History

Book Four

WITH WINGATE'S CHINDITS

A Record of Heedless Valor

WITH WINGATE'S CHINDITS

Major General W. J. Officer, C.B., C.B.E., Q.H.S., M.B.

In the blazing spring of 1943 the British fought the Japanese halfa continent away from the headquarters hives on the dusty plain of CentralIndia and many miles below the bulldozers cutting the Ledo Road to Shingbwiyang.In the Arakan, the eastern tail of India that flanks the Burma border,a disheartened army marked time ingloriously after futile efforts to sustaina limited offensive. But Brigadier Orde Wingate, prophet of unconventionalwarfare, had stealthily marched 3,000 infantrymen through the jungle, acrossthe Chindwin River, and into enemy territory. His "Chindits"cut the railroad running north from Mandalay, blew up bridges, and harassedJapanese garrisons. In a last burst of daring they plunged eastward acrossthe Irrawaddy. There the enemy nearly trapped them. Splitting into smallparties, they struggled home, leaving nearly a thousand men behind.

The value of the Chindit expedition was difficult to estimate. Thedisplays of courage and the capacity for jungle warfare were hearteningat a time when morale was low in India. From a tactical standpoint, however,it did not much matter whether Japanese communications were temporarilydisrupted, since no major campaign was in progress. Not until after thewar did it become known that Wingate's sudden appearance in Burma led theJapanese to reassess their plans for defending their Southeast Asia conquests.They had believed that the Chindwin River protected their position in Burma.The Chindits demonstrated that this sense of security was ill-founded.The Japanese concluded that they could not be safe until they drove theBritish out of eastern India and captured the American airbases in Assam.In the summer of 1943, therefore, they began to assemble a force strongenough to assail the British Army on its own ground. One more jungle campaign,they hoped, and the possibility of Allied military action in the Far Eastwould be forever ended.

Wingate's exploits soon attracted widespread attention. Disgustedwith the sluggishness of the army in India, Churchill and others applaudedthe Chindits' aggressive spirit. The Prime Minister invited Wingate tovisit him in London, and he took him on to the Quadrant Conference in Quebecin August 1943. There Wingate outlined his plans for a second, more ambitiouscampaign in 1944. To the dismay of GHQ in India, he returned triumphantlywith the authority to

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organize a Special Force of six brigades and to reinvade Burma assoon as possible in 1944.¹

By late autumn 1943, all the Allied forces in the Far East were preparingfor action--the new South East Asia Command of Lord Louis Mountbatten,Stilwell's Chinese Army in India, and the Generalissimo's American-supported"Y-Force" on Burma's eastern border. Lt. Gen. Sir William Slim,commanding SEAC's chief weapon, the Fourteenth Army, concentrated uponretraining his troops and restoring their confidence. Although suspectingthe forthcoming Japanese attack, he himself planned a major offensive.Stilwell had the approval of Mountbatten and Chiang to attack the enemyin North Burma and reopen land communications with China. He had retrainedand reequipped the Chinese 22d and 38th Divisions, veterans of the FirstBurma Campaign. They were the nucleus of the Chinese Army in India. Chianghad promised to add at least two more divisions to Stilwell's command,and, at Quebec, the Combined Chiefs of Staff issued orders to send himan American infantry regiment. Only Generalissimo Chiang was a doubtfulstarter. He was disappointed that more grandiose plans had not been adopted,and he was loath to risk his Y-Force in North Burma unless the enemy washeavily engaged in the south by a full-scale amphibious assault on Rangoon.

February 1944: The monsoon rains had abated, the roads and trailswere drying, and the rivers had subsided. Stilwell's Chinese divisionsand American infantry regiment began the descent of the Hukawng Valleybelow Shingbwiyang, straining to dislodge the crack Japanese 18th Division.Then suddenly, far to their south and west in the Arakan, the Japanesebroke out of the jungle. Fast-moving columns drove in the forward unitsof the Fourteenth Army. But behind them, one of Wingate's brigades wasmarching down from Ledo, Assam. Four others were poised for flight intoNorth Central Burma.

March 1944: The Chinese Army was at the base of the Hukawng Valley,ready to attack across the heights which separated it from the broaderMogaung Plain. The Fourteenth Army, having blocked the Japanese assaultin the Arakan, was under massive attack on the Imphal Plain to the northand appeared to be in perilous straits. Yet it was doggedly holding onto key positions. As Slim maneuvered his reserves into position withoututterly committing them, he became confident that he could repel the attackon India and shift to a counteroffensive in Burma by midsummer. The Chindits,soon to be bereft of their commander, were establishing strongholds inthe jungle, from which their columns could emerge to molest either theJapanese who

¹See Kirby, II, pp. 243-244, 309-329; III,pp. 5-6, 8-10, 37-38; Slim, pp. 162-163, 216-220; Sykes, pp. 371-374, 412-448;Mosley, pp. 187-213; Romanus and Sunderland, I, pp. 357-367, and passim.In U.S., Department of the Army, Burma Operations Record, 15thArmy Operations, pp. 7-10, the Japanese assess the effects of Wingate'scampaign in 1943. The works of Rolo and of Fergusson: Chindwin,are entirely devoted to the first Chindit expedition.

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opposed Stilwell in the north or those who attacked Slim in the west.The Second Burma Campaign had commenced.²

To steal into enemy territory unencumbered by a long supply train,to skirmish without the burden of heavy weapons, to hit and run--thesewere the tactics on which the life of the Chindits depended in 1943. Atfirst Wingate's superiors supposed that the new Special Force, althoughseveral times larger than the original Chindits, would be equally mobile.To their dismay, however, Wingate soon began to talk of establishing partof his Force in fixed "strongholds" deep in enemy territory.From these hornets' nests he proposed to send out his raiding or "floater"columns. If the enemy attacked the strongholds, he would swiftly draw inhis columns to fall upon his assailants' rear. In his most prophetic moodshe claimed that the strongholds could become great fortified bases to whichthe Fourteenth Army could be flown and from which it could issue to reconquerSoutheast Asia.

Now seen in terms of strongholds and now in terms of guerilla-Iikecolumns, the image of Special Force became blurred. Whether its tacticswould emphasize dispersal or concentration only Wingate himself could havesaid. Whether its strength would suffice to operate in both ways was veryuncertain. His superiors finally warned him to avoid excessive commitmentto the stronghold plan, anticipating that it might lead to unsupportabledemands for reinforcement. But scorning their skepticism, Wingate determinedto let success speak for itself. In 1943, his superiors had doubted thepossibility of long range penetration. The result? In 1944 he had beenrewarded by receiving a much stronger force with which to repeat his adventure.He was now confident that the campaign of 1944 would likewise confoundhis critics, and that his victories would win acclaim for the strongholdplan.

