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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 havetaken back 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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FIGURE 320.-(See opposite page for legend.)
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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.
FIGURE 320.-"They are well pleased withthe surgical teams." Bougainville. A. A surgical team operating in itsunderground surgery. The floor is about 4 feet below ground level; the sides arebuilt up with sandbags, and it is roofed with heavy logs. (Left to right: Capt.Charles E. Troland, MC, Assistant Surgeon; Sgt. William T. Marsden, Scrub Nurse;Capt. William G. Watson, MC, Chief Surgeon; Capt. Harold C. Schulman, MC,Anesthetist.) B. A surgical team, operating in a clearing station, 17 December1943. Note the improvised lighting and the use of combined intravenous andendotracheal anesthesia.
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The Medical Corps officers of the 182d Infantry wanted toknow why they were kept out here away from home for 3 years when so many peoplewere sitting at home. When this campaign is over they are turning in theirresignations [sic]. They want postgraduate work after the war, and the AMA hasdone 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 tankshave been removed. I have been troubled with prickly heat and with generalizedskin edema, so I am not displeased to leave this buggy place where the bugs aremore 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 StationHospital, 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 onto help these hospitals straighten out some of their problems. I found that theywere injecting gas gangrene antitoxin into wounds and into the tissue around thewounds, but not introducing enough antitoxin intravenously. Cases were comingdown 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 downin poor condition or too soon after an operation. Others, with compoundfractures of the humerus, were in hanging casts. Once again it must be concludedthat not enough emphasis is being placed on getting the best men into theforward 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 thewounded are quickly brought back to the evacuation hospital. In the cases of theseriously wounded, the clearing station is bypassed. If the wounded man can bereached, he will find himself in the hospital within from 1 to 4 hours. This isthe first time in the South Pacific that an evacuation hospital has been able tofunction 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 sofar in the area that our burial parties have dared to cover. This is animportant problem as the unburied attract swarms of huge black flies as big asbumblebees, and the leaves of vegetables are black with them. The hill wasretaken 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 examinethis problem.
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 agarden, 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.
NOTES1. The 9th Station Hospital needs an EENT officer. He will beprovided 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 complainthat many hospital staffs are kept inactive over long periods of time. Theycontend that under such circumstances the men should be sent home, since manyplanes and ships go back empty. These people refuse to recognize that thedifficult problem is to bring men out here. They only see the issue in terms ofavailable transportation back to the States. It was remarked that morale is badbecause the Army hasn't been keeping its promise to ship people back onrotation. These men complain that they were not told that the Army's promisewould 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 andspent several days gathering data, as New Georgia and Bougainville pass to theSWPA (Southwest Pacific Area).13 They(i.e., SWPA) either have no regular allotment for consultants, or someone elsehas filled them, and Col. Wm. Barclay Parsons, MC [Consultant in Surgery, Officeof the Chief Surgeon, U.S. Army Services of Supply, SWPA], must be carried asthe commanding officer of a hospital. Moreover, being in Services of Supply,they have nothing to do, except by invitation, with combat troops. I realize nowwhat 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 wouldnot consider it. No news has come from Washington so I will sit tight as I havea 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 largedinner party for Generals Bliss and Rankin, given by Colonel Streit [Col. PaulH. 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 infection report. Havenot yet been able to establish a record system.
I would like to go forward, for the flow ofPhilippine casualties will soon be coming through. The invasion was announced 2 days agoand is going well
17Brig. Gen. Earl Maxwell had been notified ofimpending assignment to the U.S. Army Forces, Pacific Ocean Areas; however, whenofficial request had been received in South Pacific Base Command, GeneralGilbreath 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 byHeadquarters, U.S. Army Forces, Pacific Ocean Areas, on 20 October 1944 asTraining Memorandum Number 8, subject: Training Program for Medical Officers.Colonel Oughterson later rewrote this directive, adapting the principles in itto 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 ofCarnes 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 weekshould bring clarification of the situation here.
Thursday, 23 November
Eddie [Ottenheimer] arrived today with many tales, some new stories. He certainlywas most welcome as I need him to lift myspirits. Things here have been most discouraging, although I would nothave missed the experience, which is unique in my Army career. I beginto appreciate what is meant by the word bureaucracy, although I think Marine terms are probablymore expressive. Three months have I labored here and brought forth one directive onthe training of medical officers. All others have been blocked for various and sundry 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 1944under 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 noone could find them. It was not uncommon to find everyone looking verysolemn, as though in conference, then to discover that they were onlylooking for a lost document.
