Dr. Ivan Brown dreaded "flak time."
A doctor in the Duke-affiliated 65th General Hospital during World War II, Brown counted the bullet holes as planes returned to base. More holes meant more hours treating injured pilots.
"We called 4 p.m. every day when the bombers came back from their missions, 'flak time,'" said Brown, Med '40 and former James B. Duke Professor of Surgery, in a statement. "We'd prepare all afternoon for that."
The 65th General Hospital was established during World War II in East Anglia, England to serve primarily the 8th U.S. Air Force-a unit that ran daily bombing missions over Germany. The American planes were sometimes hit with anti-aircraft fire or bullets from German fighter planes, and pilots often needed immediate medical care.
Brown, along with a team of more than 500 other health professionals from North Carolina, staffed the complex of 35 Nissen huts that made up the 65th's Botesdale compound, one of several in East Anglia.
"Our bed capacity was 1,456, and we stayed full," Brown said. "At times, we would get trainloads of 600 to 700 patients at once from the front."
The 65th was one of several initiatives Duke Hospital administrators undertook to help the Allies. As officials celebrate the 75th anniversary of Duke Health this year, the war effort stands out as one of the institution's crowning achievements.
In early 1940, the impending war loomed over Duke's campus and medical establishments. University administrators initially turned down offers from the Army and Navy to establish medical units for overseas services in emergencies. The University cited a need to focus on its heavy patient and teaching loads.
After France was invaded, however, officials resigned themselves to the war's inevitability.
"It is a time to shake man's faith in man, but it is also a very fitting time to dedicate to the service of sick mankind one more small evidence that medicine holds fast to sanity in a world that seems violently insane," said Dr. Frederic Hanes, then-chair of the Department of Medicine, at a dedication of the Department of Neuropsychiatry.
The University signed a deal with the Army Oct. 17, 1940 to work as the 65th General Hospital if called on in an emergency situation. Duke also affiliated itself with the 65th during World War I.
Doctors and administrators began preparing for war.
Ten days after the strike on Pearl Harbor Dec. 7, 1941, Duke was the first medical school in America to adopt a mandatory four-quarter schedule. Each student would receive their degree after three years of consecutive schooling instead of four.
Also, in the midst of the war, administrators allowed one year of Army or Navy Medical Corps work to be counted toward a compulsory two-year postgraduate requirement.
Administrators increased the size of the class by 10 percent in order to fill the rapidly growing need for doctors.
"As would be expected for patriotic reasons, as well as because our oldest graduates are younger than those of other schools. Duke had the highest percentage of medical alumni on active duty," Dr. Wilburt Davison, the first dean of Duke Hospital and the School of Medicine, wrote in a book tracing the first 20 years of medicine at Duke. "The majority of the 722 graduates and postgraduates. who had completed at least nine months of internship were medical officers on active duty in the Army. stationed in practically every theater of war."
The 65th was placed on active duty in July 1942. The unit then underwent basic training at Fort Bragg and waited for facilities to be built.
"After 15 months' training and the process of staging, waiting and restaging, involving three moves and an overseas trip, the 65th was finally able to function as a whole," Davison wrote. "The major job at first was to equip and furnish the hospital. Off-duty hours were spent inspecting the English countryside via bicycle, studying cathedral architecture and adapting one's individual physiology to British beer, no perspiration and Brussels sprouts."
March 4, 1944 was the first day of full operation for the Duke-affiliated 65th General Hospital. One thousand heavy bombers attacked Berlin by day, and 23 men needed treatment that night. Before doctors could finish tending to those wounds, two planes crashed on take-off, and the injured were admitted in the early morning.
Thus began 20 months of continual operation for the hospital.
In all, the unit treated more than 17,250 patients during its time in England with a mortality rate of less than four-tenths of 1 percent. "If they came in breathing, if they were alive, they had a 99 and six-tenths percent chance of making it. That's a better rate than the average civilian hospital for trauma cases," Brown noted.
The group labored 16 hours straight after D-Day. "We worked very, very hard," said Dorothy Salerno, Nursing '40 who oversaw an orthopedic ward for the 65th. "After the second Christmas there, we sometimes felt the war was never going to end."
The 65th ceased operations Aug. 29, 1945. The unit still reunites every year at Duke.
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