CHAPTER XIII
From Auckland to Tokyo
Ashley W. Oughterson, M.D.
INTRODUCTORY NOTE
The material in this chapter is derived from the officialwartime diary of the late Ashley W. Oughterson, M.D., and is presented insubstantially the form in which the then Colonel Oughterson prepared it. Theoriginal plan was for Dr. Oughterson to write this chapter, from his diary andother official papers. With hisuntimely death, that plan became impossible, and, since no one else possessedthe information, the best solution seemed to be to use the material he hadrecorded during the war.
Dr. Oughterson, Clinical Professor of Surgery at the YaleUniversity Medical School, entered active duty in the Medical Corps of the U.S.Army in January 1942 as a lieutenant colonel (fig. 300). His first assignmenttook him to the Army Medical School, Walter Reed Army Medical Center,Washington, D.C. From April to June 1942, he was at Lovell GeneralHospital, Fort Devens, Mass., as chief of the surgical service. He was nextassigned to the 39th General Hospital, a medical unit sponsored by andaffiliated with the Yale University Medical School. The unit was staged at CampEdwards, Mass., and was subsequently shipped to New Zealand, where itestablished facilities at Auckland in November1942. Colonel Oughterson served as chief of the surgical service of the 39thGeneral Hospital until March 1943, and then as hospital commander until July ofthe same year.
It was after this experience that Colonel Oughterson receivedhis first assignment as a surgical consultant. As the tempo of fighting in thePacific accelerated, he was moved from one key assignment to another, whereverthe services of a medical officer of his capabilities were urgently needed. As aresult, Colonel Oughterson eventually served as a surgical consultant in everymajor command in the Pacific theater of war. His account may overlap portions ofothers in this section on the activities of surgical consultants in the Pacificareas, but his outlook and perspective differed somewhat from those whoseinterests were perhaps more parochial. Related accounts are also presented inchapters XVII and XIX of "Activities of Surgical Consultants, Volume I"of this historical series. These chapters, by Dr. Frank Glenn andDr. Frank J. McGowan, respectively, pertain to consultation in surgery in the Sixth and Eighth U.S.Armies, which served in theSouthwest Pacific Area.
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The diary material has been compiled and edited by Maj. JamesK. Arima, MSC, and Pfc. Jacques Kornberg of The Historical Unit, U.S. ArmyMedical Service, but editing has been kept to a minimum.
Since this account was prepared, for the most part, fromhandwritten notebooks maintained by Dr. Oughterson during his war service, asEditor-in-Chief of the historical series, I considered it advisable to have themanuscript reviewed by the former chief surgeons of the commands in which Dr.Oughterson served. They were Brig. Gen. Earl Maxwell, MC, USAF (Ret.); Maj. Gen.John M. Willis, MC, USA (Ret.); and Maj. Gen. Guy B. Denit, MC, USA (Ret.).These reviewers were asked to verify the general authenticity of Colonel Oughterson`s statements, and, especially, to addany comments whereever their broader knowledge of the events discussed mightplace the data in better perspective for the reader. They were also asked toreview the manuscript in the light of subsequent events, just as Dr. Oughtersonmight have done had he lived to do so himself.
FIGURE 300.-Col. Ashley W. Oughterson, MC
The general comments of these reviewers follow in this introductory note. Their comments on specific passages are included as footnotes in the appropriate places. The reviewer making the comment is identified by his initials.
With respect to the entire manuscript, General Maxwellcommented:
I have made very few correctionsor comments since it [the diary] was so typically thethoughts of such a great organizer. To change the wording or to delete some of his caustic remarks I think would detract fromthe entire theme of the manuscript.
I will assure you that the entire diary is exactly thethinking of a mature mind on a very difficult subject. Dr. Oughterson, or"Scotty" as we all called him, believed in sayingexactly what he thought and I believe if he could have edited this manuscript hewould still think and write the same context.
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General Willis wrote:
I do not mean to bedisparaging toward ColonelOughterson`s service, because I think he did a magnificent job. I do not, however, believe that he realized that the tactical useof medical units had been a subject of study by experienced officers ever sincethe end of World War I, nor do I believe herealized that these tactical units were "personneled" by officers oflittle military experience, and necessarily there were many square pegs inround holes and vice versa. These could only be "fitted" by removalfrom one place to another, involving transportation which was at apremium.
* * * I firmly do not believe in placing the highly experiencedsurgeon in the Battalion Aid Station or even an Advanced Surgical Hospital. Ithink they could be of greater use to a greater number further back.
In explanation ofthe latter point, General Willis noted: "[Dr. Oughterson] entered activeduty * * * with a wide experience in peace-timegeneral surgery. Unfortunately, there were too few such qualified surgeons andeven fewer who were available to the Military Service." Had the type ofsurgeons Dr. Oughterson desired been provided, as he advised, in sufficientnumbers "to man the Clearing Stations, the Portable Surgical Hospitals, theField Hospitals, and the Battalion Aid Stations, the evacuees at the generalhospitals, both advanced and athome bases, would have suffered, and many of those still training would neverhave arrived at the front to relieve the tired andwounded already engaged incombat."
General Willis also noted that certain conditions in thewestern Pacific in late 1944 and early 1945, upon which Dr. Oughterson hadcommented adversely, existed as a result of policies and practices in effectbefore his (General Willis`) arrival on the scene, and"everything by that time had been formulated and was going."Moreover, General Willis informed me in a telephone conversation on theOughterson diary in February 1959: "* * * I arrived in Hawaii around themiddle of November in `44 and left there on the 31st of January or the 1stof February with Kirk, Simmons, and Welch and that group down there and wentover to the South Pacific. Of course I didn`t have anything to do with the South Pacific-but it [the tour] didinclude Saipan and those places, so I went with them to see that, and, beingwith them, I had to go all the way around."
Another point is evident from General Willis` remarks,that, when Colonel Oughterson was himself in the Marianas, he might not havebeen fully aware of the planning that was going on inHawaii and also might not have appreciated the time required to put theaterplans into effect so that results would be noticeable at the working level where he was. He might, GeneralWillis thought, have taken into more consideration the fact that many of theproblems that faced the medical service in the Pacific existed, and continuedto exist, as a consequence of circumstancesoutside the control of the Medical Department.
Finally, General Willis wrote: (1) "The early sectionsof Col. Oughterson`s report deal with observations, comments and criticismswithout giving the credit to the younger and perhaps less talented medicalofficers who were work-
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ing in the mostunfavorable conditions, but nevertheless were giving everythingthey had"; (2) "The routine ? gr.of morphine, the too-tight plaster bandage, the poorly kept records and the failure totransmit them with the patients were the results of `hurried-up training` atthe home training centers, butsuch was necessary because of the pressing need of replacements;" and (3) theslow evacuation sometimes evident in thePacific was "the result of the lack of sufficient transportation and the distancesinvolved."
General Denit`s comments were as follows:
Thank you for letting me see Colonel Oughterson`smanuscript. I am glad it is to be published. I think it is very interesting. Iwish I had been able to keep notes as he did.
My general comment is that I am not inclined to takeexception to anything he has to say. After all he gives the picture as he seesit.
Let me say here about any medical history of the PacificAreas, the organization of the Pacific was so complicated that in order tounderstand how the medical services functioned, one would have to study theoverall administrative volumes of the history of each headquarters of thePacific Areas. To do this would require many months of study. Therefore, towrite a correct history and to find out who did what in the various medicalheadquarters would be impossible unless one had had experience in all areas ofthe Pacific. Now take General MacArthur`s headquarters. He did most of hisfighting with so-called task forces. The CG of the task force, most oftenGeneral Krueger, but not always by any means, would determine his needs tocarry out his missions. This of course included medical units. I sometimes got a chance to review and comment but no amount of pleading could change things if the CG, task forces, ruled otherwise. Of course I never thoughtenough medical means were provided. Often I was right.
Then when the means in way of organizations were provided,the task force commander would not force his engineers to build minimumfacilities for the hospital. Hence my remark [p. 852] that the Armywouldn`t obey orders. Many times, in fact at all times the engineers were waybehind schedule in helping the medical service build its own hospitals.But such is war in the jungles. No one who hasn`t experienced it can believethe difficulties encountered.
For instance * * * the Signal Officer * * * was next toGeneral MacArthur and had his ear. Inevery area he got the high ground for radio; I took what was left. Not onlythat, but he said our X-ray and diathermy machines caused interference with hissending and receiving communications, so we had to be a certain distance fromhis installations. Hence the frog ponds for hospital areas. In truth,though, all areas at certain seasons in the tropics are mud holes.
I wish it were possible for me to tell of how the complexorganization made it impossible for the Chief Surgeon of the American Forces inthe SWPA [Southwest Pacific Area] and USAFFE [U.S. Army Forces in the FarEast] to force upon the various commands his ideas. Even when hisrecommendations to GHQ were accepted they were not carried out by the taskforce commanders. Possibly in a number of instances tactical considerationsgoverned.
I will say this. The medical service knew what it wanted,its planning was good, and, considering all factors, the medical service of theSouthwest Pacific Area was superb. General MacArthur said so repeatedly.
* * * * * * *
I had a great admiration for Colonel Oughterson and gave himthe job of "thinking" and advising me on how surgery and care of thewounded could be improved. I didn`t want him to have any administrativeauthority. I wanted him to (1) see, (2) think and (3) advise. Often when onetries to correct he loses his value as an adviser.
* * * * * * *
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FIGURE 301.-Tontouta Airfield, New Caledonia, August 1943.
The use of Colonel Oughterson`s diary was necessary, as already noted, because of the information contained in it and not available elsewhere. In the light of the comments of the chief surgeons under whom he served, its publication in essentially the form in which it was written by him during his wartime service seems even more justified.
Col. JOHN BOYD COATES, Jr., MC, USA
Editor in Chief
Auckland, Friday, 6 August 1943
Orders today from COMGENSOPAC [Commanding General, South Pacific], permanenttransfer to USAFISPA [U.S. Army Forces in the South Pacific Area].1
Noum?a, Wednesday, 11 August
Took off in a B-24 at 0730. Down at Tontouta Airfield, 1400 (fig. 301).
Quartered at Noum?a [Headquarters for USAFISPA was at Noum?a, NewCaledonia] in the Grant Hotel Central which I am told was formerly a house ofill repute (fig. 302).
1U.S. Army Forces in the South Pacific Area wasestablished in July 1942 with responsibility for the administration, supply, andtraining of the U.S. Army ground and air troops stationed in the South PacificArea.
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FIGURE 302.-Noum?a, New Caledonia. An aerial view of the central part of the city.
Saturday, 14 August
Looked over the medical supply situation with Colonel Stuart[Col. Samuel E. Stuart, MC, Deputy Surgeon, USAFISPA]. Met Maj. Gen. Robert G.Breene, chief of SOS [Services of Supply]. "We are fighting the Japs,not each other."
Monday, 16 August
Visited the 31st Station Hospital.Poor site-hot-construction fair. Records fair. No monthly records arekept on surgery. Excellent equipment. They are having trouble with skintight plastercasts. A vaginal insufflator is needed.
Esp?ritu Santo, Tuesday, 17 August
Arose at 0200. Drove to Tontouta Airbase. Arrived atEsp?ritu Santo Islamd [New Hebrides]. Visited the 25th Evacuation Hospital,Chicago group-excellent. Casualties are arriving here with dirty wounds. Lt.Col. (later Col.) Willis J. Potts, MC, the chief of surgery, wants a proctoscope, Berman locator, smaller catgut, plasterknives, shears, Roger Anderson pins, light bulbs, lead letters for X-ray, jarsfor sutures. He has too many silver clips.
Wednesday, 18 August
Made rounds at the 25th Evacuation Hospital. Saw about 35patients. Maj. (later Col.) Harold A. Sofield, MC, is in charge of orthopedics.They
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do elective operations on patients remaining on the island-knees,removal of large chondroma. Very few infections have occurred.
Visited the 122d Station Hospital.
Guadalcanal, Thursday, 19 August
Off at 0800 in General Owens` [Brig. Gen. Ray L. Owens,Deputy Commander, Thirteenth Air Force] plane. Arrivedat Guadalcanal at 1130. Lunch at Thirteenth Air Forcewith Maj. Gen. (later Lt. Gen.) Nathan F. Twining [Commanding General,Thirteenth Air Force]. Then toService Command Headquarters, Col. Russel J. Caton, MC, Surgeon. Watched LST [landingship, tank] unload 200patients on the beach. Most of these were wounded on Monday. Today is Thursday;thus 72 hours have elapsed. Most of the wounds were dressed in a short timeexcept for the 20 caught on Baanga Island (?) for 4 days without medical care.Need better facilities on the LST.
Visited the 21st Medical Supply, "Hicks`Guadalcanal Pharmacy." Captain Hicks is a livewire from Shreveport, La.Visited the 20th Station Hospital. The buildings are thatch tents withgrass and canvas, which last about 3 months here. This is actually a 500-bedhospital with facilities for 840 beds. The operating room is of the quonsettype. They are doing little elective surgery, but have done a few openreductions in the past. This island already has miles of good road. The drainagesystem is improving.
Went to the 52d Field Hospital, which has done mostof its major work under Major Baker-welltrained. Saw a patient who had suffered a compoundfracture of the tibia yesterday at 1100,on an island off New Georgia. He was brought here by boat and SCAT [ServiceCommand Air Transport] in 24 hours. A good debridement had been done, dry gauze left inplace.
New Georgia, Saturday, 21 August
Up at 0330 and drove to Henderson Field. Took off at 0530 ina transport plane. Landed at Segi, a small airstrip built in 10 days on thelower end of New Georgia.2 The Russells are beautiful, and at 0630 the viewfrom Segi is the most beautiful that I have seen in the South Pacific. We were joined by another transport andtook off for Munda with four fighter escorts. The airfield is in good condition except forthe litter of Japaneseplanes and materials (fig. 303). Drove over some of theworst roads I have ever seen to headquarters of theXIV Army Corps. Met Maj. Gen. Oscar W. Griswold [Commanding General, XIVCorps]. Talked most of the morning with Col. Franklin T. Hallam, MC, surgeon tothe XIV Corps-a fine person doing a grand job. He needs more help to do it.
Drove to Laiana Beach in the afternoon, through adevastated area, and was amazed at thesize and number of Japanese foxholes at about every 30 feet or less. Shellholes were almost continuous. Materiel and firepower played
2The capture of New Georgia Island with its important Munda Airfield wasaccomplished by Maj. Gen. Oscar W. Griswold`s XIV Corps. The first landing in force was made 30 June onnearby Rendova Island. Elements of the 37th and 43d Divisions thenlanded on New Georgia enveloping the western end of the island. After our forces werereinforced by troops of the 25th Division. Munda was captured on 5 August.
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FIGURE 303.-Munda Airfield, New Georgia.
an impressive role in getting the Japanese out with so few casualties on our side. There was an estimated 4,000 to 5,000 Japanese [there were 9,000 Japanese troops defending New Georgia] on this island, but it took the better part of three divisions to get them out. Many Japanese skeletons were lying about in their clothes.
Visited the clearing station, 37th Division-100 patients-well run(fig.304). These clearing stations require either a full complement of personnel or outside help, in order to set up. In islandwarfare they sometimes assume the function of surgical or field hospitals. The37th has about 100-plus cases of diarrhea per day, returns more than 40 per day-morethan most clearing stations. Must look into the sedation that is being employedhere. Ten thousand units antitoxin being given asprophylactic for gas gangrene. Chest wounds are wellhandled. There are no nets in use here.
The clearing station is surrounded by barbed wire on whichtin cans have been placed. Some Japanese have raided the hospital. War hereappears to be more vicious than in most places.
Patients are evacuated to the beach through 3 to 5 milesof circuitous roads (fig. 305). An LCT [landing craft, tank] takes them to the17th Field Hospital on Kokorana Island. From there they are transported by LSTor by SCAT to Guadalcanal. The trail for jeeps and ambulances is very rough.Some with severe fractures die as a result of the ride. Very impressed by
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FIGURE 304.-A clearing station, 37th Division, August 1943.
"carryall" which will go through mud that the jeep cannot maneuver. The boats should have regular schedules for stopping along shore to transport the wounded. As it is now, the wounded must take thier chances on the supply boat reaching them in time.
Colonel Hallam-"War neurosis starts with thepool officer who cracks up-for then the men go."
Staying here at headquarters at the eastern endof Munda strip on a hilloverlooking Rendova Island. Most of nature`s creatures here areharmless, except for man. Many flies get in your mouth, but mosquitoes are very rare. There arered ants in the area, but they don`t bother us much. Some masks have beenfound that were used by the Japanese for terrorizing purposes. This climate ishot and wet; everything molds, including the feet. No wonderfungus infection is a problem.
Here is one place where folks don`t want to wear medals oranything else to distinguish themselves. Everybody from the general on downwants to be as inconspicuous as possible. The wounded do notcomplain and are quiet. I suppose thereis relief in the knowledge that they are out of it now. My impression is thatthis is a good Army, with wonderful equipment, which moves forward slowly, andponderously, but inexorably. It is amazing how the jungle is transformed into "civilization,"at least superficially.
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FIGURE 305.-Evacuation to beach by litter bearers and by jeep, New Georgia, 1943.
Sunday, 22 August
Drove to Headquarters, 25th Division-Lt. Col. Raymond H.Bunshaw, MC, Regular Army, is division surgeon. The roads are almostimpassable. The clearing station is with headquarters in a hollow 1? miles from Munda Field.The food here is only fair.There are flies everywhere. Operating tents are screened with mosquitonetting. Bunshaw says that ear dermatitis is caused by swimming in streams.
Owing to the fact that the clearing station is split up, oneplatoon being on Vella Lavella Island, the other on Guadalcanal, they are short of equipment. Bunshaw lost three surgeons to Guadalcanal and is short ofboth surgeons and men. Most of the doctors are young and inexperienced. ColonelBunshaw says that he needs two surgeons for each platoon. He thinks thatrotation of 3 to 4 months is not enough.
Captain Silverstone, in charge here, says that they use alot of oxygen, but have no apparatus. Should clearing stations have arebreathing outfit and so save the O2? Suctionapparatus is also badly needed. A folding Mayo table is urgently needed. Wateris a problem here as it must be transported to this spot, and the roads are inbad condition. Water is now being brought in by 5-gallon cans. Why not have acanvas storage tank to tide them over when roads and weather are bad? They needa gasoline washing machine too,
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FIGURE 306.-A 2?-ton truck evacuates casualties to the beach, New Georgia, 1943.
and a refrigerator for serums. Many eyeglasses are broken and because of this the men must be evacuated or placed on limited duty.
The mud is knee deep; thewoods are thick, hot, and steaming, but not real jungle. Because of the greasiness ofthis mud, hobnails are neededfor the stretcher bearers. The wounded are evacuated here from as much as 5miles away-some through swamps-and2 days are sometimes required for a litter to get through. The ?-ton ambulancedoes not have enough power to get through these roads; the ?-tonis okay (fig. 306).
War neurosis is less in this division than in others. This is because of better leadership;40 percent of the officers are Regular Army. Both Colonel Bunshaw andColonel Hallam believe that weak leadership is the chief cause of war neurosis.
Kokorana Island, Monday, 23 August
The road to the front is closedto all but engineer and signal troops, so I decidedto go with the patients who were being evacuated to the 17th Field Hospital at Kokorana Island,which is off Rendova Island and about 14 miles fromMunda (fig. 307).3 Weleft the 25th Division clearing station at 0830 and arrived at the 17th at1230. The boat trip was pleasant for a well man, but there were no facilitiesfor the patients. I climbed from the LC [landing
3The 17th Field Hospital arrived on Russell Island on 31 March 1943 and received patients the first day. On 16 July and 25 July 1943, the 1st and 3d platoons,respectively, left to take part in the New Georgia operations, while the 2d platoon continued to operate a 100-bed hospital on Russell Island.
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craft] to an LCT and then to shore, only to find that we were at the 118th Medical Battalion. So we embarked again to find the 17th Field. This moving about is tough on very sick patients.
The 17th has a beautiful location in the middle of a coconut grove. The climate here is cooler and dryerthan New Georgia. Thishospital has been bombed and strafed. Six or eight tents were knocked downby 500-pound bombs, and eightcorpsmen were killed. They have done an impressive job. Two operating roomshave been built underground, but again there is no screening. The mess tent isscreened, but, as in all these places, the tables are not. Why not have alittle more screening in order to protect the food? The flies swarm on thefood, though somehow diarrhea has not become a problem here. However,the 37th Division clearing station has had a lot of diarrhea. Major Willis[Maj. James G. Willis, MC], the surgeon, is cognizant of the fact that toomany dressings are taken down, but this appears to be necessary since thereis no way to tell if they have been properly done at the forward area. Many wounds are dressed4to 6 times before definitive treatment is given. Undoubtedly,many wounds are infected in this manner. There is little reason for screening a division clearing station andnotscreening the succeeding stations where dressings are done. I have not seen a mask here,and yet sore throatsare frequent among the medical personnel. Instruments are kept in sterilizingsolutions, usually alcohol.
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Evacuation has been a problem in thisarea. The LST`s carry supplies which they land at another island, and they donot like toremain around here too long. They do not always take the time to run over to the17th. The movement of patients from island to island, or along the shore, is notunder unit or Army control. This lack of organizationresults in many delays. Can thismovement be correlated with the Navy? The suggestion that more surgery be done onthe LST appears unsound only because not enough good surgeons could be obtained forthis purpose. Why not?
Tuesday, 24 August
Remained at the 17th Field today. Talked long with Colonel Bell,the commanding officer. The morale of this outfit is low; the old problem of rotationand promotion.
Many ear conditions here, canal furuncles andfungus. It is thought to be dueto the moisture in the air and not due to swimming. Many of theseears appear to be filled with scaly exudate. It occurs in both the healthy andthe malnourished. Another problemis refractions. There are many broken spectacles and new cases requiringrefraction, but no sets. Tonsils all bled, so theygave up operating on them. They want tuning forks to test hearing. There isa need for sulfamicro drugs for wound dressings.They must also have more ready-made splints, sealing dressings againstflies and ants, and soap solution. The orthopedist says that cases arrive ingood condition except during a push. A few cases have arrived in a state ofshock. He has seen a few skintight plasters. He believes that a portableHawley table would be of great help in the field hospital.
Visited the 25th Division casualty setup adjacent to the 17th Field,in charge of Major Klopfer. Theclinic is excellent. This unit really functions asa convalescent camp, since many patients enter from the 17th Field without adiagnosis. Those with war neuroses may be kept here for one month to see if they can makeuseof them.
Major Klopfer believes that one month is too long aperiod to keep men in the line. The men may have only three hot meals during the whole time.Theyget little sleep and they must fight all day. As he said, "it takes asuperman." He finds that a considerable number of the warneurosis cases are due to exhaustion. He thinks the situation would be helped byshorter periods at the front. The men should also be able to look forward tosomething in the way of relief after the job is done. Malingering isnot high here.
Conversation with Capt. Benjamin A.Ruskin, MC, a psychiatrist. He divides neuropsychiatric cases into twocategories: Group I, those who have had trauma; and II, those who are afraidof trauma. The functions of these psychiatrists seemto be: (1) Sorting out the patients who can be saved,(2) educating officers and enlisted personnel, and (3)therapy. They do not appear to have enough diversional activity; more books,movies, and games are needed.
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Rest camps should be set up only where these activities can beprovided. The morale of the 25th Division ispoor because of the length of time away from home plus the long campaigns.Efficiencyis dropping rapidly.
New Georgia, Wednesday, 25 August
Left Kokorana Island at 1030 on a mail barge from MundaBeach. We were accompanied by boats of all varieties: personnel barges, LC`s, LCT`s, et cetera. Allkinds and combinationsof uniforms were to be seen. Some men were stark naked; others wore only a hat orshoes. One sergeant had all sorts of insignia on his hat.Asked why, he said that they all came in handy, depending on where hewas. A boatload of men went by looking more like a band of pirates thansoldiers. One man in a mottledjungle suit appeared in our boat. Someone asked hima question. He promptly lay down, saying "I don`t know or give a damn,"-andwent to sleep. We arrived at XIV Corps headquarters,1400, to find that Colonel Hallam has been down with dysentery for the last 3days.
Although it had been on thesame site for 1 month, the 17th Field Hospital on Kokorana had screened only themess building, and that just partially. It would have taken very little more to havescreened the entire mess. If not with screen, mosquito bars would have done for 1month. The latrines were open and poorly constructed.Operating and dressing rooms were not screened. No effort has been madeto improve conditions, although it is true that they have been expectingto move. Since only a minimum of lighting is available, everyone goes to bed at 1830.The 25th Divisionoperating room is screened with a mosquito bar, although they are working under more difficultconditions.
Thursday, 26 August
Slept soundly in spite of an alarm and the sounds of 105mm. guns shooting over our heads. However, this morningmy head feels as though it had been pounded. Went over to the 37th Divisionclearing station (fig. 308) and also visited the 43d Division. Men of the 37thsay that they are handicappedbecause the clearing company does not function as a unit. They are more shortof enlisted men than officers, although the new T/O [table of organization] cutstheir enlisted strength even more. Whenever they have had to move, they havehad trouble in getting help to set up and have not been able to get bulldozers.Help is most needed in the initial stages, for screening, etc. Anopheles aregetting worse in the Laiana Beach area, and there is not enough mosquito bar for screening. Therehas also been sometrouble and confusion in connection withpriority of location for the clearing station, and some unnecessary moveswere made. Headquarters seems to decide on one location and then change its mind. Lt.Col. HobartL. Mikesell, MC, is division surgeon [acting]. He thinks that the triangulardivision splits up medical personnel too much for island warfare. Coulddoctors be obtained by substituting MAC[Medical Administrative Corps] officers to do the routine administrative tasksin the collecting company, sincethese units function chiefly during battle?
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The men of the 37th Division came on New Georgia with inadequate equipment, for some things had to be left behind. Many left their bags behind, hence they do not have enough socks, shoes, etc. They need a refrigerator for serum and cold drinks, and a washing machine. The sterilizers are too small. How to blackout! Allowed four basic instrument sets, they found out that they only had two. There are no batteries for lights, but they are short of bulbs anyway. Splints and litters tend to run out. Wire ladder splints are needed. No screening anywhere, neither in latrines, mess or operating room-and flies are swarming. I wonder if they do enough debridement?
Guadalcanal, Friday, 27 August
Batteries in headquarters camp began a barrage at 0430, and Iwas sleeping in the corps surgeon`s tent on a small hill directly in front ofthe guns. Japanese planes came over and bombed us at 0530. They didnot hit the field, so I took off at 0800.
We made an unexpected stop at Russell Island, so I got out tovisit another platoon of the 17th Field, which is in command of Major Addison,who is also the island surgeon.4 They needan intensifying screenfor the X-ray, as the X-ray generator fluctuates too much. The incidence ofmalaria on Russell is more than was anticipated. Dental work is behind, andsome patients
4See footnote 3, p. 777.
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are evacuated because of the lack of dental facilities. Adentist reported here today. There is not much surgery to be done here.They have done only one major surgical operation this month and a moderateamount of minor surgery. Malaria and dentistry are the big problems. Thesplitting up of these field hospitals takes away a certain amount of equipmentand cuts the personnel, particularly corpsmen. Asa result, these hospitals leave much to be desired.
In this rapidly moving front of island warfare, a fieldhospital cannot stay put very long. As a result, they do not put much effortinto keeping up to the highest possible standards and tend to get intoslovenly habits. The 1st and 3d Platoons of this hospital were located onKokorana instead of at the forward area on New Georgia, thus adding 4 to 5hours` delay to the care of casualties. The hospital has remained there fornearly a month, though this location is not particularly invulnerable. It hasbeen bombed and had 8 or 9 deaths-more fatalities than even the dressingstation on Georgia. With better forward clearing stations and LST`s with anadequate operating room, the field hospital here would act primarily as aholding and evacuationstation.
I caught the 1530 plane for Guadalcanal and met Capt. Richard A.Kern, MC, USNR., and Cdr. Theodore E. Reynolds, MC, USNR, medical and surgical consultants forthe Navy. There was anenormous amount of destroyed Japanese shipping between Florida Island andGuadalcanal. The loss of materiel and personnel must have been very great. This wasthe show that definitely stopped the southward advance of Nippon. The Canal isone great dust cloud and fairly cool in contrast to the steamy heat and mud in New Georgia. I put upat the Service Command in a newscreened and floored tent. The eternal cry is "screening."
Saturday, 28 August
I spent the day going about with Captain Kern and CommanderReynolds. Visited several Seabee installations and they are splendid. Theiringenuity is astounding. Washing machines were improvised out of gasolinedrums. The Seabees and the LST ships are the greatest innovation I have seenin this war.
Filariasis has now been found here. Some native villagesstill remain as close as one-quarter of a mile from the camps. This may be aproblem (fig. 309). The Navy experienced a severe amount of dysentery on landinghere. Again, screening is the answer. More dental equipment anddental officers are needed here too. This seems to be true in all echelons.
I visited the Mobile 8 [U.S. Naval Mobile Hospital No. 8].Capt. William H. H. Turville, MC, USN, is commanding officer. He is anintelligent, able disciplinarian, who has built the best naval hospital I have seen inthe South Pacific. The total area covered is 79 acres. The hospital is of prefabricated construction. It took 2 months to build,and has 400 patients at the moment; it is expanding, however, to a1,500-bed hospital.
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FIGURE 309.-Blood specimens being taken to determine the index of malaria in a native labor camp near a military base, Guadalcanal, August 1944.
Sunday, 29 August
On this rainy dayI am plagued by a head cold anddiarrhea. I visited the 24th Field Hospital. Lt. Col. L. B. Hanson, MC, is thecommanding officer. He is one of the finest commanding officers I have seen inany hospital. His unit has not yet seen action. They are a hand-pickedgroup of men with varied talents. In ingenuity they compare favorably with theSeabees. A field hospital is supposed to have 150 tons of equipment.Hanson now has about 300-plus, including cement, lumber, screening, tworefrigerators, one large reefer (freezer), numerous engines, an ice cream unit, etc.This looks like the Army`s number one field hospital. Thegenerators furnished to the field hospitals are inadequate for the load.Not enough mess equipment orcarpenter tools are being supplied.