The prevailing idea seems to be that the consultant is hereprimarily to make inspections, write long-winded reports about trivialmatters, sit on boards, and see patients. In trying to accomplish something, Ihave encountered resentment and a feeling that I was interfering with thingsthat were none of my business. The consultant takes no part in planning,although the office is making the same mistakes in planning that were madein the South Pacific a year and a half ago. Results: The mortality of wounded on Saipanwas twice as high as on Bougainville, and one-third the number of patients returned to duty.20
I spent the evening with the general and accomplished much business very pleasantly. My first impression ofthe general is that heis outstanding in his desire for, and insistence on, a high standard of work.Being new, he of course does not wish to move rapidly against tradition,although he sees the need clearly. This is a fine education on how to winfriends and influence 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 nowbeen in this headquarters over 3 months and still have not been asked to takepart in future planning; nor after my request, have I been permitted to takepart in planning. A field hospital is going in [to the Philippines] with theMarines. They say it will function as an evacuation hospital. The Army says itwill not, and I suggest that it should have surgical teams if it is to function.Responsibility is being shifted along. Only God cares for the little fellow! Iam wondering when this will crack. It can't go on forever. Once again I mustspeak to the general or be derelict in my duty. I would rather be out of thething than in it and wrong.
Friday, 1 December 1944
Ben Baker arrived today. The role of consultants in the Army needs clarification, and Regular Army personnel must be educated as to the medical problems of a theater. There is only one partially qualified neurosurgeon in this area. The determining factor in the distribution of battle casualties was the 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 thelack of "qualified personnel" previously commented on from time totime. 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 thatthe world judged the theater and was met by stubborn incomprehension.
Saipan, Thursday, 7 December
Yesterday, having a chill and after numerous inoculations,I received notice at 2200 to appear at Hickam Field at 0015. We took off at0130, and, fortunately, being the senior officer on board, I had a bunk. Owing to repeatedchills, I stayed aboard until Kwajalein where there was a dismal rain, making thisdismal place look worse than usual. I havesympathy for the men whose lot it is to stay in such an unattractive partof the world. Arrived just before 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 disconcertedto find no foxholes. Found the colonel in charge of ATC digging a foxhole,asked him why, and he pointed to his teeth marks on the floor. The 148thGeneral Hospital is still in tents although prefabricated buildings are under construction. Headquarters is builtin quonset huts, and the laborhas been used to improve this and other sites. Colonel Colby says thathospitals have "No. 1" priority, but then "No. 1" becomessubdivided into "a, b, c, et cetera." Visited the supply depot incharge of Captain Phillips. Most supplies are out of doors on the ground,although covered with tarps.
Visited the 369th Station Hospital, where I saw MajorGoldsmith who is in charge of a civilian section which will be taken overby the Navy on 1 January. According to Colonel Colby, in the original plan the Navy had designated one medical officer and one corpsman to treat civiliancasualties. There were a large number of civilian wounded, even on the beaches. Oneplatoon of the 31st Field Hospital was designated as a civilianhospital. This platoon with 100 beds soon had 880 patients. A second stationhospital of 500 beds is under construction adjacent to the 750-bed 369th. This total of 1,250 beds requires a duplicate setup of surgeons, administration,equipment, and so on. This does not seem to be good economy of personnel orequipment, but owing to the difficulty of putting these hospitals togetherunder one T/O they must be set 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.The hospital is now under construction and should take patients in about 2weeks.
Tinian, Sunday, 10 December
Visited the 289th Station Hospital, under construction at the edge ofthe 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 tobe about 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. FoundMajor 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 theSeabees. Shaw had drawn up some very good plans, and this should be asuperior station hospital. These two hospitals can provide facilities for2,000 beds if they get the additional personnel. Flew to Saipan in theafternoon to attend a medical meeting. Pathologist reported findings onautopsies of 60 civilians. About 70 percent were tuberculosis and beriberi,frequently mixed. The next largest group was 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 the station hospitalsinto a general hospital. It is understood thatall battle casualties will pass through the general hospitals and that thestation hospitals will be used primarily for garrison work. The 39thGeneral Hospital is 8 miles from the airstrip, as is also the 148th General;and the 39th is 5 miles from the docks, while the 148th is only 1? milesfrom the dock. At present, the 148th General is doing about 40 percent stationhospital work. Yesterday, evacuation policy for patients was increased to 60days for the general hospitals, 30 days for the station hospitals. The 21stBomber Command has 100 beds to act as a clearing station at the strips, and theATC has two quonset huts to care for casualties that have arrived or areawaiting 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 the functions of various hospitals.
