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Journal of Emergency MedicineElsevier Editorial System(tm)^ for The Manuscript Draft
Manuscript Number: JEM-D-18-00281R Title: Revisiting Desmond Doss (1919-2006): Merging CombatBenevolence on the Battlefield Medicine and
Article Type: Medical Classics Keywords: Combat Medicine; World War II; Desmond Doss; ConscientiousObjector
Corresponding Author: Dr. Basil H. Aboul-Enein, MSc., MPH., MA., EdD.,FRSPH
Corresponding Author's Institution: London School of Hygiene & TropicalMedicine
First Author: William C Puddy, MSc, MA Order of Authors: William C Puddy, MSc,Joshua Bernstein, PhD; Basil H. Aboul-Enein, MSc., MPH., MA., EdD., FRSPH MA; Lisa A Blankinship, PhD;
Editors' comments: Please note the suggestions of the reviewer, below. Could you briefly describe Mr. Doss's training as a combat medic. Authors response: Revised. See lines 114-122. Reviewer #2: The authors present a fascinating, well-written narrative on the career of Desmond Doss, a medic during World War II. He was the first non-combatant conscientious objector to receive theCongressional Medal of Honor. His story is valuable, and this narrative is thought-inspiring. The discussion is rather brief, but perhaps long enough. I would have appreciated more effort to explain thetiming of this submission - why this story of Doss now? Perhaps it is the link to the recent movie, "Hacksaw Ridge"? Perhaps this is a response to current policy or practice? Greater clarity on what inspired the author to submit this biography now, rather than just a vague discussion on preservingConstitutional rights, would be appreciated. What is new about that? Help the audience understand why your message is important now? I sense there is more to the story, and the audience will also be leftwondering. Be careful to avoid overly focusing on the religious aspect of his life. Authors response: Revised. See edits made in the introduction section. Lines 33-40. That will marginalize some readers, which is not needed. Attempt to expand on the good start towardsthis universalization that you began in the discussion, regarding Constitutional rights. At present, this manuscript is enjoyable reading without a clear sense of urgency or immediacy. I agreewith the bland comments about the Constitutional rights of all soldiers, but it is not clear to me why our readers need to receive this message this month, this year, or even this century. These are not new,timely, or controversial topics as they are described in this manuscript. Fix that, and you will have a great article. Authors response: Revised. See lines 252-264. Please remove figure legend from the figure file and enter it into the manuscript file after the references. Authors response: Revised. Figure inserted after the references section.
Detailed Response to Reviewers
rights. At present, this manuscript is enjoyable reading without a clear sense of urgency or immediacy. I agree with the bland comments about the Constitutional rights of all soldiers,but it is not clear to me why our readers need to receive this message this month, this year, or even this century. These are not new, timely, or controversial topics as they are described in this manuscript. Fix that, and you will have a great article. Authors response: Revised. See lines 252-264. 4.) Please remove figure legend from the figure file and enter it into the manuscript file after the references. Authors response: Revised. Figure inserted after the references section.
Revisiting Desmond Doss (1919-2006): Merging Combat Medicine and Benevolence on the Battlefield Authorship and Affiliation William C. Puddy a; Lisa A. Blankinship b; Joshua Bernstein c; Basil H. Aboul-Enein d a (^) United States Army, Col (RET) Frostburg, MD, USA Email: bill.puddy@hotmail.com b (^) University of North Alabama Department of Biology 1 Harrison Plaza Florence, AL, USA Email: lblankinship@una.edu c (^) A.T. Still University of Health Sciences College of Graduate Health Studies 800 W. Jefferson St. Kirksville, MO, USA E-Mail: jbernstein@atsu.edu d (^) London School of Hygiene & Tropical Medicine Department of Global Health & Development 15 - 17 Tavistock Place London WC1H 9SH United Kingdom Email: Basil.Aboul-Enein@lshtm.ac.uk Address correspondence and reprint requests to: London School of Hygiene & Tropical Medicine Department of Global Health & Development 15 - 17 Tavistock Place London WC1H 9SH United Kingdom Email: Basil.Aboul-Enein@lshtm.ac.uk
*Cover sheet containing author details