Twenty-plus cases of gangreneoccurred during the month of July at the 20thStation Hospital and the 52d Field Hospital. A tremendous amount of debridement was done atthe 52d Field Hospital. Why so much here-moreshould be done forward?
Monday, 30 August
Spent the day at the 52d Field Hospital. The location isnot too good. The site is hot, on low ground, and on the dusty side of theroad. It has an advantage in being between two airstrips, affording the use ofa Japanese powerplant and water supply. The hospital is now in command of Major
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Baker, who is well trained and has good judgment. Theorthopedist is also good. Tents are built off the ground. The operating roomis well screened with good fly locks. This hospital has an adequate amount ofscreening, which is well distributed, except that the mess kitchen and mess tables are located in separate tents, whilethey shouldbe combined. The patient is sprayed before he enters the hospital. He is marked "today" for dressings.A large sterilizer was obtained, since the pressure cooker was too small.The sterilizer is heated on a field range. They refill bottles and make theirown sterile waterwith an autoclave. They have averaged about 325 patients per day and use about 3,000 gallons ofwater per day, kept in tanks which last from 2 to 3 months. The 14 Japanese treatedhere have been good patients. The onlycases of tetanus seen have occurred among them. Many patients are waitingfor new spectacles.
It seems that the splinting done in the forward echelonis frequently inadequate toimmobilize and does not extend over the adjacent joints; for example, theankle. Applying one layer of sheet wadding and then plaster, would be abetter method. The area should be shaved and washed with green soap and water.Debridement is frequently inadequate, dirty clothing and dead tissue are not removed,and hemorrhage is not adequatelycontrolled.
In the beginning of the New Georgia campaign many of thewounded never went through a clearing station, and treatment was delayedfor from 48 to 96 hours. The 17th Field was established about 4 weeks after thelanding on Rendova, and patients were then evacuated in much bettercondition. Before this there were, for example, casualties with the femoralartery and vein severed that were not ligated upon evacuation.
LESSONS OF THE NEW GEORGIA CAMPAIGN
There is, in general, too much dependence on sulfonamides andnot enough on debridement. There is a tendency to dump sulfonamides into woundsthat are not deeper than 1 inch. The same is true for larger wounds in theapplication of debridement. One doctor here found that spores and grams androds are common in thesewounds and sometimes exist in almost pure culture. The only complications causedby sulfonamides were seen in five or six cases of suppression of urine withblood, and all of these cases recovered. Some through-and-through wounds havecome in with a sponge in either end (plug), held in by a catgut suture.
Fifty percent of the tags attached to the patients areuseless, and rarely do they contain clinical information. The chief questionthat is to be answered is what was donewhen, and when the wound needs a dressing. The people here would like to knowwhat eventually happens to the gas gangrene cases and if any new ones develop later on.
I have now collected data on 20 cases of gas gangrenefrom the 52d Field and 20th Station Hospitals. There appear to be at least twounderlying reasons for the occurrence of gas gangrene:
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1. The reasons of organization and administration, which contribute to delay in the treatment of the sick and wounded. Hence, the failure to provide adequate medical care in the forward areas during the New Georgia campaign. Some of this was probably unavoidable and was caused by such incidences as the bombing attack on the beachhead shortly after the invasion. With the difficulty of communication in island warfare, there are plausible reasons why all patients do not go through a clearing station. However, this lack of medical facilities resulted in long delays in the treatment of casualties. Although sulfanilamide was applied rather routinely in the early stages, this did not prevent gas gangrene. However, gas gangrene occurred only in very severe wounds.
2. Professional care was at times inadequate due to: (a)Failure to appreciate the importance of thorough debridement-in many instances itwas superficial only, (b) failure to control hemorrhage, (c)inadequate cleansing with razor, soap and water, (d) doctors in clearingstations said that patients were in too great a state of shock to permit morethorough debridement; also, the number of casualties that passed through theclearing stations were at times greater than could be cared for adequately, and (e) patientstransported on LST`s to Guadalcanal received inadequatecare. The trip lasted from 20 to 24 hours. Only one doctor was assigned to eachboat, and there were no adequate facilities for operating or dressing wounds(fig. 310).
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The following is an extract on the problem of gas gangrenefrom the sanitary report for July 1943, Headquarters, XIV Corps, ForwardEchelon, New Georgia Occupation Force:
Hospitals in rear areas began to report, earlyin July, theoccurrence of gas gangrene among battle casualties arriving from the NewGeorgia area. Immediate investigation as to the probable causes of gasgangrene infections was undertaken, both by the rear echelon of the Corps atGuadalcanal and by the forward echelon at New Georgia. It was found that themain causes were lack of early debridement, primary closure of wounds, tightpacking to prevent hemorrhage, and a lapse frequently as long as 72-96 hoursfrom time of injury before definitive treatment could be instituted atGuadalcanal.
Immediate steps were taken to minimize the incidenceof gas gangrene among battle casualties. The division in combat at that timewas notified of the occurrence and probable causes of the gangrene. Largequantities of gas gangrene antitoxin were sent to New Georgia with instructions to administer prophylactic doseswherever indicated. Medicalfacilities aboard LST`s, which carry patients to the rear areas, wereincreased by the Navy.
It should be remembered that, while the occurrence ofgas gangrene among battlecasualties is unfortunate, division medical service was the only source ofmedical treatment of battle casualties in the New Georgia area during thefirst 28 days of July. Facilities for definitive surgery were lacking northof the Guadalcanal-Russell Islands area. The 24-36 hour trip by LST from thecombat area to Guadalcanal, during which time the wounds were not redressed,except in emergency, provided an excellent incubation period.
The establishment, toward the middle of July, of the policythat all casualties should be cleared through the division clearing stationbefore evacuation to the rear on the LST`s, did much to prevent long journeysto the rear by casualties who had received only aid station care. The arrivalduring the latter part of July of 21 medical officer replacements andelements of the 17th Field Hospital did much to provide adequate early surgicalcare, and the occurrence of gas gangrene was reduced to a minimum.
FRANKLIN T. HALLAM
Colonel, Medical Corps
It should be noted that the above use of antitoxin is of questionable value. It should in no way minimizethe surgical care (debridement). The increase of medical facilities on LST`s(September 1) consisted of two doctors instead of one. Their facilities werestill inadequate.
Tuesday, 31 August
A boy was riding on the fender of a truck when a bullet froma machinegun, one of ours, hit him in the back. He was instantly paralyzed. This happened at 1700. He arrived by plane at the 52d Field Hospital atnoon next day. A boy, the tail gunner in a B-24 on a bombing mission onBougainville, parachuted from his burning plane, and was strafedby the Japs. He was shot through the belly and the right side, and had alarge exit wound just to the right of his spine. There were six perforationsof the intestine and the missile had passed medial to the right kidney. He wasoperated on at the 20th Station Hospital within 2? hours and is doing well this afternoon. A boy, belly gunner on a bomber, was shotthrough the upper third of the left leg. Both veins and arteries gone, and a compoundcomminuted fracture-amputation was necessary. He was operated on within 3hours and is doing well. Air transport of the sick can accomplish wonders, but itshould not supplant proper
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FIGURE 311.-Evacuation by C-47 transport plane from Munda Airfield, New Georgia, August 1943.
surgical care in the proper place, which is still forward (fig. 311). A detonated dud hurt no one but a cook 200 yards away in the messhall. The fragments took out both eyes and the bridge of the nose, passing very cleanly sideways. He is in good condition and wants to know about his eyesight.
Spent the day at the 20th Station Hospital. Col. Harvey Laton iscommanding officer. They landed on Guadalcanal January 16th,and took patients on the 24th. They have been flooded out once. Thearea is low and hot and unsuitable for a station hospital.
Colonel Rosenzweig, a gynecologist, is chief of surgery.Captain Kluger, orthopedist, is young and verygood. He states: "All wounds with gas gangrene gave evidence of hastytreatment and inadequate debridement." They are short 1 officer and 40 men.The ophthamologistemphasizes the need for spectacles. More than 100 men are waiting in theconvalescent camp for spectacles. Major Lechen, an otolaryngologist, wants toknow about doing tonsils. Infected ears have been cultured and a variety offungi found. The incidence of optic neuritis and choroiditis is out ofproportion. There have been many cases of concussion deafness, and a set oftuning forks is needed to differentiate the degrees of deafness. The lab needsfacilities for anaerobic cultures. Pyrogallic acid is in demand. The dentist isshort of articulation sets.
It is desirable to have a well-qualified surgeon in theforward echelon for each of the following jobs: Neurosurgery and thoracic,orthopedic, and gen-
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eral surgery. The latter is the most important. Too muchassembly line treatment occurs in forward hospitals. The extension arm splints were found to be no good.
This hospital appears to be doing a good job. Their recordsare fair; eye, ear, nose and throat care is okay; the X-ray service is good; the lab is fair; the food is fair;the library is good. Staff meetings were held formerly but are irregular now.
Wednesday, 1 September 1943
Visited the convalescent hospital under Major Kellefer, anorthopedist. They have not begun to keep systematic records yet. I talked to him about this. Hethinks that 80 percent of the war neuropsychiatrichistories are poor; that sorting is done on snap judgement. The chief problem inchoosing psychiatrists is separating the sheep from the goats. He raised thequestion of reclassifying doctors at home.
The 43d Division attackedRendova on 1 July. The beach was bombed and strafed by the enemy on 2 July.There were more than 350 casualties. No clearing station had been set up, andthe casualties were loaded directly onto an LST. For some reason the LST couldnot get off, and all the patients were transferred to another LST during thenight. The 43d never had a clearing station on New Georgia Island.
Major Barker, medical inspector of the 37th Division, is downwith dysentery at the 20th Station Hospital. Barker thinks that some of the dysentery contracted was due tothe use of halazone tablets. How manytablets to a canteen would be safe? Look up the division sanitary reports.
The 37th Division medical service was operating with ashortage of 8 officers and 100 enlisted men. The eight officer replacementshad no field training but were put out into the field nevertheless, and oneof them cracked up within 24 hours. One officer and six enlisted men werekilled.
Lt. Col. James H. Melvin, MC, Surgeon at the ServiceCommand here, and Major Barker both agree that a force medical supply unitshould accompany the infantry in island warfare. Many of the units lostpart of their supplies during the landing, and there was nosource of replacements short of Guadalcanal. Captain Hicks, 21st Medical Supply,agrees thatit would also simplify his problem. He found it impossible to get supplies tothe various isolated units whose supplies would get lost on some island, sincefrequently he did not know where they were. Recommend that the force medicalsupply unit function as in quartermaster exchange of property on LST`s. Theproblem here is chiefly one of making litters and blankets available for thewounded. Since the men must frequentlysleep in foxholes, it is to be expected that cots or litters may be used forcasualties, and allowance should be made for this in the exchange of supplies.This new plan, by giving adivision the things it needs when they are needed, would avoid burdeningthe divisions unduly.
All agreed that since clearing stations frequently functionas field hospitals, they should also be provided with washing machines. The 24th Field Hospital hasthree. There is no time to build these thingsduring a "push,"
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when they are most needed. Improvisations of all sorts can bedone in a quiet time, but by then the need has largely disappeared and thedamage has been done.
Thursday, 2 September
Spent the day reading, arranging transportation,writing, and treating my feet for the "rot."
Esp?ritu Santo, Friday, 3 September
I rose at 0300, although we did not leave the airfield until 0630. Arrivedat Esp?rituSanto [New Hebrides], 1030. Called Colonel Morgan Berry, MC, and stayed withhim. Met Lt. Col. Benjamin M.Baker, MC, medical consultant for this command, who was on his way north to theCanal. He has worked chiefly on theproblem of malaria. I attended a session of the Esp?ritu Santo MedicalSociety, which meets every other Friday. The hospital staff put on a goodprogram. Reports were given on: Subphrenic abscess, malaria and dengue, internalderangement of the knee joint, anesthesia-verygood.
Capt. Richard A. Rose, MC, 321st Service Group, wants a transfer for duty asan anesthesiologist.I talked to Captain Miller, who was on anLST that was bombed and sank off Vella Lavella Island. He agrees that they needan operating roomaboard, preferably on the side forwardwhere the carpenter shop is. This side isrelatively quiet and easier to lightproof. Better arrangements shouldalso be made for keeping food dry.
The loading of patients must be planned out before the boat comes in, so that thosewho are seriously wounded will be putin the proper place and receive earlier attention. Miller suggested that two menbe used for this purpose,one of whom would remain at the landing point. He says that two doctorsaboard the LST would not be enough, and that four to six corpsmen wereneeded, two of whom should be of top caliber. These measures would apply onlyat the time of a "push."
I talked with Colonel Potts and Major Sofield regarding apolicy on leaves. Six months or more of continuous duty in the islandsseriously affects morale. Moreover, some men have been here longer than othersdue to lack of replacements. It is also important to keep up the morale of themen who treat the sick.
Saturday, 4 September
I spent the morning on the wards with Colonel Potts andMajor Sofield. I saw a compound fracture of the lower third of the humerus with ahanging cast, and unfinished at that. There was a knee case that hadto be reoperated. What was supposed to be a cyst turned out to be a rupturedmuscle. Evidently more information must be entered on the EMT [Emergency MedicalTag]. Baker left today. We will meet again in Suva [Fiji] on the 18th. I amscheduled to fly to Nandi [Fiji] on the 15th.
I saw anotherdisturbing case. This soldier had been wounded in the arm late one afternoon duringthe New Georgia fighting. The wound was dressed almost immediately. He was evacuatedthe next morning at 1000 andreached the 17th Field Hospital at 1500. Only the 25th Division clearing
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FIGURE 312.-An aid station on Rendova Island, Solomon Islands, 12 July 1943.
station had moved forward on New Georgia. If just one platoon of the 17th had been near the beach, he could have been debrided. Debridement with anesthesia wasn`t done at the 17th, although he was there for 4 days. He was then sent to Mobile 8 on Guadalcanal, where a Roger Anderson splint was applied. From there he was sent to the 25th Evacuation Hospital [Esp?ritu Santo]. He continues to have fever and a great deal of pus from his wound.
Folding fracture tables are needed for field hospitals.
MANAGEMENT OF CASUALTIES IN THE NEW GEORGIA CAMPAIGN
1. First aid treatment was usually promptly received by the injured (fig. 312). The delays that did occur were usually unavoidable. A shortage of litters and of hobnailed shoes for the litter bearers was partially responsible for the delay.
2. Clearing Stations.
a. They get little or no help to set up at a time whencasualties are coming in heavy, and do not have enough time with the helpavailable to give adequate care to patients in a "push."
b. Supportive treatment appears to be good.
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c. Debridement is inadequate in many cases because the men arepressed for time. Furthermore, some of them do not even understand theprinciple of debridement. Not enough soap and water are used. Moreinstruments and a larger sterilizer-or preferably two sterilizers-areneeded. More good surgery is needed in the clearing station and nothing should be spared tomake thispossible. In island warfare the field hospital may be so far from the clearingstation that many serious cases must receive definitive treatment here. Bettersorting of cases at the clearing station and a more efficient system oftransportationto the field hospital is needed.
d. Records on the EMT are poorly kept. Enlisted men should be trained to putdown what was done, and when the next dressing is due.
e. Fracture treatment is poor andis characterized by inadequate debridement, inadequate immobilization, andinadequate use of plaster.
f. Sanitation methods must be improved. The screening ofmesses should include the space set aside for eating. Flies are present inabundance. The operating tents must be screened.
3. Field hospitals should be placed as far forward aspossible. The inadequacies mentioned above with regard to treatment in theclearing stationapply to the field hospital too. The field hospital should go in with a fullcomplement of supplies. Dividing up of supplies has proved a seriousdrawback in many instances. They should have help immediately on landing, in order to set up one good-sized bombshelter. The clearingstation or the field hospital should be located on or near the beach, inorder to have the best possible liaison with the LST`s.
4. Hospitals that are to be used in the line of evacuation shouldhave more clearly defined locations. If station hospitals are to be used in evacuation,their personnel should be pickedaccordingly, with at least one first-class surgeon. The less well trained menshould be used in hospitals that are off the direct line of evacuation. The25th Evacuation Hospital is too far back now to perform the functions of anevacuation hospital.
Sunday, 5 September
I spent the day with Harper [Lt. Col. Paul Harper, MC,Malaria Control Unit] and Sapero [Cdr. James J. Sapero, MC, USN, CINPAC] who aredoing a fine job. Commander Sapero was teaching in the Navy school in Washington beforethe war and has had some experience in malaria work. He was ordered out hereduringthe thick of the crisis, when 16 percent of the men who had landed here [Efate Island, New Hebrides] were inthe hospital as a result of malaria, the noneffective rate growing steadily.They had a so-called commission onEfate Island when he arrived, which did not even know to look for breedingplaces of Anopheles but set out to destroy all mosquitoes. Malariacontrol is just now getting under way, 1 year from the time of our arrival here.Only one educational directive has been published, and a commanddirective is just now being written. Sapero should be encouraged and hiswork recognized.
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Monday, 6 September
Visited the 25th Evacuation Hospital-Col. Morgan Berryis commanding officer. They have two good orthopedists. Maj. Harold A.Sofield is chief orthopedist. He could be used as a consultant in the teaching program, beingput on detached service at first. The orthopedic andsurgical service in the 25th Evacuation is well covered, so that this is notentirely unfair to Colonel Berry. At the 25th Evacuation Hospital, 35 percent ofthe casualties are fractures, of which 93 percent are compound, 15 percentfemur. Next to general surgery, the biggestsurgical problem is orthopedics. However, Lt. Col. Willis J. Potts, thechief of surgery, is well qualified. He is a competent surgeon and a goodadministrator with a pleasing personality. The 25th Evacuation Hospitalis a well-run hospital doing professional work of a high quality.
UTILIZATION OF MEDICAL FACILITIES IN A THEATER OF OPERATIONS
In general, the surgical care of the wounded does not appear to be badly done, and the Medical Department is doing a good job under difficult circumstances. However, there is room for improvement.
1. The problems are: To provide the best possible earlytreatment for the wounded at the front during the "golden hours";to insure the same high quality of treatment all along the line ofevacuation.
The above can be accomplished by:
a. Planning good locations for facilities to be set uppromptly when needed, and a well-organized system of transport.
b. Adequate trained personnel: Since we are short of trained personnel,this problemresolves itself into one of distribution of the best-trained personnel in keypositions. The distribution of personnel along the line of evacuation must besuch as to make them available to the greatest number of patients. This meansthat the line of evacuation must be planned out carefully, since thenumber of trained specialists is limited. Transportation under conditions ofbattle does not always allow for the proper sorting of casualties. The firstwave of patients that arrived on Guadalcanal were transferred to hospitals onthe basis of the seriousness of the case in relation to the condition of theroads and distance of the trip. This whole problem might have been eliminated bythe proper location of facilities. Furthermore, not enoughconsideration was given to thepersonnel available at these hospitals. Thus, if only one orthopedist orneurosurgeon is available at a certain hospital, the patients that fallunder these specialties should be sent there. This sorting should be a functionof the island or service command surgeon, and should not be done solely on thebasis of the number of beds available. However, if there is only onehospital on an island, this procedure is not necessary. Economy of supplies andpersonnel is one of the advantages of centralizing hospital facilities.
2. Medical officers, especially those in the forwardechelons, should receive some instruction in the care of wounds and thetreatment and trans-
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portation of fracture cases. These are the two majorproblems in the care of battle casualties, and it is here that instructionis most urgently needed. In order that this instruction may reach personnel inas short a time as possible, the instructor should visit the forward echelons.It would be particularly desirable that they first visit troops andinstallations that are about to go into action.
3. Since there are extreme fluctuations in the casualty loadin island warfare, a more flexible medical service should be provided. This can best be done by using surgical teams, operatingunder thedirection of the corps surgeon. Such teams could be drawn from hospitalinstallations in the rear echelons, provided that these are kept up to strength.
4. The policy of promoting officers in order to fill theT/O (table of organization) of an installation-even when the bestavailable men are chosen-has often resulted in placing officers inpositions which they were not qualified to fill. The promotion of any medical officer tothe grade of lieutenant colonel or colonel, shouldreceive very careful consideration from both the professional and theadministrative standpoint. The essential problem is to find posts that they are qualified to fill. When they are notqualified for such posts, either professionally or administratively, thequestion of promotion should be precluded.
It has rained buckets all day and night.
I visited the 122d Station Hospital, which is makingexcellent progress. Major Camp has built a well-designed surgery, though it ismuch larger than is necessary for a 500-bed hospital. They expect to open the surgery in2 weeks. Thepersonnel of this hospital is young and enthusiastic, but not well qualified.
Capt. Gilbert N. Haffly, MC, of the 25th EvacuationHospital, an excellent EENT [eye, ear, nose and throat] man, is training ageneral practitioner to do EENT work in this hospital. Captain Haffly says that nose and throat maladiesconstitute 65to 70 percent of his work. Not a single paracentesis has been done here so far.He does not think anyone with a chronic ear condition, or with a historyof recent ear trouble, should be taken in the Army. Exposure to a tropicalenvironment results in an acute exacerbation of chronic trouble. Otitis externais a big problem. Haffly intends to report further on this. He recommends theapplication of 1 percent thymol in 50 percent alcohol, or thymol iodide powder.He does not think that this inflammation is contracted by swimming in the localwaters.
It was raining by the bucketfull all day, and all flightswere grounded. My plans to travel to Efate must await the favorable decision ofthe gods. I spent the afternoon talking with the Navy consultants, Captain Kernof Philadelphia, the medical consultant, and Commander Reynolds of SanFrancisco, the surgical consultant, and with Cdr. Emile Holman, MC, USNR, andLt. Cdr. James C. T. Rogers, MC, USNR. They have just returned from Tulagi andFlorida Islands [the Solomons].
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Surgical and medical care for the Marine Raiders appears tobe a very difficult problem, since they carry so little medical equipment. They do noteven carry a stretcher-nothing but fighting equipment and alittle food. Losses in the 4th Marine Raider Battalion, which made initialassaults on New Georgia, were: 33 killed, 134 wounded, 170 medical casualties,or 48 percent casualties, of which almost half were surgical cases. In theaction at Bairoko Harbour [New Georgia Island], therewere approximately 600-plus casualties. Four hundredwere evacuated by PBY ["Catalina"] flying boats, one hundred byAPD [transport (high speed)] fast destroyer transport, and one hundred by LST.The second wave of Raiders carried some dressing station, but these did not usually get set up untilsome 2 or 3 days later.Hence there is very little substantial treatment until the wounded areevacuated to Guadalcanal.
While at the Mobile 8 Naval Hospital, I heard it stated that, since practically allhead wounds, most chest wounds, and themajority of the belly wounds turn out to be fatal, these casualties should beconsidered lost and no attempt be made to save them. Someone added that perhaps thiswas the right thiing to doand that only the minor cases should be treated. The point here, I suppose,is to utilize personnel and equipment as efficiently as possible. I objected,for I believe that every effort should be made to save lives, if this can atall be done without materially jeopardizing the outcome of the war. We mustconsider that morale would go to pot in ahurry if the soldier thought that in certaininstances no attempt would be made to save him. It is true that many menhave been wounded and a few killed while trying to save a wounded man. Iknow of one instance when three were killed by Japanese snipers while tryingto help one wounded man. The Japanese use our casualties as bait for a kill.
Captain Kern thinks that the men should be instructedto crawl for cover when wounded. The white dressing of a wounded man makes a beautifultarget. The Japanese have foreseen this and use a green triangular dressing as acovering. Some of our men smear mud over their dressings so that,they are not conspicuous. Another practice to correct is that of giving all of ourwounded one-half grain of morphine. Because of this, many walking cases areconverted into litter cases. Kern is much concerned over the absence of campsanitation. Piles of tin cans, partlyfilled with food, act as fly breeders.
The Navy badly needs 6-inch prepared plaster. That is the firstthing I have heard of that the Army has, and that the Navy doesn`t have. The Navyhas given us just about everything else, and perhaps we can help them out inthis case. The Navy has been wellsupplied with washing machines, refrigerators, tables, quonset huts,and what-have-you. Their equipment for tropical warfare, as one New Zealandofficer, Colonel Twhigg [Col. John M. Twhigg, New Zealand Army MedicalCorps] remarked, includes, "everything that opens and shuts."However, Reynolds and Kern observed that the greater mobility of Army equipment isan important asset and that the Navy is not prepared to
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move fast. However, most of the comforts of tropical warfare arefurnished by the Navy.
Kern and Reynolds are both in favor of surgical teams,particularly as the Navy has a surplus of doctors in their rear echelons. They toldme about some Marine divisions, which among their medical staff did not number asingle qualified surgeon. On the whole, their care of the wounded and theirorganization of evacuation lines is in a worse state than the Army`s. We are stillmaking many of the mistakes of the last war andare not getting all of the squarepegs into square holes. These Navy people are beginningto recognize, I think, the importance of having adequate medical facilities onthe LST`s. However,"the skipper would never give up his carpenter shop." We will see whathappens.
Efate, Wednesday, 8 September
I left Esp?ritu Santo Island this morning at 1000, had lunch atthe Efate Island airstrip, then drove to headquarters of the island command at Vila.Headquarters is situated on a fine hill overlooking a beautiful harbor. Colonel Carrollis the island surgeon-a pleasant fellow. The 48th Station Hospital is underthe command of Lt. Col. (later Col.) Lester F. Wilson,MC. It is the only large Army medical installation on the island. Partsof two platoons are set up on the far side of the island to act as a fieldclearing station foremergencies.
U.S. Naval Base Hospital No. 2 is the largest hospital on theisland and has a beautiful location on a hilltop. It is well equipped and well run,although I am a bit skeptical of some of their talent. They now have some 700 to800 patients, half of which are Army personnel. Most of the patients from the20th Station Hospital, and the 52d Field Hospital, both at Guadalcanal,have been evacuated here. There has been some trouble with records and somefriction with the 48th Station Hospital. The Navy does notsend their records along with the patients. I don`tsee any reason why hospitals should keep the recordsof their patients. Certainly all ofhis records, and not only the EMT, should accompany the patient. There are a greatmany orthopediccases here.
The 48th Station Hospital is being enlarged to a 500-bedhospital and has about 300 beds at present. Colonel Wilson is a generaltraumatic surgeon and does some surgery. The hospitalhas a beautiful site on the hillside overlooking the harbor view. Most of the buildings arequonsets, with a boardwalk running between them. The messes are excellent,clean, and well screened. Good planning is everywhere in evidence. A very goodmedicalsupply unit, the 24th, is part of the hospital. The staff was drawn mostly fromthe 12th General Hospital, which is the Northwestern [University] group. Theyare young but energetic. The chief of the medical service is good. The chief of surgery,Major Douglas, is young but well grounded. Unfortunately, they have noorthopedist. Captain Lindberg, laboratory head, is excellent.Morale is good.
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They are having trouble with their water supply-inadequatefilter. The proctoscope bulbs are all out, owing to line fluctuation. Can aCastle light battery be used instead? They have a good GU man, but no cystoscopefor him to use. It has been on order for 6 months. Is there one at Noum?a? They are out of2? percent sodium citrate ampules.Their needles and sutures are too large. Check onmaintenance at Noum?a; this is a general complaint. Opium powder is needed forthe pharmacy, and more class IV supplies for the laboratory: beakers,flasks, glassware. They also want washing machines and gaskets for sterilizers.
Colonel Carroll says that the dental problem is considerablehere. Seven to ten percent of new arrivals from the States have deficient teeth, butthe hospital is short of dental equipment. They have seen threecases of yaws among Army personnel here.
Captain Lindberg has found that low glucose toleranceoccurs in cases with jaundice and small livers. He needs brown sulphaline. Hehas a new, quick, thick-smear Giemsa stain-takes 10 minutes.
I saw a femur fractured up to thetrochanter that had been kept here 12 weeks. The fellowalso had a compound fracture of the wrist and hand. He should have beenevacuated, since they have no orthopedist here. But apparently the boats do notcome in often. Why can`t air evacuation be used for these cases?
I left Efate at 1400 and arrived at Noum?a, 1615 hours, withCharles G. Mixter. He says that only 50 percent of their planes are usedfor the evacuation of patients. Personnel is available, but the planes are beingused for other than ambulance transport purposes. There is too much of thislack of good management. I have observed plenty of patients who would benefitby air evacuation. This source of assistance has been neglected, however, simplybecause people don`t get together on these problems.
Noum?a, Thursday & Friday, 9 & 10 September
I spent these two days getting organized here atheadquarters, writing reports, letters, etc. Two eye magnets are available forshipment. I took up the question of screening with Major Moore of the Engineers.How much should a hospital or medical installation take with them to theforward areas?
Saturday, 11 September
Worked on reports today. I received a splendid report fromMajor Barker, the 37th Division Medical Inspector. His findings sounded asthough I had written them up myself. It is amazing how closely our observationshave coincided.
Wednesday, 15 September
I was supposed to bein Fiji today and have my orders to proceed there. But it seems as though fateorders otherwise. Went for a 5- or 6-mile walk with PaulHarper Sunday evening andfelt fine. I had on a new pair of shoes. Awoke that midnight with a verysevere shaking chill. It was so severe that I could not get out of bed for sometime. By morning the chill had subsided,
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although I knew I was not quite all there when theytook me to the hospital. I thought surely it was malaria,but to my amazement it turned out to be a lymphangitis. It is now subsiding.I suppose it will be a week before I get going again.
Friday, 17 September
Sulfadiazine is certainly amazing. I now learn that I camein here quite balmy with a temperature of 104-my WBC [white blood count] was19,000 on Monday. I now feel fine but Captain Dietrich won`t let me up. Hehas done a good job of keeping tabs on my blood count, urine, etc. My bloodlevel was 5.5, but WBC fell to3,000, so he stopped the drug. I have a little residual redness, soreness, andswelling of the right leg. But I don`t think there is any thrombosis, althoughthe captain thinks differently.
