comment at that time was “General, you go run the Army, I'll run this hospital!” and gave “pistol-packing George Patton a push out of the front door”[20].

At the height of the Battle of the Bulge with the 5th General Hospital at Toul, orders came to prepare to retreat. Colonel Zollinger as CO was to stay alone with the patients to properly surrender and handover the patients to the enemy forces. Bert Dunphy said he looked forward to liberating “Zolly” from a German POW camp.

COLONEL SINCLAIR'S IMPORTANT ASSIGNMENT

Matron Bernice Sinclair was transferred along with the other Harvard personnel to the 5th General Hospital's new location near Salisbury, England [17, 21]. In May 1944, she was appointed Chief Nurse for the United States 3rd Army, and became the only woman on General George S. Patton Jr.'s staff. Eisenhower felt that Patton needed a moderating influence [17]. From what my father later ascertained, she was recommended by Arthur, later Lord Porritt, Surgeon to Montgomery and King George VI[22, 23]. She was promoted to Colonel and given her own transportation and laissez-faire pass. Her letter to the Peter Bent Brigham was contemporaneously written, but released on 9 May 1945:

“Gradually we worked our way through the towns that you will recall reading about, Periers, St. Lô, Avranches…. General Patton is a charming host, keenly appreciative of the work of the Army Nursing Corps… For a while my tent was pitched on the famous race track at Rennes, then I moved along through LeMans, Chartres, Orleans, visited Fontainebleau and got into Paris about two weeks after it was taken”[24]. By Christmas 1944 the 5th General Hospital had moved up to within a few miles of Patton and Sinclair, who had moved to Luxembourg to “help take care of the Bastogne break-through”[24, 25].

On December 9, 1945, Colonel Sinclair was consulted about the most appropriate neurosurgeon to treat General Patton's cervical dislocation. Patton had been admitted to the 130th Station Hospital of the U.S. Seventh Army. Brigadier Cairns was forthwith flown from Oxford to Heidelberg. On December 17th zygomatic hooks were replaced with a plaster collar: the fracture-dislocation alignment was nearly perfect. On December 19th, Cairns decided it was safe to fly a conscious, spontaneously breathing Patton to the U.S. On December 20th, Patton suffered a right pulmonary embolus verified by X-ray; Patton died in his sleep on December 21, 1945[25]. I was kindly fed by the Cairns’ in their Oxford home. The question of Patton came up. Professor Cairns thought he might have made it except for the pulmonary embolus.

OTHER SURGEONS AT MUSGRAVE PARK

Richard Warren (1907-1999) had an illustrious medical ancestry. Dr. Joseph Warren was the leading surgeon and physician in Boston and Major General under George Washington [26, 27]. Joseph's younger brother, John, founded Harvard Medical School in 1782. Thereafter his son, John Collins Warren co-founded the Massachusetts General Hospital in 1811 [28, 29, 30]. His life seemed to me in 1942, and for the next half century, to be “entirely fitting for the inheritor of a family tradition, going back more than three centuries”[31].

Fiorindo A. Simeone (Fig. 1) was educated in Providence, Rhode Island, and at Brown University where his distinguished research on smooth muscle led to work with Walter Cannon and an MD magna cum laude from Harvard Medical School in 1934. Simeone completed his surgical residency at the Massachusetts General Hospital under Professor Edward D (Pete) Churchill[9] before in 1940, being seconded to the Peter Bent Brigham. His war research with Professor Henry K. Beecher, the head of Anaesthesia at the Massachusetts General Hospital, led to classic reports from their World War II research group[32, 33]. Having set up a vascular unit with Robert R. Linton at the Massachusetts General Hospital, Simeone was called to Western Reserve University in Cleveland. In 1967 he returned to Brown to become Head of Surgery. He came often to the operating rooms and offices at Harvard where he was “kind, thoughtful and compassionate”[33].

Carlyle G. Flake was a Virginian who received his M.D. from the University of Virginia in 1931. Internship and residency in surgery at Johns Hopkins followed. In 1937 Flake was called to Harvard. On January 10, 1942, he joined the 5th General Hospital as a Major and Chief of ENT. Flake was superb at retrieving extraneous objects from the lung. He commented on his extensive experience: “At least 30 a year for 30 years—bullets, safety pins, stones.” Flake was discharged in November 1945 as a Colonel. He returned to the Brigham and the adjacent Children's Hospital to add his experience of draining World War II lung abscesses via the bronchi or by thoracotomy. He retired in 1971 [34, 35].

The Chief Orthopaedic Surgeon at Musgrave Park was Thomas B. Quigley[2]. After college and medical school at Harvard, Quigley spent 1934 studying Pathology in New York City, from where Elliott C. Cutler appointed him Harvey Cushing Fellow at the Brigham followed by the Arthur Tracy Cabot Fellowship[12]. He was appointed an Associate at the Harvard University Athletic Department in 1945[36]. The President of Harvard University, James B. Conant, appointed Quigley Chief Surgeon to the Athletic Department in 1952.[37]

LEGACY

The Hirsch (h) indices of citation for the four 5th General Hospital general surgeons, Zollinger, Dunphy, Warren and Simeone, average 36, twice the de facto hurdle of 18 for a full professorship in a medical school[38, 39]. Collectively this general surgical quadrumvirate wrote 30 papers that have each been cited more than 100 times. In the last five years to the present the publications of Dunphy have been cited more than 250 times and Zollinger's 200 times. Each of the 1942 Musgrave Park surgeons were transformative figures of surgery[32, 40, 41]. Judging by the high rate of citation of a quarter century after their deaths, their influence does not wane. Zollinger was from 1958 to 1986 Editor-in-Chief of the American Journal of Surgery [8]; almost contemporaneously, Warren was Editor-in-Chief of the Archives of Surgery [12, 26].