During the winter of 1943-44, Special Force organized under the coverdesignation of 3d Indian Division. Two brigades were formed especiallyfor the Force, the 77th and the 111th. They contained some survivors ofthe first Chindit expedition. Three more brigades--the 14th, 16th, and23rd--were produced by dismantling the 70th Division, veteran of the MiddleEast campaign. The 3d West African Brigade was brought in to complete theforce. In all, the strength of Wingate's command approximated 20,000 troops.Some were destined to garrison the strongholds. The rest were assignedto mobile columns--two colums per brigade, four battalions per column.Except for one brigade, which was to enter Burma on foot, Special Forcewas to fly to its battle stations. Moreover, Wingate secured the assurancethat aircraft would carry in his supplies and evacuate his casualties.

The principal mission of Special Force was to assist Stilwell's NorthernCombat Area Command. This it was to do by interfering with the line ofcommunications running north from Mandalay to the 18th

²Op. cit. Burma Operations Record presentsthe war on the Central Front from the Japanese standpoint. Also, SouthEast Asia, op. cit., pp. 1-51; U.S. Department of the Army, BurmaOperations Record, 33rd Army Operations, pp. 1-4.

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Japanese Division, facing Stilwell's Chinese Army in India in NorthBurma. It was to begin its campaign in the vicinity of Indaw. There itcould cut the railroad leading up to the Kamaing-Mogaung-Myitkyina triangle,the advanced base of the enemy troops in the north. Or it could demonstratein a westerly direction, behind the Japanese forces attempting to invadeIndia.

The 16th Brigade opened the campaign. Leaving Ledo, India, in earlyFebruary, it marched down trail toward Indaw. Its purpose was to assurethe security of Stilwell's right flank while his Chinese Army in Indiafought in the Hukawng Valley. Nearly 500 miles from its starting point,16th Brigade formed a stronghold, Aberdeen. Wingate ordered it to attackIndaw immediately. Several days of arduous maneuvering and sustained firefights proved futile. The l6th withdrew toward its stronghold, in whichit tried vainly to rest portions of its columns, turn and turn about, whilepatrolling and skirmishing along the road leading north. Late in Aprilit was obviously exhausted. The 16th assembled at Aberdeen and was flownback to India.

Meanwhile, Chindit columns and strongholds invested other sectorsof the Railroad Corridor leading to Mogaung through Indaw. The 77th and111th Brigades flew in early in March. After a bad first night, when wreckedgliders and scattered equipment obstructed the landing ground, the fly-inproceeded rapidly. Near Mawlu, shortly after the fly-in, the 77th Brigadeattacked a Japanese garrison and established a stronghold, White City.For several weeks it menaced Japanese roads while under increasingly severeattack.

The 111th Brigade flew to two sites widely separated by jungle andhilly terrain. Part of the brigade, known as Morris Force, worked its waynorthward on the more easterly trails and roads of the area. The main bodyclosed slowly on the strongholds established by the 16th and 77th Brigades.Its principal action in the campaign began early in May when it put downa roadblock below Mogaung. It fought tenaciously to maintain its stronghold,Blackpool, while waiting for the 77th Brigade to disengage itself fromWhite City and march northward to ambush the Japanese attacking the 111th.But monsoon rains greatly hampered the air supply program. The enemy'sstrength increased rapidly. The "floater columns" of the 77thcould not close in fast enough. Under very heavy attack near the end ofMay, the 111th finally abandoned Blackpool and struggled back into thejungle.

By this time, the 14th and 3d West African Brigades were also inBurma, having been flown in during April. Both were used partly to manthe strongholds and partly to supplement the efforts which the 77th and111th Brigades were making to isolate the Japanese defenders of Mogaung.Fourteenth Army retained the 23d Brigade with the 33d Corps. In April itwent into the jungle to interrupt enemy lines of communication on the CentralFront, but it never did serve as part of Special Force, itself,

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In June the battle for North Burma reached a climax in the Kamaing-Mogaung-Myitkyinatriangle. While the Chinese pressed toward their objectives from the north,Stilwell ordered the Chindits to pinch the enemy from the south. The easternsection of the 111th Brigade moved toward Myitkyina. The 77th Brigade attackedMogaung. The western columns of the 111th marched north from the shatteredstronghold of Blackpool and fought for positions which threatened Kamaing.The 14th Brigade was ordered to block the route which the Japanese woulduse if they tried to retreat.

Throughout June, Special Force maneuvered and attacked under unfavorablecircumstances. The enemy possessed well-prepared positions and well-establishedground communications, while the Chindits were deprived of the advantagesof surprise and mobility. As the battle for the Kamaing-Mogaung-Myitkyinatriangle became unexpectedly protracted, the strength of Special Forcedwindled rapidly. It held to its task, however, despite criticism and complaintsof its apparent inadequacy. Only when the vital area had been secured andthe fresh troops of the British 36th Division arrived was it allowed toleave the battleground.³

The value attached to the exploits of Special Force varies with theviewpoint of the commentator.⁴ All have agreed that itsmission