Brig. Gen. Fred W. Rankin [Director, Surgical Consultants Division, Office ofThe Surgeon General] just walked into my room. He is along with a troop of Senators, and they wouldn`t leavehimalone long enough to let him chat with me. The Senators, as usual, were allinterested in people from their own State. He has been to Australia. ColonelPincoffs [Col. Maurice C. Pincoffs, MC] is Chief of the Professional Service[Headquarters, USAFFE] and, he says, a trouble shooter for Col. (later Brig.Gen.) Percy J. Carroll, MC [Chief Surgeon, USAFFE]. Fred doesn`t thinkhe is as much use there as he would be in the job of consultant. Fred says hewants to stop the practice, among soldiers, of self medication withsulfonamides, but is a little afraid of public opinion. I wish he had stayedlonger, for I could have told him a lot of things. However, it is nothing thathe could do much about. I presume it is our job to try to straighten things out.
Tuesday, 21 September
Discharged from 27th Station Hospital today (fig. 313).
Listened to a talk by Maj. Gen. Brehon B. Somervell,Commanding General, Army Service Forces. He says that in 3 months we willhave as much shipping available as we did at the beginning of the war, but that it will be next spring before our facilities for passenger shippingreach that stage.
Wednesday, 22 September
Spent the day writing directives on medical specialty boards,and on debridement and the care of wounds. Had a conference with Captain Kernand Commander Reynolds of the Navy.
Fiji Islands, Thursday, Friday, and Saturday, 23, 24, 25 September
Arose at 0300 hours-turned my ankle in the dark. Arrived atTontouta Airfield 0500, from which we flew to Plaine de Gaiacs, New Caledonia. Hadfresh eggs for breakfast. Took off at0945. Arrived at Fiji at 1430. Nandi [on the western side of Viti Levu Island,the largest island in the Fijis] is in a valley surrounded by high mountains.The grass is green and the island appears fertile.Talked with a captain who had been at the 39th General Hospital as a patient. He wasstationed at Bora-Bora, Society Islands, with the 8th Station Hospital, 280 beds.There are only about 1,500 men stationed
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FIGURE 313.-An aerial view of the 27th Station Hospital, New Caledonia, February 1943.
there now, and about 35 to 50 in the hospital, which has 10 officers. Three officers would be plenty now. Colonel Sherwood plans on sending those patients who have been here over 1 year back to the States, because of the prevalence of filariasis. Certainly no replacements are needed here or possibly some could be taken out.
Monday, 27 September
Flew from Nandi to Suva [on the eastern side of Viti LevuIsland] in a New Zealand de Haviland. We went above and through the clouds,over mountains, and then down througha hole into Suva. I prefer to take my chances over the ocean. Checked into theGrand Pacific Hotel. Met Ben Baker and Colonel Dovell, island surgeon.
Tuesday, 28 September
Spent the day at the 18th General Hospital-a grand crowd.The hospital is on the grounds of Victoria College, the Fijis` institutionof higher learning-a fine location.
They need masks, bladders for the anesthesia machine,intratracheal anesthesia sets. They have five National field sterilizers wecan have, and an extra 230 kv. electric sterilizer. They also have horizontalautoclaves, utensil sterilizers, and hot water sterilizers-all of them run onsteam. The supply unit is well equipped.
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They have done a fair amount of work but less than the 39thGeneral Hospital and not enough to keep the men busy or happy. Much of their work isordinarily done in a station hospital. These hospitals are chiefly taking inmalaria patients from the Americal Division. They have more surgeons than theyneed for the work they have been doing. It seems that through ignorance of thefunctions of the different types of hospitals, the 142d General Hospital wasoriginally set up in the field. Eventually, it was brought over to Suva.Now, however, there are two general hospitals at Suva. Colonel Dovell thinks thatthe 7th Evacuation Hospital, part of which is on Tongatabu, South Tonga, is ofno use at Nandi and that it should come over to the Suva area to function as aconvalescent hospital. While it is true that there should be a convalescenthospital at Suva, the personnel of the evacuation hospital should not be used forthis purpose.
Wednesday, 29 September
Spent the day at the 142d. Lt. Col. Murray M. Copeland,MC, is commanding officer. Lt.Col. Harry C. Hull, MC, is the chief of surgery (fig. 314). Their physical plant,an old New Zealand hospital, isbetter than that of the 18th General Hospital. Very littlesurgery is being done. There are160 patients, with space here for 450. They still work on a 60-dayevacuation policy.
They have no intratracheal closed-tube anesthesia set,no Roger Anderson splints, or tincture of Belladonna; are short of sodiummorrhuate, phenobarbital, resorcinol, sodium citrate ampules 2? percent,aluminum sulfate, traction bows, and wood applicators. Gigli`s saw andSteinmann pins are of poor quality. They have an extra water bath setup andthree National field sterilizers. Their biologicals are getting out of date.
Thursday, 30 September
Back at the 142d General Hospital. An excellent orthopedisthere. They are about to lose two men from their surgical staff of nine.The mess isexcellent. As at the 18th General, all of these men are anxious to go to thefront with a surgical team. Colonel Dovell thinks that it is agreat mistake to send good men to the front where they may be lost. However, he can beconvinced.
Friday, 1 October 1943
Left Suva in the morning with Col. George G. Finney,MC, and Col. Murray Copeland and droveto Nandi via the Queen`s Road. Had a pleasant luncheon on the beach withColonel Dovell and Miss Donohue [Lt. Regina M. Donohue, ANC], Chief Nurse at the142d.Arrived in the evening at the 7th Evacuation Hospital, which is situated in a delightful valley near amountain range,about 10 miles from the Nandi Airport and 18 miles from the dock. Lt. Col. Robert B.Lobban, MC, is commanding officer. Lt. Col. McKelvie is chief of medicine, and Maj. RobertS. Ackerly, MC, is chief of surgery. They came from the States last spring,first to Tongatabu and then to Fiji. They never functioned as an evacuation hospitaland have done very little surgery. They acted as a station hospital indemalarializing the American Division.
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A good staff, but no talent to spare. Most of their surgeonsare young, with few specialists and no orthopedist. This hospital was firstbuilt by the New Zealanders and is now partly under wood and canvas. Had dinner-goodfood with sauterne.
Saturday, 2 October
Made the rounds at the 7th Evacuation Hospital. They needportable lamps, microscopes (now have one field microscope), antigen for Kahntest, homatropine, and pyrogallic acid. They have a portable orthopedic table,which could be used with a Hawley table. Scissors are of poor quality. Twoutensil sterilizers, the 240 and large field sterilizer, have been acquired. Nospecial anesthetist is assigned here. They would like Lt. Fred Dye, who is with the Americal Division.
Visited Lt. Col. James F. Collins, MC, Division Surgeon of the Americal Division. Appears to me to be afine person doing a good job, and he has plenty of ideas which he promises toput down on paper. He is now short 15 men, and 6 of his doctors are sick. Hebelieves that the old system ofthree clearing companies is better than the present one clearing company setup.
I put George Finney on a plane and spent the night at the71st Station Hospital, which is now under construction on a good location. Theywill be ready to take patients in 2 weeks and could even do so now. Lt. Col.Anthony Ruppersberg, Jr., MC, an obstetrician, is commanding officer. He isenergetic and is doing a fine job. Thehospital will have 250 beds and eventually expand to 500. They need an EENT man.Check with the possibility of getting Bodein from Americal. Are they getting thejournals here? Major Heyer, chief of themedical service, wants an EKGmachine. Carbon dioxide tanks with proper connections for frozen sections areneeded in all general hospitals.
Sunday, 3 October
Drove from Nandi via the King`s Highway to Suva (180miles), thus circling the island.
SUMMARY OF THE FIJI TOUR
1. Hospitals.
a. The 18th General Hospital is about to expand to a1,000-bed T/O. They have excellent talent. Should this hospital be enlarged,however, it would take considerable building.
b. The 142d General Hospital is also about to expand to a1,000-bed T/O. They also have excellent talent. This hospital is on a good site,which can easily absorb some additional construction.
c. The 7th Evacuation Hospital should be divided up in order to provide a convalescenthospital, and could be best placed in Suva in the camp partly occupied by the Quartermaster. Theremaining units of this hospital could be utilized to supplement the 142dGeneral Hospital, or to form a smaller evacuation unit.
2. At present there are approximately 2,500 beds on Fiji andtoo much concentration of medical andsurgical talent. One general hospital, the 142d,
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with a capacity of from 1,000 to 1,500 beds, one convalescenthospital with 2,000 beds, and one station hospital on the north side of theisland would be ample. This would leave from 3,500 to 4,000 beds on Fiji and freethe talent of the 18th General Hospital for assignment nearer the zone ofcombat.
3. At least two well-equipped surgical teams can be providedfrom Fiji. Colonel Dovell tends, as usual, to push off theless-qualified and less-experienced men for duty at the front. We shouldfirst give it a try with the best men.
Noum?a, Monday, 4 October
I was up at 0400, took off at 0600 in a GI clipper ship,landed at Esp?ritu Santo 1100 hours, then to Efate, and arrived at Noum?a 1500 hours.
Sunday, 10 October
Hal Thomas [Lt.Col. Henry M. Thomas, Jr., MC] arrived yesterday onhis way to the Southwest Pacific as medical consultant.I`m still working on directives and hope to finishup in a few days. Ed Ottenheimer [Lt. Col. (later Col.) Edward J. Ottenheimer, MC,Chief, Surgical Service, 39th General Hospital] says he will send us Claiborn [Lt.Col. Louie N. Claiborn, MC] and Post for the surgical teams.
Tuesday, 12 October
Completed the gas gangrene directive. Experimented withinsufflators for sulfanilamide; perhaps I can stop its too liberal use in wounds. MetColonel Ward, who is going to Fiji. Col. (later Brig. Gen.)Earl Maxwell [Surgeon, USAFISPA]is off on a trip to New Georgia and will try tostraighten out the morale of the 17th Field Hospital. He will seeMaj. Gen. Robert S. Beightler of the 37th Division and lay plans forour next move.
Wednesday, 13 October
Dinner last night at Mobile 8 with Jack Carmody [Lt. (later Cdr.)John T. B. Carmody, MC, USNR] and Frank Hauter.Mobile 8 has a new clubhouse witha large fireplace and a bar. Drinks are the best ever. Ten to fifteencents is what they charge. Chatted with Captain Dearing after dinner concerningplans for Bougainville, our next major military objective.5He is a very pleasant fellow. General Rankinmet him at the hospital.
Sunday, 17 October
Spent yesterday at the 8th General Hospital (fig. 315) withColonel Miller. They have no urologist and can use a major ora captain. He might be exchanged for an anesthesiologist whom they could trainhere. They also have no neurosurgeon.
The problem in Army medicine is, as in civilian medicine, oneof getting the right man in the right place at the right time. Here, under theconditions of
5Bougainville was to provide the Allied forces withimportant airfields from which Rabaul and the remaining Japanese installationsin the Solomons could be neutralized. New Zealand troops occupied two islands inthe Treasury group of the northern Solomons late in October. The 3d Marine Division of the I Marine Amphibious Corps landed on 1 November at EmpressAugusta Bay in western Bougainville. On 11 November, elements of the 37thDivision entered the line.On 15 December, command of the beachhead passed to the American XIV Corps,which had been reinforced by the Americal Division.
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island warfare, we are trying to make each island a unit in itself, with all branches of medicine adequately covered. But there are just not enough qualified men to go around. This is particularly true for the forward hospitals. Field hospitals have had to perform the work of evacuation hospitals in these areas. I`ve seen three divisions here without one competent surgeon. Hence it is no wonder that the early treatment of wounds is not good. It would take a lot of shifting to change the situation, and they are a little loath to move people for fear of not getting their cooperation.
One of the great difficulties of getting adequate personnelin the right places is due to the fact that too many high-ranking officers havebeen promoted without the proper professional qualifications. Every commanding officerwants to promote the officers in his own organization. Even some old Army menlook more to their own organization thanto the good of the service. Moreover, I am very, very doubtful of the wisdom ofhaving affiliated units. This results in too great a concentration of talent.The area surgeon does not feel free to move these men about.6Hence there is no way of strengthening the weak spots in the command.
6Colonel Oughterson has answeredhis own criticism: "There are just not enough qualified men to go around".They are all "agglutinated" in the affiliated units, and it isdifficult to pry them out. See also p. 823.-J. M. W.
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Tuesday, 19 October
Lt. Col. Paul Kisner, MC, and I left Noum?a in a staff carat 0730 to drive to Plaine de Gaiacs, a distance of 160 miles.The road beyond Bouloupari was very rough. We arrived at Bourail, Headquarters,New Zealand Forces, South Pacific, at 1200 and had lunch with Colonel Twhigg. I acquired anew pair of New Zealand army boots, and then onto Plaine de Gaiacs at 1600. We looked over the hospital there and had agood supper.
The 331st Station Hospital now has 50 beds and 50 more thatare almost ready for occupancy. Maj. Hugo A. Aach, MC, is commanding officer and has one lieutenant who assists him. He is doing a good job developingthehospital. Laboratory facilities are meager. He has had quite a number ofaccidents from the ATC (Air Transport Command) base. Eight patients with burnshave been treated, one of whom died. The grounds are very dirty, and under these conditions burns treatedwith paraffin can easily become infected, as these did. They soon after adoptedthe practice of bandaging these burns. Hisequipment is good and he has no needs except for more medical personnel.
After supper we droveback to Bourail where we stopped at the New Zealand Hospital. Up at 0500 and arrived back atNoum?a, noontime.During this 2-day trip, I wore the seat out of a new pair of cottontrousers. There is no argument about trauma aggravating pilonidal cysts.
Friday, 22 October
Visited the 31st Station Hospital today. Lt.Col. Corren P.Youmans, MC, is commanding officer. This is the breakdown of the University of Minnesota hospital group after a change in T/O. There are fiveyoung and energetic surgeons here. They should have a chief of surgery sentin if they are going to expand to a 500-bed hospital. Not that the young menare bad, but they are immature.
Six hundred patients have been transported here by airsince 15 September. These are seen at Tontouta Airfield by the 31st StationHospital men. The sick cases are kept at the 31st Station Hospital and theothers are sent on to the 8th General Hospital. Many patients who haverecently been operated on have been shipped down here. These surgeons areobjecting to what has been done at other hospitals. A directive is neededregarding records and X-ray procedures. They think that too many cases withsimple ailments are being evacuated. Besides, patients with psychosis arebeing sent down with an organic diagnosis, which throws them off the trailhere and obviously makes treatment more difficult. This is a rather dirtyhospital, hot, and on low, mosquito-ridden grounds.
Esp?ritu Santo, Monday, 25 October
I left this morning with Ben Baker on a Navyflying boat. Left at 1200. Sandwiches and coffee served en route.Stopped at Efate-Havannah Harbour is full with battlewagons. Arrived at Esp?ritu Santo, 1730hours. Stayed at the 25th Evacuation Hospital.
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Tuesday, 26 October
Saw Lt. Col. Arthur G. King, MC [Surgeon, Service Command]. He is not doing a bad job-efficient.Sofield`s orders arrived (assigning him to SPA [the South Pacific Area] asorthopedic consultant). The 10th Medical Supply Depot under Capt. E. Lucas is doing betterand is nearlyall undercover. Found three anesthesia chests and two field sterilizers.Visited the 122d Station Hospital. Major Camp seems the head here and he hasdone a good job planning. The hospital now has 500 patients, although capacity is rated at 1,000.
Guadalcanal, Wednesday, 27 October
Arose at 0400 and after a good breakfast of ham and eggs wetook off for Guadalcanal in a B-24 Liberator.
Arrived at Guadalcanal 0930 and reported to the 37thDivision headquarters. Met Col. Edward J. Grass, MC, a pleasant divisionsurgeon from Washington, D.C., who was very cooperative. He plans on using surgical teamsin the collecting stations. This should work out well,since there is a collecting company with each combat team. For a second echelonhospital, we shall use the clearing station. Will the combat operation be such as tomake this practicable? Distance is thedetermining factor. Major Bliun, Commanding Officer, Company D, 112th MedicalBattalion, is a fine fellow. There is the utmost spirit of cooperation, andI think that the venture will succeed.
The supply problem has not been cleared up. Plaster ofparis in cans has been issued in quantity for the combat teams, but only 24dozen bandages are on hand. We will change that. Prophylactic kits arestill being issued, with no females within 1,000 miles of here. Other uses havebeen found for them, such as covers for pistol barrels, watches, andpocket drug kits. Started Atabrine therapy today. Two ships were sunk offshore carrying power generatorsfor the 37th Division. Mono was takenby the Marines today.7
Thursday, 28 October
Went over the supply question with Lieutenant Rhodes, medical supply officer ofthe 37th Division. The maintenance lists are not adapted to this area. There is a surplus ofsomeitems; for example, mops, prophylactic kits, tons of cotton, and not enoughof other items. What good are mops with no floors to mop? We talked about the plan for surgical teams. Since they still do not graspthe principle oftime relationship in the treatment of casualties, it will take a lot ofconversation to convert them. There will be trouble getting lightingfacilities, since there are no generators.
Visited Capt. George Ellis [Capt. James W. Ellis, MC, USN],Surgeon, 1st Marine Amphibious Corps, at the old Imperial JapaneseHeadquarters-a lovely site on the beach. Emile Holman [Cdr. Emile F.Holman, MC, USNR, Surgical Consultant, 1st Marine Amphibious Corps] was there as aconsultant surgeon to the Marine Corps. They plan to evacuate serious casualties fromBougainville to Vella Lavella Island by destroyer, which again means from 3
7See footnote 5, p. 802.
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to 4 hours by boat, anda total delay of approximately 8 or 12 hours.It will be interesting to compare Army methods with those of the Navy in thisoperation. Only the two anesthetists, Lieberman and Rose, havearrived so far.
Friday, 29 October
Plans today for the movement of three combat teams. The plan is to use surgical teamsin the collecting stations. The two surgeons, one anesthetist and two corpsmen ofthe surgical team, with its extra equipment, will be attached to the four officersand men of the collecting company.
We have no generators for the collecting company,so I have spent the day in pursuit of three light generators and so far havefound none. Major Smith, a pleasant fellow from the Engineers, offered one5-kilowatt generator weighing1,800 pounds-a fine piece of equipment, but a white elephant to move. Elevengenerators were lost in the two boats the Japanese sunk off the shore the other day.Why do theystill put all their eggs in one basket? The Navy doesn`t have any either, sothey say. The Seabeesare making three plaster supportsfor shoulder spicas, using heavy steel since it is the only thing available.Weight could be saved by using an alloy.
Acquired a carbine today. This is a fine outfit: ColonelGrass, surgeon; Maj. John Bliun, commanding officer of the clearing company; and Vic Kolb,an excellent officer. They put on a fine reviewthis afternoon.
Saturday, 30 October
Went to see the the 117th Engineersabout digging in for operating rooms, andso forth. Surgeons for the teams arrived today.They are Shackelford, Watson, Manwell, Post, and Troland. Three anesthetists,Schulman, Rose, andLieberman, and a bacteriologist, Michael, also arrived (fig. 316).8
Monday, 1 November 1943
Navy started shelling Bougainville yesterday. Had conferencewith General Beightler [Maj. Gen. Robert S. Beightler, Commanding General, 37thDivision] and staff this morning.
Friday, 5 November
A busy few days, mostly spent in gathering supplies.Eighty-eight hundred pounds ofsupplies were supposed to arrive on the Currey and did not. Headquarters,USAFISPA, informed us by radio that they were put on the boat.After I had given them a reply, we received a radio saying that the supplies hadbeen found and were to be shipped by air. Yesterday 34 of 48 boxes arrived. Todaythey were sorted andput aboard ship. Almost all personnel were on board today. Don`t know where Iam supposed to be, but I will board the President Adams tomorrow.
The cooperative spirit and morale of this division, andof the officers and men of the forward area, appear wonderful. The soldiersare not worried about the outcome of the war,but they are full of doubts and fears for the
8So far as they couldbe identified, these officers were:Capt. William G. Watson, MC, Maj. Edward J. Manwell, MC, Capt. Charles E.Troland,MC, Capt. Harold C. Schulman, Capt. Max Michael.
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future. The bold confidence of a century ago, or even of the last war, is not to be seen. They are not sure why they are fighting. They want to go home, since they feel they have done their bit. Nevertheless, they carry on.
Saturday, 6 November
1445 hours. Since I could get no information as to what ship I was supposed to go on, I stayedashore last night. We had an air raid at 0100. Went to the beach this morningand found Captain Ellis, Senior Medical Officer of the 1st Marine Amphibious Corps, and General Craig [Brig.Gen. Charles F. Craig, Assistant Division Commander, 37th Division] sitting ontheir jungle packs. So I finally climbed on and went out with them to the Adams, where Iwas put in a large stateroom next to General Gage of the Marines and General Craig ofthe 37th Division. The room is equipped with a fine shower bath and a fan. Had afine lunch of iced tea, spaghetti, meat sauce, and apricots. Thetable was set with napkins and a white tablecloth. I have to pinch myself to realizewe are off to invade Bougainville. There are about 20 ships in sight, and thedestroyers and cruisers are gathering around, so it won`t be long before we are off.
We intend to use the surgical teams with the collectingstations, though this may be too far forward. Ideally the surgical teams should bebehind the collecting stations, but General Beightler is afraid of isolating the teams and
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leaving them open for infiltration. The Engineers havepromised to dig us in with bulldozers, if the road comes up with us.
The weight and transportation of equipment is a big problemin island warfare. Each team has a 250-pound chest full of instruments, etcetera. In addition, I have provided sterilizers, autoclaves, anesthesiamachines, suction, generators, orthopedic tables, etc. The equipment shouldbe as light as possible for this type of warfare. For example, the horizontal field sterilizerweighs 350 pounds crated. Equipment could be permanently attached to a light truckwithout great loss, since the truck engine could be used to run the generator. So far Ihave seen no operating installation where a truck could not getto. However, one disadvantage to a truck would be the difficulty of digging inand the fact that it might be damaged as a result of bombing. Thiscampaign should enable us to discover the best method of handling ourequipment.
It is obvious that the clearingcompany T/O is not adaptedfor this type of warfare in which combat teams operateindependently. The clearing company has one set of equipment and two clearingplatoons to be divided into three small hospitals, which is impossible. I wouldsuggest that, given this situation, each combat team should operate as aself-sufficient unit with one collecting station and two small hospitals foreach team. Two hospitals are needed in orderto "leapfrog." If need be, the collecting stations could be combinedwith the two hospitals, one of which would operate as a surgical hospital,and the second would care for routine cases not requiring skilled surgery. Thus, ifthere is a danger of infiltration, they can be combined: hospital number onewith number two, or number one with the collecting station. Afield hospital can be used to back up the division, both as a rehabilitationcamp and to hold patients for evacuation. We will watch this operation to seehow the arrangement functions.
The President Adams, Sunday, 7 November
We left Guadalcanal last night at 0100, just as the moonwent down. I had a good sleep in spite of the fact that it was hotter thanHades, even with the fan working. This morning we hada wonderful breakfast of ice-cold grapefruit, ham, eggs, toast, and coffee. Ican`t tell how large the convoy is, for the ships extend further than I cansee. We are sailing up through The Slot. New Georgia ison our left and Choiseul Island will soon be on the right. The news says thatthe Japanese are sending down large convoys from the TrukIslands naval base. A lovely day, with a gentle roll to the sea and lots offlying fish. Apparently we haveplane protection from the adjacent islands.
Bougainville, Monday, 8 November
Bougainville, 1400 hours. An uneventful night, but hotterthan Hades; cloudy and raining, so there was nobombing. A lovely clear morning-could not see land yet. It appears that wecame straight in. The cargo ships are in line, with destroyers on either side.The island has a beautiful skyline with rugged mountains and two volcanoes thatare said to be active. One of them
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is directly behind the landing point [Empress Augusta Bay]. Our guns arefiring west at the Japanese lines, where they landed several barges lastnight. As far as we know they have no artillery. We were ordered to land at0850, and in less than an hour there was nobody left on board but the crewand some supplies.
The terrain near the beach is lava sand, with some swamp behind. However, it isfairly dry now. Tremendous confusion on shore, but after about two hours wefound the clearing station and the collecting station. Wewill stay put here for the night until a plan of the campaign is givenus. At 1100 hours, the Japanese came over. I guessed that there were about25 to 30 planes, later found out there were 70. The shipshad 15 minutes` warning and pulled out to sea. The sky seemed fullof ack-ack and planes. I hear that one of our ships was hit butstories fly so thick and fast that you can`ttell what is really happening. Hal Sofield just came up and told meto put in my diary: "The Adams was hit in the stern a half hour after wedebarked." The boys already have the barbed wire up around the clearing station. Ihave dug a foxhole and put my jungle hammock in it, since we must all stayunderground at night.
Tuesday, 9 November
There has been very little infiltration of Japanese. Only a fewcasualties. The 37th is to take the left half of the perimeter. TheMarines have a clearing station in this sector, and so far are doing thesurgery under poor conditions. They don`t have screening and thedebridement is very crude. There is a division hospital (3d Marine Division, IMarine Amphibious Corps), with a Dr. Bruce [Lt. Cdr.Gordon M. Bruce, MC, USNR], an ophthalmologist from NewYork, in command.
Wednesday, 10 November
Some trouble today on the right flank, about 90 Marine casualties. Thebeach along the left flank is being evacuated by amphibious tanks. I sawreturning tanks, loaded with our dead. We are not yet set up for operating,although fortunately it would make littledifference if we were. The planningof this clearing station has been noticeable by its absence, partly due tolack of information, and partly because we are waiting to take overafter the Marine division hospital moves out. Finally found Captain Ellis ofthe Marines in his headquarters about 100 yards behind us in thisextraordinarily dense jungle.
Thursday, 11 November
0800 hours. Armistice day and a good joke on the well-known human race. Onthe present model, all days will eventually be armisticedays. Six hours of bombing and strafinglast night, from 2000 to 0200, with many humorous situations and much shouting and conversationin one syllable words. Some fellows stayed in the foxhole, but with a littlepractice, I foundI could beat the best of them in the race back. The onlytrouble was that the first in was at the bottom of the heap. The landing craftcarrying the Marines
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FIGURE 317.-A surgical team at work 5 days after the landing, Bougainville, 13 November 1943.
for the main attack on the island took more than 60 casualties. A destroyer and numerous barges are said to have been sunk.
Friday, 12 November
Bombing last night was limitedto an attack on the LST`s. There is a question as to whether surgical teams will workunder the present arrangement. This is a good outfit witha fine cooperative group of men (fig. 317), but after 5 days here we still haveno adequate surgical setup and nothing screened, not even a latrine. Thesurgical team, not being a separate unit, can do nothing. It would bebetter for the surgical team to go in asa unit with its own command responsibility. Without good surgical care, thisoutfit would have been sunk if there had been a large number ofcasualties. Captain Ellis has changed the evacuation policy again. This timeevacuation is to be to Vella Lavella Island by boat and PBY["Catalina" flying boat] but again this is too late for definitivesurgery. It must be done on this island to be effective. Admiral Halsey [ViceAdm. William F. Halsey, Commander, South Pacific Area, and Commander, SouthPacific Forces] was here this morning.
Saturday, 13 November
0800 hours. The convoy with the 129th Infantry Regiment is coming in.Yesterday we moved to the edge of the [Koromokina] River. The woods here areinfested with every kind of bug as well as mosquitoes. I awoke this morn-
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ing with six of them inside my net.Air raids last night at 8, midnight, and 2, 3, 4 and 5 in the morning.
Sniper fire getting closerthis morning. The NCO`s at the far end of one tentstarted shooting at what they said were Japanese. The Japanese hadinfiltrated through this area at the beginningof the week, and shotat the corpsmen in the Marine hospital. I was not too confident andso got out my carbine. The orders are to shootanything outside the area that moves. Hence, the boys are likely to try outtheir guns. Some of the Japanese snipersare brought down by this method, and, of course,if one of our boys moves about out there afterdark, he can only blame himself for the consequences. The Japanese infiltrates inthe night and usually climbs a tree to await his opportunity at daylight. One ofthem waited until the middle of the day when there were plentyof people about the hospital, and then opened up with a machinegun. Fortunatelyno one was killed, but several were wounded. This is of course suicidefor the Japanese, for he never gets away after that. The 129th Infantry came in, but couldnot land all its men owing to the high surf. Ben [Baker] and Kaufman [Lt. Col. MosesR. Kaufman, MC, Consultant in Neuropsychiatry, USAFISPA] arrived.
There is dissension between the surgical team and theclearing company. The surgeons wererestless because of the slow progress and lack of organization. Surgicalpatients were coming in, and the surgeons were not beingasked to see them. The clearing station personnel, whoare not surgeons, were attempting todo the work in the same old fashion. I have asked Hal Sofield ifhe can get the teams organized and build an operating room. We have beenhere 6 days with nothing much to do, and still noadequate operating room. There is no provision for blood transfusion, nohemoglobinometer or microscope. These were to be broughtup later. I am not yet sure how this experimentof ours will work out. This is a loyal outfit,and for anyone to show them up is of course disastrous. Even though theyadmit they are not first-class surgeons, nevertheless, the demonstration of thisin front of their own companyis too much for them to take. I am inclined to thinkthat surgical teams must function as separate units undera separate command. They cannot be held responsible for good surgery without good surgicalequipment, and it appears that the teams do not have enough authority to getthings done. Theunit should have the responsibility under the division surgeon for all surgeryin the forward area. Clearing stations, which are without first-class surgeons,cannotbe expected to turn out high caliber work.
