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Related Resources: Oral History: Appendectomy Performed on USS Seadragon, 1942
SS188/A9-8 U.S.S. SARGO
(SS188) Flagship
22 October, 1942
From: The Squadron Medical Officer
To: The Chief of the Bureau of Medicine and Surgery
Via: The Commander Submarine Squadron Two
Subject: Appendectomy aboard a submarine, special report of.
1. Major operations aboard a submarine are sufficiently rare that
the first appendectomy performed by a pharmacist's mate aboard
a submerged submarine on war patrol, in a combat area, warrants
a detailed report.
2. On September 11, 1942, an appendectomy was performed on RECTOR,
Darrel Dean, Sea1c, USNR., by LIPES, Wheeler B., PhM-1c., USN.
The submarine, U.S.S. SEADRAGON, was commanded by Lieutenant Commander,
W.E. FERRALL, USN. The operation was done at a depth of 120 feet.
The pressure within the submarine was two inches of mercury greater
than atmospheric pressure. The ward-room mess table was utilized
as an operating table. The instruments consisted of a pocket case
of twelve hemostats; a packet of scalpel blades (a hemostat was
utilized as the handle); five tablespoons with the handles bent
back served as retractors; the suture material was No. 0, twenty
day, chromic catgut. The instruments were sterilized by boiling.
Rubber gloves and operating clothing (pajamas) were sterilized
in alcohol. Commercially sterilized "Handi-pads" enclosed
in tissue paper envelopes were used as gauze sponges. Ether was
used as the anesthetic, and a large tea strainer covered with
gauze as the mask.
3. The medical facts are as follows: The patient first came under
observation on September 8, 1942, and was placed on the sick list
with a diagnosis of: Diagnosis Undetermined (Appendicitis, Acute).
He complained of abdominal pain, particularly in the right lower
quadrant, and of nausea for about an hour. He vomited once. There
was no fever at this time, but within the next twenty four hours
the temperature rose to 102.4, and abdominal tenderness, rigidity,
and rebound pain developed in the right lower quadrant. After
three days observation the diagnosis was established and changed
to Appendicitis, Acute. The Commanding Officer was informed of
the condition and an operation was ordered.
Anesthesia was started at 1046 by the Pharmacist's mate. After
induction it was maintained by Lieutenant F.P. HOSKINS, USNR.
Detailed observations at one to four minute intervals were made
and recorded by the Commanding Officer, The incision was made
at 1107. The appendix was amputated at 1230.
The stump was treated with phenol and alcohol and was not inverted.
Closure was completed at 1322. Seventy one sponges were used and
accounted for. Sulfanilamide powder was sprinkled in the peritoneal
cavity and on each layer during closure. Consciousness was recovered
in two hours and fifty two minutes.
The highest temperature was 103.6 at the eighteenth post-operative
hour. The respiration rose to a height of fifty per minute and
the pulse rate to 144. Oxygen was administered for several minutes
(using the cupped hand, holding the delivery tube, as a nasal
mask) at the extreme of the post-operative depression, with marked
improvement in the patient's condition. Water by mouth was started
six hours after the return of consciousness and a good balance
was established. After the fourth day convalescence was uneventful.
On return from patrol, six weeks after the operation, examination
by the squadron Medical Officer revealed a firm, non-tender scar.
The appendix, which had been preserved in alcohol, appeared, grossly,
in its distal third, to be blackened throughout, suggesting a
diffuse hemorrhage. It was submitted to the pathologist at the
Australian General Hospital No. 110, for microscopical examination,
the report of which is not available.
4. While it is by no means desirable to encourage major surgical
procedures on naval personnel by other than qualified surgeons,
yet in this particular instance, it appears that deliberation
and cautious restraint preceded the operation; the operation was
performed under difficult circumstances and with pioneering fortitude
and resourcefulness; and that the result was entirely satisfactory.
19 October 1999