³Op. cit. Three of the brigade commandershave written about the campaign. Bernard Fergusson's The Wild GreenEarth (1946) concerns the 16th Brigade. Michael Calvert, inPrisoners of Hope (1952), accounts for the exploits of the 77thBrigade. John Masters, who commanded the columns of the 111th Brigade whichfought at Blackpool and Kamaing, describes his part in the Second BurmaCampaign in his autobiographical The Road Past Mandalay (1961).In the Stilwell Papers, Hoover Institution on War, Revolution, and Peace,Folder 4 contains the Fourteenth Army Operation Instructions Nos. 60 and61, 4 and 10 Apr. 1944, wherein the LRP mission is set forth. Its firstresponsibility is to support Stilwell's advance on Mogaung and Myitkyina.Second, it is to assist the Fourteenth Army by disrupting enemy communicationseast of the Chindwin River. General Slim's letter of 12 April designatesIndaw as the most southerly point for LRP operations. The Chindits areto concentrate upon the LOC leading toward the enemy positions which Stilwellis approaching. The 3d Indian Division "Precis of Op. InstructionsNo. 8 dated 28 April" (1944), also in Folder 4 of the Stilwell Papers,sets forth the plan to place the brigades south of the Kamaing-Mogaung-Myitkyinaline.
Stilwell's headquarters prepared several summaries of the conferences,orders, and plans relating to 3d Indian Division. An untitled statementdated 25 July 1944 is the most comprehensive of these summaries (Folders4 and 160, Stilwell Papers, have copies of this statement). With this summaryare itemized accounts of the movements and engagements of the 14th, 77th,and 111th Brigades ("Notes on 14th Brigade," etc., Folder 4,Stilwell Papers). Documents in Folder 45 of the Stilwell Papers revealthe relationships between Stilwell and his British peers and subordinatesduring April 1944.
⁴Assessments and critiques are found in Romanus and Sunderland,II, especially pp. 220-222; South East Asia, pp. 74-75; U.S., Departmentof the Army, Burma Operations Record, 33rd Army, pp. 5, 8-10, 17-19,and ibid.., 15th Army, pp. 94-96, 144-149; Fergusson, Earth,p. 127; Masters, pp. 147, 212-213, 244-246, 272-283; and Calvert, pp.226, 238, 241-242, 247, 250-51. In June, Mountbatten asserted thatthe effects of Special Force had been to break the LOC to the north, killapproximately 4,000 of the enemy, destroy supplies, and hinder the movementof certain Japanese units into position on the LOC supporting the attackon India. He estimated that before May the enemy had used the equivalentof two regiments against the brigades. After that time, he thought, atleast three and possibly six more enemy battalions were directly or indirectlyengaged in coping with the Chindits: Hq SEAC, "Secretary Plans SAC(44) 240," 12 June 1944, Stilwell Papers, Folder 7.
Stilwell's suspicious, contemptuous, and rigid attitudes toward the Britishare repeatedly exhibited in his diaries from the middle of May to August.(For this point, however, the published Stilwell Papers is incomplete.The original diaries, now on microfilm in the Hoover Institution on War,Revolution, and Peace, must be consulted.) In Folders 4 and 7 of the StilwellPapers, notes on conferences between Stilwell and principal British officerson 25 May, 30 June, and 11 July 1944 reveal Stilwell's undisguised hostility.His staff, too, shared his attitude, as is clear in the holograph reportsof Brig. Gen. Haydon L. Boatner in June, while he commanded the MyitkyinaTask Force, Folder 207, Stilwell Papers. A memorandum of 17 July, for example,concerns an incident in which Brigadier Lentaigne protested a statementfrom Boatner's office which seemed to be a "slur," Stilwell Papers,Folder 4; Boatner's response was officially correct but hardly reassuring.Fred Eldridge, who was on Stilwell's public relations staff, consistentlymaintains a tone of aggravation in describing the British (and Chinese,too, for that matter): Wrath in Burma.
Stilwell wrote and spoke of Special Force as if most of its troopswere poltroons. He accused the commanders of insubordination. More thanonce he threatened to take official action against them (see part IV).He assumed that Chinese and American successes would humiliate the British.He felt that the British press outrageously glamorized the Chindits atthe expense of American and Chinese troops. He, in turn, acknowledged Chinditaccomplishments in a tone which implied only that, for once, they had merelynot let him down. That the officers of the 3d Indian Division respondedin kind, so far as their subordinate position allowed, is evident fromthe narrations of John Masters and, to a lesser degree, Michael Calvert,as well as the responses to Stilwell in the documents cited.

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was extraordinarily hazardous and arduous. The Japanese testified,after the war, that it was a serious annoyance. The consternation causedby the sudden appearance of airborne troops in Burma led some commandersto propose a postponement of the invasion of India. Some troops in thestrategic reserve were diverted to attack the Chindit landing grounds andstrongholds. Other troops were delayed in their movement to administrativeand transportation posts behind the Central Front.

Most particularly, the defense of North Burma became more difficult.With Special Force behind them, the Japanese facing Stilwell could notfall back indefinitely. Consequently, when they were forced to retreatfrom the Mogaung-Myitkyina line, they had to sacrifice the garrison atMyitkyina, disengage rapidly, and regroup along a line further to the souththan they originally had chosen.

British and American evaluations are less generous and more qualified.Neither Slim nor Stilwell felt that Special Force interfered decisivelywith enemy communications, nor did they believe that its strongholds and"floater" columns were heavily enough armed to engage reallysignificant numbers of the enemy. During the first 2 months, Special Forcewas too far south to help the Chinese directly and too far east to influenceevents on the Central Front significantly. In June and July, the discouragementof its officers and the debility of its troops brought it little--probablytoo little--credit for its contributions to the campaign.

Several explanations have been offered for the questionable featuresof Special Force. First, on 24 March, before the Force was well established,General Wingate, its originator, died in an airplane accident. Wingate'ssuccessor, Maj. Gen. W. D. A. Lentaigne, the former commander of the 111thBrigade, followed Wingate's plans for tactical operations as far as theyhad been divulged to him. But possibly, to be most successful, SpecialForce needed the special zeal and inspiration of its first prophet. Certainly,no one except Wingate might have proposed independent ideas for the deploymentof Special Force, over against the plans of Slim and Stilwell.

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A second factor in the situation was the prolonged period requiredto place Special Force in position. The time-consuming and exhausting marchof the l6th Brigade almost certainly produced the failure of the attackon Indaw. During April, Fourteenth Army held back the 14th and 3d WestAfrican Brigades because all available cargo planes were being used onthe Central Front. Consequently, when the 77th and 111th Brigades neededhelp in May, the 14th and 3d W.A. Brigades were just moving into position.

The third cause of the limited effectiveness of Special Force hasbeen said to be its physical destruction by enemy action, fatigue, anddisease during the campaign. Its own commanders repeatedly made this pointwhen they sought to convince Stilwell, Slim, and Mountbatten that the Chinditsshould be relieved. Subsequently, those who feel that Special Force hasbeen unfairly judged as a fighting unit speak of its physical incapacityfor the tasks assigned to it in the battle for Mogaung.

The truth of the point appears obvious. Sixteenth Brigade was exhaustedwhen it left Burma in April. When the 77th Brigade was evacuated in mid-July,most of its troops were headed for the hospital, and its few remainingeffective men were, in fact, in very poor condition. An assessment of thestrength of the 14th, 111th, and 3d West African Brigades late in Julyshowed that only 3,400 officers and men remained from the fly-in and replacementstrength of 11,200 troops. Thirteen hundred men of the three brigades hadbeen killed, wounded, captured, or were missing. Nearly 7,500 were sickand either had been or were scheduled for evacuation. In these brigades,too, the men still listed as fit were disheartened, exhausted, and aboutas ill as those under medical surveillance.⁵

Despite the emphasis upon the physical deterioration of Special Force,published accounts of its operations have not given more than perfunctoryattention to its medical history.⁶How did the medicalcatastrophe come about? How adequate was its medical service? Did the troopssufficiently recognize the peril of a tropical environment? Is there amedical reason why the Force seemed to be more effective in its early hit-and-runmaneuvers than when it fought in prepared or in relatively stationary positionslater on? Finally, was the last and sorriest stage of Chindit operationsthe unavoidable medical consequence of military operations in the junglesand swamps of Burma?