Sunday, 14 November
We are experimenting with putting one surgeon and oneanesthetist from each team with the collecting station and using three of oursurgeons with the three doctors in the clearing station, allthis in the interest of harmony. I am putting up General Breene`s sign,"We are fighting the Japs and not each other." Hal has been working onthe surgery. He has it above ground in a
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tent. General Beightler came over and immediatelyperceived that being situated next to the antiaircraftguns was not the right place for us. We will move in 10 days, but having asurgery is worthwhile even for so short a time.
The Japanese are trying to come over here through twomountain passes.
Monday, 15 November
We opened the surgery today although it is not yet screened.The plain facts are that the medical men of this outfit do notbelieve in the bacterial theoryof disease, or, if they do, they do not appreciate its significance. It isalmost hopeless to expect that directives or conversations will quickly change the prevailing concept of surgery. I have yet to see a surgeonwhodid good surgery at home do bad surgery in the Army. It is my opinion thatthe sloppy surgery I have observed in the Army is merely a reflection of sloppysurgery in civilian practice.
The Talbot, Guadalcanal, Wednesday, Thursday, 17, 18 November
Sofield and I were at the beach at 0730 in order to go to Vella Lavellawith patients. A Japanese attack came at 0800. I don`t know how many planesthere were, for the air was full of both theirs and ours. It was fascinating towatch the 90-mm. shells following the planes. The marksmanship was very poor, forthe crews were not leadingthe aircraft sufficiently. They were too excited and shot at anything insight.
We finally put off for the Talbot, an APD(transport, high speed), and had the 40 patients aboard by 1030. For somereason, we circled around until 1400. Then we started out for Vella Lavella,at 22 knots.
When we approached Vella Lavella, our orders were changed and wewent on to Guadalcanal, arriving at 1000. Hence, the tripby fast destroyer transport took about 24 hours. There was only one doctor onthe ship, and operating facilities were meager. Patients were carried up anddown steep companionways-no way totreat an acute belly. The captain said this was a usual performance andthat the schedules of the APD`s were not correlated with the needs of thewounded. Two patients have died in transit. Both were in shock when put aboard.We wentto the 37th Division rear echelon headquarters, where Colonel Moore gaveus some beer and clean clothes, and then to the 20th Station Hospital.
Friday, 19 November
The 20th Station Hospital has poor morale and is doingpoor surgery. The beast that should be done is to give them a strong commanding officerand a good surgeon.
Saturday, 20 November
The 25th Division needs more doctors. They now have 35 andshould have 49. They could then send out two anesthetists to train others. The 21stEvacuation Hospital is being set up, as is also the 137thStation Hospital. The 9th Station Hospital has not yet opened its surgery.Sofield and I talked to all the doctors on Guadalcanal today, including Army surgeonsat the 20th Station, 137th Station, and 21st Evacuation Hospitals.
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Sunday, 21 November
Spent the day packing, washing, and trading. ColonelHallam came over to visit me. The XIV Corps is moving to Guadalcanal and then toBougainville.
New Georgia, Monday, 22 November
Off at 0500. Stayed at XIV Corps headquarters. Thetransformation of Munda since my last visit 2 months ago is amazing. The airfield isenormous and there are good roads, quarters, et cetera. Saw Colonel Melvin, who drove usaround and arranged a meeting of the island surgeons at the 24th Field Hospital for 1800.
The 17th Field Hospital now has a much better setup and theyhave profited by experience and example. The morale is better. The 24th Field Hospital,which is on the edge of the airstrip, has a most elaborate layout (fig. 318). Builtin a sort of amphitheater cleared of all trees, the buildings form a horseshoe.The buildings extend out, like a series of terraces, giving the hospital theappearance of a stadium, especially when seen from the air. This is probably the bestconstructed, laid out, and equipped field hospital in the U.S. Army.In fact it is so well and thoroughly set up that it canno longer be called a field hospital.
The new T/O doesnot allow enough corpsmen for evacuation of casualties bylitter carry, which is so important in tropical warfare. This has often re-
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sulted in late treatment with loss of life or limb andprolonged convalescence. It shouldillustrate the impossibility of laying down a standard T/O for a worldwide warfought under varying conditions. The surgical teams should carry more than twomedical technicians-possibly six. Men sent into the area fresh from theStates should not be sent directly to divisions in combat. One-third or one-half ofthem will usually show up poorly.
There is a general request from doctors for some sortof postgraduate training, since many of them have done nothing butadministrative work since the war started.
A urologist and a neurosurgeon are needed at the 8th General Hospital[New Caledonia]. They need three-way stop cocks for anesthesia. Order book, "Fundamentals ofAnesthesia," for distribution here. Emergency Medical Tags and indeliblepencils areneeded. Records of the patients come down late. Division will not send theservice records of their men to hospitals because they are afraid ofpermanently losing their hospitalized personnel.
The 109th Station Hospital [New Caledonia] has 24officers, and it should have 33. They want Lieberman and need a MedicalAdministrative Corps officer, an EENT man, and some more enlisted men. Anoptometrist is needed for both the 17th and 24th Field Hospitals. The 43dDivision is short eight medical officers, two dentists, and a large numberof enlisted men.
The evacuation from Bougainville was planned by CaptainEllis of the Marine I Amphibious Corps. While at Guadalcanal, we were told thateverything was settled and that casualties could be evacuated by APD in 3 to 4 hours to Vella Lavella Island. Just beforeleaving Guadalcanal, Ellis said this was all off; that all work would be doneat Cherry Blossom [Bougainville], and the Army could have the installations atVella. On arriving at Cherry Blossom, we saw that all of the work was not being donethere. Some patients were being takendirectly to APD`s and transported to unknown destinations. I later met someonewho had just come from Vella Lavella. He told me that they had not received a singlepatient there. Moreover, the trip from Bougainville to Vella takes 10 to 12 hoursand not 3 to 4 hours. Emile Holman was there, tearing his hair out.
Tuesday, 23 November
The above was written while sitting on the beach at NewGeorgia. We took off in a Higgins boat. The youngster in charge drove to thewrong side of the marker, ran on a reef, and then finally deposited us on shore. After a 4-hourwait, we got another boat that took us to Ondongo Island. Cordially received by theMarines, we were treated to excellent food, had clean towels, and slept between sheets inone of their quonset huts. Tomorrow there will bea plane to take us back to Bougainville.
Bougainville, Wednesday, 24 November
We took offat noon with General Harris [Brig. Gen. Field Harris, USMC, Commander, AirCommand, North Solomons] in a Dumbo (patrol bomber, "Catalina") with a verycompetent pilot who had been decorated at Midway.
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Escorted by 10 fighter planes, we arrived at Bougainville in1? hours without incident.
They have made great progress here, and theclearing stations have been moved. The boys had many stories of bombing, strafing,and shelling. Ben [Baker] produced the head of a90-mm. ack-ack shell, which came through his tent and punctured his rubber mattress.
The Marines reported having had eight cases of gas gangrene.Their evacuation is not completely controlled, and some of the patients havebeen put on the boat without receiving prior treatment. A considerable number ofpatients died in transit. Colonel Melvin told me of 12 on one LST. Two died onan APD from Bougainville. A complete and unified control of evacuation from an islandisnecessary.
Thursday, Thanksgiving Day, 25 November
Only one plane dropped its bombs on us last night. The Japanese havesome artillery in and are shelling the beach. We had a fine Thanksgiving dinner; very good turkeywith stuffing, cauliflower, peas, mashed potatoes, pumpkin pie, luscious biscuits,and coffee. I ate too much as usual.
The construction on the island is developing very rapidly.Planes are now makingemergency landings and takeoffs.
Friday, 26 November
Last night we were shelled by Japanese artillery and today everyone isdigging deeper. Thereis still inertia about getting patients underground. They are screening theoperating room today (fig. 319). The surgical teams must have the responsibility forbuilding andoperating the surgery and furnishing its supplies. Supplies, such as screening,sandbags, et cetera, should not be left under the supervisionof any other branch of the service. Experience shows that they are notlikely to be on hand when needed. Furthermore,these supplies should go in with the first wave, when casualties are likely to be heavy.
Saturday, 27 November
Last night, the first night on Bougainville without an alert, Ihad a wonderful, cool, refreshing sleep on my air mattress. Armycasualties are still light here. The doctors of the 37th Division have requested thatwe give nightly lectures on medical topics.
Sunday, 28 November
An uneventful day. Listened to Chaplain Kirker [Lt.Col. Kirker, 37th Division chaplain] talk on "True and FalseTruth." I remarked that the boys seemed very interested. "That groupwas christianized by bombs before we got here," said he.
Monday, 29 November
Went out on the right flank to visit a battalion of the 145thInfantry Regiment, who are with the Marines. Went up to within 500 feet of thefrontlines, but I could see no Japanese, probably owing to the fact that theland is a dense swamp except along the beach. About 1,000 Marines struck thebeach [Koiaris Beach] below herelast night. They suffered 40percent casualties and were lucky to get back with the help of a destroyer.Last night the Japanese shelled
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FIGURE 319.-A screened and dug-out operating room, Bougainville, December 1943.
the beach with 8-inch naval guns, location unknown. They hit a gas dump which caused a tremendous fire. Puruata Island [off Empress Augusta Bay, Bougainville] is certainly one of the most bombed and shelled of islands.
Thursday, 2 December 1943
Nothing new, not even the rain. Talked to a group last nighton planned health and had a good response. It seems that mobilesurgical trucks would be very useful here.
Sunday, 5 December
Everything okay in CherryBlossom so I decided to return to Cactus [Guadalcanal]for further organization. Had dinner last night with General Beightler,General Craig, and General Krueger [Lt. Gen. (later Gen.) Walter Krueger,Commanding General, Sixth U.S. Army], and they are well pleased with thesurgical teams, with our teaching, et cetera (fig. 320). There has been a lotof discussion about how to keep doctors happy while they are in the service,and the consensus is that it is generally impossible.
We have come down to the beach for a Dumbo. No one knows when it will come or where it will go, andthe pleasant part of it is thatno one seems to care a great deal. The uncertainty and variability of ourmovements serve to throw the enemy off, but it is amazing how much doesget done in this situation.
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Fresh supplies of meat, oranges, et cetera, are beingunloaded today. The food on the whole has been very good, and there are someexcellent cooks and bakers here. Sanitation is not all that it should be, owingto the laxity of the medical officers and their failure to appreciate theimportance of good sanitation. There were almost no flies when we first landed;now there are swarms of them. Even after a month very few messes have beenscreened. However, we have had no dysentery problem.
The mobile surgical units, mounted on trucks, would be atremendous asset in this kind of warfare. This type of setup would save muchlabor, while providing facilities in the early stages of combat. I have yet tosee a place where a hospital was needed that could not be reached by thesetrucks.
The foreign body localizer is valuable, but it should beconstructed to stand up under damp tropical conditions and function on abattery. A blower is needed to dry plaster casts.
Guadalcanal, Monday, 6 December
Took off from Cherry Blossom in a Catalina yesterday at 1600.We skirted the edge of the island with 10 fighters, then over to the TreasuryIslands, and landed at Ondongo at 1730. There were no planes going to Munda, sowe started out in a personnel boat. With the aid of a light, great caution, andgood luck, we made a landing in pitch dark at 2030. Colonel Hanson came down totake us to the 24th Field Hospital, where we had a good meal and quarters.
This morning we took off by SCAT for Guadalcanal. ColonelCaton is using the 21st Evacuation Hospital for all initial admissions on theisland. Patients are distributed from there to the other hospitals. VisitedColonel Taber at the 52d Field Hospital.
Tuesday, 7 December
Two years today since Pearl Harbor. What would people in theStates have said if they were told at the time of Pearl Harbor that in 2 yearsJapan would have achieved most of its imperial aims and have conquered thePhilippines, Malaya, and the Dutch East Indies, and that all we would have takenback were two or three islands in the Solomons that few had even heard ofbefore.
Spent the day with Paul Kisner at the 20th Station Hospital.He is already beginning to bring order out of chaos. He wants a chief ofsurgery, for he cannot raise the level of surgery by himself. He also wants alaboratory man, a trained lab technician, and an eye man.
Visited Mobile 8 and talked about debridement and gasgangrene. They have had about 300 compound fractures with 20-plus cases of gasgangrene, resulting in 2 deaths. The estimate is that 8 to 10 percent of thepatients with compound fracture have gas gangrene. Treatment was conservativefor the most part. The cases from Bougainville came in with either poordebridement or none at all. I saw some cases, in which the patient had not evenbeen shaved.
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Noum?a, Wednesday, 8 December
Off at 0830 for New Caledonia with freight cargo including a5,000-pound Allison motor. It was raining, and we went up over 10,000 feet toget out of the bad weather-very bumpy ride. I kept wondering what we would doif the motor got loose. However, we landed at 1430 without mishap, and onceagain sat down for cocktails at the Grand Hotel Central.
Friday, 10 December
Much surprised and pleased to receive a promotion to fullcolonel today. It looks as though Hal Sofield will be assigned with me asorthopedic consultant.
Tuesday, 14 December
Spent the last 2 days trying to get boat passage to Fiji, butgave up owing to the weather and will try NATS [Naval Air Transport Service].
Wednesday, 15 December
Found out that Ben Baker and Kaufman had returned. Heard thatmobile surgical hospitals were on the way. Will they have qualified surgeons?Read Churchill`s [Col. Edward D. Churchill, MC, Consultant in Surgery, NorthAfrican and Mediterranean Theaters of Operation, U.S. Army] report on NorthAfrica. His problems are the same as those met in this theater.
Fiji Islands, Thursday, 16 December
Off at 0800 for Suva, arrived 1330.
Saturday, 18 December
Flew to Nandi where I was met by Colonel Ruppersberg, 71stStation Hospital. While at supper, much to my surprise, in walked Gen. George C.Marshall. He stayed for a few minutes and rushed on. He appears to be vigorousand full of energy. I talked to the hospital staff this evening.
Sunday, 19 December
Went to the 7th Evacuation Hospital in the morning, and gavea talk there at lunch time; then to Americal Division headquarters from 2 to 4 o`clockfor a talk; after that back to the 71st and a talk from 6 to 8 in the evening.
Monday, 20 December
Flew over to Suva this morning and spent the afternoon at the142d General Hospital. Talked to the 182d Infantry [Americal Division] inthe evening, about to embark for Cherry Blossom. The 142d General Hospital has afine plant, and I am told that the Fiji Government proposes to take it overafter the war. This hospital is doing a good job in pilonidals. The had a largenumber of corneal ulcers among the survivors of a torpedoedship (fig. 321). The exact cause of this is unknown and the really bad ulcerscause permanent damage.
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The Medical Corps officers of the 182d Infantry wanted to know why they were kept out here away from home for 3 years when so many people were sitting at home. When this campaign is over they are turning in their resignations [sic]. They want postgraduate work after the war, and the AMA has done nothing about it.
The British authorities (minor officials) have shownreluctance to cooperate in sanitation and venereal disease control. Many of thewater supplies are contaminated, and there have been outbreaks of dysentery."I`ve drunk this water for 20 years, and it is good"-in spite ofthe bacterial count. It is against the law to examine food handlers here.Prostitution is ignored by the Home Officer, although it exists everywhere.
Tuesday, 21 December
Toured the 142d General Hospital. It is a good institution.They need an otolaryngologist and cannot spare a surgeon.
Noum?a, Monday, 3 January 1944
Since my return to New Caledonia, I have been very busychecking on personnel. We still have a great dearth of qualified surgeons. Themen we have are a cross section of American surgeons. We have many specialists,such as gynecologists, whom we must put in charge of station hospitals; and itis unfair to expect too much of them. There is still too much concentration of
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talent in the affiliated hospitals, which appears to me tohinder the total war effort. Such men may set a high standard in thesehospitals, but, as in civilian life, they have too little influence on the totalproblem. Their influence is even less than it would be were they in civilianlife, for these rear area hospitals cannot function as educational centers. Theportable surgical hospitals, as judged so far, are not fulfilling theirfunction, because they lack qualified surgical personnel. No amount of goodsurgery in the rear can make up for poor surgery at the front.
Wednesday, 5 January
I am starting an educational program-have acquired a 35-mm.projector and am now having film strips made. It seems to me that this has greatpossibilities. I have designed a fly net to be used inside the tent.
Met Captain Hook [Capt. (later Rear Adm.) Frederick R. Hook,MC, USN], Chief Force Surgeon, Navy. He is a fine person with a good knowledgeof surgery and a determination to get things done-the best of the lot. Surgeryin this neck of the woods will unquestionably improve under his influence.
Guadalcanal, Tuesday, 11 January
Off at 0500, island hopping to Bougainville. Left TontoutaAirbase, my first stop, at 0900. Arrived at Esp?ritu Santo, 1200. Left at 1300,arrived Guadalcanal, 1700. Stayed with Colonel Caton at the service command. Heis dubious of the 137th Station Hospital, and the 9th Station Hospital has notyet proven itself surgically. The 21st Evacuation Hospital is now ready to moveforward.
Bougainville, Wednesday, 12 January
Up at 0400 and left Henderson Field at 0530. Landed at Mundawhere we picked up a fighter escort and left again at 0810. Arrived inBougainville at 1000 and landed on the new bomber strip. There has been anamazing transformation on this island in 6 weeks. Forty miles of roads have beenbuilt.
Thursday, 13 January
Went over the supplies of the portable surgical hospital withColonel Hallam. Together they weigh 8 tons, so our next problem is to break themdown for at least three purposes: (1) To function intact (adjacent to a clearingstation or in a stable situation), (2) to function adjacent to a collectingstation in a forward area-capable of being easily broken down and relocated,and (3) to function over distances and thus be air transportable. Max Michaelwill instruct on blood transfusions and falling-drop protein method [forhematocrit determination].
Visited Colonel Collins, division surgeon, at the AmericalDivision. They have an excellent operating room setup, neat and screened. Theyhave no definite scheme yet for a convalescent camp. Each division plans onoperating its own camp, and there must be a third one for the nondivisionalunits. This setup has its advantages in that the doctors know the men from theirdivision. But no one has considered the inefficiency of operating three campswhen one would do.
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The 52d Field Hospital is being set up. Major Davidson, abright young chap, is Chief of Surgery. He may do all right, or better. Thesurgical teams left Bougainville this morning.
Saturday, 15 January
I`ve been giving talks every night. The 37th Division hashad an increase of neuropsychiatric patients and raises the question of acorrelation between this and the use of Atabrine. The mosquito net tent hasproved a success. We will need 15 per division for a start, though the tentswill have to be reinforced at the top and at the door. Collecting companiesshould have a larger sterilizer (14- or 20-inch) and blood pressure apparatus.They need a small autoclave, for these units often occupy isolated positions.Each clearing station needs a horizontal field sterilizer. Many of the gascasualty kits have deteriorated and need replacement. Ambulance headlightsshould be sent up for the Americal, and five sets should be supplied to eachdivision. The Americal needs Mayo stands. They could use an anesthetist. Theyhave Stokes litters, which should be provided for the other divisions.
I visited the frontlines today and could see the Japanesepositions. This is beautiful mountain country, and I was amazed at how well ourpositions have been dug in. Some of the aid stations were right on the rifleline.
Those wounded while out on patrol have a bad time, for alitter carry through the jungle takes 8 or 10 hours. Each battalion should haveabout 30 more men for litter bearers as it takes 8 men to carry back 1 casualtyover this rugged terrain, and the battleline is so thin that infantrymen cannotbe spared for this purpose (fig. 322). There are no natives here that could beused as carriers.
Sunday, 16 January
Hal and I spent the Sabbath watching the bombing of"Unknown Hill." As I went up to within 100 feet of the line, we weregreeted by strains of "Vienna Waltz." This came from the 145thInfantry and I have never seen a more spic and span outfit. Everything on thefrontline is clean and in its proper place, sanitation is perfect, and the foodis superior. The climax of the morning was the large bamboo settee constructedby the command post, with its sign, "for visitors only."
Wednesday, 19 January
I have been giving talks each evening. Each night brings theair raids and the need to get up and take cover. Those who are protected infoxholes are almost 100 percent safe. The papers have stated that there is nomalaria on Bougainville, yet the 3d Marine Division came down with malaria at analmost 1 to 5 ratio.
The portable surgical hospital needs electric headlights,gowns, caps, and half sheets. Having no generators or sinkers, they are forcedto function close to the clearing station.
Guadalcanal, Thursday, 20 January
Left Bougainville this morning without a fighter escort.Since one plane recently disappeared with all on board, everyone must now wearlifebelts. No
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FIGURE 322.-Difficulties of litter carry over the rugged terrain of Bougainville, March 1944.
smoking is permitted on the plane, and the auxiliary gas tanks have been removed. I have been troubled with prickly heat and with generalized skin edema, so I am not displeased to leave this buggy place where the bugs are more abundant and bigger than anywhere else. We went nonstop to Guadalcanal. Went to see Colonel Caton and then to stay with Paul Kisner at the 20th Station Hospital, where Hal [Sofield] was put to bed with boils on his fundament.
Friday, 21 January
Visited 21st Medical Supply. Sent suction apparatus andsterilizer to Americal Division and sterilizer to 52d Field Hospital. Suppliesare coming in very slowly, and there is a considerable amount of loss.Apparently people are helping themselves along the line.
Saturday, 22 January
Visited Colonel Bolend, commanding officer of the 21stEvacuation Hospital. He is one of the finest commanding officers I`ve met."No man should command a unit from his home town," said he, to which Iagreed. Very few people can be really objective in such a situation,particularly if they must go back to the town to live with these same doctors.Difficult situations have arisen where some bad appointments have been made inorder to keep the peace. So far, I can see nothing to justify the affiliatedunit and a great deal that speaks against it. Besides, talent should not beconcentrated to the extent that it is in the affiliated unit, from which it isextremely difficult to transfer personnel. A good distribution of qualifieddoctors is essential to the welfare of
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the Armed Forces. Colonel Bolend has his hospital wellcovered from every angle and can spare three surgeons. We could use such men onour surgical teams.
Sunday, 23 January
Visited the 9th Station Hospital. Colonel Walker says that heand his men have lost their pep-and they have. There are 14 officers here whohave been out of the States for 2 years, and they certainly need some new blood.The 20th Station Hospital needs three surgeons-a chief of surgery, anassistant chief, and a genitourinary man.
This afternoon we had a meeting of the portable surgicalhospitals. Three of them are good and the other three cannot be used, for theylack qualified personnel. I cannot understand why such unqualified personnel aregiven rank and sent out here to do a job they cannot do well.
Monday, 24 January
Visited 40th Division headquarters. Major General Brush [Maj.Gen. Rapp Brush] is commanding general. The division surgeon, Colonel Ghormley[Lt. Col. (later Col.) Verne G. Ghormley, MC] is a fine person. He says thatthey have already weeded out the senile and incompetent. This looks like a goodoutfit, but Ghormley says that the exact quality of the surgeons is an unknownfactor. Much equipment is still lacking: Three number 2 chests so that theclearing company can be split up for the three combat teams, three anesthesiasets, X-ray apparatus, 5-kw. suction generator, Mayo table, instrument table,laundry or washing machines, refrigerator, and reefer.
The National Guard divisions range from good, indifferent, tobad. The medical personnel of those I have seen have, in the initial periods oftheir operation, always had poor leadership, which resulted in unnecessary lossof life among our men. This tragic situation is due to the two types of men kepton as division surgeons-the senile and the incompetent. It apparently takesabout 2 years to get rid of these people. Commanding generals usually do notknow enough about medical problems to be able to do anything about thisstumbling block. One cannot blame them. One commanding general, who is a goodtactician and has splendid morale in his division, does not know the differencebetween general hospitals and field hospitals. I have never seen a commandinggeneral who did not want to do the best job possible. But, just as they do incivilian life, some unqualified and incompetent doctors sell themselves on thebasis of their personality or loyalty. There should be some method of weedingout such division surgeons before going into combat, so as to avoid theunnecessary sacrifice of human life.
Esp?ritu Santo, Wednesday, 26 January
Plane yesterday to Esp?ritu Santo. Visited the 122d StationHospital. They need an EENT man and a young orthopedist. They are also shortthree doctors, but two could hold them for now. Moreover, the hospital has 21nurses of 2-years-plus service, of whom 10 are sick at present. There is aquestion
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as to whether promotion of nurses should be done on the basisof 50 percent of T/O strength or 50 percent of actual strength. As for technicaldifficulties, there is a dust problem in their operating room.
Thursday, 27 January
Visited the 31st General Hospital. The hospital is on abeautiful site overlooking the bay and shows promise of development. They arebuilding the surgery and have not as yet taken any surgical patients. The chiefof surgery is a proctologist.
Noum?a, Friday, 28 January
Off at 0330 by NATS to Noum?a, where I found a pile of mailand other documents waiting for me.
Sunday, 30 January
Conference with Captain Hook, Captain Kern, CommanderReynolds, and Emile Holman. The Navy is loathe to adopt the idea of consultants,since they have not had the long experience with this type of work that the Armyhas had. Captain Hook says that they must "go slow." They would bepioneering and would have to proceed by trial and error. The Navy likes thesurgical team idea and wants to use it on its next move. We should supply themwith material on this subject.
Guadalcanal, Saturday, 11 March 1944
This book has been neglected this past month owing to severalfactors. For one, I suffered a pigskin heat rash and probably some mentaldepression. I have been engaged in a long struggle to get some things done. Themajor projects I`ve been trying to push through are adequate record and filingsystems, on which the general [General Maxwell, Chief Surgeon, USAFISPA] finallyagreed to back me. I think that he remained very skeptical though, and I hopethat I have not asked for too much. The following information on each patientshould be recorded: Name, serial number, diagnosis (according to nomenclature),operation performed, total days in hospital, and disposition. This will enableme for the first time to answer some questions on surgery. The Surgeon General`sOffice has been asking repeatedly for information which we could not hithertofurnish. A study on wound ballistics has been organized. Ben [Baker], Hal [Sofield]and Max [Michael] got off to New Zealand, and 10 days later, after my work wascleaned up, I joined them.
The 39th General Hospital, with formal flower gardens, isspic and span as an insane asylum. The interior is also shipshape. I wonder whatthe feeling of the staff will be when they go home to the ordinary dirt ofcivilian hospitals. It was good to see all my friends again-good for the ego.Col. Don Longfellow, MC [Commanding Officer, 39th General Hospital, U.S. ArmyForces, Pacific], did not want to part with Eddie [Colonel Ottenheimer, Chief ofSurgery, 39th General Hospital], so we may take Frick on our next move.
I left Auckland via NATS stopping 4 days at Headquarters [Noum?a]to catch up on some last minute things. Then I was off to Guadalcanal, leav-
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ing Tontouta at 0830 and arriving at Guadalcanal, 1600. Wehad a warm front and some very rough weather between Esp?ritu and Guadalcanal.It was raining hard at Guadalcanal when we arrived, and I went to the 20thStation Hospital with Paul Kisner.
At Guadalcanal, I went over plans and supplies with ColonelGhormley, Surgeon, 40th Division-a superior fellow. Saturday night festivitieswere the best in the Pacific and better than the majority of New York clubs. Thelocal talent is amazing and in sharp contrast to the very average talent sentdown from the States. Saw Emile Holman, Bruce, Calloway, McMaster and Rogers.They still know little of the plans.9
Monday, 13 March
Finney, Sutherland, Hull, Greiner, McQuinton, Troland, andSofield arrived today. I spent the day chasing supplies. Saw Colonel Lobban andhis staff playing poker in the mud, and I extracted three X-ray technicians andtwo stenographers from the group.
Wednesday, 15 March
Worked on final preparations and went with Colonel Ghormley,Ben [Baker] and Moe [Kaufman] to visit Captain Hughes of the I Marine AmphibiousCorps, who told us that the show was off. Apparently, final plans had beencompleted as of midnight last night. Quite a letdown! Reasons unknown.
Saturday, 18 March
The FOREARM plan being off, our plans are changed, and theextra surgeons are greatly disappointed. Had cocktails and a swim with AdmiralHalsey and then saw General Harmon [Lt. Gen. Millard F. Harmon, CommandingGeneral, USAFISPA], who had just returned from Cherry Blossom and is havingtrouble with his knee. I had a talk with General Harmon and had no trouble inconvincing him that a wound ballistics study was desirable, and he wiredinstructions.
Sunday, 19 March
Everyone is feeling optimistic over the recent change inplans, for it looks as though many lives might have been lost.
Tuesday, 21 March
The wound ballistics team will go to Bougainville by order ofGeneral Harmon and at the request of General Griswold of the XIV Corps.Persistence certainly paid off in this case. The team consists of Harry Hull,surgeon; Dan Greiner, pathologist; Frank Sutherland, surgeon; two enlisted men;and one photographer (fig. 323).10
9The plans were for the proposed invasion of Kavieng, New Ireland, Territory of New Guinea, referred to hereafter by its code name, FOREARM. On 12 March, the Joint Chiefs of Staff canceled the Kavieng operation. Preparations had been far advanced, however, and the men and ships that were to invade Kavieng had already assembled at Guadalcanal.
10See: Oughterson, Ashley W., Hull, Harry C., Sutherland, Francis A., and Greiner, Daniel J.: Study on Wound Ballistics-Bougainville Campaign. In Medical Department, United States Army. Wound Ballistics. Washington: U.S. Government Printing Office, 1962, pp. 281-436.
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George Finney, Bill Potts, and Captain McQuinton are staying on to help these hospitals straighten out some of their problems. I found that they were injecting gas gangrene antitoxin into wounds and into the tissue around the wounds, but not introducing enough antitoxin intravenously. Cases were coming down from the front without adequate information on operations or drug therapy. Some had a red blood count of 1.5 million, and some patients have been sent down in poor condition or too soon after an operation. Others, with compound fractures of the humerus, were in hanging casts. Once again it must be concluded that not enough emphasis is being placed on getting the best men into the forward hospitals.
Bougainville, Wednesday, 22 March
Up at 0330 with the ballistics team and off to Bougainville(map 5).11 We landed at 0830 on the fighterstrip, since the other two strips were being shelled. The Torokina fighter stripis also under fire, but is nevertheless functioning. Colonel Hallam met us atthe airport-a very efficient, pleasing, and cooperative fellow. He took theteam to the 21st Evacuation Hospital for rations and quarters and then showedthem his bug and butterfly collection and introduced them to the 37th Divisioncrowd.