27 hero. All Americans ought to consider his heroism: A citizen soldier who put aside civilian 28 comforts to serve his fellow man, his comrades, and the nation in time of war. A major motion 29 picture such as Hacksaw Ridge and the requisite book can sometimes light a fire of interest in 30 American heroes. Doss was and remains a hero in a long and proud line of American heroes, a 31 personage worthy of esteem and emulation. This paper offers a concise narrative review of Doss’ 32 life including his personal and spiritual development, his service during World War II, and his 33 legacy as a conscientious objector and combat medic. This paper necessarily follows Hacksaw 34 Ridge to provide a thorough and in-depth look into Doss, his military career, the values that lead 35 to his character development before and during the war, and the legacy that endured. Medical 36 professionals could benefit from the cultural and spiritual reflections and the compassion that can 37 result from understanding aspects of medical humanities. These virtues are not often overtly 38 present in medical provider curricula, training, and practice yet do surface in works of fiction and 39 non-fiction. This paper represents a brief attempt to fill these gaps by presenting Desmond Doss 40 and his story in this professional journal. 41 42 Desmond Doss – His Early Life 43 Desmond Doss was born February 7, 1919, in rural Lynchburg, Virginia. He was the 44 second son of William Thomas Doss and Bertha Edward Oliver Doss. Theirs was a simple 45 working-class family – his father a carpenter and his mother a shoemaker. The single most 46 important factor influencing Doss during his formative years was upbringing as a strict Seventh 47 Day Adventist (10). His parents immersed him in a devout faith-based environment, emphasizing 48 honest and selfless living, which became the focus of his altruistic worldview. Doss grew up 49 wanting to be either a doctor or a missionary. Academically this did not work out for him as he
50 only completed one year of high school before getting a job as a ship joiner in Newport News, 51 Virginia (12). 52 As a young boy Doss developed a deep reverence for the Ten Commandants but most 53 especially the Sixth Commandment: “Thou shall not kill.” Stories conflict as to whether the 54 lithograph poster, vividly depicting an angry Cain standing over his slain brother Abel, was in 55 the family home or a gift from his father hanging in Doss’s room. Either way, that image made a 56 profound impression on Doss and he swore that he would never, under any circumstances, take 57 another man’s life (3). This was a vow that Doss would keep despite ridicule, harassment, 58 conflict, and extreme danger to himself. Growing up surrounded by like-minded people, Doss 59 was free to practice his religion, be active in his church community, and ultimately become a 60 deacon at age 21 (10). 61 Eventually, war came to America and Doss found himself in a job that was vital to the 62 defense of the nation and critical to America’s efforts to exact revenge upon Japan: Ship 63 building. He easily could have avoided military service through deferment because of his trade 64 but that was not consistent with Doss’s values. Doss was a patriot who wanted to serve his 65 country and not shirk his duty. However, he wanted to serve his country and his fellow man in a 66 way consistent with his religious beliefs. He desired to serve as a non-combatant in the medical 67 field, helping to preserve life and ease suffering caused by the war. When Doss became a ship 68 joiner in 1941 he was required to register for the draft and despite some misgivings, he chose to 69 file as a conscientious objector, called 1 AO status by the Army. Telzrow (10) explains Doss’ 70 concern that such a label placed him in the company of men he believed were shirkers, 71 seditionists, and unpatriotic. In the end he registered anyway, preferring to call himself a 72 “conscientious cooperator,” and specifically requested duty in the medical corps. This he
96 with weapons or even touch a firearm. Doss would receive various work details around the rifle 97 range but never touch a weapon. This further separated him from his fellow soldiers and 98 aggravated his standing with his superiors (13, 14). 99 Eventually Doss was brought before a board of officers to consider discharging him from 100 service on psychological reasons, essentially because he did not “fit in”. It is interesting to note 101 that even Doss knew the questionable character and poor service performance of other 102 conscientious objectors which worked against him, yet Doss eschewed such behavior. He had 103 been a model soldier in all respects save for not touching a weapon. He was a hard worker, 104 learned his medical trade, was alert in class, offered assistance to others, and kept his personal 105 appearance, area, and equipment in fine shape. He willingly requested extra duty on Sundays and 106 obeyed orders. In his own defense Doss fought against separation and convinced the commander 107 to admit that his overall performance was exemplary. In the end Doss argued the only apparent 108 reason he was being separated was his religious beliefs that were guaranteed by the same 109 Constitution that he swore an oath to defend that made the difference. Taking those two points 110 into consideration plus Doss’ determination to succeed against opposition and willingness to 111 serve in combat, the military board relented and dropped all charges. Still, the medical officers 112 had seen enough of Doss and had him transferred to the 307th^ Infantry Regiment of the 77th 113 Infantry Division where he served the remainder of his service time as a medic (12-14). 