⁵Statistics among the available documents rarelycheck exactly with one another. The medical situation is discussed below,but the summary here is drawn from the "Orders," 3d Indian DivisionHeadquarters, 19 July 1944, which appends a status report on the brigades,Folder 4, Stilwell Papers.
⁶The United Kingdom Medical Series of The Historyof World War II includes the volumes by F.A.E. Crew, The Army MedicalServices: Campaigns, the fifth of which treats Burma. By the time itappeared in 1966, the text, notes, and commentary presented here had beenentirely completed. They have been adjusted, however, to provide appropriatecross-references to the official history. Crew does not fail to considerthe questions of medical policy raised by the Chindit campaign, nor ishis evaluation uncritical. He concludes that Wingate's decisions impairedthe effectiveness of the Force medical establishment. But he does not testthe hypothesis that the Chindit medical history is the key to itstactical history.

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Medical Report of the Work of Special Force 1943-44 sheds so muchlight on these matters that its specific contents require little more thanprefatory assistance. Its opening section criticizes the initial plansfor medical support of Special Force and the spirit in which those planswere conceived. The author's position--for reasons which become apparentin the Report--leads to brevity, if not circumspection, in the discussionof the original medical plan. A brief review of its background is appropriatehere, therefore.

When General Slim took command of the Fourteenth Army in 1943, herecognized that its health and morale were unsatisfactory. He directedthat steps be taken (1) to employ the latest results of medicalresearch and practice in treating sick and wounded, and to obtain adequatesupplies of recently-developed therapeutic drugs; (2) to move closeto the troops the treatment facilities needed to care for malaria patients;(3) to provide air evacuation facilities for seriously ill or injuredmen; and (4) to take a variety of measures to improve morale and therebyreduce the malingering and insanitary practices which augmented the alreadyhigh sick rates. Thus:

Air evacuation, in the long run, probably made the greatest differenceof all to the wounded and sick * * * but it should be remembered that wherethe surgeon saved the individual life, the physician, less dramatically,saved hundreds by his preventive measures * * * Good doctors are no usewithout good discipline. More than half the battle against disease is fought,not by the doctors, but by the regimental officers.

To emphasize the importance of the daily intake of the malaria-suppressant,mepacrine (called Atabrine in the American army), Slim "had surprisechecks of whole units, every man being examined. If the overall result(of the blood tests) was less than 95 percent positive I sacked the commandingofficer. I had to sack only three; by then the rest had got my meaning."⁷

General Wingate's attitudes toward health and toward Army medicalservices were parts of his eccentric and militant personality. As for himself,he took pride in his hardihood. His passionate hatred for flies was asmuch a form of fastidiousness as it was a salutary contribution to campsanitation. Although fully aware that all food and water in the tropicsare presumed to be contaminated, he suffered a nearly fatal case of typhoidfever after impetuously downing the water in a vase of flowers in his hotelroom in India.

Troops sent to him for his first long range penetration force wereexactly the kind to arouse his prejudices. They were disgruntled, overage,and beset by various chronic disabilities. The weeding-out process beganas soon as they assembled for their training--first, by their own pellmellflight to the medical stations. He wrote:

⁷Slim, pp. 173-180.

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Hypochondria is the prevailing malady of the Englishman and of civilisednations. From earliest youth all are taught to be doctor-minded. NationalHealth Insurance, necessary and beneficial in many ways, plays its partin inducing this disease complex. While a native of India or Africa willnot, unless encouraged to do so by a European, even bother to mention atemperature of 103° F., an Englishman will throw himself out of workon account of the slightest deviation from normal. Even common colds areregarded as serious excuses for idleness. To this kind of self-indulgencethere is no end * * * The first thing that had to be done when trainingthe Long Range Penetration Groups was to root out the prevailing hypochondria.For this the co-operation of the medical profession was necessary. Althoughone would suppose my theory to be contrary to their interest, I must admitto having had the full, although sometimes misgiving, co-operation of medicalofficers.

Wingate's medical theories fitted his tactical practices. To guardthe secrecy of his whereabouts on the march, he forbade the establishmentof open lines of communication. Thus he had no means for evacuating sickand wounded men. The idea of devising an air evacuation system seems notto have been suggested. Instead, Wingate taught his troops that "sicknessmeant capture or death. He [the soldier] therefore did not only not gosick, he did not even fall sick." He also reported:

I am at last getting Platoon Commanders to be their Platoon Physiciansfor minor ailments and treatment. I never allowed this to interrupt ourmarches or operations. Gordon said, "A man is either his own physicianor a fool at thirty." On this standard a great part of our nationmust be classified as fools. I do not sit and take that as an unalterablefact, but set out to alter it, and I hope to succeed in doing so.

Wingate's first campaign did nothing to amend his principles, butit did convince him that his zeal for medical self-sufficiency had beenexcessive. The officers and men had found almost unbearable the necessityto abandon their sick and wounded. A sound evacuation plan, therefore,was considered an absolute prerequisite for the second campaign. Wingate,no less than others, saw that light planes or cargo aircraft would be Heaven-sentsolutions to the problem of retaining mobility for the Force while adequatelyproviding for the evacuation of severely sick and wounded men. Not onlywould marching columns periodically be relieved of the unfit, but the strongholdscould serve as temporary evacuation points without becoming choked by casualties.The less seriously sick and injured, however, were to remain in the Forceand recuperate on the march.⁸

⁸On Wingate's plans and attitudes, see Sykes,pp. 371-374, 415, 431, 469, 476-486; Rolo, pp. 156-160, 174-176, 188-189;Mosley, pp. 188-189, 201, 312; and Crew, V, pp. 133-136. Crew rejects theextreme position Wingate took, but he concludes that the campaign was sosevere as to overwhelm any other medical policy that was likely to havebeen adopted.

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Wingate's parsimony and prejudice on medical matters unquestionablyaffected his decisions about the organization and training of Special Force.After his death in March, however, the attitude of his subordinates becamecrucial. Such evidence as is available suggests that they were about atthe average for line officers in their regard for medical services andin their cordiality to medical personnel: ready to accept available aidsto the health and security of their men, but equally unwilling to allowtheir command to be coddled. Typically, their admiration of their own medicalassistants was balanced by indifference to or resentment of medical advicefrom the rear. The three brigade commanders who have published their memoirswere realistic--although not especially optimistic--in accepting the traditionalresponsibility of a commander for the health of his men, second to, butnot unrelated to, their fighting power.

Brigadier Bernard Fergusson has reported the regular administrationof Atabrine (or mepacrine) to his troops in 16th Brigade. He claims thatAtabrine was less effective than it was expected to be, even when faithfullytaken. But he also confesses that:

In one respect we had the wrong attitude to malaria: we looked on itas inevitable; we believed that we were all bound to get it every so often.Good work and propaganda by commanders, doctors, officers and men elsewherehas shown that this is by no means true * * * But in one respect we hadthe right attitude, in that we never treated malaria as a disease meritingevacuation.