11The fighting had not yet ceased on Bougainville. During March, the Japanese made three unsuccessful attempts to dislodge the American forces from the perimeter that they had occupied.
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MAP 5.-Medical units on Bougainville, March 1944.
Thursday, 23 March
Toured the frontlines of the 37th Division. The collectingstation of the 129th Infantry is about 200 yards behind the front, and they havecleared out a beautiful garden here in the jungle with lots of tomatoes,cucumbers, melons, radishes, and some corn.
The Japanese came over the Numa Numa Trail withone-regiment-plus and hit the 129th at a strongly fortified point (fig. 324).Some 400 of them are now being buried by our bulldozers. By climbing over theirown dead until our machineguns jammed, they had managed to take some of ourforward pillboxes. They would also walk in file straight across a minefield,advancing over the bodies of those who had blown up the mines. However, theirlosses were too heavy, and except for a few snipers the main body withdrewtoday. There is no question about their morale and courage. No prisoners arebeing taken.
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The roads here are good right up to the frontlines, and the wounded are quickly brought back to the evacuation hospital. In the cases of the seriously wounded, the clearing station is bypassed. If the wounded man can be reached, he will find himself in the hospital within from 1 to 4 hours. This is the first time in the South Pacific that an evacuation hospital has been able to function as such.
This particular hospital is in front of the artillery, orrather in the middle, as the 155`s and 105`s are behind us and the 75`sare in front. The 155`s go chugging overhead night and day. The chugging noiseis made by the wobble of the shell as it passes above. The wobble thendiminishes, and the shell moves into a straight path. The sounds coming fromthis change of motion make it seem as though the shell were falling, although ofcourse it doesn`t, and it lands about a mile beyond the hospital.
We also visited Hill 700 where elements of the 145th Infantryare located (fig. 325). This is a very rugged section, and the Engineers havedone a really superb job in putting a road right behind the frontline. However,the wounded could not be transported along the road except in armored halftracksbecause the Japanese have the road covered. It is amazing when one considersthat the Japanese tried to attack at this point, for the line runs along a hillwhich is too steep in spots even to crawl along. They did manage, however, totake the top of the hill, though the ravine below was piled deep with Japanese
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bodies. Thirteen hundred corpses have been counted and buried so far in the area that our burial parties have dared to cover. This is an important problem as the unburied attract swarms of huge black flies as big as bumblebees, and the leaves of vegetables are black with them. The hill was retaken by us at a cost of about 60 dead and 300 to 400 wounded.
We saw General Griswold, Commanding General, XIV Corps, andhis chief of staff, General Arnold, who furnished us a vehicle and a driver. SawLieutenant Torrance of the Graves Registration Service, Quartermaster Corps. Ourdead, as they are brought to the cemetery, will be detoured a short distanceaway to the morgue of the 21st Evacuation Hospital where Greiner, thepathologist, with two stenographers and a photographer, will be set up to do hisjob.
Friday, 24 March
Of all the islands I have visited in the Solomons,Bougainville has the best climate. The nights are always cool, and a blanket isoften necessary. The air is also dryer because of the sand subsoil that permitsgood drainage and because of the slight elevation of the land.
The 21st Evacuation Hospital is a clean and well-organizedinstitution. Colonel Allen [Lt. Col. (later Col.) Robert E. Allen, MC],Commanding Officer, was the former executive officer. Everyone in the XIV Corpsis well pleased with them, and they have a good esprit de corps.
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We visited Colonel Collins of the Americal who has a splendidclearing station, really more elaborate than is needed. But now that they aregetting a number of casualties it has come in very handy for taking in a heavyload. They have underground operating rooms and wards with forced ventilation.This clearing station has been shelled almost daily, and a direct hit was madeon the division surgeon`s office. Fortunately, he wasn`t there at the time.The 52d Field Hospital has also been shelled and took a direct hit on one of itswards. Several patients were wounded although there were no fatalities.
The Japanese hand grenades do not appear to be too effective.12It seems that the explosive charge is too small. Five grenades were throwninto one of our foxholes without killing a man, though no one escaped beingwounded. Two men are needed to fire our bazooka; the forward man frequently getspowder burns while the man behind may suffer hand injuries. We will examine thisproblem.
Saturday, 25 March
A small sector of the 129th Infantry was infiltrated thenight before last by about 200 Japanese. As a result of this action, 100 of ourmen were wounded and 30-plus were killed. The ballistics team had more work thanthey could handle at one time.
The surgical service at the 21st Evacuation Hospital is doinga good job, although the hospital is inadequately designed for the load that ithas to carry. For example, the original operating room was made far too small(fig. 326). An operating room in a 750-bed evacuation hospital should providefacilities for eight tables to function at once. It should be centrally locatedand easily accessible to the laboratory and X-ray. The shock room should beadjacent to the operating room and large enough to hold 30 to 40 patients at onetime. When the operating room is placed in front of the artillery, as is thecase here, underground wards should be available for at least 200 patients. Atthe present time this hospital has nearly 100 litter patients aboveground andapproximately 120 below ground. Many of these patients are thrown into a stateof shock during the process of being transferred underground. Fortunately,shelling and bombing have been light in this particular area. Furthermore, X-rayequipment has been kept together, and one hit could have done away with it all.Part of the X-ray equipment should be located in, or adjacent to, the shockward, and part in the operating room. This hospital could benefit by instructionon such subjects as sterile technique, the use of plaster, records, et cetera.This will have to be arranged.
Visited the EENT clinic. There are many middle-ear cases, alarge number of whom can give no story of how their drum was perforated. One maneven had a complete absence of the drum. I believe that a great many men sufferruptured drums from explosions and do not report this fact. Many of themprobably don`t recognize any symptoms until their ears become infected.
12For data on this and other Japanese missiles, see: Beyer, James C., Arima, James K., and Johnson, Doris W.: Enemy Ordnance Materiel. In Medical Department, United States Army. Wound Ballistics. Washington: U.S. Government Printing Office, 1962, pp. 1-90.
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There are many men in combat who have defective vision and badhearing, which are particularly dangerous in jungle warfare. I heard about oneman who was up for court-martial during the fighting on New Georgia. He hadturned his Browning automatic on a patrol returning to our lines, withdisastrous results. The fellow could barely distinguish a man at 200 feet, letalone be able to tell the difference between friend and foe.
Saw Maj. Paul Troop of the 145th Infantry this morning. Hehad a minor wound caused by a "hung bomb" which had caused a tree toburst within the area, killing one and wounding nine.
A Japanese message intercepted yesterday indicated that theywould begin an attack. Hence, our heavy artillery barrage last night. Our Cubshave spotted most of their gun positions, and we can only hope that we haveknocked them out. Anyway, it appears that we have stopped them for the timebeing. Yesterday, the Japanese used machineguns to shoot down several of ourplanes which were flying low over the lines. Americal headquarters is jittery,for the Japanese naval 6-inch guns on Empress Augusta Bay are dropping shellsaround the general`s tent. Everywhere the story of Japanese morale is thesame. The Japanese soldier when cornered shouts back that the Japanese Armynever surrenders. So far they are right.
Saw Capt. Carnes Weeks [Cdr. Carnes Weeks, MC, USN] who nowappears to be Halsey`s personal physician. Had luncheon with him and AdmiralHalsey several times on Guadalcanal.
The Fiji Scouts are here in force (fig. 327). Their officersare New Zealanders. Both officers and men have won the admiration of all theunits here. I just watched a battalion go down the road with a snap that isnever seen in our troops. Their casualties are heavy, and the Japanese feartheir courage and their ability as natural jungle fighters.
The dead are not coming in so rapidly now, only about 10 to15 per day, so that Greiner, assisted by Hull and Frick can keep up with thepost mortems. Two stenographers are there to take dictation, and they have aphotographer there to take the pictures. We have two undertakers who take chargeimmediately after our work is done. They sew up and wash the body and wrap it ina mattress cover. This project shows earmarks of being a valuable study.
Monday, 3 April 1944
The action is quieting down, although Greiner still averagesabout six post mortems a day, about half of which are Fijis who were on patrolduty. Opinion differs as to their value as soldiers. They are universally liked,and everyone agrees that they are good on patrol, but apparently they do notstand mortar fire well.
The morale of our troops is high, although we have quite afew neuropsychiatric cases. However, the vast majority of these wereneuropsychiatric problems before they entered the Army and cannot serve as anindex of the morale of the troops in general. One lieutenant cracked up becausehe had to lead his men on six assaults of a hill, incurring 50 percentcasualties. He felt that he was to blame for the casualties, although he wasonly obeying orders.
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FIGURE 327.-Fiji Scouts returning from patrol into enemy territory, Bougainville, March 1944.
The food here is excellent. Almost every installation now has a garden, and some of these are on a grand scale. Sweet corn, tomatoes, potatoes, onions, radishes, okra, carrots, and the like grow well.
The question of rotation versus leave has now become optionalfor officers below the grade of lieutenant colonel who have 2 years of overseaservice. Most of the doctors prefer rotation to leave. They feel that they havebeen overseas long enough, 24 to 28 months, and that something has been put overon them by the doctors who have remained at home. The stories of doctors who are"cleaning up" at home does not help morale. This attitude is also inevidence among enlisted men. Obviously, the morale of those serving overseas isin inverse correlation to the income of the people at home. If the income of thecivilian population were limited to the corresponding Army income, this factorwould be eliminated.
Tuesday, 4 April
Activity is steadily quieting, and nothing is coming in butpatrol casualties. Yesterday I completed the initial records of the 37thDivision.
Last night, had dinner with Col. Eddie Grass at the 33dPortable Surgical Hospital. Major Tyler, of Denver, is Commanding Officer. Thisunit wants to stay with the 37th Division. They are set up beside the collectingstation and have taken the more seriously wounded who could not standtransportation to the evacuation hospital. They received a direct hit from a500-pound bomb
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early in the battle, which wiped out their equipment,including even the pots and pans in the kitchen. All the personnel were infoxholes, and there were no casualties, although the bomb dug a 20- x 6-footcrater. They have been reequipped since then and have only had to contend withmortar fire and sniping. The operating room should obviously have been placedunderground. Digging tools and one power saw should be a permanent part of theirequipment.
Thursday, 6 April
The cards have been made for all those killed in action andwounded in action on Bougainville since February 15, and some 200 are completed.We found some wooden bullets yesterday. They are said to be used by the Japanesefor close-range fighting in order to avoid injuring their own men.
I had dinner last night with General Beightler of the 37thDivision. General Griswold, XIV Corps, told me that the 37th was the"banner division" of the South Pacific. General Beightler is one ofthe world`s fine people-simple, modest, and direct. He can also be tough ifthat is necessary. The general is intent on maintaining high morale and a prideof accomplishment among the men. This is best attained by the careful selectionof leaders, fairness, and recognition for a job well done.
NOTES
1. The 9th Station Hospital needs an EENT officer. He will be provided by the 29th General Hospital.
2. Complete field X-ray equipment should be kept in theforward area. In general, more supplies should be kept in the forward arearather than at Noum?a.
3. It should be possible to return an officer from thetropics without a recommendation for either promotion or reclassification. Manyof them are inefficient in tropical service and do not fall into either group.Here is a case in which administrative redtape is working against the bestinterest of the service.
4. More of the following items must be obtained: Scales,blood pressure apparatus, otoscope, sterilizer (Wilmot-Castle), small burnersfor sterilizer, orthopedic tables; powersaws, axes, and ventilation fans forunderground wards and operating rooms; headlights; sclerosing solution forhemorrhoids, eye anesthetic, copper sulfate for phosphorous wounds.
5. Spectacles are still a problem. Do all the men have asecond pair?
6. The journals are still not coming through.
7. Replacements should come in early enough for priortraining.
8. The Japanese make better use of cover than we do and digin quicker, using smaller, better constructed foxholes. Every recruit shouldlearn how to dig fast. This is of more value than walking in jungle warfare. Themen must also learn to dig deeper and narrower foxholes. They are far too large.Many buttocks wounds are seen in the wards. The soldier must be advised to gethis backside down. Careless exposure of the silhouette is too frequent.
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We must learn to crawl more often. The Japanese stick closerto the ground. Furthermore, our boys frequently don`t wear their helmets onpatrol, for they soon find the helmet too tiring.
9. Should patrols (fig. 328) be accompanied by a medicalofficer? Not unless the medical officer has enough equipment to do more than anaidman`s job. Small patrols of less than nine men have an aidman along, andmany of them are lost on patrol. One patrol had a battalion aid section of 28men of whom 10 were wounded in action and 4 seriously. General Hodge [Maj. Gen.(later Lt. Gen.) John R. Hodge, Commanding General, Americal Division] gaveorders for a doctor to accompany a reinforced company of 175 men, although noequipment was carried. Citations for medical aidmen are insufficient. However,an infantryman who takes no more risks gets a citation. One battalion commandingofficer insisted on bringing back his dead at great risk to the aidmen. Aidmenhave been used to carry the dead down from the aid station. Since there are alimited number of aidmen, they should not be used for this task.
10. The 37th Division clearing station performed primarysuture of the minor wounds of about 30 men. Almost all healed per primam.
11. More instruction is needed on sucking chest wounds andthe proper way of sealing them, which is with a tight adhesive over a pad andgauze, the latter impregnated with petrolatum jelly.
12. Statistics gathered from the 21st Evacuation Hospital:
41 cases of penetrating chest wounds-12 percent mortality.
21 cases of sucking chest wounds-18 percent mortality.
27 cases operated open-29 percent mortality.Note: Second echelon medical service must have thoracic surgery.
13. We need a movable metal pillbox. It would be of greatvalue in going over a ridge against Japanese positions. A periscope could beattached, so one could look over the ridge. Many Japanese are killed by heavyfire because of their concentration prior to an attack.
14. Captain Dick states that about 5 percent of the men takesulfa tablets by mouth when wounded. It might be better to discontinue thispractice entirely, unless they are out on patrol. The full dose, given by adoctor, would more quickly assure an adequate blood level.
15. The Japanese hand grenade is grooved, but does notfragment along its grooves. Having so much powder, it is almost pulverized;hence, its burst is not effective very far. Men sitting in a foxhole in which agrenade has been tossed have been known to put up their feet and come offwithout serious wounds. However, the blast effect is considerable. Small skinpuncture wounds and extensive damage to muscles occur as a result of the blast.A Japanese grenade was seen to go off under a man and lift him 2 feet in theair.
Sunday, 9 April
I was under the impression that the Japanese had finally beendriven away, but I was awakened this morning by the shelling of the fighterstrip. Last
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FIGURE 328.-A patrol crossing the Piva River on Bougainville
night I had a long discussion with the officers. They complain that many hospital staffs are kept inactive over long periods of time. They contend that under such circumstances the men should be sent home, since many planes and ships go back empty. These people refuse to recognize that the difficult problem is to bring men out here. They only see the issue in terms of available transportation back to the States. It was remarked that morale is bad because the Army hasn`t been keeping its promise to ship people back on rotation. These men complain that they were not told that the Army`s promise would be fulfilled only "if the tactical situation permitted."
Saturday, 15 April
We have been interviewing line soldiers and get much valuableinformation from privates and noncoms. Many discrepancies having to do with thecircumstances in which wounds occur are corrected. It appears that thesestatements may be taken as about 85 or 90 percent accurate. There is generalagreement that every man should know the principles of first aid treatment sinceregular aidmen cannot get to them at night.
More attention should be given to having better pillboxes,sacrificing camouflage if necessary. The Japanese knew where they were locatedanyway. Windows on the pillboxes should be screened with chicken wire or, betterstill, some kind of rubber wire off which the grenades will bounce. The pillboxshould slope down at the sides so that the grenades will roll off. Barbed wireshould be used more freely. A telephone is needed in every pillbox. These
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telephones should be attached to the ear in order to leavethe hands free. Our logging trails, which were cut for timber, were used by theJapanese for their main attacks. Flamethrowers would be useful on the defensiveagainst mass attacks. A flamethrower with a long hose is more efficient than atank when the position of the dug-in enemy is known. Our minefields limit ourmeans of withdrawal, but kill many Japanese. A bulletproof vest might be usefulin this type of warfare. Inside the pillbox, the noise of firing is intenselyannoying, and the helmet makes it even worse. The 60-mm. mortar shell flare isokay, but the airplane flare is too bright. The frontlines should be cleared for300-yard lanes of fire. The bazooka is very useful against banyan trees.More men are needed who are trained in the use of bazookas, as many of theseguns were available and stood idle. More Browning automatics are needed, andevery pillbox should have one.
Tuesday, 25 April
Went over our results with General Griswold. He is skepticalabout our figures on machinegun casualties, probably because of the gun`shighly lethal effect.
Russell Islands, Saturday, 13 May 1944
Off this morning for the Russells. Went to the 222d StationHospital. Colonel Currie is commanding officer. This shows promise of being afine hospital, and the morale is good. Visited Colonel Bell at the 17th FieldHospital where the same old problem seems to exist. Went to the 41st StationHospital where construction has been stopped. Colonel McLaughlin [Lt. Col.William B. McLaughlin, MC], Commanding Officer-a fine type. They need alaboratory officer. None of these hospitals has a well-trained anesthetist.
Noum?a, Monday, 15 May
I am now back at Noum?a. Left Bougainville the first week inMay for New Georgia Island. Stopped at Ondongo Island, then by boat to Munda.Stayed at the 144th Station Hospital on New Georgia. Colonel Haines [Lt. Col.Hilton D. Haines, MC] is hospital commander.
Friday, 14 July 1944
Today is Bastille Day, and tonight the natives are in thesquare across from Le Grand Hotel Central, beating tom-toms and having a greattime shouting and singing-a regular old shakedown (fig. 329). I felt ratherunder the weather from around May 15th until early in June, although I keptgoing. Had no appetite, which caused a loss of weight, and had sporadicdiarrhea. Stool examinations did not reveal any ameba.
Hull, Greiner, and Sutherland stayed on to help with thereports. I have learned how necessary it is to be careful when choosing peoplefor such work, and I would never again attempt it with anyone whom I did notknow was definitely interested in the problems.
Admiral Halsey and his staff departed on about June 15th, andGeneral Maxwell, Hal Sofield, and General Harrison left for Washington 5 dayslater.
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FIGURE 329.-U.S. Army nurses participating in a native dance at Saint-Louis Village, New Caledonia.
Everybody here is full of rumors as to what will happen next, but fortunately I have been so busy that I have not had time to think about it. Around July 1st, Col. Maurice C. Pincoffs, MC, came over from Australia and spent several days gathering data, as New Georgia and Bougainville pass to the SWPA (Southwest Pacific Area).13 They (i.e., SWPA) either have no regular allotment for consultants, or someone else has filled them, and Col. Wm. Barclay Parsons, MC [Consultant in Surgery, Office of the Chief Surgeon, U.S. Army Services of Supply, SWPA], must be carried as the commanding officer of a hospital. Moreover, being in Services of Supply, they have nothing to do, except by invitation, with combat troops. I realize now what a very fine situation I have had here in comparison. "Pink" [Pincoffs] suggested that the Sixth U.S. Army should have a consultant and asked if I would not consider it. No news has come from Washington so I will sit tight as I have a lot of reports to finish.14
13On 15 June 1944, the islands in the Solomons Group north of the Russells were designated as part of the Southwest Pacific Area.
14On 19 June 1944, Colonel Oughterson was awarded the Legion of Merit "for exceptionally meritorious conduct in the performance of outstanding services in the South Pacific Area from 1 December 1942 to 13 June 1944."
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Tuesday, 18 July
Heard that we will go under the Central Pacific but do notknow as yet what is to be done with the consultants.15The ballistics report has been completed except for the typing.
Auckland, Tuesday, 8 August 1944
Today I received orders to go to New Zealand. The planecoming over flew at 10,000 feet, and I was uncomfortably cold in spite of thewoolens I wore. Arrived at Auckland at 1600 hours and went out to the 39thGeneral Hospital. Colonel Longfellow is looking well. They have 300 patients,and most of these will soon be gone. The grounds are beautifully landscaped, andthe hospital itself is immaculate. It has stood up very well. Gave two talks onwound ballistics.
Noum?a, Saturday, 12 August
Received orders from the Commanding General, South PacificBase Command, to return. I was having a gastrointestinal series done and had toleave in the middle of the series. Arrived August 15 at Noum?a to fluid that Ihave been ordered to Headquarters, USAFPOA (U.S. Army Forces, Pacific OceanAreas), Hawaii.16 Eddie Ottenheimer`sorders are out, following Colonel Longfellow`s okay. He will be invaluable incompiling surgical statistics for the theater. Furthermore, General Maxwell, whohas returned, wants to use him as a historian.
Saturday, 19 August
Eddie arrived today, and I have started him on the analysisof surgical records. General Gilbreath [Maj. Gen. Frederick Gilbreath], who isnow Commanding General, South Pacific Base Command, has made many reforms, andlife for the officers is not generally as pleasant as it was. But there arecompensations in better discipline.
Tuesday, 22 August
Drove out to Tontouta and spent the night with Colonel Shope,now commanding officer of the airbase.
Wednesday, Thursday, 23, 24 August, Oahu, T.H.
At 1300 I got on a C-54 coming through from Sydney. Theseplanes are like huge flying boxcars. Arrived at Nandi Airport at 1715 and hadsupper. Took off at 1815 in a beautiful sunset. Arrived at Canton Island,Phoenix Islands, at 0200. As the plane taxied down to the end of the field ontakeoff, it was discovered that the hydraulic system was leaking. This wasrepaired by about 0600, and we finally took off. We landed at Hickam Field at1600.
15The U.S. Army Forces in the Central Pacific Area was the forerunner of the U.S. Army Forces, Pacific Ocean Areas, referred to and discussed later.
16USAFISPA was redesignated in July 1944 SPBC (the South Pacific Base Command). USAFPOA was established at the same time as a superior headquarters with jurisdiction over the South Pacific Base Command and what had been USAFICPA (U.S. Army Forces in the Central Pacific Area) which was similarly reduced to a base command, CPBC (the Central Pacific Base Command). Colonel Oughterson was placed on temporary duty as surgical consultant at Headquarters, USAFPOA from the South Pacific Base Command, since there were no position vacancies for consultants of his rank at Headquarters, USAFPOA.
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Passed through Army Customs and went out to Fort Shafter,Oahu, T.H. [Headquarters, USAFPOA], where I signed in and looked up ColonelYoung [Col. Charles T. Young, MC, medical consultant] who fixed me up for thenight in the old Tripler Hospital. Here everyone is dressed up, and there islittle evidence of war. Today, Wednesday (having crossed the date line again), Imet Brig. Gen. Edgar King (Chief Surgeon, USAFPOA), my new commanding officer.Although he has a fearsome reputation, my first impressions are very good.Colonel Gates [Col. Kermit H. Gates, MC], Deputy Surgeon, is a very busy andpleasant person. Thursday, I visited Lt. Col. (later Col.) Forrester Raine, MC,of Milwaukee, who has been acting surgical consultant for the Central PacificBase Command. He tells me that there are only four board members in the wholearea and that there is a great dearth of good surgeons.
Saturday, 26 August
The general had asked me to write down some of my ideas onthe function of a consulting surgeon, which I did and which he approved. He hastaken quickly to all my suggestions, and I think that I am going to like workingwith him. The only aspect of the work that I dislike is that I also have somefunctions as an inspector. I am afraid that this may strain my pleasantrelations with the surgeons. Perhaps this need not happen.
Monday, 28 August
Today I lectured to a medical group and afterward traveled tothe northern side of the island to deliver the same lecture to the 71st MedicalBattalion. I am beginning to think that my illustrated lecture on debridementmust be good, as I could hardly fool all the people all of the time.
Tuesday, 29 August
Spent the day with General Bliss [Brig. Gen. Raymond W.Bliss, Chief of Operations, Office of The Surgeon General, and Assistant to TheSurgeon General] and General Rankin [Brig. Gen. Fred W. Rankin, Director,Surgical Consultants Division, Office of The Surgeon General] visiting the NorthSector Hospital [219th General Hospital]. Colonel Green [Col. Philip P. Green,MC] is commanding officer, Fisk of Boston is Chief of Surgery, and Robertson[Col. Robert C. Robertson, MC] is Chief of Orthopedics [and Consultant inOrthopedic Surgery, USAFPOA]. Then we were off to the 204th General Hospital ofwhich Col. Tracy L. Bryant, MC, is commanding officer. I had not seen him forthe past 25 years. Thence to Doris Duke`s and to the Moana Hotel for drinks.
Thursday, 31 August
Off at 0630, visited the jungle course over the Pali [CampPali]-a very profitable forenoon (fig. 330). Maj. Bryant Noble, MC, in chargeof medicine, is doing a good job. Thence to Koko Head, to visit the field andportable surgical hospitals just out of Saipan. Colonel Pettit-very able.Major Tinkers, who is the son of Dr. Tinker of Ithaca, was in command of aportable surgical hospital on Saipan and did a fine job-2 to 5 percentmortality on the
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FIGURE 330.-Training in how to live in and on the jungle, at the Jungle Training School, Hawaii.
island. Back to the office and off with General King to a large dinner party for Generals Bliss and Rankin, given by Colonel Streit [Col. Paul H. Streit, MC, Surgeon, CPBC] at the Pacific Club. A good dinner.
Saturday, 2 September 1944
Went out this morning to see General Hodge [Maj. Gen. John R.Hodge, Commanding General, XXIV Corps]-"Old Corkie." The nextoperation (Leyte Campaign) was explained by Colonel Potter [Col. Laurence A.Potter, MC, Surgeon, XXIV Corps] in a most excellent manner. While there, wereceived word of an emergency meeting with General King at 1300 hours. Five ofus were called; Col. Charles Young, Kester [Col. Wayne O. Kester, VC, ChiefVeterinarian, USAFPOA], Lt. Col. Moses Kaufman [now neuropsychiatric consultantfor USAFPOA], Diver, and myself. We were brought before a huge table holding 50items-planning for the next year, involving 50,000 medical personnel. Ourconclusions were due immediately, so we had only a half hour to look thesituation over. I hope the corrections we made turn out to be right.
Wednesday, 6 September
Still snowed under with work. Checked reports of the MarianasCampaign. The portable surgical hospital, while well adapted to jungle warfare,
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appears ill-adapted and wasteful when communications aregood. Furthermore, their talent is poor and not as well attuned to needs as isthe personnel of the surgical teams. Generally speaking, the largerinstallations are more efficient as regards such things as specialized talent,protection (guards), laundry, triage, and the treatment of shock. On the otherhand, in amphibious operations, size is a limiting factor. The 400-bedevacuation hospital is about right for these operations, as is also the fieldhospital if properly staffed.
Talent is wasted by using two smaller hospitals to take theplace of one larger one. Dumbea Valley is a good example of this. Anothermistake is to require station hospitals to do the work of general hospitals, aswas the case on Guadalcanal. The fact is that there were too many stationhospitals there, and, taken individually, they were too small for the job. Wenow have a 750-bed station hospital which has been organized by combining three250-bed station hospitals. We expect to use it as an evacuation hospital, thoughthe staff is inadequate. The chief lack is qualified surgeons. I looked over twoportable surgicals and a field hospital and found only two surgeons with ratingsbetter than "C."
Thursday, 7 September
Talked to the 76th Station Hospital this forenoon. This is agood station hospital. If this next action is severe, I would expect trouble,for the 165th Station Hospital is made up of three 250-bed hospitals, andconsequently the personnel is poor. The conversion of several smaller hospitalsinto a large hospital is unsound policy. They don`t seem to realize that thequality of personnel in a small hospital is, and must be, different than that ofa large hospital. The 69th Field Hospital hasn`t any well-qualified surgeon.To expect these hospitals to function adequately as evacuation hospitalsrequires more optimism than I possess. The 51st and 52d Portable SurgicalHospitals are short on surgical talent. Certainly the portable surgicalhospitals are wasteful, and unless their talent is better than in those I haveseen, they only succeed in giving the dangerous illusion that a surgicalhospital is available.
The general has been very kind and considerate toward theconsultants. When I told him of the lack of surgical talent, he said: "Ididn`t know your standards would be so high."
I looked up some of the anesthetists today, and they arescattered in all sorts of positions. One of the best, with 6 years`experience, is an executive officer.
Friday, 8 September
To Koko Head where I talked at the 69th Field Hospital, whichis not too strong in personnel. Spent the afternoon with Robertson who insiststhat he wants to do hospital work as well as act as a consultant. Thinks catgutis better than silk or cotton.
A three-star general here burned his fingers when a matchboxcaught on fire. I went down to see him in response to a call and a two-stargeneral who was there asked why such high-powered talent was needed for such alittle thing.
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I said: "I thought perhaps things had gotten so hot thatthere was danger of a general conflagration." This seemed to please thegeneral to the extent of relieving his pain.
Saturday, 9 September
Visited the new hospital ship Mercy, which had Armypersonnel aboard (fig. 331). Seven hundred patients and only two operatingrooms, inadequate for a combat mission. There were only eight medical officersaboard, five of whom are would-be surgeons. The ship should have had thepersonnel of at least a 400-bed evacuation hospital.
Spent the evening with the general. He is a fine person towork for. Unfortunately, he has not had enough advisers to whom he coulddelegate responsibility.
Monday, 11 September
Spent yesterday writing a directive on surgery for theforward echelon. The general, to my amazement, insisted I sign it. "Itwould come better," he said, "from a doctor."
Some doctors are against the use of plaster in the nextoperation because of gas gangrene. Correcting one surgical mistake with anotherit would appear. I am more than ever convinced that, as a whole, the amount ofgas gangrene is an index of the quality of surgery at the front, and admittedlyit was not of the best on Saipan.