114 His medical training can be best described as advanced first aid as it applies to the 115 battlefield. He received this training as part of the medical detachment of the 77th^ Infantry 116 Division, at Fort Jackson, South Carolina. Each medic was issued two canvas first aid bags and 117 learned how to use the contents of each bag. Topics include battlefield dressings, sulfanilamide 118 powder, and morphine syrettes. Other training included making field expedient splints (using
119 rifle stocks and branches), administering plasma, and knowing when to allow patients to drink 120 water. While compared to modern military medical training, what Doss received seems 121 rudimentary, he did make expedient use of everything he learned during his brief medical 122 training on the battlefield (13, 14). 123 Upon arriving to the new unit, one of three medics so assigned, Desmond Doss soon 124 made his mark and gained the lasting admiration of the infantrymen. Right after arrival, his unit 125 went on a 25-mile forced march – 25 miles in 8 hours with full gear – an exhausting exercise for 126 any experienced infantryman. Doss also carried his medical bag knowing it would be needed. 127 During the entire march Doss was busy caring for the feet of his soldiers (as he considered these 128 men to be). During halts or whenever a soldier fell out of the formation, Doss was there 129 checking, lancing, bandaging, and pushing them to catch up. Doss completed the march with the 130 unit and without any physical problems of his own and that night rechecked his platoon’s 131 condition (13, 14). This deep abiding concern for his fellow soldiers and selfless service helped 132 his platoon mates see Doss in a new light and accept him as one of their own. 133 134 Military Service and Combat 135 The 307th^ Infantry Regiments’ accomplishments and the horrors of war they experienced 136 across many Pacific island battlefields are truly astounding. Woven into that record are the many, 137 almost unbelievably heroic actions of Desmond Doss. In the 2016 movie Hacksaw Ridge the 138 emphasis was on the fight for the Maeda Escarpment on Okinawa but the foundations for Doss’ 139 actions there were laid long before. First, Doss often volunteered to stand watch and to go on 140 dangerous patrols while himself unarmed. Here Doss disregarded the edict to observe the 141 Sabbath only by church attendance, convinced that since Jesus healed on the Sabbath, that he
165 ships, to allow the soldiers to climb straight up (15). The Japanese were dug into the mountain on 166 the reverse slope and fought hard to retain it, just as they had done throughout the war. From the 167 1 st^ until the 4th^ of May the 307th repeatedly climbed the escarpment to capture the entire 168 mountain and Desmond Doss was a busy man throughout this battle. On the 2nd^ he exposed 169 himself to heavy rifle and mortar fire to rescue a soldier laying 200 yards in front of friendly 170 lines. On the 4th^ he crawled perilously close to an enemy fighting position and, disregarding hand 171 grenades thrown at him, treated and recovered four wounded men, one at a time in separate trips 172 (16). Later that day came the event that defined Doss’ valor on the battlefield and earned him the 173 Congressional Medal of Honor. Men of the 1st^ battalion attacked and destroyed an enemy bunker 174 complex, but a furious Japanese barrage and counterattack drove this unit back over the 175 escarpment with heavy losses. For the next five hours, Doss remained forward of the lines to 176 locate, care for, and individually evacuate 75 wounded Americans. Using available ropes and a 177 litter technique that he had devised back in training, Doss fashioned a sling that secured each 178 man’s legs through loops and doubled around the chest. This worked perfectly and ensured that 179 lowering the wounded over the jagged cliff would not result in any additional injuries (10). 180 Throughout this ordeal Doss repeatedly exposed himself to heavy enemy fire and sometimes hid 181 himself from Japanese soldiers sent to kill the wounded. The next day, Doss braved enemy 182 artillery fire to aid an American artillery officer who had been wounded; and even later crawled 183 to within 25 yards of an enemy cave to treat and recover a wounded soldier, pulling him back 184 100 yards to safety despite continuous enemy fire (16). 185 The magnitude of Doss’ accomplishments during this five-day period is staggering from 186 a military point of view and incomprehensible to those who have never seen combat. Doss was 187 not finished until two weeks later when luck finally ran out for one who had taken so many risks.
