SUBMARINE SQUADRON TWO
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.
THOS. G. WALSH
19 October 1999