Tuesday, 26 September
I am still laboring to get out: (1) An educational directive(none has been issued); (2) a statistical directive (no method exists forgathering statistics on surgery, and one should be set up for POA); (3) a planfor a wound ballistics study (none has been contemplated); and (4) ETMD(Essential Technical Medical Data) reports to this theater, and a plan fordeveloping our own. Discussed some revisions of this plan for ETMD reports withGeneral Bliss. The classification was too high, and subject matter should beconcentrated just as in any other medical paper. A consultant, or some one onhis staff, should act as editor.
The great shortage in this area is talent. There is only onesurgeon here who can qualify as chief of surgery in a 2,000-bed generalhospital, and there is a dearth of specialists.
One of the chief functions of a general hospital should be toact as a teaching center; however there is a shortage of good teachers. Very fewlives can be saved in a general hospital (area Naval hospital had 1 death in6,000). The patients die before they reach a general hospital. The shortage ofqualified men here is due to the fact that there are no affiliated units. Thosefrom the South Pacific Base Command are tied up by agreement with the SouthwestPacific Area, and personnel cannot be moved although many are idle in that area.The 39th General Hospital has 100 patients.
The portable surgical hospital is too small to function as ahospital and too large to function as a team. It should be disbanded.
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FIGURE 331.-U.S. Army Hospital Ship Mercy. A. The Mercy. B. Operating room.
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Maui Island, T. H., Monday, 2 October 1944
Flew from John Rogers Field to Molokai Island, and thence toMaui Island to visit the 8th Station Hospital. This unit was formerly onBora-Bora. Lt. Col. Julius Sobin, MC, is Commanding Officer-F.A.C.S., a goodsurgeon. Chief of surgery is Maj. Charles E. Town, MC. His surgery appears to begood, and he is capable of handling a 500-bed hospital. Capt. Irvin E. Simmons,MC, ENT man, is young but appears capable. Capt. Rosario Provenzano, MC, is incharge of orthopedics-young, but also seems capable. Capt. Leo Tyler, MC, isthe anesthetist. This hospital, developed by the 20th Station Hospital from someformer school buildings, has barracks-type wards of 750-bed capacity. It has apleasing location at 1,800 ft., cool, exceptionally well adapted to a stationhospital. They now have 600 patients; average census for 1944 was 300. A Marinedivision is now training here, and they expect an increase in patients. The250-bed personnel is not enough for present needs, and the Navy has supplied 15medical and dental officers. The equipment is superior to most generalhospitals. In fact, no extra buildings or equipment would be needed to make thisinto a 500-bed hospital, and their key personnel would be adequate. However, thelaboratory does not use the copper-sulfate method. Attended an excellent medicalmeeting. The staff does not have help enough to offer training courses. Theyneed a dietitian and more enlisted men for the basic jobs.
Hawaii, Wednesday, 4 October
Off to the Large Island [Hawaii] and landed at 1100 hours.Went directly to the 75th Station Hospital, which was organized as a 750-bed andis functioning as a 250-bed hospital. Colonel Underwood of Brooklyn iscommanding officer and also functions as district surgeon-a fine fellow doinga good job. Colonel Mayer is Chief of Surgery. He is one of the two or threebest-trained surgeons in the CPA (Central Pacific Area). They need a goodorthopedist. Pfiffer, general surgeon-young, but has aptitude; Goldman,genitourinary specialist-good; Freidman, ENT-good; Captain Foster (nurse) isthe anesthetist. They have one physiotherapist. This service should bedeveloped. One dietitian-good. They need more. The library is good-sixtextbooks of Christopher and six of Cecil. They do not know the copper-sulfatemethod at any of these hospitals.
Friday, 6 October
Started off at 0800 to drive around the island through theKona country. At 1400 we arrived at the 26th Station Hospital on the Parkerranch-35,000 cattle and 10,000 sheep and goats-looks like Wyoming. Thishospital has 150 beds and two surgeons. Captain Amstutz is doing an excellentjob here. Captain Bigliani, an orthopedist, is assisted by numerous doctors fromthe Marine division. Cooperation is excellent with the Navy. They need an X-rayman and an ENT man. Anesthesia is done by the nurses-two good ones. CaptainSpalletta, laboratory officer, also does cystoscopy. They are doing a lot ofwork on appendixes and pilonidal sinuses. On the whole they are doing as well ascan be expected, and Amstutz is a superior officer.
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Saturday, 7 October
Off at 1230 from Hilo and landed at John Rogers Field [NavalAir Station, Honolulu], 1430 hours.
Oahu, Sunday, 8 October
After 6 weeks, I have still not accomplished any of myoriginal projects. There has been a tremendous passing of "buck"slips. It is almost as difficult to get something done here as in a universitymedical school. The educational directive is under way, stated by G-3 as beinglong needed. Reproduction of ETMD will be delayed indefinitely, as the photo labburned down last week. The statistical project is at status quo with more andmore excuses developing, such as no help or no room.
There are three ways of determining the quality of medicalcare: (1) Inspection of hospitals and personnel by consultants and others; (2)statistical record of results (as the cash register is to business, so is thestatistical record to surgery); and (3) questions and answers on what thesoldier thinks of his medical care. With these three methods correlated, weshould be able to determine the quality of medical care and devise means forimproving it where needed.
Sunday, 15 October
Still no news from Washington, and General Maxwell is stillin New Caledonia.17 The educational directiveis about to be published, so my number one project is done.18Must now get out a directive on reparative surgery and another on penicillin.Penicillin has not been used to the extent that it should be. Reports coming inindicate that we are making the same mistakes in medical planning here that weremade in the South Pacific one and a half years ago. This also applies to mattersother than medical. This theater is fighting its first battles, and, since noneof these men have had experience, they must necessarily learn through trial anderror.
Sunday, 22 October
Got out the directive on penicillin. We have not been usingenough in this theater, and there is confusion as to when to use sulfonamidesand penicillin. Arranged program for a territorial medical meeting. Abstractingand getting out ETMD for all hospitals, divisions, corps, and armies-this hasnot been done before. I`m working on a gas gangrene, anaerobic wound infectionreport. Have not yet been able to establish a record system.
I would like to go forward, for the flow of Philippinecasualties will soon be coming through. The invasion was announced 2 days agoand is going well
17Brig. Gen. Earl Maxwell had been notified of impending assignment to the U.S. Army Forces, Pacific Ocean Areas; however, when official request had been received in South Pacific Base Command, General Gilbreath had radioed back to the Commanding General, the U.S. Army Forces, Pacific Ocean Areas, that General Maxwell was not available as he had no replacement.-E. M.
18The directive published at this time was promulgated by Headquarters, U.S. Army Forces, Pacific Ocean Areas, on 20 October 1944 as Training Memorandum Number 8, subject: Training Program for Medical Officers. Colonel Oughterson later rewrote this directive, adapting the principles in it to Headquarters, U.S. Army Forces in the Pacific, when that command became the superior headquarters in the Pacific.
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(fig. 332).19 Saw a picture in Time of Carnes Weeks with Admiral Halsey. I envy his seeing the show. Spent a pleasant afternoon at the beach today, swimming with Colonel DeCoursey [Col. Elbert DeCoursey, MC] and Colonel Curtis-both fine fellows. This week should bring clarification of the situation here.
Thursday, 23 November
Eddie [Ottenheimer] arrived today with many tales, some newstories. He certainly was most welcome as I need him to lift my spirits. Thingshere have been most discouraging, although I would not have missed theexperience, which is unique in my Army career. I begin to appreciate what ismeant by the word bureaucracy, although I think Marine terms are probably moreexpressive. Three months have I labored here and brought forth one directive onthe training of medical officers. All others have been blocked for various andsundry reasons.
General Willis [Brig. Gen. John M. Willis, Chief Surgeon,USAFPOA] arrived about 5 days ago. Some personnel have been returned to theStates. One officer, in charge of the personnel of a hospital, never developedanything worth the name of a department. There was no name file norclassification of
19The X Corps from the Southwest Pacific Area and the XXIV Corps from Pacific Ocean Areas made the landing at Leyte on 20 October 1944 under the operational control of the Sixth U.S. Army. The customary "D-day" for this operation was formally designated "A-day," and the terms are used interchangeably by Colonel Oughterson.
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personnel. The general filing system in the office wasreminiscent of my grandmother`s attic. Things were probably there, but no onecould find them. It was not uncommon to find everyone looking very solemn, asthough in conference, then to discover that they were only looking for a lostdocument.
The prevailing idea seems to be that the consultant is hereprimarily to make inspections, write long-winded reports about trivial matters,sit on boards, and see patients. In trying to accomplish something, I haveencountered resentment and a feeling that I was interfering with things thatwere none of my business. The consultant takes no part in planning, although theoffice is making the same mistakes in planning that were made in the SouthPacific a year and a half ago. Results: The mortality of wounded on Saipan wastwice as high as on Bougainville, and one-third the number of patients returnedto duty.20
I spent the evening with the general and accomplished muchbusiness very pleasantly. My first impression of the general is that he isoutstanding in his desire for, and insistence on, a high standard of work. Beingnew, he of course does not wish to move rapidly against tradition, although hesees the need clearly. This is a fine education on how to win friends andinfluence people, but not much help yet to the war effort.
Thursday, 30 November
Dinner tonight with George Finney. Says he: "How can weplan when we don`t have anything to plan with?"21I have now been in this headquarters over 3 months and still have notbeen asked to take part in future planning; nor after my request, have I beenpermitted to take part in planning. A field hospital is going in [to thePhilippines] with the Marines. They say it will function as an evacuationhospital. The Army says it will not, and I suggest that it should have surgicalteams if it is to function. Responsibility is being shifted along. Only Godcares for the little fellow! I am wondering when this will crack. It can`t goon forever. Once again I must speak to the general or be derelict in my duty. Iwould rather be out of the thing than in it and wrong.
Friday, 1 December 1944
Ben Baker arrived today. The role of consultants in the Army needsclarification, and Regular Army personnel must be educated as to the medicalproblems of a theater. There is only one partially qualified neurosurgeon inthis area. The determining factor in the distribution of battle casualties wasthe number of the doctors available, including those in station hospitals.Anesthesia departments, headed by doctors, have not been established. Essen-
20Attention is called to Colonel Oughterson`s statements on the function of a consulting surgeon (p. 841) and his participation in planning, such as it was (p. 842), written before the undersigned reported for duty. The comments on this instance were made only 5 days after my arrival. Consultants working under my command, including Colonel Flick, Colonel Mason, Colonel Loutzenheiser, Colonel Oughterson, and Colonel Ottenheimer, were always consulted on every phase of my duties and at all times were kept aware of any plans involving the medical service.-J. M. W.
21I believe Colonel Finney`s comment has reference to the lack of "qualified personnel" previously commented on from time to time. Surely that decision had been made prior to my arrival.-J. M. W.
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tial Technical Medical Data have not been distributed tohospitals. I suggested that it was by the ETMD more than anything else that theworld judged the theater and was met by stubborn incomprehension.
Saipan, Thursday, 7 December
Yesterday, having a chill and after numerous inoculations, Ireceived notice at 2200 to appear at Hickam Field at 0015. We took off at 0130,and, fortunately, being the senior officer on board, I had a bunk. Owing torepeated chills, I stayed aboard until Kwajalein where there was a dismal rain,making this dismal place look worse than usual. I have sympathy for the menwhose lot it is to stay in such an unattractive part of the world. Arrived justbefore dark at Saipan.
Today, with Col. Eliot Colby, MC, Surgeon, Army GarrisonForce, Island Command, Saipan, we had a hurried preliminary survey of theisland, which is far more attractive than I had anticipated. There was aJapanese air attack this morning, and on getting up I was a bit disconcerted tofind no foxholes. Found the colonel in charge of ATC digging a foxhole, askedhim why, and he pointed to his teeth marks on the floor. The 148th GeneralHospital is still in tents although prefabricated buildings are underconstruction. Headquarters is built in quonset huts, and the labor has been usedto improve this and other sites. Colonel Colby says that hospitals have"No. 1" priority, but then "No. 1" becomes subdivided into"a, b, c, et cetera." Visited the supply depot in charge of CaptainPhillips. Most supplies are out of doors on the ground, although covered withtarps.
Visited the 369th Station Hospital, where I saw MajorGoldsmith who is in charge of a civilian section which will be taken over by theNavy on 1 January. According to Colonel Colby, in the original plan the Navy haddesignated one medical officer and one corpsman to treat civilian casualties.There were a large number of civilian wounded, even on the beaches. One platoonof the 31st Field Hospital was designated as a civilian hospital. This platoonwith 100 beds soon had 880 patients. A second station hospital of 500 beds isunder construction adjacent to the 750-bed 369th. This total of 1,250 bedsrequires a duplicate setup of surgeons, administration, equipment, and so on.This does not seem to be good economy of personnel or equipment, but owing tothe difficulty of putting these hospitals together under one T/O they must beset up separately. Certainly T/O changes should be made more easily.
Guam, Saturday, 9 December
Left by plane at 0800 for Guam. Visited the 273d StationHospital-Colonel Batterton, Commanding Officer. This is a 750-bed stationhospital at about 20 miles from the port, but fairly close to the airfields. Thehospital is now under construction and should take patients in about 2 weeks.
Tinian, Sunday, 10 December
Visited the 289th Station Hospital, under construction at theedge of the depot field-a splendid location. Quonset hut construction, a100-bed unit expanded to a 200-bed unit. Maj. Paul S. Read, MC, is commandingofficer and
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also does some surgery. The surgical personnel seems to beabout as good as can be expected in a small hospital.
Left Guam at 1900 and arrived at Tinian, passing close toRota Island which the Japanese still have in their possession. Found Major Shaw,island surgeon-a pediatrician and very energetic.
Saipan, Monday, 11 December
Visited U.S. Naval Base Hospital No. 19 under the command ofCaptain Mueller, USN. The station hospital at Tinian, the personnel of whichhave not yet arrived, will be constructed of quonset huts by the Seabees. Shawhad drawn up some very good plans, and this should be a superior stationhospital. These two hospitals can provide facilities for 2,000 beds if they getthe additional personnel. Flew to Saipan in the afternoon to attend a medicalmeeting. Pathologist reported findings on autopsies of 60 civilians. About 70percent were tuberculosis and beriberi, frequently mixed. The next largest groupwas dysentery and colitis.
Tuesday, 12 December
Drove around the entire island [Saipan] in the afternoonlooking at hospital sites. The two general hospitals are toward one end of theisland, and the station hospitals are together at the other end. While this isundesirable geographically, it would be unsatisfactory to try to convert thestation hospitals into a general hospital. It is understood that all battlecasualties will pass through the general hospitals and that the stationhospitals will be used primarily for garrison work. The 39th General Hospital is8 miles from the airstrip, as is also the 148th General; and the 39th is 5 milesfrom the docks, while the 148th is only 1? miles from the dock. At present, the148th General is doing about 40 percent station hospital work. Yesterday,evacuation policy for patients was increased to 60 days for the generalhospitals, 30 days for the station hospitals. The 21st Bomber Command has 100beds to act as a clearing station at the strips, and the ATC has two quonsethuts to care for casualties that have arrived or are awaiting evacuation.
Summary of Informal Report to General Willis
There has been a need for sometime for a consultant in thisarea. The chief problems are: The planning and construction of hospitals;shifting of personnel; and professional questions, especially in relation to thefunctions of various hospitals.
The 148th General Hospital is now under construction,although they are now functioning in the area under tents. The surgery should bein quonset huts in 2 to 3 weeks. The personnel of the surgical service of thishospital will require strengthening. Further observation at a later date isrequired for proper evaluation. Approximately 40 percent of the surgery in thishospital involves the garrison forces. Twice the number of beds may be madeavailable for battle casualties by allocating most of the garrison work tostation hospitals. This has been discussed with Colonel Colby who has givensplendid cooperation.
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The 369th Station Hospital, 750 beds, is also underconstruction and is now functioning in tents in the same area. Lt. Col. JosephKuncl, Jr., MC, Chief of Surgical Service, is doing an excellent job, althoughhe is short two Medical Corps officers. The 176th Station Hospital, 500 beds, isalso under construction adjacent to this hospital and will be functioning withina few weeks.
I understand the 39th General Hospital is coming here.Neurosurgery and thoracic surgery can be allocated to this hospital, which hasqualified specialists. There are also some board members available in thishospital qualified to act as chiefs of service.
I have seen the plans of the 39th General Hospital and thereis room for much improvement to insure a better functioning unit. I wouldstrongly recommend that Lt. Col. Edward J. Ottenheimer, MC, be sent here as soonas possible to assist in the planning and construction of this hospital. ColonelColby concurs and has radioed a request.
With the arrival of the 39th General, the surgical serviceson this island can be staffed with qualified men, and, with the properallocation of functions, all specialties could be covered in a superior manner.Guam will be well staffed with qualified specialists, except in neurosurgery.
148th General Hospital.-Of 303 battle casualtiesreceived in the 148th General Hospital, Saipan, 149 were evacuated to Oahu and154 were returned to duty forward. Table 5 shows the number of operationsperformed during 4 months (August to November, inclusive) in 1944.
TABLE 5.-Operations, blood transfusions and deaths, by month, at the 148th General Hospital Saipan, Philippine Islands, during the period August-November 1944
MonthOperations
Blood transfusions
Deaths
August
108
30
6
September
221
10
3
October
248
35
1
November
263
54
1
Leyte, Wednesday, 13 December
Amid wind and rain, arrived at Isley Field, Saipan, 2200hours. Wet-slept in ATC holding tent for patients. Plane left at 0200. Sat upall night, arrived Tacloban, Leyte, at 1000 hours and circled for an hour beforelanding. Drove to Tacloban and met General Denit [Brig. Gen. (later Maj. Gen.)Guy B. Denit, Chief Surgeon, USAFFE, and SOS, SWPA, and later Chief Surgeon,AFPAC]. General Denit: "This damn Army won`t even obey orders. Supposedto have 12,000 beds by this time and we have only a fraction." I like thegeneral.
Drove to Sixth U.S. Army headquarters and met Col. (laterBrig. Gen.) William A. Hagins, MC [Surgeon, Sixth U.S. Army], a Regular Armysurgeon (fig. 333). The most outspoken man I have seen in a responsible
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position in this war. Says he: "The casualties are nothigh enough in headquarters." They do not like the PSH (portable surgicalhospital) as a tactical unit, although individual surgeons and units deservehigh praise.
Saturday, 16 December
This is a fine country for ducks and it might well be left tothem. Instead we fight over it.
Drove to Dulag. Visited the 165th Station Hospital andskidded around the mudholes in which it operates. This is a 750-bed stationhospital functioning as an evacuation hospital-840 beds available and 899patients. The hospital is insufficiently staffed to act as an evacuationhospital. Nurses are badly needed here. Colonel Sneideman, Commanding Officer,appears to be doing a good job under difficult circumstances. Lt. Col. Philip L.Battles, MC, is doing excellent work on disrupted wounds.
FIGURE 333.-Brig. Gen. William A. Hagins, Surgeon, Sixth U.S. Army.
Across the road or pond was the 76th Station Hospital. Colonel Bramble [Lt. Col. Russell B. Bramble, MC] is Chief of Surgery. This hospital is on a drier site; it is better laid out, is more compact, and has a splendid underground surgery. Saw many cases coming in from the 36th Field Hospital across the island, a 2-day trip by road from Baybay. Records were good and the patients were in good condition. Observed numerous cases described as trenchfoot, but they do not appear to me to be typical.
The evacuation of patients has not been good. Too manypatients have been evacuated from Leyte. Fifty percent of the Leyte patientssent to Saipan have been returned to duty in 1 month. However, there were notenough beds available on Leyte. They were supposed to have 9,000 beds by D+20.Now, D+60, the only general hospital functioning is the 118th with 600 beds.With the beds of the station hospitals this adds up to approximately 2,000 bedsavailable. The reasons for this failure seem to stem from rain and the difficult
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engineering problems in this area. Hospitals have not gottenhelp from the Engineers. Also, hospital sites were poorly chosen.22Headquarters has one of the best sites along the beach, which I enjoy, but whichis not fair to the hospitals and the sick. The evacuation route is hospital tobeach, but there is often no LST to pick up the patients. Talked with theskipper of an LST, and he said that the patients were never on the beach whenrequested. Obviously, an evacuation station should be established on the beachas a holding station to correlate evacuation. Thus, there has been inadequatecontrol of evacuation from the island, and much unnecessary evacuation ofpatients who could well have recovered here if facilities had been available.
Sunday, 17 December
Went out this morning to visit the Wasatch, flagship,and Captain Walker [Capt. Albert T. Walker, MC], USN, surgeon of the SeventhFleet. Colonel Kendrick [Col. Douglas B. Kendrick, Jr., MC, Special Assistantfor Shock and Transfusion, USAFPOA] and I had a long talk with Walker regardingthe blood bank. He impressed me with the soundness of his ideas and has a bettergrasp of the surgical problems of combat amphibious troops than anyone I haveseen in the Pacific Ocean Area. Moreover, he has accomplished more than anyoneelse. We then visited LST 464, which is undoubtedly the finest medical unitafloat. This is an LST that has been converted into a 200-bed hospital ship-clean,good food, laundry, good operating room. Here is the most concentrated and bestorganized surgical care I have seen in a forward area in the Pacific.
They`re doing excellent investigative work on shock andburn patients, whom they have in great numbers. Japanese suicide bombing resultsin many burns. For burns, they are using plasma and serum albumin in largequantities, all controlled by hematocrit and protein levels-as much as 1,200units per patient-plus blood. They find serum albumin better than plasma whenthe condition is severe. They have their own blood bank. The donors are Armypersonnel who are picked up on the beach. The LST proceeds to pick up patientswhile the donors are bled, then the donors are disembarked on the way back. Only1-qt. containers, discarded vacoliter bottles, are used. For pooled group Oblood, eight donors are bled into 10-gallon bottles. Nine thousand cc. blood,plus plasma, were given to one patient.23
22I saw these installations when I was with General Kirk and party in February 1945. The locations were miserable but were all that were available at the time. By February, they had either moved or were in the process of moving. I think the medical service did very well, as did the patients with whom I talked.-J. M. W.
23Dr. Ernest Eric Muirhead, formerly the director of the blood bank on LST 464, in a telephone conference with Maj. J. K. Arima, 11 December 1958, stated that Captain Walker, surgeon of the 7th Amphibious Force, wanted whole blood and had picked Dr. Muirhead to get it, since Dr. Muirhead had had some experience with whole blood before the war. The Red Cross blood was not then available. So LST 464 was set up in New Guinea and then went to Leyte. According to Dr. Muirhead, they (on LST 464) "had to do with what we had." Two kinds of bottles were used-the 1,000-cc. vacoliter bottles and the 20,000-cc. regular laboratory water bottles. Preservative was made from citrate and dextrose because the ACD solution was not yet available. Any number of donors with group-O blood were bled directly into these bottles, appropriate amounts of citrate and dextrose were added, and the bottles were stored in the ship`s walk-in type of refrigerators. The blood was not typed for Rh factor, neither was it titered. In times of stress, transfusions were effected directly from the large bottles, which had been adapted for giving purposes with pressure bulbs.-J. K. A.
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Large amounts of citrate may result in carpopedal spasmswhich are relieved by calcium gluconate. The Navy makes up and distributes setsof copper sulfate for bedside work.
Casualties received earlier were given better treatment thancasualties now being received. When the S.S. Bountiful took in one loadof patients, nearly every compound fracture was infected owing to the poor setupand overloading of shore facilities. The 7th Amphibious Force now has 70 LST`swith surgical facilities and 23 surgical teams.24Each team is composed of 5 surgeons and 18 corpsmen. These are quicklyshifted from one LST to another. This ship [LST 464] also moves about among thefleet, taking cases from ships that have been hit. The LST goes in on theinitial landing and remains as a floating emergency hospital. The 60well-trained corpsmen work most efficiently. The LST unloads its patients to anAPA [transport, attack], APH [transport for wounded], or other ship which takesthem to hospital ships outside the combat zone. He, Walker, is not informedregarding beds available in the Marianas. See Admiral Laning [Rear Adm. RichardH. Laning, MC, USN, Inspector, Medical Department Activities, Pacific OceanAreas] about entire theater correlation. Will these LST`s and surgical teamslater be available for Western Pacific operations?
Captain Walker first described these procedures for theBureau of Medicine and Surgery in May. They consented to equipping LST`s withsurgical facilities, but refused to build LST hospital ships on the grounds thatconventional hospital ships were being built. They apparently missed the pointthat hospital ships outfitted in accordance with the Geneva Convention cannotoperate in these waters during combat. Three attempts were made to bomb hospitalships, one at night when the ship had to be lit up. Captain Walker asks that Itake up the LST hospital ship problem with Admiral Laning. This was the programI tried to institute in the South Pacific a year ago, and which met with CaptainHook`s approval but was turned down because of construction difficulties.
Observations on Blood ProgramWhen General Rankin and General Bliss visited USAFPOA, Iadvocated a blood bank program for all Pacific Ocean areas and suggested thatsomeone who had had experience in the European theater should set it up, DougKendrick if possible. Apparently the Navy had also been working on a program,and the first I heard of this was when Blake and Brown came through Hawaii withthe blood, on their way West. This had developed into a combined Army-Navyprogram on the West Coast. The Army was collecting blood in San Francisco andthe Navy in Los Angeles. Blood was transported by NATS to Guam under thedirection of the Naval District and Capt. Newhouser [Capt. Lloyd R. Newhouser,MC, USN]. The ATC was landing on Saipan, so refrigeration was set up there. Butthe blood arrived in the Marianas before
24The 7th Amphibious Force under Rear Adm. Daniel E. Barbey, USN, comprised one of the two attack forces of the Seventh Fleet in the assault on the Philippines.
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any real preparation had been made to receive it. Unfortunately, no one inthe Pacific Ocean knew about the program, so it got off to a bad start. TheNaval surgeons in CINCPAC [Commander in Chief, Pacific Fleet] were peeved butcooperative. When Kendrick and I arrived at Leyte, considerable time and effortwas needed to establish cordial relations. Both Army and Navy had had bloodbanks functioning for some time in the Southwest Pacific, and the LST 464,especially, had performed outstanding service. The people in the SouthwestPacific Area were perturbed that the first they learned of the blood program wasfrom the newspapers. Consequently, their first inclination was to say that theywanted no part of it. However, in spite of the excellent blood bank alreadyestablished here, there was a need for still more blood. Many of the hospitalsdid not know that blood was available. The loss in early shipment of blood toLeyte amounted to approximately 50 percent owing to the fact that arrangementshad not been made for proper refrigeration or distribution. The chief reason forthis loss was lack of ice. There is a need for a directive on the use of bloodand an educational program among the medical officers.
There has been a heavy loss of men from the line because of the lack ofhospitals. Although the hospitals are here, there are few good sites, and thesehave been used for other purposes, such as headquarters. Result: Engineeringproblems are so great that hospital building has been slowed down. Now, D+60, a15-day evacuation policy is in force. Patients have had to be transported 1,500miles to the nearest hospital, and since many are returned to duty, time andtransportation are lost unnecessarily.
Tuesday, 19 December
Saw Colonel Wills, Base Surgeon, who was very cooperative in helping toarrange the blood program. Visited the S.S. Mactan, the last ship onwhich Colonel Carroll came out of Manila. It now serves as the surgeon`soffice. Major Steinberg is in charge of planning, another young officer with alarge job. The Southwest Pacific Area has 44,000 beds, but about 25 percent ofthese are inactive due to moving. There are 23 general hospitals. Obviously,general hospitals are being used for station hospital work, which is one of thereasons that there are not enough specialists to go around.
The overall plan is to support each division with one 400-bed evacuationhospital, one 400-bed field hospital, one separate clearing company, oneseparate collecting company, one company from the engineer special brigade, andthree portable surgical hospitals. Portable surgical hospitals are used becausesurgical teams are not available. The general impression is that the portablesurgical hospitals are not adapted to this type of land fighting, but that theyare useful as 25-bed station hospitals, for example, to support an isolatedairstrip.
Saw Colonel Weston, 44th General Hospital. They were set up near an airstrip.About 600 Japanese paratroopers landed on the strip, and a few nights laterreinforcements came in to join them. Our men decided to hold the perimeter, asthey had about 200 patients in tents and the road in was im-
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FIGURE 334.-A scene at the 116th Station Hospital, Leyte Island, December 1944.
passable. The Japanese came into a signal company first, and the guards were ordered out to the perimeter. By this time, the Japanese had machineguns set up on three sides of the hospital. There was an all-night fight, and in the morning they found 23 dead Japanese. Two officers of the hospital were wounded. None of the hospital personnel had had training in firearms other than squirrel shooting. The commanding officer suggested, before leaving the States, that they should have such training, and he was told that all the training they would need was in getting into formations, so as to be able to march on and off the trains.
Wednesday, 20 December
Today, I tried to drive to the 44th General Hospital, but thebridges were still out and the roads were impassable. D+60, and no generalhospital has been set up as yet to receive surgical patients. Visited the 116thStation Hospital which never took any patients and is now moving (fig. 334).
Saturday, 23 December
Much conversation during the last few days regarding the useof blood and how to get it distributed. Much careful sidestepping to avoidstepping on toes, which have been rendered more sensitive than usual becausetheir owners have missed so many boats. But, slowly the plan is being acceptedand cooperation is being achieved. The prima donnas and the weak egosundoubtedly retard military accomplishment. In the Army as in civilian life, ifnonmedi-
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cal men are to assume administrative responsibilities formedical care, they should be educated in medical problems, at least to theextent of being able to identify a competent surgeon.
This morning, I visited the general`s (MacArthur`s)quarters situated on the beach. Adjacent to these quarters are frame buildingsfor the staff. The general`s house is huge and beautifully furnished.