Exceptions to the rule were made for men with cerebral malaria orfor those who had had numerous debilitating recurrences of the disease.Fergusson acknowledged the principle that: "Health in the jungle isnot only the business of the doctor or the commander; it is the job ofevery officer and of every individual."⁹

Brigadier Michael Calvert, 77th Brigade Commander, has spoken especiallyto the point of Wingate's attitudes:

Those who accused him of not paying attention to the medical side, maybe surprised to learn that we were the first brigade to have mepacrinein Burma, and that very many medical ideas which later were used throughoutthe Army were first tried out on Wingate's brigade and in some cases startedby him. I do not suppose at that time any commander in Burma * * * tookmore trouble and interest in the medical health and hygiene of his troops.

He comments, from time to time, on the medical situation of his brigadein the second campaign. Like other commanders, his remarks give reasonto suspect that disease and emaciation might be doing more than the enemyto destroy Special Force.¹⁰

⁹Fergusson, Chindwin, pp. 221, 239-240;Earth, pp. 197-199.
¹⁰Calvert, pp. 86-87, and passim. Calvert's comparisonsapply mainly to the campaign of 1943. Then, indeed, since Wingate's Chinditswere the only troops fighting in Burma, they were the only ones using mepacrine,the value of which had been demonstrated in the South Pacific in 1942 andearly 1943. That Wingate was more concerned about medical matters thanmany line officers is also probably true. As his own statements indicate,he at least had positive and distinct views which were cogently appliedto tactical problems. The figure of the "old India hand" whotook a completely fatalistic and negligent attitude toward health is afar more familiar one in 1942 (and even later) than the prejudiced butserious Wingate.

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Brig. Maj. John Masters, who commanded part of the 111th Brigade,has testified to the importance of air evacuation, and to the serious consequencesarising from lax Atabrine discipline. He was aware that some malaria "breakthroughs"resulted from deliberate failure of men to take Atabrine regularly. However,he and his medical officers were convinced that these lapses in moralewere rare. In their opinion, the rapid rise of sickness in the summer of1944 resulted from the debility which had accumulated during an excessivelylong campaign.¹¹

The attitude of junior officers and of the men can only be surmisedon the basis of common observation. Typically, it involved acute apprehensionabout the effects of a tropical environment and (apparently by derivation)the medical measures taken to combat it. The myth that Atabrine producedsexual impotence or sterility was rampant among all Allied forces, forexample. Yet conversely, the enormous labor required to reduce the hazardsof contaminated water, insect bites, and fungus infections of the skin--indeed,the impossibility of preventing them entirely during a long campaign--producedlaxity bordering upon hostility toward medical discipline.

The belief that Asiatics endured disease and physical distress moreeasily than Caucasians also was widespread, although the high mortalityand morbidity of the native populations provided visible contrary evidence.Such leaders as Wingate and Slim insisted that Western troops could fitthemselves for tropical campaigns, but the troops commonly felt that theirenemies suffered less than they did from tropical perils. The sense ofinevitability which accompanied such a prejudice produced, of course, aself-fulfilling proposition.

From this background, as well as from the objective realities ofa severe campaign, the medical history of Special Force derived many ofits peculiarities. The description of that history in Medical Reportof the Work of Special Force is urgent and intelligent. It conveys thespecial anxiety of a participant who observes the intersection of a highlysophisticated science and art with a completely primitive situation andenvironment. When it was written, the author had every reason to supposethat the experience of 1944 would be used as a lesson for 1945 and 1946.That the turn of events proved otherwise does not

¹¹Masters, pp. 133, 137, 237, 262-276. Crew,V, pp. 216-232, quotes at length the official medical report of Major DesmondWhyte, RAMC, the senior Medical Officer of 111th Brigade. It presents,of course, a responsible perspective on malaria control. Whyte's reportmay be profitably compared with that of General Officer; the two reinforceeach other, although the latter is far more informative and judgmental.The quality and impact of Crew's history is much enhanced by his extensiveuse of quotations from participants.

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reduce the importance of his report. For it shows how the technicalresources and valor of Special Force were needlessly wasted by ignorance,indifference, and intransigent prehistoric attitudes toward hygiene, sanitation,and medical discipline.

MEDICAL REPORT OF THE WORK OF SPECIAL FORCE,1943-44

Introduction

The following is a Report covering the Medical Aspects of the Forcefrom its inception to the conclusion of its operations in Burma in 1944and it covers the whole field of Training, Organization, and Battle Experience.

Such a report must, of necessity, be frank and outspoken and opinionsmust be given frankly and fearlessly if it is to achieve the object forwhich it is written, namely to benefit future similar undertakings andto avoid the repetition of the mistakes and omissions which are bound tooccur in new and original undertakings.

Many of the assertions may be considered unduly dogmatic and merelymy personal opinion and for that reason many of the statements may notmeet with universal approval. At the same time it must be realized thatthey are based upon a not inconsiderable experience of warfare in thistheatre and on my own personal observation during the period of operationsunder review. For this reason it is considered that they should be givendue consideration and weight and not discarded lightly on the grounds thatthey are so personal.

The report is divided into three phases, each covering a distinct periodof the life of the Force and ending with the conclusions drawn and therecommendations made for the future.

I. HISTORY AND OPERATIONS

The medical establishment of Special Force was underranked and undermanned.It consisted of (1) a Deputy Director of Medical Services and the Headquartersmedical section of three officers and four other ranks; (2) the brigademedical units, each composed of two medical officers, a warrant officer,and 20 other ranks; and (3) the column medical units. Wingate intervenedto prevent the senior medical officer from attaining a rank commensuratewith his position as D.D.M.S. Wingate also reduced the size of the columnmedical detach-

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ments below the level which the medical administration believed wouldbe adequate.¹²

The D.D.M.S.¹³ put forward that each Column should have oneMedical Officer and eleven other ranks R.A.M.C. (or I.A.M.C. for Indiancolumns).¹⁴ This was turned down by General Wingate, his reasonbeing that it would increase the size of the columns too much, and makethem unwieldy, and he suggested that one Medical Officer and two otherranks would be sufficient; as all ranks in the column should be capableof looking after themselves, and only require medical assistance in themore severe type of case.¹⁵

General Wingate suggested that use could be made of the Column Padreas a Medical Orderly but this was not agreed to by the D.D.M.S. However,after more discussion, it was finally decided by the General that the Columnestablishment would be one Medical Officer, one Sergeant and two otherranks R.A.M.C. on the columns with Padres, and one Medical Officer, oneSergeant and three other ranks R.A.M.C. on columns without Padres. On Indiancolumns the establishment was fixed at one Medical Officer, one SergeantR.A.M.C. and three Indian other ranks, I.A.M.C.