The 148th General Hospital is now under construction,although they are now functioning in the area under tents. The surgery should be in quonsethuts in 2 to 3 weeks. The personnel of the surgicalservice of this hospital will require strengthening. Further observationat a later date is required for proper evaluation. Approximately 40 percent ofthe surgery in this hospital involves the garrison forces. Twice the numberof beds may be made available for battle casualties by allocating most of thegarrison work to station hospitals. This has been discussed with ColonelColby who has given splendid 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.Joseph Kuncl, Jr., MC, Chief of Surgical Service, is doing an excellent job,although he is short two Medical Corps officers. The 176th StationHospital, 500 beds, is also under construction adjacent to this hospital andwill be functioning within a few weeks.
I understand the 39th General Hospital is coming here.Neurosurgery and thoracic surgery can be allocated to this hospital, which has qualified 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 assoon as possible to assist in the planning and construction of this hospital.Colonel Colby concurs and has radioed a request.
With the arrival of the 39th General, the surgicalservices on this island can be staffed with qualified men, and, with theproper allocation of functions, all specialties could be covered in a superiormanner. Guam will be well staffed with qualified specialists, except inneurosurgery.
148th General Hospital.-Of 303 battle casualtiesreceived in the 148th General Hospital, Saipan, 149 were evacuated to Oahuand 154 were returned to duty forward. Table 5 shows the number of operationsperformed during 4 months (August to November, inclusive) in 1944.
| Operations | 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 up allnight, arrived Tacloban, Leyte, at 1000 hours and circled for an hourbefore landing. Drove to Tacloban and met General Denit [Brig. Gen. (later Maj.Gen.) Guy B. Denit, Chief Surgeon, USAFFE, and SOS, SWPA, and later ChiefSurgeon, AFPAC]. General Denit: "This damn Army won't even obey orders.Supposed to have 12,000 beds by this time and we have only a fraction." Ilike the general.
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 (portablesurgical hospital) as a tactical unit, although individual surgeons and unitsdeserve high praise.
Saturday, 16 December
This is a fine country for ducks and it might well be leftto them. 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-bedstation hospital functioning as an evacuation hospital-840 beds availableand 899 patients. The hospital is insufficiently staffed to act as anevacuation hospital. Nurses are badly needed here. Colonel Sneideman, Commanding Officer, appears to bedoing a good job under difficult circumstances. Lt. Col. Philip L. Battles, MC, isdoing 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. Thishospital is on a drier site; it is better laid out, is more compact, and hasa splendid underground surgery. Saw many cases coming in from the 36thField Hospital across the island, a 2-day trip by road from Baybay. Records weregood and the patients were in good condition. Observed numerous cases described astrenchfoot, but they do not appear to me to be typical.
The evacuation of patients has not been good. Toomany patients have been evacuated from Leyte. Fifty percent of the Leytepatients sent to Saipan have been returned to duty in 1 month. However,there were not enough beds available on Leyte. They were supposed to have 9,000 beds by D+20. Now, D+60,the only general hospitalfunctioning is the 118th with 600 beds. With the beds of the station hospitals this adds up to approximately 2,000 beds available. The reasons forthis 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, SpecialAssistant for Shock and Transfusion, USAFPOA] and I had a long talk with Walker regarding the blood bank. He impressed me with the soundness ofhis ideas and has a better grasp of the surgical problems of combat amphibioustroops than anyone I have seen in the Pacific Ocean Area. Moreover, he hasaccomplished more than anyone else. We then visited LST 464, which isundoubtedly the finest medical unit afloat. This is an LST that has beenconverted into a 200-bed hospital ship-clean, good food, laundry, goodoperating room. Here is the most concentrated and best organized surgical careI 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 suicidebombing results in many burns. For burns, they are using plasma and serumalbumin in large quantities, all controlled by hematocrit and protein levels-asmuch as 1,200 units per patient-plus blood. They find serum albumin betterthan plasma when the condition is severe. They have their own blood bank.The donors are Army personnel who are picked up on the beach. The LST proceedsto pick up patients while the donors are bled, then the donors are disembarkedon the way back. Only 1-qt. containers, discarded vacoliterbottles, are used. For pooled group O blood, eight donors are bled into10-gallon bottles. Nine thousand cc. blood, plus plasma, were given to onepatient.23
22I saw these installations when I was with GeneralKirk and party in February 1945. The locations were miserable but were all thatwere available at the time. By February, they had either moved or were in theprocess of moving. I think the medical service did very well, as did thepatients with whom I talked.-J. M. W.