Sunday, 24 December
Saw Col. Morris Bradner [Col. Morris R. Bradner, MC] of NewYork. An excellent surgeon who thought he could do more good in this war in anadministrative capacity. He was surgeon of the 248th Garrison Force attached tothe XXIV Corps. They started for the Palaus from Hawaii, target then changed toYap, then changed to the Philippines.25 Theywere at sea for 54 days and debarked on Leyte D+12. Of this force, apparentlyonly the XXIV Corps was wanted, and now, D+60, the garrison force has not beenused and they do not know what their assignment is to be. These hospitals havetherefore gone through 4 months of training in Hawaii and have spent 54 days atsea and 2 months on Leyte. Colonel Bradner is discouraged, he has offered hisservices through the usual channels, but no one seems to want them. Another goodsurgeon gone to waste in a campaign where surgeons were at a premium.
Monday, 25 December
Visited LST 1018-Lieutenant McDermot, surgeon. They had cutwatertight doors between the tank deck and the troop quarters, where they made adressing room and washing room for patients and an operating room. There wasspace there for the seriously wounded and 200 patients could be put on the tankdeck. Certain equipment was lacking, such as anesthesia machines, waterpitchers, and some means of keeping hot soup or coffee. They were staffed with aminimum crew of 2 doctors and 10 corpsmen, which is not enough during anassault. All LST`s are to be converted in this manner-they now have 17converted. In addition, such ships as the LST 464 are needed as floatinghospitals.
7th Amphibious Force: 70 LST`s, 17 now converted forsurgery; No. 464, a hospital LST with complete staff and 60 corpsmen; and 23surgical teams (5 surgeons, 18 corpsmen each).
Navy doctors say that the initial phase of surgery on land ispoorly done. On S.S. Bountiful every CC [compound comminuted] fracturewas found to be infected. Captain Walker, 7th Amphibious Force, gets a report-name,rank, and serial number-in all cases of improper handling.
The handling of blood is improving but still needs muchsupervision. Need a system for dropping blood from "Cubs" by parachutewhen the roads go out. There is a plan for 96 L-5`s ("Cubs") totransport casualties. They can carry one litter and two sitters and operate froman 800-ft. runway.
25How could anything but confusion result from such a change of plans? Yet the Medical Department had no choice-Yap Island was never invaded!-J. M. W.
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FIGURE 335.-Wards of the 165th Station Hospital, Leyte Island, December 1944.
A better plan for marking hospitals is needed. Some commanding generals are said to be afraid of signs.
Visited Abuyog, the eastern terminal of the road from Baybay.One platoon of a clearing company is here to transfer patients to DUKW`s[amphibious trucks 2?-ton] to go to Dulag-about 200 daily. Those who did notstand the trip well (4 hours over bad roads) from Baybay are held here at Abuyog.More serious patients come from Ormoc by boat. Air evacuation from Valenciabegan on D+60.
Wednesday, 27 December
The 165th Station Hospital (750 beds) was sent in as anevacuation hospital to support the 96th Division. They had two additionalsurgeons attached. The 76th Station Hospital (500 beds) was to act as anevacuation hospital in support of the 7th Division.26Because of the terrain, weather, and tactical situation, these two hospitalswere placed adjacent to each other and received patients from both divisions.They were situated about 500 yds. from the beach at Dulag. The site was verypoor, so low and muddy that it severely handicapped the functioning of thesehospitals.
The 165th Station Hospital usually has about 300 surgicalpatients, the rest are medical (fig. 335). Since 1 December, they have performed17 major and 353 minor operations. There were 44 deaths, of which 14 werepostoperative (5 abdomen, 9 other) and 30 were nonoperative. The operating roomis well set up, but aboveground and without sandbag protection. Wards are of the"T" variety with pyramidal tent junction. Equipment isadequate. This hospital could be improved by a better planned layout. Allhospitals that have
26The 96th and 7th Infantry Divisions comprised the XXIV Corps and took part in the initial landings at Leyte.
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not functioned in the field should receive instruction as toplanning from those who have had such experience.
On A+1, 21 October, word was received on shipboard that foursurgical teams were needed ashore. They started ashore but were driven off bymortar fire, then went 5 miles down the beach toward Abuyog and landed. Theyfound a few soldiers there who knew nothing of the local situation. They thenstarted up the beach and dug in for the night. Next day they still could notfind out who had wanted the surgical teams. They set up at this site on A+4 andimmediately received 200 civilian casualties in bad condition. The G-2[intelligence] was not good, and much of the land and roads that were thought tobe usable were actually under water. They had many more casualties than could behandled during the first week, and large numbers were evacuated without beingseen. After the first week, by dint of very hard work, they were able to seemost of the casualties. However, the job done forward was not entirelysatisfactory. Again, this was due to the excessive work that was demanded of theforward installations. Many patients had incomplete debridement. Thisnecessitated the frequent changing of dressings in order to determine thecondition of wounds, some of which were labeled "moderate debridement."Since the four surgical teams could not work 24 hours a day, only two surgicalteams were operating at a time.
The number of beds available in support of the divisions wasinadequate: 750-bed station hospital, 500-bed station hospital, two 400-bedfield hospitals-total 2,050 beds. These were situated behind the clearingstation to serve three divisions-about 700 beds per division. Result: Largenumbers were evacuated from the island who might otherwise have been returned toduty; inadequate surgery and lack of beds prohibited reparative surgery.
There is too much emphasis on planning the rear echelonhospitals. More emphasis is needed on staff planning for hospitalization inforward areas.27
Friday, 29 December
Flew over to Valencia, Bohol Island-a former Japanese strip-thismorning in a "Piper Cub."
Drove over to Headquarters, 77th Division.28The roads were crowded with thousands of natives transporting theirhousehold goods on their heads or on the backs of water buffaloes. Thismigration was coming from the mountains. The GI and the native women were allbathing together in the streams we crossed-danger of schistosomiasis.
Colonel Ivins [Lt. Col. John C. Ivins, MC], surgeon of the77th Infantry Division, was out. The 95th Portable Surgical Hospital wasfunctioning with the clearing station here. The surgeons of the clearing stationwere alternating with the surgeons of the portable hospital so that they eachdid about the same amount of surgery. Reports from the field hospital indicatedthat the
27I agree, but task force commanders determined the number of beds in forward areas.-G. B. D.
28The 77th Division, which had been engaged in the recapture of Guam, was sent to Leyte in late November 1944 to reinforce the embattled XXIV Corps. On 7 December 1944, it had made a surprise landing near Deposito and had driven through the Ormoc Valley to effect a junction with the 1st Cavalry Division near Valencia, Bohol Island.
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surgery of the clearing station was not good and that theywere doing other than emergency surgery. Furthermore, the emergency surgery wasnot well done.
Talked with General Bruce [Maj. Gen. Andrew D. Bruce,Commanding General, 77th Division] who is very medically minded. He says thatthe foot problem is most important and he wants one pair of socks brought upwith the rations each day. He was unhappy with Navy evacuation and stated that100 wounded men were left on the shore because the boats would not wait. Brokenglasses are a major problem. He wants an extra case issued to each man forreplacement lenses and frames, especially as he has many men of 35 years orolder (average age in the 77th Division, 29 years). Morphine seems to be verybeneficial for morale; the surgeon said he had seen no ill effects. GeneralBruce also wants a bag in the hat for a latrine at night. Evacuation is beingdone extensively by Cub and this is good for morale. They badly need ambulanceCubs.
Drove to Ormoc, Leyte, to visit the 36th Field Hospital. Lt.Col. Devine [Lt. Col. John L. Devine, Jr., MC] is commandingofficer-a superior officer. This hospital is set up in a shelled 16th centurycathedral. There is no roof, but the thick walls provided goodprotection. They will need much equipment and some personnel before their nextoperation. Generators and X-ray machines are worn out. They need two surgeonscapable of heading a team-one general, one orthopedic. They are short 3officers and 12 enlisted men. Colonel Devine believes that many of the officersand men, having been on five missions, are fatigued. In common with othercommanding officers, he emphasizes the need for nurses early in a campaign.
The 36th Field Hospital had 1,884 patients in 17 days, mostlysurgical. They averaged 125 per day, 250 patients on the top day. They diddefinitive surgery mostly-2,600 in a month with three moves. This hospital haskept permanent records for its own use. They are abstracted and typewritten onall field records. The surgical records are superior. They received casualtiesfrom the 7th Division, the 77th Division, and the 1st Cavalry Division.
More directives and instruction are needed. Limbs are stillbeing lost due to tight casts. One patient had a cast on over a clovehitch. Result: loss of foot. These hospitals, the 36th and 69th Field had neverheard of the copper-sulfate method for protein determination. The 36th Fielddoes not have a qualified anesthetist or anesthesia apparatus.
Saw Colonel Kamish [Lt. Col. (later Col.) Robert J. Kamish,MC] division surgeon of the 7th Division, and talked with General Arnold [Maj.Gen. Archibald V. Arnold, Commanding General, 7th Division]. He is verymedically conscious and recommended Kamish for the Legion of Merit. The XXIVCorps under General Hodge has offered full support and recognition to theMedical Corps, and any shortcomings cannot be attributed to lack of support bythe commanding generals. Unfortunately, many of the good division surgeons donot and cannot be expected to appreciate surgical principles, since they are notsurgeons. Having developed through the field service, they are
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prone to believe that field surgeons are better qualified todo surgery than is actually the case.
Saturday, 30 December
After seeing Colonel Kamish this morning, I drove to the 69thField Hospital which has been set up for about a week near the airport atValencia. The hospital commander is ill and has been evacuated. Maj. FieldingWilliams [Maj. Fielding P. Williams, MC] is acting hospital commander. They haveno anesthesia machines. This hospital needs at least one surgeon qualified aschief of service. The laboratory has never heard of the copper-sulfate proteinmethod.
Waited at the airstrip and watched a number of patientsevacuated by Cub. Compound comminuted fracture of the femur, belly, head wounds,and so on; all evacuated sitting up. They appeared to stand the trip from theclearing station (20 minutes) very well. Ambulance Cubs are needed for economyof operation (three planes needed now where one ambulance plane could suffice)and welfare of patient.
Sunday, 31 December
Spent the night at the 69th Field Hospital and on to theairfield the next day. While at strip, saw General Hodge, Commanding General,XXIV Corps, who stated that he was pleased with the medical service but feltthat hospitalization was inadequate. General Richardson [Lt. Gen. Robert C.Richardson, Commanding General, U.S. Army Forces, Pacific Ocean Area] came in,and a guard of honor was present. Came back to Sixth U.S. Army headquarters [theSixth U.S. Army was comprised of the X and the XXIV Corps] in a "Cub"and spent the afternoon looking over the harbor for Captain Walker.
Monday, 1 January 1945
Japanese started the celebration by bombing last night, andat midnight our boys responded. Felt less safe than in an air raid. Arrangementsmade for Lingayen operation. I am to go on an LST (H) [landing ship tank(casualty evacuation)] and remain at target.29
Aboard LST 1018, Wednesday, 3 January
Boarded the general`s crash boat, then on to Wasatch, flagship.Left some luggage with Captain Walker who invited me to join him after we reachthe target. Left Wasatch in search of LST 1018. The coxswain of the boathad received instructions, but got mixed up between true and relative bearings,and we ended up on the opposite side of the bay. We boarded the LST 1018 atsupper time after two hours` search.
There is a surgical team aboard of four doctors plus the ship`sdoctor. This appears to be a capable surgical team that is well organized, butthey are
29The Biennial Report of the Chief of Staff, U.S. Army, for the period from 1 July 1943 to 30 June 1945, to the Secretary of War states: "In the first week of January [1945] a new American assault force gathered east of Leyte, slipped through the Surigao Strait * * * and passed into the Mindanao and Sulu Seas. This American force was treading its way through the heart of the Philippine Archipelago and through waters where the Japanese Navy and air forces had for two years maintained unchallenged supremacy, to invade Luzon by effecting a landing in Lingayen Gulf * * *." D-day was 9 January 1945 and, in this case, was formally designated "S-day."
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short of supplies because they were not notified that theywere going to function as a hospital ship. Supplies were not available in Leyte,and they could not return to Hollandia or Manus. Furthermore, the other hospitalships have not had the supplies, or they have been reluctant to part with them.
Thursday, 4 January
Clear, set sail at 0600, about 80 ships in sight in theconvoy.
1600. Have met a large convoy presumably from Hollandia-numerousbattlewagons, cruisers, destroyers, flattops.
1800. Apparently, this convoy is to be about 75 miles longand we have joined up too soon, so we are now going back past innumerable shipsto get into position before darkness.
2000. We have now turned around and are heading into SurigaoStrait toward a golden glow beneath thick laden clouds.
Friday, 5 January
1400. Sailing through Mindanao Sea-smooth and hot. Boholfading and Cebu Island can be seen in the distance off starboard.
1830. Negros Island off starboard, like a camel`s hump inthe clouds-a beautiful golden sunset.
Saturday, 6 January
Negros still off starboard. Smooth sailing through the SuluSea.
Sunday, 7 January
Peaceful ships and a clear, bright, hot morning. Japaneseattacked at 0600. We are about 8 miles off the lower end of Mindoro Island.
Monday, 8 January
1100. The mountains of Bataan are plainly visible off ourstarboard. It has been quiet since 0900, and two carriers can be seen between usand Bataan. The convoy plows steadily northward.
Tuesday, 9 January
D-day, reveille 0500.
0600. Up on the bridge; clear starlight with a sliver of anold moon. The dim outline of Mount Santo Tomas on the portside. We are well intothe Lingayen Gulf and moving steadily ahead. The dim silhouette of thebattlewagons can be made out.
0700. All the battleships opening fire on the portside,followed by the guns on the starboard. We are in the middle. There are two taskforces, one off the port (the landing is to be made on WHITE, RED, and BLUEbeaches near Mount Santo Tomas) and the other off the starboard bow, preparingfor a landing at the town of Lingayen. The shelling starts rather slowly andcontinues with increasing tempo.
0815. We have moved through the haze nearer the shore, and Ican now see the church in Lingayen.
0850. Bombardment continues. Our bombers can now be seenbombing the shore, and great clouds of smoke and dirt shoot into the air in1-2-3 order. The first wave of small boats loaded from the transports behind usare now passing. They are scheduled to reach the beach at 0930 (fig. 336).
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FIGURE 336.-Troops of the 37th Division coming ashore, Lingayen Gulf, 9 January 1945.
0920. The roar is deafening and continuous. The shore has disappeared in a great wall of smoke and fine into which the small boats disappear.
1000. The naval bombardment has nearly ceased, like an intermission when onecan relax. From out of the smoke toward the shore comes the sound of distantmortar fire. A great pillar of black smoke appears from the general direction ofClark Field, Luzon.
The smoke is lifting, and once again I can see the shoreline. Everywhere,small boats, like water bugs, are darting hither and yon. The great symphonicoverture is over.
Wednesday, 10 January
0500. General quarters; Japanese torpedo boats are among the fleet. Went ondeck. Very dark night plus a smokescreen. The Infantry is putting up flares onshore so they can see the Japanese, and we are putting up a smokescreen so theJapanese cannot see us.
0600. Japanese planes overhead, and everybody shooting at things they cannotsee.
0645. Another plane raid. This time I saw them diving into the smoke, withtracers going in every direction. Most of the fighting today is in the SanFabian beach section.
Aboard LST 911, Thursday, 11 January
1000. The usual air raid this morning. Went toward shore to visit LST 911which was unloading on the beach and had a surgical team aboard. A heavy surf-6-footwaves-was running, and I felt and acted like the man on the flying trapezewhen boarding this LST.
The 911 had excellent plans worked out for triage, records, and availablebeds. They have a surgical team of 5 doctors and 11 corpsmen headed by Dr.
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Sasnow of San Francisco. They, as well as LST 1018, are shortof supplies and equipment for adequate performance in case of heavy casualties.They tried to obtain these from the hospital ships but were unable to do so.Apparently, hospital ships are not fulfilling their function as supply ships.This ship was unable to receive casualties until D+2 as it was not loaded forassault shipping. They have shot down five Japanese planes. As near I can learn,out of some 230 LST`s, only one has been hit on this mission, and that by atorpedo. The risk to an LST therefore seems to be slight. Furthermore, they nowcarry a lot of firepower-ten 20-mm. and seven 40-mm. guns. (Interrupted byanother air raid.)
The Wasatch, Friday, 12 January
0700. Heavy air raid. This afternoon I went to the Wasatchto see Capt. Albert Walker and Lt. Col. Stuart Draper, MC. The latter is aSixth U.S. Army evacuation liaison officer with the 7th Amphibious Force. Ifound out that two other LST`s are functioning as surgical ships on WHITEbeach, where most of the casualties have been received.
Returned to LST 1018, packed my duffle, and returned to the Wasatchat Captain Walker`s invitation. This is Admiral Kincaid`s flagship.
Saturday, 13 January
Visited all the beaches today and went up a river to delivera Filipino to his family. This chap had 25 years` service in the Navy and hadhidden out in Manila for these 3 years. Yesterday he reported to the flagshipfor duty. He went ashore proudly, dressed in white, to visit his family. On thebeaches, the surf was very high, and not one LST was unloading although severalwere beached. The pontoons were washed up on the shore.
The Blue Ridge, Sunday, 14 January
Went with Captain Walker and Commander Klein, who is Walker`sassistant, to visit two LST`s that are functioning as surgical ships. Waterand steam are piped to the tank decks. There are auxiliary lightingfacilities and surgical faucets. Steam and water are available in the head forcleaning bedpans. About 50 percent of the cases here have had debridement andcasts applied in the clearing station. Some were well done and others poorly.The blood appeared to be in good condition, dated 1 January, "WestCoast," and was well refrigerated.
DUKW`s bring patients out from the beach and drive them upon the ramp for unloading. However, when weather is rough this may be difficult.The beach setup is splendid. A Navy medical officer and four corpsmen areassigned to the beach. He sets up adjacent to or with a medical company of thespecial engineer brigade. The engineer medical company designates patients forevacuation and the Naval beach officer is responsible for obtaining the shipsand supervising the loading. This plan has been slowly evolved throughexperience and is the best that I have seen in the Pacific. It could be improvedupon with better equipment [in the LST`s], such as (1) portable anesthesiamachines Heidbrink, (2) intratracheal anesthetic apparatus, and (3) portableorthopedic tables. The personnel of these ships may be overworked, and Army sur-
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gical teams functioning on these ships would be of greatassistance until shore installations were ready.
This afternoon I heard that the Blue Ridge, AdmiralBarbey`s flagship of the 7th Amphibious Force, was to return to Leyte, so Itransferred to her.
SUMMARY OF MEDICAL CARE AND EVACUATION DURING THE LINGAYEN CAMPAIGN
1. The plan.
a. General objective.
(1) The distance involved in evacuation made it imperative that definitive surgical care be provided at the target. Emphasis was placed on early and adequate surgical care at the target rather than on speed of evacuation to the rear areas.
(2) Cooperation of Navy and Army planning was emphasized, and a close liaison was maintained between the commander of the Seventh Fleet and the commander of the Sixth U.S. Army and subordinate units.
b. Fleet surgical facilities and supplies at combat area.
(1) Numerous and varied types of vessels carrying combat supplies and personnel to the target were equipped to provide surgical care. Evacuation from the Lingayen Gulf to Leyte was by APH, APA, and LST.
(2) Near the beaches, main reliance for surgical care was placed on the LST`s. Eighteen of these ships had been converted to provide facilities for surgery. Six of these converted LST`s were staffed with augmented surgical teams (5 doctors and 18 corpsmen). These ships were under the control of CTF [Commander, Task Force] 77. After unloading, they were to anchor near the flagship for ease of communication. The medical representative of the Commanding General, Sixth U.S. Army, was also aboard this ship. The ships were to remain in the combat area, receiving casualties day and night, and be on call to proceed to beaches or go along the side of damaged ships as needed. One of these LST`s was assigned as support for each beach. As they became loaded, and according to the condition of the patient, the casualties were transferred to APA`s or APH`s for evacuation to Leyte.
(3) In addition to servicing the ships in the harbor, three PCE (R)`s [patrol crafts, escort (rescue)] were stationed near the flagships. These ships proceeded immediately to any vessel that was hit.
(4) Whole blood was available from S-day onward on flagships, on any surgical LST, and at reefers on BLUE and ORANGE Beaches.
(5) Supplies were available, as follows (fig. 337):
LocationOrganization
Period of time
WHITE Beach
I Corps Medical Dump
S-day onward
ORANGE Beach
XIV Corps Medical Dump
S-day onward
LST`s 564, 118, 704, 202
Medical Exchange Units
S+2 onward
WHITE Beach
21st Medical Supply Platoon
S+4 onward
Dagupan, Luzon
49th Medical Supply Depot
S+4 onward
ORANGE Beach
55th Medical Supply Depot
S+4 onward
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(6) Beach medical party consisting of one doctor and two corpsmen acted as liaison for Army evacuation from the beach. This officer maintained contact with the beachmaster and the medical company ESB [engineer special brigade] which performed triage for the Army during the early phases of the assault and later acted as a holding hospital on the beach.
c. Army surgical facilities at combat area.
(1) Each division was to be supported by one field hospital; one evacuation hospital; one clearing company, separate; one collecting company, separate; and one medical company, engineer special brigade.
(2) The medical company of the engineer special brigade was to be the first medical facility ashore. It was established on the beach and remained there, allowing the divisional medical units to proceed inland with the troops (fig. 338). It acted as a holding station on the beach for patients transferred to the LST`s and also cared for the casualties that had been wounded on the beach.
2. The functioning of the plan.
a. Combat loading of surgical LST`s.-In order that these ships may be able to perform their function in providing early surgical care during the initial phases of the assault, it is necessary that they be loaded with combat supplies having an early priority on the beach. One of these ships, transporting bridge pontoons, was not unloaded until S+5. Part of this delay was due to the very heavy surf which prevented the LST`s from getting closer than
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500 feet from the shore; the remainder of the distance had tobe spanned by pontoons.
b. The surf was so heavy that when pontoons could not be maintained only DUKW`s were suitable for the transfer of casualties to the LST`s.
c. The LST`s appeared to be relatively immune from airattack as there were so many more profitable targets. It is likely that LST`sare hit only when they become targets of opportunity.
d. The equipment of the surgical LST`s could beimproved upon by the addition of portable anesthesia apparatus, intratrachealanesthesia sets, and portable orthopedic tables. Those ships acting as surgicalstations should also have portable X-ray apparatus. An additional number ofpitchers and bowls should be provided to facilitate the distribution of liquidsand soup.
3. Observations.
a. The LST converted, equipped, and staffed as a surgical hospital for use during the initial phases of the assault has many advantages:
(1) They provide adequate facilities for early definitive surgery at a time when this cannot be provided on shore.
(2) They provide adequate facilities for handling a large number of casualties (185 casualties) in comparative comfort.
(3) They remove the wounded from the immediate frontline and provide a sense of relative security.
(4) The LST is less likely to be attacked than a larger ship. It carries more firepower than the smaller craft and is less likely to incur serious damage when attacked as a target of opportunity.
(5) When beaching is possible, the transfer of casualties from shore is accomplished with the greatest ease (fig. 339). Transfer of casualties to the deck of APA`s or APH`s is facilitated from the deck of the LST.
(6) A surgical hospital available to the beach at all times is essential until surgical facilities can be established on shore. This can be provided by the LST with a minimum loss to combat shipping. Inasmuch as several ships are available, they may be dispensed with as the need diminishes.
(7) The presence of such a hospital facility afloat diminishes the need of establishing operating facilities ashore until this can be accomplished adequately and in safety.
(8) There are now 60 LST`s converted for surgical use. It is desirable that all LST`s be constructed or remodeled so as to be used for patients.
(9) Two types of LST`s are needed for surgical care. One functions primarily as a cargo ship, with casualties incidental, and does not remain at the target. A second type, with adequate equipment and a surgical team aboard, remains as a hospital ship at the target.
b. Shore units and control of evacuation.
(1) The beach medical officer and two corpsmen are stationed at each beach and function with the medical company, ESB. The medical company, ESB, performs three functions: Care of beach casualties; triage for casualties
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before evacuation; and holding casualties on the beach so that ships do not need to wait for casualties.
(2) The beach medical officer is essentially a traffic officer, for liaison between the Army ashore and the Navy afloat. He is familiar with the surgical ships available and is responsible for seeing that casualties are properly distributed so that ship hospitals do not become overtaxed. For example, when casualties are heavy, minor wounds cannot always be treated ashore and should be sent to any ship that has a doctor aboard, while the serious casualties should be sent to the surgical LST`s. When the operation is on a large scale, specialized surgical teams may be spotted on certain LST`s.
(3) In heavy surf, as at Lingayen, the DUKW appears the safest means of transporting casualties to ships.
4. Recommendations.
a. Use of medical company, ESB, to act as holding hospital on the beach and for triage.
b. Use of beach medical officer (Navy) to correlateArmy-Navy shore-to-ship evacuation.
c. Use of LST`s as surgical hospitals. Conversion ofall LST`s so that they may be used surgically, since the loading and unloadingof LST`s cannot be controlled according to ship. Certain LST`s that haveearly priority in unloading should be used as evacuation hospitals and remain onthe beach until shore facilities are established (one LST to each beach or Armydivision).
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These ships must be adequately equipped for major surgery, including anesthesia.
d. At least one of the surgical teams to be employed (five per division during combat) should function aboard the LST until the shore facility is ready for use.
e. More indoctrination of corps and division surgeons concerning the function of various units, such as clearing stations, surgical teams, field hospitals, and evacuation hospitals.
f. Clearer definition of evacuation policy. Too many men are evacuated who are well before they reach the next echelon.
g. More prompt establishment of convalescent hospitals or units so as not to overutilize the beds of acutely needed surgical hospitals [for those with minor wounds] and so as not to force evacuation of minor wounded from the island.
h. Clearer definition of policy concerning priority for hospital sites and assistance in construction. When hospitals are expected to provide their own construction, they should have the requisite equipment.
Saturday, 13 January
Set sail at 1700 with two APA`s and a convoy of destroyers.This should be a fast trip.
Leyte, Wednesday, 17 January
Not one single Japanese attack. Today we passed a slow convoygoing south and another one going north. The Sulu Sea seems like an Americanlake.
Tonight Admiral Barbey invited me up on the bridge for a chat(fig. 340). He is known as "Uncle Dan the amphibious man." The admiralis a large, dark-complexioned man with a friendly, jovial, simple direct manner.He is medically curious and deserves great credit for his cooperation andenthusiasm in developing the medical service for amphibious warfare. He thinksthe Japanese conceded the Philippines after the Leyte Campaign, and that Luzonwill be only a delaying action while they marshal their forces for the next lineof defense.
Sailed into Leyte Gulf and over along the coast of Samar,then straight into our anchorage in front of Tolosa. It began to rain, and Iwent ashore to what was left of Sixth U.S. Army Headquarters with the Admiral`sjeep. The storm increased and reached typhoon proportions during the night.
Thursday, 18 January
Went down to stay in the 118th General Hospital. In the mudand confusion of construction, I had a fine talk with Col. Jim Bordley [Col.James Bordley III, MC] and his colleagues, in the middle of their frog pond.
Peleliu Island, Friday, 19 January
Signed out at Sixth U.S. Army. Boarded plane at TaclobanField at 1000 hours. Landed Peleliu Island [Palau Islands] at 1400. Wentdirectly to the 17th Field Hospital, now under Navy management. Its chieffunction is to act as a transfer or holding point at the field. Still raining,but the island is coral and not muddy. Cordially received by Commander Kelley,pediatrician.
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After cleaning up I was taken to [U.S. Naval] Base Hospital No. 20 and shown the sights of Bloody Nose Ridge. There I found Emile Holman, somewhat lonely, a bit discouraged, but carrying on. As usual, a fine type of quonset hut construction-1,000 beds. There is no anchorage here, and the only casualties coming in are expected by air.
Guam, Saturday, 20 January
Off at 0945 hours, and arrived at Guam at 1515 hours, aftersevere rough weather. Amazed at the transformation here since my last visit.After Leyte the air terminal here looks like Grand Central Station, and thepaved roads are impressive. Went directly to the 204th General Hospital.
Sunday, 21 January
The 204th General Hospital is set up in tents, with theexception of the operating room, laboratory, X-ray, and nurses` quarters.Their semipermanent installation is being built. They are now operating morethan 1,000 beds but at present have only 150 patients, owing to the fact thatevacuation to Guam by ATC will not begin until 1 February. This hospital is oneof the best set up tent hospitals I have ever seen.
Guam, Friday, 26 January
Have spent the last 4 days recuperating from a cold andvisiting the 373d Station Hospital.
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Saipan, Monday, 29 January
Arrived at Saipan. Saw Colonel Longfellow and learned of thearrival of the 39th General Hospital. He had sent in an advanced party fromAuckland. Ottenheimer had not been sent forward to check on the plans.
Wednesday, 31 January
Construction started on the 39th, and ground cleared. Some ofthe best level land was not used for the site. No thought to future expansion to2,000 beds.
Friday, 2 February 1945
Have spent the last 3 days at the 148th General Hospital,which is slowly evolving into a hospital. Construction has been very slow. Itstill has only a 1,000-bed capacity (total beds available on Saipan, 2,000).Airfields and headquarters have priority.
Saturday, 3 February
Worked on logistics and visited the 369th Station Hospital awell planned and constructed hospital. Colonel Lubitz [Col. Benjamin Lubitz,MC], the commanding officer, was formerly surgeon with the 27th Division.
Monday, 5 February
Visited the 176th Station Hospital, a stone`s throw fromthe 369th. Both have excellent quonset construction. Why two station hospitalsshould be placed so close together is beyond me. They care for garrison troopsscattered over the island. Since these hospitals are not geographically suitedfor this purpose, they wish to combine them into a general hospital forcasualties, thereby correcting one mistake with another. This would entail anunnecessary duplication of skilled personnel as well as equipment.
Tuesday, 6 February
Radio today assigning Baker and me to the 204th GeneralHospital [Guam]-as this is the only hospital with vacancies for full colonel-andto temporary duty with the Surgeon`s Office, Western Pacific Base Command.30Also, a teletype for me to return to Headquarters, USAFPOA, by 15 February.