Although this establishment was finally passed by G.H.Q. (I)¹⁶it was never agreed to by the D.D.M.S., and as anticipated, it proved itselfquite inadequate in that the Medical Officer was severely handicapped whena Medical Orderly was required for an isolated group, e.g., the Recce Platoon¹⁷or Commando Platoon; and further if a group was isolated for any lengthof time from the Main Column, the responsibility for any casualties, etc.,rested with the officer in charge. An attempt was therefore made to giveinstructions to the officers in First Aid with a view to making Columnsself-sufficient and avoiding this; but with the limited time availableand the lack of interest in anything Medical by combatants, only a sketchycourse was covered.

Training

During the Training period each brigade operated independently, concentratingon column exercises. The medical personnel were attached to the columns,and apart from their work with them no collective medical training wasdone in the Force.

¹²General Officer begins by describing thecomposition of Special Force and its medical establishment. His commentsthereon are here summarized.
Unless otherwise indicated, notes and text summaries have been suppliedby the Editor. A few trivial typographical and verbal errors have beencorrected.
¹³The Deputy Director of Medical Services occupied a positioncorresponding to that of the principal medical officer of a Corps in theAmerican Army. At that level, the rank of Brigadier would have been appropriate.
¹⁴Royal Army Medical Corps; Indian Army Medical Corps.
¹⁵For comparative purposes, it may be observed that the medicaldetachment of a U.S. Army infantry battalion was composed of two medicalofficers and 32 men. On this scale, Special Force columns had medicalpersonnel equal in number to that allotted to a company in an Americanbattalion.
¹⁶General Headquarters (Intelligence).
¹⁷Reconnaissance Platoon.

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Brigade Medical Units lived in the Brigade Area but took no part inthe general training. They proved, however, too small to deal with allthe sick in the brigade, and became merely a collecting post to which theColumn Medical Officers sent the sick. These were then evacuated to thehospitals in the Jhansi Area.¹⁸

Although on the establishment of the unit six ambulance cars were authorized,these could not be obtained and three-ton lorries fitted with Berridgeequipment were issued in lieu, and these in their turn were later replacedby 15-cwt. trucks fitted to carry four patients. As brigades were widelyseparated from each other and as there was no central point at which casualtiescould be collected and evacuated to hospital, the Medical Units had tofunction independently. This meant that units had to evacuate in most casesover a distance of 100 miles, and with the limited transport availablethis was most difficult.

When the brigade moved out for an exercise away from its permanent area,the medical unit had to send a detachment with it, and from the limitednumbers of officers and men available it was only possible in most casesto send one truck and a few R.A.M.C. orderlies.

It is considered that the evacuation should have been carried out bythe areas and subareas concerned.¹⁹

Supplying Medical Stores to Columns

The O.C.²⁰ Brigade Medical Unit indented in bulk from theMedical Store, Jhansi, and issued to the columns as required. For the collectionand distribution of the stores the ambulance trucks were used as no othervehicles were available.²¹

¹⁸In northeastern India. The author here callsattention in the text to a map enclosed with the report
¹⁹On this point two opinions are hardly possible. The rangeof evacuation for so small a medical unit would properly be no more thana few miles, at the very most. In a brief section which has been omitted,the author reports that a hospital nearer than the one at Jhansi was closedto Special Force troops, for reasons unexplained to him. Requests for regularambulance units to help the brigades went unfulfilled. As a result "thevehicles of the Brigade Medical Units were fully employed day and night."Not much better arrangements could be made to use railway coaches on atrain which passed through a nearby town three times a week--at midnight!Fortunately, two brigades were close to Jhansi, and the medical sectionin the West African brigade had 11 ambulances.
Nonetheless, the inadequate facilities for evacuation and hospitalizationled to costly expenditures of troop strength. Brigade ambulances were offstation for long periods of time. Casualties with minor illnesses and injurieswere taken too far from their operational areas, although Fourteenth Armystressed the importance of providing close-in medical services, especiallyfor malaria cases. Not only was it important to avoid excessive delaysin returning troops to duty, but it was also desirable to remove any temptationto malingering that a distant hospital might offer. See Slim, pp. 178-179;Crew, V, pp. 189-190.
²⁰Commanding Officer.
²¹At this point in the report, the author inserted completeWar Establishment tables of personnel, equipment, and supplies. The equipmentand supply lists provided instruments and drugs for first aid and short-termtreatment of injuries, wounds, and such common diseases as diarrhea, dysentery,and malaria. The units of supply and equipment were relatively small, sincethe Special Force required the utmost mobility.

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Force Concentration

On completion of training, the brigades moved to their ConcentrationAreas. 16 Brigade [went] to Ledo Area, 77 Brigade to Lalaghat, and 111Brigade to Imphal Plain, leaving only the Brigade Depot Staffs in theirTraining Area. Brigade Medical Units followed their brigades and openedin the Rear Brigade Headquarters Area. Once the brigade moved into Burma,the main function of the brigade medical units was to supply their respectivebrigades with medical stores and equipment and take over medical chargeof the personnel of Rear Brigade Headquarters.²²

Meanwhile the D.D.M.S. recommended the following Administrative Lay--outof his staff on the move of the Force to the Operational Area: At Gwalior,D.A.D.M.S., D.A.D.H.; at Sylhot, A.D.M.S.²³ The D.D.M.S. andthe D.A.D.H., while being mainly at No. 1 Air Base, Sylhot, would be freeto move into any area he considered necessary.

This, however, was not agreed to by Force Headquarters and instead itwas laid down that as the brigades moved forward into the operational areathe Medical Headquarters Staff would be: (a) At Gwalior, D.D.M.S., D.A.D.M.S.,D.A.D.H., D.A.D.M.²⁴ and the whole of the Clerical Staff, (b)at Sylhot, the headquarters of 3d Indian Division,²⁵ A.D.M.S.How the D.D.M.S. was ever expected to direct the Medical Services of theForce or to advise his Commander on matters of medical importance so farin the rear of Main Headquarters, is beyond comprehension. Yet at the sametime the D.D.M.S. Colonel [W. E.] Campbell has received all the blame forthe nonworking and the maladministration of the Medical Services. When,as will be seen later, the D.D.M.S. was not even allowed to visit the OperationalArea or to contact his new A.D.M.S. on the latter's arrival at Sylhot,it can be understood in what a difficult position the D.D.M.S. found himself.

Prior to the Brigades' moving to the Operational Area, the D.D.M.S.decided to visit the D.D.M.S. Fourteenth Army, put him into the pictureas to the role of the Force, and prepare a plan with him for the hospitalizationof the casualties on their evacuation.

Permission to do this was denied him on the ground that the A.D.M.S.had already visited D.D.M.S. Fourteenth Army and had made all necessaryarrangements. It was only after the troops had moved to the forward areathat the D.D.M.S. was allowed to pay them a visit. When in the area hesuggested that his office should no longer be at Gwalior but should moveup to No. 1 Air Base at Sylhot where Main Force Headquarters was now situated.