188 On the 21st^ of May he was seriously wounded in the legs and left by his comrades in enemy 189 territory during an attack near the town of Shuri. Rather than risk being misidentified as a 190 Japanese infiltrator if he attempted withdrawal, and not wanting to risk another medic’s life to 191 rescue him, Doss treated his own wounds and waited. About five hours later a litter team came to 192 evacuate him, however, upon seeing another soldier wounded more seriously Doss got off the 193 litter and told the other medics to treat that man instead. Again, awaiting evacuation, Doss was 194 wounded in the arm by a sniper. Fashioning the broken stock of a rifle into a splint, Doss then 195 crawled 300 yards to an aid station (16). He later recalled that that was the first and only time he 196 had ever touched a rifle. World War II had finally come to an end for Desmond Doss and he was 197 flown back to the United States for medical treatment. This would not be the end of Doss’ 198 medical problems as his wounds were serious enough to prevent him from regular employment. 199 In addition to his wounds he had contracted tuberculosis and would spend the next five years 200 recuperating under a doctor’s care (17). 201 202 Desmond Doss – The Post War and His Legacy 203 Desmond Doss became the first non-combatant conscientious objector to receive the 204 Congressional Medal of Honor in a White House ceremony on October 12, 1945. President 205 Harry Truman took special note of this young man who upheld his personal religious beliefs 206 while living up to his patriotic values in service to his country and fellow man. As Senator Max 207 Cleland recalls, in addition to Doss’ Congressional medal of honor, he also received two Bronze 208 Star medals, 3 Purple Hearts, the Asiatic-Pacific Campaign ribbon with 3 stars and one 209 beachhead arrow head (for landing ashore under fire), and the Presidential Unit Citation (as a 210 member of the 1/307 Inf (77ID) during the battle for Maeda Escarpment) (15). By any standard
235 Conclusions 236 The history of the combat medic dates back over 2000 years to Roman’s use of the 237 Capsarii , or bandagers, who experienced war alongside their armed countrymen (20). The story 238 of Desmond Doss is inspiring, uplifting, entertaining, and endures as a living history of courage 239 and faith. We are reminded that heroes are not born, they are made through hard work, sacrifice, 240 and adversity. Many perceive adversity as physical or mental or emotional and while Doss 241 experienced all of these before and during the war, his most and least difficult obstacles were 242 spiritual. Doss’s story contains lessons for everyone across all walks of life. The military can see 243 the result of acceptance and understanding, the medical profession should honor bravery and 244 courage, and the citizen must recognize that extraordinary heroism can be found in the most 245 unlikely places. Doss’s experiences, and the stories told about him by those he served, and most 246 importantly the experiences lived by those he saved on the battlefield, should be remembered, 247 revered, taught, and shared as an example of how principles of faith and duty can and should co- 248 exist. 249 Marginalization of the individual based on constitutionally protected choices, such as 250 conscientious objectors, can and should be discussed at the policy level within our armed forces. 251 The story of Desmond Doss is just one example of why regular re-evaluation of military 252 screening processes, enlistment procedures, and field training require periodic re-evaluation. The 253 criteria for enlistment in the military often includes vague and potentially exclusionary language 254 such as unfitness , unsuitability , and misconduct. One potential avenue to address these 255 ambiguously defined clauses would be a renewed focus on merit and a reduced focus on 256 potentially unconstitutional disqualifiers similar to the rationale used with Doss. What was once
257 stigmatized and marginalized as cowardice should serve as a model for institutionalized 258 misunderstanding built into our code of conduct. While the current literature supports broad use 259 of and support for the profession of combat medic (21, 22), the person who aspires to become 260 that medic can still face unwritten obstacles and disqualifiers similar to Desmond Doss. Should 261 constitutionally-protected choices such as religious affiliation, gender identity, sexual 262 orientation, or pacifism adversely affect a person’s desire and passion to serve their country? 263 Should disqualifying language in our military enlistment code overshadow or supplant 264 meritorious inclusion? These are questions Doss might ask us to consider if he were asked today. 265 Governing bodies for medical fields and each branch of the military must recognize the 266 ethical precedent set by Desmond Doss before and during his World War II campaign. His 267 principled opposition to violence, previous considered an act of self-preservation, cowardice, or 268 attempted desertion, has and must continue to be a standard and a baseline for current and future 269 generations of American’s willing to serve in the military. A person’s faith should not be used as 270 a predictor of their character, their courage, their sense of honor and duty, or their value. Doss 271 was initially judged as a man using only his spiritual convictions and had to fight to remain in 272 service to a military and a country that sought to remove him. 273 274 275 276
323 Figure 1. United States Army Combat Medic - Desmond Doss (1945)
325 Source: U.S. Army Medical Department, Office of Medical History 326
