Page 30 - JSOM Fall 2023

removal, abscess drainage, and fracture reduction among other traumatic wounds. It was not uncommon for the patient
other procedures. 5 to survive an extremity gunshot wound, only to lose the limb
5
secondary to frostbite during transport. Many Partisans suf-
2
Austerity forced Partisans to improvise with whatever mate- fered from “shell shock.” Downed American airmen treated
rial was on hand. Partisans manufactured supplies including by Dr Rogers primarily suffered from communicable diseases
stretchers, splints, dressings, bandages, and “made various including dysentery, typhus, and sexually transmitted infec-
types of instruments, such as shears, pincers, tongs from high- tions. Many of the wounded had pressure ulcers, while ban-
1
grade steel taken from disabled enemy tanks.” Drugs report- dage shortages forced the Partisans to reuse bandages 10–12
edly manufactured by Partisans included morphine, procaine, times. 5
saline, and glucose solutions. Nails replaced Steinmann pins
for fracture management, and parachute cord served as lig- Patient Evacuation
ature material. When a B-17 “Flying Fortress” crashed near
the Kosta hospital, it was quickly harvested for raw materials. Partisans relied primarily on aerial evacuation provided by
Windows for a new surgical theater were made using the air- Allied fixed wing aircraft for inter-theater movement. Bari,
craft’s acrylic windows, and parachute silk was used to cover Italy served as a major base of operations for evacuation and
5
the ceiling and walls. Hot showers were built using various aerial resupply. Evacuations occurred only at night due to
piping and nozzles recovered from the aircraft. 2 enemy air patrols and ground spotters. Allied aircraft flew in
the vicinity of the evacuation zone as signal fires identified
Dropping supplies by parachute was a necessary but inefficient makeshift mountain runways. Signaling mistakes often led to
method of delivery. Challenges included poor communication, aircraft turning back for fear that the signal fires were enemy
limited landing areas, difficult terrain, supply collection, and decoys. Casualties were also evacuated by sea after arrival to
drop zone security. Approximately 65% of supplies were the island of Vis. Figure 4 shows approximate air evacuation
5
1
unable to be recovered by friendly forces. Partisans who re- distances from Dr Rogers’ and Dr Dafoe’s primary areas of
covered supplies would often take what they needed before operation. 19
forwarding supplies to the appropriate unit. Supplies were also
shipped from Italy to the Partisan stronghold on the island of FIGURE 4 Map of partisan evacuation routes.
Vis and then to the mainland. The British and Allied forces
provided medical supplies to the Partisans at a rate of 3,000
air drops per month. 2

Some regional hospital systems had a dedicated quartermas-
ter service. This service helped keep remote, secret hospitals
supplied with food through coordination with the central hos-
pital’s robust food acquisition network. Almost all food was
obtained locally. Dispersed regional food depots ideally held
2 to 3 months of reserve food. Mt. Rog hospital bunkers con-
tained 15,000-kg potatoes, 800-kg sugar, 10,000-kg wheat,
1,000-kg salt, and 400-kg of smoked meat. 1

Injury Care

Injuries suffered by the Partisans included expected traumatic
war wounds of the era and disease nonbattle injuries (DNBI)
secondary to harsh living conditions. The austere conditions
and limited surgical capability resulted in many future compli- Air evacuation distances to the Allied airbase at Bari, Italy
cations for casualties who did not die immediately from their from Dr Rogers’ and Dr Dafoe’s primary areas of operation.
wounds. The island of Vis served as part of an important maritime evac-
uation corridor.
Gunshot wounds, fractures, and blast injuries were the most
common injuries and were often badly infected once they made Litter-bound and other patients requiring long-term recovery
it to a surgeon. Dr Dafoe described, “The cases came on one stayed in the more remote hospitals to minimize the possibility
after the other, gunshots in limbs, with and without fractures. of enemy attack and subsequent additional movement. Ambu-
Most of them severe and running with pus. I never believed latory patients were treated at more vulnerable locations close
that there was so much pus in the world . . . literally buckets to communication lines because they could more easily evac-
2
5
of it.” Osteomyelitis was common, and many fractures could uate if the enemy was encroaching. Figure 5 shows Partisans
not be properly cast at the time because of infection. Sparse of the Vinica hospital moving wounded after surgery through
antibiotics and poor patient nutrition complicated and pro- the hospital complex. 20
longed patient recovery. Long-term complications of traumatic
injuries included enteric fistulas, amputations, arteriovenous The Partisan resistance was a national effort captured by this
fistulas, and the need for revision plastic surgery. Less com- quote from the medical officer Dr Irina Kovanjko Kneževi´c
mon injuries included eye trauma and injuries secondary to regarding the villagers of Tepci: “For five full days and nights
enemy torture. DNBIs represented a large portion of Parti- these people worked in shifts, up to their knees in water,
5
san patients. Poor lodging, lack of blankets, poor nutrition, transporting our wounded, hospital staff and Italian stretcher-
18
and bedridden patients contributed to frostbite in addition to bearers. The Tara river was streaming in the frost, an icy film
28 | JSOM Volume 22, Edition 3 / Fall 2023