²²In a brief passage here omitted, the authorreports the appointment of base depot medical officers. These arrangementswere made by higher administrative headquarters and did not involve SpecialForce.
²³D.A.D.M.S.: Deputy Assistant Director, Medical Services--astaff position appropriate for the second-ranking medical officer of adivision and below that of the A.D.M.S. D.A.D.H.: Deputy Assistant Director,Hygiene. A.D.M.S.: Assistant Director, Medical Services--the chief medicalposition in a division or brigade.
²⁴Deputy Assistant Director, Malariology.
²⁵"3d Indian Division" was the "cover" identificationof Special Force.

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This suggestion was not approved and the D.D.M.S. had reluctantly toreturn to Gwalior.

Shortly after this Lt.-Col. [John L. Mewton], I.M.S.²⁶ wasappointed A.D.M.S. of the Operational Area with the title of A.D.M.S. 3dIndian Division and reported at Sylhot after visiting the D.D.M.S. FourteenthArmy. It was natural at this stage, and in effect essential, that the newlyappointed A.D.M.S. should contact his D.D.M.S. and get some indicationfrom him as to what his duties in a Force of this nature were likely tobe and be put in the picture generally as regards the tactical situation.This, however, he was not allowed to do, nor was the D.D.M.S. allowed tocome forward from Gwalior to contact him. The signal received at Gwaliorin answer to the D.D.M.S. signal stating his intention of proceeding toNo. 1 Air Base was "D.D.M.S. not required at No. 1 Air Base."

Thus with the exception of two brief visits to the forward area theD.D.M.S. remained at Gwalior until he left Special Force on repatriationto the United Kingdom.

From this it can be seen that the Medical Branch of the Force was notonly not receiving every assistance to carry out what at the best of timescould only be an extremely difficult administrative task but was meetingwith active opposition. The D.D.M.S. had not been allowed to administerhis command and the newly appointed A.D.M.S. had not the slightest ideaof what his duties involved. Medical Units and the personnel were thusleft without any leader, without any clear-cut Medical plan and they embarkedon a hazardous undertaking with a feeling of insecurity and bewilderment.

After his interview with the D.D.M.S. Fourteenth Army the A.D.M.S. 3dIndian Division reported his arrival to his D.A. QMG²⁷ (Brigadier[Neville] Marks) in Sylhot. He requested permission to proceed to Gwaliorto meet the D.D.M.S. but was told that, while it might be desirable forhim to see his D.D.M.S., there was first a more urgent task for him todo in the forward area. He was to visit the two brigades which were likelyto go into Burma in the near future as General Wingate had reported thatthey were all suffering from a mild degree of Avitaminosis. He was directedto go to Imphal that afternoon and see 111 Brigade. When this inspectionhad been completed he was to return to Lalaghat and examine 77 Brigade.He would then report to Administrative Headquarters in Sylhot and aftertaking all necessary action he could report to Gwalior.

On his arrival at Imphal the A.D.M.S. reported to General Wingate andtold him the purpose of his visit. General Wingate assured the A.D.M.S.that from his experience he personally had a much greater knowledge ofAvitaminosis than any doctor but that he, the A.D.M.S., was to carry outhis orders and report to him his findings.

The A.D.M.S. visited 111 Brigade in its camp 31 miles down the Tiddimroad. All Medical Officers agreed that while the health of the men wasof a very high order they had, some six weeks ago, "gone off theirfeed" as the

²⁶In the typescript, the first and middle namesare omitted and the initial letter of the last name is illegible.
²⁷Deputy Assistant Quartermaster General. Marks was Wingate'schief administrative officer.

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diet had then been of a very poor quality and very monotonous, but thatsince the visit of the D.D.M.S. a few days ago the diet was now above reproachand nothing more was needed or wanted. 77 Brigade was then visited in Lalaghatand all Medical Officers told a strikingly similar story. Brigadier MichaelCalvert told the A.D.M.S. that in his opinion the diet was perfectly goodand that the complaints were inversely proportional to the efficiency ofthe unit's internal administration. The Kings Regiment, whose internaladministration was good, made no complaints while another regiment, whichwas not so well administered, was full of complaints. This the A.D.M.S.found to be so. While the Kings said that they had more food than theycould eat the other regiment complained bitterly of the insufficiency andthe poor quality of the ration. The ration in both cases was the same andit was pointed out to the latter where the trouble lay and by what meansit could be remedied.²⁸

On completion of these inspections the A.D.M.S. returned to Imphal wherehe made his report to General Wingate. He was then told that as no arrangementhad yet been made for the reception of casualties on their evacuation fromBurma, when operations began he was to return to Sylhot and make, in conjunctionwith the D.D.M.S. Fourteenth Army, whatever arrangements he considerednecessary.

A few days later, during the course of a visit to 77 Brigade, the A.D.M.S.was horrified to note from the Senior Medical Officer²⁹ thatthe "Fly-In" into Burma was due to begin the following evening.This was the first information he, the A.D.M.S., had received on the subjectand up to this time no arrangements had been made for the hospitalizationof the casualties occurring either during the landings or during the operations.³⁰

A plan had, therefore, to be made immediately to deal with the situation.

Operations

It was at this time--10 April 1944--that I took over the appointmentof D.D.M.S. Special Force and reported my arrival to the D.D.M.S. of FourteenthArmy and to Major General W. D. A. Lentaigne, the Force Commander³¹who was then visiting Headquarters, Fourteenth Army.

²⁸Brigadier Michael Calvert subsequently recalledthat rations were adequate, though monotonous. John Masters, then the BrigadeMajor of the 111th Brigade, later stated that the diet during trainingincluded shark liver oil. See Calvert, p. 193; Masters, p. 133. However,a later report refers to severe avitaminosis among troops seen at Imphalin September 1943. While the troops are not identified, the reference almostcertainly is to the incident described in General Officer's Report. Infour battalions, from 15 to 50 percent of the troops showed signs of vitamindeficiency. See O'Dwyer, p. 115.
²⁹Maj. C. Roy Houghton, R.A.M.C.
³⁰Fourteenth Army, in the field order which launched the campaign,required the establishment of a casualty clearing station at No. 1 AirBase as part of an air-evacuation plan. Masters had originally been toldthat casualties would be left with friendly villagers, as had been doneduring the first campaign in 1943; occasionally they might be flown outby C-47 cargo planes. However, this preliminary view was replaced by Wingate'sfirm intention to use an air-supply and an air-evacuation system. Yet Calvert,at the time of the fly-in, was worried about how casualty evacuation wouldbe carried out. The varying reports, thus, tend to confirm the pictureof administrative confusion and last-minute improvisation. See Sykes, pp.507-508; Masters, pp. 127, 137; Calvert, p. 32; Crew, V, p. 190.
³¹General Wingate died in a plane crash on the night of 24 March.Brigadier Lentaigne, then in the field with 111 Brigade, became Force Commanderon 30 March.