En route to Oahu, Hawaiian Islands, Thursday, 8 February
At 0615, just daylight, we got off and flew all day. At 1800we landed at Kwajalein, and a nice Navy lieutenant came on board and said thatthey would give us dinner on the plane and that we could leave in half an hourif it was all right with me. As though I would have nerve enough to tell theNavy what to do! So we left at 1900, and I played poker with four aviators until0300 of the same day, because we had crossed the dateline. I then went to sleepsoundly on my air mattress on the floor until they poked me to tell me that wewere starting down. At 0600, with the east in a pink glow, we landed at JohnstonIsland.
30The Western Pacific Base Command was activated on 25 April 1945. Included in this command were Army units on Saipan, Guam, Tinian, Iwo Jima, Peleliu, Ulithi, and Angaur Islands. The Western Pacific Base Command was subordinate to Headquarters, U.S. Army Forces, Pacific Ocean Areas.
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En route to Saipan, Friday, 23 February
Arrived at Fort Shafter, Oahu, and found Eddie Ottenheimervery industriously acting as consultant, working on history, personnel, etc. BenBaker was about to leave for Saipan. Many new officers have arrived. The portstill has a peacetime atmosphere and everyone is griping about the red tape, etcetera. Most of my time was spent in helping to put together a concise directivefor the Tenth U.S. Army on surgical care in the combat zone.31
Finally, I got the orders through and escaped with Eddie asthough from an asylum. We took off on 22 February at 2300 hours. The nurses whowere liberated at Luzon were at the field on their way to the States. The bandwas there playing "Show Me The Way to Go Home" and other similartunes, and everyone wore leis.
Saipan, Saturday, 24 February
Spent the day touring the island with General Kirk [Maj. Gen.Norman T. Kirk, The Surgeon General], General Simmons [Brig. Gen. James S.Simmons, Director, Preventive Medicine Division, Office of The Surgeon General],General Willis, and General Jarman [Maj. Gen. Sanderford Jarman, CommandingGeneral of the Army Garrison Forces, USAFICPA and USAFPOA].
Found that only one operating room was functioning at the148th General Hospital. We spent the remainder of the day trying to get somesemblance of organization. We transferred large numbers of the 39th GeneralHospital staff and a large number of nurses. These changes were quicklyaccomplished with the support of General Kirk and General Willis.
Note [written, apparently, sometime between 24 February andthe next entry, 15 March]: The hospital was soon running on a 24-hour basis withfour operating teams working continuously, averaging 60 majors per day. In all,2,200 [sic] serious casualties were treated, with a mortality of 1.1 percent.Considering the circumstances and the character of the casualties received, thuswas a splendid record.
Had a meeting with Ben Baker, Colby, General Willis, andGeneral Kirk this evening. Discussed evacuation policy with Willis, with a viewto avoiding the loss of shipping and manhours brought about by having toevacuate patients to Oahu, nearly 4,000 miles away.32
NOTES ON RECOMMENDATIONS FOR MAJOR GENERAL KIRK
1. The essence of good surgical care in the Army is to get the right man at the right place at the right time, in adequate numbers and with adequate equipment. None of this can be accomplished without planning. Consultants in the Pacific Ocean Areas have not been consulted in planning as of 10 February 1945. The efforts of a consultant who has not taken part in planning are
31This directive, the subject of which was "Surgery in the Combat Zone," was promulgated by Headquarters, U.S. Army Forces, Pacific Ocean Areas, on 27 February 1945. Colonel Oughterson was later to rewrite this directive at Headquarters, U.S. Army Forces, Pacific, where it was published in that command`s The Journal of Military Medicine in the Pacific, September 1945, pp. 11-23.
32The situation was corrected.-J. M. W.
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chiefly limited to trying to lock the stable door after thehorse is gone. Under these circumstances, there is a great danger of theconsultant assuming a one-sidedly critical attitude, since there is little leftfor him to do. His mission in planning, to improve the care of the sick andwounded, is blocked at the source.
2. Clinical research, for the benefit of the sick and woundedin this war and in future wars, is a responsibility of the Medical Department ofthe U.S. Army. It is recognized that the first responsibility is the care of thepatient, but there is an equal responsibility for investigative work which willimprove the care of the patient. Theater surgeons should be made aware of theirresponsibility in this field.
3. The essence of good surgical care is to provide goodsurgeons. The limited number of good surgeons available requires planning in thedistribution of skilled talent. Surgeons can be conserved by careful planning ofthe geographical distribution of hospitals, the size of hospitals, and the typeof hospitals. Two or more smaller hospitals should not be used where one largerhospital can do the work. This policy has resulted in a great waste of highlyskilled medical talent as well as equipment. Also, the less-skilled surgeon canfunction satisfactorily in a station hospital, if he is limited to the stationhospital type of work.
4. There has been too great a tendency to keep skilledsurgical talent in the rear, whereas the most difficult surgical tasks are to befound in the forward area. The wounded soldiers who die, usually do so at thefront. Greater mobility of these surgeons through the use of surgical teams isrecommended.
5. In the vast stretches of the Pacific Ocean there are agreat number of hospitals, large and small. The leapfrogging of these hospitalsmay involve distances of a few hundred miles or as much as 4,000 miles. Betweenthe time the hospital ceases to function and the time it receives casualties atits new location, several months to a year may elapse. In this manner the 7thEvacuation Hospital was inactive for at least a year. This results in a greatloss of highly skilled manpower, as well as a lowering of the morale of theunit. At the same time, the shortage of medical officers, nurses, andtechnicians in the forward areas has been increased. Air transport should beused to make this idle manpower available.
Saipan, Thursday, 15 March 1945
The major part of the Iwo Jima casualties have now beentreated. Plans are now being laid for Operation ICEBERG [the Ryukyus offensive,25 March 1945]. The shortage of personnel has necessitated that the hospitalfacilities on this island be organized as a hospital center. Furthermore, thesmall number of medical casualties has made it necessary to nearly abolish themedical service. Colonel Colby and Colonel Baker have given full cooperation inthe face of most trying circumstances. All medical cases are to be transferredto the 176th Station Hospital which, together with the 94th Field Hospital, hasfive psychiatrists plus other personnel, and functions as a station hospital formedical cases. This frees the 148th and 39th General Hospitals, plus the 369thStation
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Hospital, for surgical cases. The 148th General will take anysurgical cases except for neurosurgery, while the 39th will take any surgery,but not thoracic cases. The 148th will have a thoracic team, and the 39th willhave a neurosurgical team. The 369th Station Hospital, which is short ofqualified surgeons, will handle only soft-tissue wounds.
Thursday, 22 March
The chief of the surgical service, 148th General Hospital,Colonel Cornell, has been transferred to chief of surgery, 176th StationHospital. He deserves great credit for the cooperative spirit and equanimitythat he has shown under these trying circumstances. Colonel Ottenheimer was madechief of the surgical service of this hospital and again demonstrated his rarecapacity for surgical organization and judgment. Colonel Bishop became chief ofsurgery at the 39th, and Major Sutherland was transferred to the 148th General,leaving Major Claiborn at the 39th as assistant chief of surgery. Captain Postand Major DeSopo were placed on temporary duty at the 148th to strengthen thethoracic team. This has necessarily weakened the 39th General, but still leavesit with the strongest professional staff in the Marianas.
A meeting was held with General Kirk, General Willis, ColonelColby, Colonel Baker, Colonel Oughterson, and Colonel Welsh [Col. Arthur B.Welsh, MC, Deputy Chief, Operation Division, Office of The Surgeon General]regarding the medical problems of the Army in the Western Pacific. The questionof the medical support of the Tenth U.S. Army was discussed. It was agreed thatthis was inadequate, but I am not sure that the shortage and seriousness of thesituation was fully realized. The need for hospital beds in the Marianas wasdiscussed, and the great shortage of beds was pointed out. The need forinvestigation of wound ballistics (requested in a previous letter by The SurgeonGeneral), shock, and related problems was discussed. The meeting adjourned afterassurances had been made that everything possible would be done.
I made a visit to Guam and found the situation therecomparable to the situation on Saipan. However, no effort at triage has beenmade here. Control was in the hands of the Navy. Had a long conversation withCaptain Anderson [Capt. (later Commodore) Thomas C. Anderson, MC, USN], AdmiralNimitz` surgeon, who was most cooperative. The Army does not have thespecialized personnel necessary to provide adequate care for the patients onGuam. Only by making Guam a hospital center can adequate care be provided.General Kirk agreed to the consolidation of small station hospitals as a meansof saving personnel, and to the use of surgical teams and the inactivation ofportable surgical hospitals.
Friday, 23 March
Received word that 5,000 additional beds may be put on TinianIsland-source of personnel unknown. At least some arithmetical facts aresinking into the planners` minds. Had a conference today with the CommandingOfficer, 148th General Hospital, and with Colonel Colby, Colonel Ottenheimer,and Colonel Baker. The problem discussed was how to use the engineers inconverting the 148th from an old broken-down farm in appearance and function
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to a modern hospital. There are inches of mud and dust in thewards and operating rooms. CinCPac has ordered A-1 priority for hospitals, andnot without reason.
Thursday, 29 March
The Tenth U.S. Army has been with us. George Finney, HalSofield, Doug Kendrick, Ben [Baker], and I, are in the same pyramidal. All thatwas needed was a little aisle between the bunks. My orders to go along (toOkinawa) have been canceled, much to my chagrin. They sailed on the 27th. Thebest that can be hoped for is that casualties will be light.
Guam, Sunday, 1 April 1945
I went to Guam with "Red" Milliken. Stayed at the204th General Hospital. Colonel Bryant is doing a superior job. This is one ofthe best organized and planned hospitals, and certainly the best Army hospitalin the Marianas. It appears that the Navy has given preference of materials andworkmen to its own hospitals. The Army hospitals are not as well equipped as theNavy`s, which appears to be the Army`s own fault. There appears to be littlejustification for the great difference, since both Army and Navy hospitals mustperform the same functions.
Had a very satisfactory chat with Admiral Laning, Navymedical inspector for Pacific Ocean Areas-a practical, forthright, capableofficer. His observations on the Iwo campaign bear out mine on the Luzoncampaign, and corrective measures are under way. There was much delay at Iwo ingetting casualties from the beach to the ships, which the small boats hadtrouble contacting. Besides, the medical teams aboard the APA`s wereinadequate, both in number and quality of surgeons, to cope with the situation.The admiral says that the APA should not be used as a hospital ship, and that wemust have more hospital ships. However, as Captain Walker so aptly enunciated,the primary consideration must be that of providing definitive surgical care onthe spot, and not that of insuring speedy evacuation.
Visited Tom Rivers [Cdr. Thomas M. Rivers, MC, USNR] and hisMRU [Naval Medical Research Unit] No. 2 which is under construction and promisesto be de luxe. Rivers was burning with indignation as his first request forresearch was for a chemical analysis on a ton of beer. Requests for help ininvestigation far exceed his capacity. His interest in problems with the nativesis overshadowed by the Navy demand for military medicine.
Carter [Lt. Col. George G. Carter, MC] started as Chief ofMedical Service in the 204th. Woodruff [Maj. William W. Woodruff, MC] has manyinteresting chest cases and many hemothorax cases needing aspiration. Very fewof these cases (Marines) were aspirated, due to lack of adequate surgical helpat the front.
Saipan, Wednesday, 4 April
There is, today, no hospital on Saipan able to do electivesurgery. There are plans to make a hospital center on Tinian, with an additional5,000 beds. It appears that the medical bed requirement of the Marianas isfinally being
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recognized. However, it should be noted with emphasis that todate no consultant has been used for medical planning by the Surgeon`s Office,Pacific Ocean Areas.33 Many lives have beenneedlessly sacrificed. The hospital planning could have been greatly improved,and both medical and nonmedical personnel could have been more efficientlyutilized.
Friday, 6 April
Lt. Col. Pete Bishop came to see me regarding the morale ofthe 39th General Hospital. They complain that they are not getting a fair breakin construction and personnel, which is a complaint common to all hospitals. Itappears that their primary need is for leadership among themselves. Some don`tlike this and some don`t like that, and they fight with the engineers doingthe construction. One hopes that with the coming activity most of their problemswill vanish.
Manila, Tuesday, 15 May 1945
John Flick [Col. John B. Flick, MC, Consultant in Surgery,USAFPOA] arrived, and for the past month I have had a delightful time travelingover the Western Pacific Base Command. The formation of this command has been inprocess for some time. The new command of the Pacific, MacArthur and Nimitz, wasannounced, the WPBC [the Western Pacific Base Command] (p. 873) was announcedimmediately afterward.
John Flick and I visited all the institutions on Guam andwere in agreement as to what should be done, but JF asks continually: "Whatcan be done about it?" There are not enough station hospital beds on Guam,yet it is proposed to change the 373d Station Hospital, which is miles from theport, into a general hospital, and without personnel to staff it. One of thechief sources of wasted personnel in the Pacific Ocean Areas has been thefailure to distinguish between the personnel and functions of a general andstation hospital.
We journeyed on to Tinian. Colonel Shaw is here, doing asplendid job as island surgeon. He has no inferiority complex and seeks advicewherever he can find it. Result-splendid planning. Had a long conference withGeneral Kimball [Brig. Gen. Allen R. Kimball] who emphasized two importantpoints: Plan for what you want in the future and don`t try to do it by hiddenfigures; and the need for recreational facilities (morale and physical). Don`tsend out people-we have them to burn-but send the equipment we don`t have.
Went to Iwo Jima, referred to as a "solidifiedburp." It is almost as desolate as the atolls of the South Pacific. ColonelCurrey, Island Surgeon, is doing an excellent job.
There are three hospitals on this small island-the 38thField, the 41st Station, and the 232d General Hospitals. Certainly the twosmaller hospitals should be combined.
33Colonel Flick was surgical consultant at Headquarters, U.S. Army Forces, Pacific Ocean Areas, at this time, and he was consulted in all planning as were the other consultants at the Headquarters. Colonel Oughterson`s comment is not a fact.-J. M. W.
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FIGURE 341.-Destruction in the Walled City, Manila, May 1945.
Returned to Saipan and found radio orders giving Ben [Baker] and myself to Headquarters, USAFFE in Manila.34 Left by NATS on 23 May at 2230, and arrived at Manila the next morning at 0800. The plane circled the city and gave us a good view. While large areas of destruction were visible from the air, it still appeared that most of the city was intact (fig. 341). When we drove through the city we got the reverse impression. Signed in and was quartered in the Avenue Hotel. This hotel is one of the few not totally destroyed.
Tuesday, 29 May
Everything here at present is in a state of flux until thenew commands are organized. Met General Denit who is full of enthusiasm about myfuture job to the point where I am loath to think of going home immediately.
Wednesday, 30 May
Colonel Robinson [Col. Paul I. Robinson, MC] and MajorBouldvan of the USAFFE Board came up to see me about the wound ballisticsreport. They were very enthusiastic about the study that was done and enteredwholeheartedly into plans for a future study. In contrast to the attitude in thePacific Ocean Area, this was as May flowers to a summer drought, and no
34The U.S. Army Forces in the Far East, commanded by General MacArthur, was the highest strictly U.S. Army command in the Southwest Pacific Area.
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salesmanship was required. Spent the remainder of the daytrying to rewrite a directive for surgery in the combat area.
Monday, 4 June
Drove out to Sixth U.S. Army headquarters with Earl Moore[Dr. J. E. Moore, Civilian Consultant in Medicine (Venereal Disease) to TheSurgeon General], Lt. Col. Tom Sternberg [Lt. Col. Thomas H. Sternberg, MC],Chief, Venereal Disease Control Division, Office of The Surgeon General, andMajor Bouldvan of the USAFFE Board. General Hagins was in his usual good form.After lunch we discussed wound ballistics about which he [General Hagins] isvery skeptical, but I left him the Bougainville report and will return in a weekfor discussion.
Saturday, 9 June
Have been engaged for the last few days in surveying the needfor civilian medical care in Manila. This has become necessary from a militarystandpoint because civilians are occupying many beds in military hospitals. ThePhilippine civil affairs office originally tried to provide suchhospitalization. But their efforts have proven to be inadequate to the need.
Even before the war, hospital beds were inadequate to meetthe demand. Approximately 4,000 beds were available. In addition, there was one1,500-bed hospital for the insane with 3,000 patients. The Japanese set theseinmates loose, and most of them are said to have starved, although their exactstatus is unknown. At present, there are 1,419 provisional hospital beds for thementally ill, part of which are in the old hospital for the insane, and theremainder in schools. There are 2,457 government beds and 1,163 private beds,many now occupied by nonpaying patients. On 1 July, the private beds will allrevert to private-paying patients, leaving approximately 3,800 government bedsavailable.35
The Quezon Institute for Tuberculosis-1,500 beds before thewar-was always full (fig. 342). The TB death rate was very high. At presentthe lowest reported TB death rate for Manila has been 80 per week, and thehighest was 200.36 However, it is known thatthe rate exceeds this number.
The former director of the Quezon Institute, Dr. M. Conizares,is now medical adviser to President Osmena. General Valdez, chief of staff ofthe Philippine Army, member of the cabinet, and politico, is said to be the bestdoctor in the Philippines. Some think it would be better if the Army controlledthe hospitals and tackled the health problem on the islands. The problem is oneof admitting civilians to Army hospitals in those cases in which lifesavingprocedures must be employed, and of providing facilities for those cases.
35The Japanese allowed such scant rations that most of the patients in the hospital for the insane were said to have starved. There were about 300 left alive when we took over. I am very doubtful as to the figures he gives for the number of civilian and governmental hospital beds for civilians in Manila, which seems too high. However, I know of no way now of obtaining more accurate estimates for that period. (Letter, Dr. Maurice C. Pincoffs to Col. John Boyd Coates, Jr., MC 8 Feb. 1959.)
36The Civil Affairs headquarters at this time estimated the population of Manila at approximately one million. (Letter, Dr. Maurice C. Pincoffs to Col. John Boyd Coates, Jr., MC, 8 Feb. 1959.)
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FIGURE 342.-Quezon Institute, Manila.
The facts are:
1. There are approximately 2,000 nonmilitary personnel in U.S.Army hospitals in the Manila area. These fall into two groups:
a. Filipinos (civilians and veterans of the Philippine Army and guerrillas).
b. Other nationals, more than half of whom are medical cases.
2. A survey of patients at the 120th General Hospital (SantoTomas) (fig. 343) on June 1, revealed the following:
Nationality
Total number of patientsNumber who can pay
American
45
111
Filipino
31
7
Other nationality
56
18
Total132
20
1American veterans.
3. At the 80th General Hospital (Quezon Institute), therewere 6 civilians out of 94 non-U.S. Army patients, and the remainder were menwho belonged to various components of the Philippine Army and guerrillas and whorequired long periods of hospitalization. Surgical cases, 40; tuberculosis, 36;psychosis, 15; typhoid, 1; and leprosy, 2.
4. At present, the number of beds provided for the care ofcivilians in the city of Manila is 5,000 (government 3,837; private 1,163). Atthe same time, 4,488 of these beds are occupied. This may be considered as fullcapacity, as it leaves only 10 percent for distribution. Furthermore, no otherbeds are available for tuberculosis cases or for the insane, who togetheroccupied approximately 5,000 beds in the prewar period.
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FIGURE 343.-The 120th General Hospital, Santo Tomas University, Manila, June 1945.
5. Other civilian hospitals, such as the Philippine General Hospital (fig. 344), have undergone severe damage. This institution formerly had 1,200 beds and is now functioning with only 236 beds. The government is unable to obtain labor or materials to recondition this hospital. Most of these buildings could be made available with only minor roof repairs, using salvage material. A few of them would require new roofs. This type of reconstruction would provide beds with less labor and material than new construction.
6. We are now authorized to make contracts for the care ofPhilippine veterans, which includes the Philippine Army and guerrillas. Thesecontracts will be let with the Philippine hospitals to help finance theirrunning expenses. The quality of the care is not high and is uncontrolled. It`ssort of like pouring money down a rathole, but there appears to be no othershort-term solution.
Monday, 9 July 1945
Had a siege with bad teeth and a hospital sojourn in the 49thGeneral Hospital. I am now assigned as Surgical Consultant, AFPAC, but thegeneral [Denit] has other plans for me.37 Hewants me to function as a surgical adviser responsible to him and withoutadministrative responsibility. He wishes to call me a director of surgicalresearch, which I oppose as a title. Have re-
37In April 1945, the operational and administrative authority of General of the Army Douglas MacArthur was extended to all U.S. Army Forces in the Far East and mid-Pacific areas. As his operational and administrative headquarters for these forces, General Headquarters, U.S. Army Forces, Pacific, was established. At this time, U.S. Army Forces, Pacific Ocean Areas, was redesignated U.S. Army Forces, Middle Pacific, a subordinate command under Headquarters, Army Forces, Pacific.
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FIGURE 344.-The main entrance of the Philippine General Hospital, Manila, October 1945.
written a directive on surgery in the combat zone as well as a directive on anaerobic wound infections. Have also completed a program for the training of medical officers. The general has asked for a program that will put surgery in his theater on the map, and I have suggested the following:
1. Publications.
a. Medical bulletins to be started for dissemination of information.
b. ETMD to be organized.
c. History.All three to be placed under one competent Medical Corpsofficer.
2. Training Program for all medical officers to consist of:
a. Instruction in a hospital.
b. Instruction in a school of tropical and preventive medicine.3. Development of personnel files to show:
a. Each unit with MOS [military occupational specialty] classifications.
b. Personnel in each specialty and assignment.
c. Cross index by name and specialty.We are now short of personnel, but no one knows how much orof what kind. Consultants should be responsible for checking assignments andrecommending reassignment. Moreover, personnel should be interchangeable on atheater basis [assignment controlled by theater headquarters?]. At present,lower echelons may change the assignment of key personnel. Promotion should notbe made into a position unless the officer is qualified. This is very difficultto prevent as a commanding officer will usually promote on other bases.
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4. Records.-A uniform report on individual cases bythe chiefs of all the surgical services. Reports should include all deaths andcomplications, and their causes. A report should be made on each illness orinjury on duty, and each death or discharge to the States. The report would beincorporated with machine records based on the standard Army diagnosis.
5. Planning of operations.-Consultants should beused in planning. Their advice must be given more weight so that the facilitiesand personnel commensurate with the mission to be performed will be madeavailable.
6. Consultants should be heeded on plans for anesthesia,ophthalmology, neurosurgery, reconditioning.
7. Specialization.-Hospitals should specialize inspecific battle casualties and diseases. This will result in better care and agreater opportunity to study diseases.
8. Research investigation of special problems in missileballistics, body armor, shock, et cetera, should be initiated.
Friday, 13 July
We had a long teletype conference with the Surgeon General`sOffice for the purpose of finding out why, when we ordered 550 medical officers,they sent us 12. We had a lot of conversation but never found out the reason forthe deficit. They said that they would answer by mail.
Monday, 23 July
Have been working the last week trying to get up enthusiasmfor a study of body armor and missile ballistics. Splendid cooperation fromColonel Alexander, President, Pacific War Board.
Tuesday, 24 July
Gave some data to Col. Roger Egeberg [Col. Roger O. Egeberg,MC, Aide-de-Camp (Medical) to General MacArthur] in the hope that we may getGeneral MacArthur accustomed to the idea of attaching a missile ballistics team.Working on trenchfoot and wet-cold projects.
Wednesday, 25 July
It appears that, for most people, becoming accustomed to anew idea is like a woman with a new hat. It all depends on what other peoplethink of it.
Friday, 27 July
Today, Japan turned down our surrender terms. Most of thebetting here is that the war will end within 3 months.
Visited Sixth U.S. Army headquarters, and spent the night atASCOM [Army Service Command, SWPA] headquarters. Will try to coordinate themachine records with USAFWESPAC [U.S. Army Forces, Western Pacific, successor on20 June 1945 to USASOS (the U.S. Army Services of Supply), SWPA] and thetraining program of USAFWESPAC with ASCOM and the Sixth U.S. Army.
Wednesday, 1 August 1945
Today I flew out to Cabanatuan, Luzon, to visit the 43dDivision medical battalion. We flew along the edge of the mountains on the waythere and spotted a small group of Japanese who ran off at great speed.
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Had lunch with General Wing [Maj. Gen. Leonard F. Wing, Commanding General,43d Division] of Burlington-a rugged, popular fellow. Listened to the usualcomplaints about not having enough medical personnel, of always going in short,and then attaching portable surgical hospitals, the personnel of which could notbe sent into the field. They had been visited by the army consultant only once.
Monday, 6 August
Feverish activity to get the trenchfoot program underway. General Denit leftit in my charge. The Quartermaster had already gotten out a wet-cold directive.38Since the quartermaster activity is primarily for the purpose ofpreventing trenchfoot, I have developed a program that combines information onthe preventive medicine aspects and the clothing aspects of the problem in thefollowing way:
1. A letter from the commander in chief to the commanding generals of allhigher echelons emphasizing the importance of the problem and telling them whattrenchfoot is.
2. A letter from General Denit to all division commanders emphasizing thecommand responsibility.
3. A medical directive to doctors.
4. The use of information and education facilities.
a. Directive for training officers, telling them how to do the job.
b. Booklets for all soldiers.
c. Movies-shorts combined with entertainment.
d. Use of radio for short programs combined with entertainment.
e. Yank Magazine and news releases.Morotai Island, Indonesia, Tuesday, 7 August
A Japanese hospital ship was captured in the Banda Sea and brought intoMorotai Island, Indonesia. With Col. Hollis Batchelder of the U.S.S. Mercyto assist, I was dispatched to Morotai by special plane, arriving at Morotai at1600 hours. We reported to Maj. Gen. Harry H. Johnson, Commanding General, 93dInfantry Division. He is National Guard from Houston, Tex., and a forcefulpleasant Texan who gave us real southern hospitality, and as good a steak dinnerwith hot biscuits as I have ever had. Colonel Jackson is his chief of staff.
Wednesday, 8 August
Went with the division surgeon, Colonel Melaville [Lt. Col. Eugene F.Melaville, MC], to see the port director, Commander Harrison, who gave uspermission to board the Japanese hospital ship, Tachi Bana Maru. Thisship had been intercepted in the Banda Sea on 3 August. A destroyer flotilla hadgone out for this purpose.
Verne Lippard [Lt. Col. (later Col.) Vernon W. Lippard, MC] just came up totell me the radio announced that the Japanese have accepted the Potsdamultimatum.
38Medical Department, United States Army. Cold Injury, Ground Type. Washington: U.S. Government Printing Office, 1958, appendix H, p. 533.
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After boarding the Japanese hospital ship with awalkie-talkie [radio], they [the boarding party] found contraband and summonedan armed boarding party to take charge. There were so many Japanese (1,600) onboard that they did not dare go below to search. The exterior of the ship wasmarked according to the rules of the Geneva Convention. The patients weresleeping on mats spread on top of the cargo, which was mostly contraband andconsisted of boxes and bales that were packed with rifles, machineguns, mortars,grenades, and ammunition. Boxes were marked with large red crosses.
There were no seriously ill patients aboard, and allpersonnel walked off the ship. About a dozen were examined on the dock and sentto the 155th Station Hospital with diagnoses of beri beri, malaria, and fever ofunknown origin. There were no wounded, and there was only one surgical patientwith an infected leg ulcer. The patients, about 1,500, were said to be theslightly ill. On the whole, they appeared healthy and well nourished.
We visited a compound where 97 officers were interned. Theywere polite, said they were satisfied with their care, and that no one was sick.A visit to another compound of enlisted men showed several sick men. The chiefsurgeon of the ship said that he did not know that the boxes and bales containedcontraband. No records were available to prove whether these had been bona fidepatients before embarkation, and the confusion on shipboard was such thatrecords could not be located. Looting by sailors undoubtedly caused part of theconfusion. The ship was in a wretched sanitary condition. The stench wasterrific. Clearly, this is a violation of the Geneva Convention.
Manila, Thursday, 9 August
Flew back. Left Morotai at 1000, arrived on Leyte at 1500hours.
Monday, 13 August
Peace seems near, and speculations are mixed as to whetherthe Japanese will accept. Certain it is that the majority of people here, aswell as at home, are tired of war.
Wednesday, 15 August
News that the Japanese have accepted the ultimatum, whichincluded the proviso that the Emperor may remain. The morning news contains theEmperor`s rescript to the people, which, true to form, contains no admissionof guilt or moral and spiritual defeat. It only speaks of the military decisionagainst them: "The enemy has used a new and cruel bomb * * * and tocontinue would mean the total extinction of human civilization." Thisclearly puts the onus of destroying civilization upon us. "Such being thecase, how are we to atone ourselves before the hallowed spirits of ourancestors? By working to save and maintain the structure of the imperial state.Unite your total strength * * * so ye may enhance the glory of the imperialstate." We are so tired of war that we accept these words as meaning apledge of demo-
887
FIGURE 345.-U.S. Army Transport General Sturgis departing Manila harbor for Japan, 26 August 1945.
cratic government. Truly, so far we have gained a military decision only, not their ultimate defeat.
Tokyo-bound, Saturday, 25 August
Boarded the U.S. Army Transport General Sturgis todayat 1500 hrs. General Denit had returned, and I drew the lucky number for thistrip. So, with 24 hours to pack and gather up what information I could, I am offfor Tokyo (fig. 345).39
39Almost immediately upon his arrival in Tokyo, Colonel Oughterson was named chairman of the AFPAC group that was to participate in the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan. The other two groups of this joint commission were the Manhattan Project Group, headed by Brig. Gen. Francis W. Farrell, and a group of Japanese doctors and scientists, headed by Dr. Masao Tsuzuki of Tokyo Imperial University and the Japanese National Red Cross. The formal report of the commission was edited by Colonel Oughterson in Washington and published under the auspices of the National Research Council. (See: Oughterson, Ashley W., and Warren, Shields: Medical Effects of the Atomic Bomb in Japan. New York: McGraw-Hill Book Co., Inc., 1956.)