23Dr. Ernest Eric Muirhead, formerly the directorof 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 7thAmphibious 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. TheRed Cross blood was not then available. So LST 464 was set up in NewGuinea and then went to Leyte. According to Dr. Muirhead, they (on LST 464)"had to do with what we had." Two kinds of bottles wereused-the 1,000-cc. vacoliter bottles and the 20,000-cc. regularlaboratory water bottles. Preservative was made from citrate and dextrosebecause the ACD solution was not yet available. Any number of donors withgroup-O blood were bled directly into these bottles, appropriate amounts ofcitrate and dextrose were added, and the bottles were stored in the ship'swalk-in type of refrigerators. The blood was not typed for Rh factor,neither was it titered. In times of stress, transfusions were effecteddirectly from the large bottles, which had been adapted for givingpurposes 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 distributessets of copper sulfate for bedside work.
Casualties received earlier were given better treatment than casualtiesnow being received. When the S.S. Bountifultook in one load of patients, nearly every compound fracture was infectedowing to the poor setup and overloading of shore facilities. The 7th Amphibious Forcenow has 70 LST's with surgical facilities and23 surgical teams.24 Each team is composed of 5surgeons and 18 corpsmen. These are quickly shifted from one LST to another.This ship [LST464] also moves about among the fleet, taking cases from ships that have beenhit. The LST goes in on the initial landing and remains as a floating emergency hospital. The 60well-trained corpsmen work mostefficiently. The LST unloads its patients to an APA [transport, attack],APH [transport for wounded], or other ship which takes them to hospital ships outside the combatzone. He, Walker, is not informed regarding bedsavailable in the Marianas. See Admiral Laning [Rear Adm. Richard H. Laning,MC, USN, Inspector, Medical Department Activities, Pacific Ocean Areas]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 with surgical facilities, but refused to build LST hospitalships on thegrounds that conventional hospital ships were being built. They apparentlymissed the point that hospital ships outfitted in accordance with the Geneva Convention cannot operate inthese waters during combat.Three attempts were made to bomb hospital ships, one at night when the shiphad to be lit up. Captain Walker asks that I take up the LST hospital shipproblem with Admiral Laning. This was the program I tried to institutein the South Pacific a year ago, and which met with Captain Hook'sapproval but was turned down because of construction difficulties.
Observations on Blood Program
When General Rankin and General Bliss visited USAFPOA, I advocated a blood bank program for all Pacific Ocean areas and suggested that someone who had had experience in the European theater should set it up, Doug Kendrick 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 with the blood, on their way West. This had developed into a combined Army-Navy program on the West Coast. The Army was collecting blood in San Francisco and the Navy in Los Angeles. Blood was transported by NATS to Guam under the direction 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. But the 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 Fleetin 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 was fromthe newspapers. Consequently, their first inclination was to saythat they wanted no part of it. However, in spite of the excellent bloodbank already established here, there was a need for still more blood. Manyof the hospitals did not know that blood was available. The loss in earlyshipment of blood to Leyte amounted to approximately 50 percent owing to thefact that arrangements had not been made for proper refrigeration ordistribution. The chief reason for this loss was lack of ice. There is a needfor a directive on the use of blood and an educational program among themedical 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, andthese have been used for other purposes, such as headquarters. Result:Engineering problems are so great that hospital building has been slowed down.Now, D+60, a 15-day evacuation policy is in force. Patients have had to betransported 1,500 miles to the nearest hospital, and since many are returnedto duty, time and transportation are lost unnecessarily.
Tuesday, 19 December
Saw Colonel Wills, Base Surgeon, who was very cooperative in helpingto arrange 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 witha large job. The Southwest Pacific Area has 44,000 beds, but about 25 percentof these are inactive due to moving. There are 23 general hospitals.Obviously, general hospitals are being used for station hospital work, which isone of the reasons 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,and three portable surgical hospitals. Portable surgical hospitals are usedbecause surgical teams are not available. The general impression is that theportable surgical hospitals are not adapted to this type of land fighting, butthat they are useful as 25-bed station hospitals, for example, to support anisolated airstrip.
Saw Colonel Weston, 44th General Hospital. They were set up near anairstrip. About 600 Japanese paratroopers landed on the strip, and a few nights later reinforcements came in to join them. Ourmen decided to holdthe perimeter, as they had about 200 patients in tents and the road in wasim-