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It soon became apparent from the information which I had received fromFourteenth Army and from my A.D.M.S. that the task before me was to beby no means an easy one. It was common knowledge that the Force in generaland the late commander in particular were not Medically-minded to say theleast of it, and from the story given by the A.D.M.S. it was quite evidentthat my predecessor had been given no active support and had instead apparentlyreceived only active opposition. With an officer of his seniority and experience,it is quite impossible to believe that the D.D.M.S. had not done everythingin his power to put the Medical Services of the Force on as sound a basisas possible. I am confident that any faults or deficiencies which wereto come to light were through no lack of effort on his part.

On my arrival at Force H.Q. at No. 1 Air Base D.A.Q.M.G. informed methat although it was probable that I had been told that the Force was antimedical,this was far from being the case and that the best Medical Service possiblewas their one desire. I was assured that it was through no fault of theirsthat the existing Medical Setup was below normal standards, and that thefault lay entirely with my predecessor. I was assured that I would be givenevery possible support to this end, and I may say at this stage that thishas proved to be the case.³²

Taking over a "Going Concern" in the middle of an operationwas of course a difficult problem, and without seriously interfering with,and interrupting the course of operations, the institution of any radicalchange was impossible. It was quite evident that any established MedicalOrganization was completely lacking; and while the policy had evidentlybeen for the Force to be so "special" that it should be entirelyself-contained and independent of all outside help, the Medical Organizationpresumably based on this policy was completely insufficient to cope witheven the merest of operational necessities.

In order to get some clear picture of what the organization lacked andwhat, from the nature of its task, it required, an Appreciation was made,setting out all the factors and a suggested solution for the future.

After a rapid visit to the troops in "Aberdeen" and "WhiteCity"³³ as well as to the Gwalior and to the Jhansi Area,in order to get a complete picture of the general layout, the work of attemptingto direct a nonexistent Medical Service was commenced. At times it oftenappeared that all that was required was a Medical Officer of sufficientexperience and seniority to act as a Medical Adviser to the G.O.C.;³⁴at others, that the task was so large and so fraught with difficultieswhich at times appeared insurmountable, as to need a D.M S.³⁵with the staff of an Army. When it is realized that at one time the Forcewas spread from Bangalore in the South to Dehra Dun in the North of India,and through the Headquarters situated at Gwalior,

³²See pp. 208-211, for discussion and evaluationof the attitudes attributed to Wingate and others in the Force.
³³See pp. 203-205, for the summary of the campaign. In earlyApril, 16th Brigade was based on the stronghold Aberdeen, and had recentlyfailed in its attempt to capture Indaw. Not long after General Officer'strip, the brigade would be evacuated because of its exhaustion. At WhiteCity, the 77th Brigade was actively engaged throughout April and earlyMay.
³⁴General Officer Commanding.
³⁵Director of Medical Services.

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Sylhot, Dinjan, and Shaduzup to the troops operating in Central andNorth Burma, it can be appreciated how true this was. Each in turn heldtheir own importance and while medical representation was necessary ateach this could not always be provided. As it was, this multiplicity ofHeadquarters involved such a subdivision of the Medical Staff that it seriouslyreduced the efficient running of this branch and made communications allthe more difficult.

The general plan of operations was that brigades were to invade Burmaby crossing the Chindwin River at selected points, at staggered intervals.The operations were to begin with 16 Brigade advancing via Ledo and theHukawng Valley in early February, and 77 and 111 Brigades making theirapproach from the Imphal Plain. Shortly after 16 Brigade had started itsmarch, the plan, so far as it affected the other brigades, was changed,as it was apparent from information received, that a crossing of the ChindwinRiver in force would be opposed. It was decided, therefore, that the remainingbrigades would be flown in to preselected areas which were to be put intoa state of defense and form bases from which columns would operate. Theinitial assault troops were to be flown in by gliders with the task ofpreparing and protecting a landing strip to receive the larger troop-carryingaircraft bringing in the remainder of the Force. Two sites were selectedfor this purpose and given the code names of Piccadilly and Broadway. Ason the eve of the assault it was discovered that the Piccadilly site hadbeen obstructed, presumably from enemy action,³⁶ its contemplateduse was abandoned and Broadway only was used. At a later stage three furthersites, named Chowringhee, Aberdeen, and White City were made. The exactposition of these sites was not known to any of the Medical Staff at thistime, for none of its members were allowed to attend the 'S' Conferences,³⁷in spite of repeated representation being made as to the vital necessityof this.

Embarkation arrangements as regards Medical Detachments were poor, andwhile the principle of dispersal was appreciated and acted upon to a certainextent, it lacked organized plan. Officers, men, and equipment were dispersedto such good effect that there were no organized parties which could functionon landing.

In any future operation this must be appreciated, and dispersal intoparties, each capable of functioning independently, must be arranged; rememberingalways that casualties occurring from accident as well as from enemy actionat the time of landing must be anticipated and provision made for theirtreatment.³⁸

³⁶Almost at the last hour before loading thegliders, aerial photographs were obtained which showed that the clearingcalled Piccadilly was crisscrossed with logs. The only safe assumptioncould be that the enemy had discovered the plans of Special Force. Aftera dramatic conference with Wingate, Slim ordered the fly-in to proceedon schedule. Later it was learned that Burmese woodcutters had simply spreadout newly-cut teak trees to dry.
³⁷Special Staff conferences.
³⁸Many gliders in the first flights crashed at Broadway. Thefield became completely obstructed by wreckage. Survivors worked franticallyduring the early morning hours, however, and the fly-in resumed after daybreak.

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Embarkation for the fly-in took place from the airfields of Lalaghatand Imphal, but chiefly from Lalaghat.

With the construction of Dakota³⁹ strips in the defendedareas mentioned, it was now possible for casualties to be evacuated byair direct to base hospitals in Assam; and 91 I.G.H. in Sylhot was chosenas the base hospital for this Force.

It now became one of the functions of the Brigade Medical Units to receivethe casualties on their arrival at the base air strips; and while arrangementshad been made that all casualties were to be landed at Sylhot Air Strip,the possibility of their being landed elsewhere, namely Hailakundi, Lalaghat,and Agatala, had to be provided for, and Medical Detachments were consequentlysited on each of these strips.⁴⁰

The original idea that each Brigade Medical Unit would be responsiblefor the medical supply of its own brigade now became impossible, and 16Brigade Medical Unit was given the task of doing this for the whole Force.[Since it had not been decided]⁴¹ in view of the uncertaintyof the commencement of operations, as to how, if at all, evacuation ofcasualties was to take place, medical officers were instructed that everythingwas to be done with the means at their disposal to return individuals tocolumn duty as quickly as possible. This meant carrying the sick and woundedwherever possible, either on stretchers carried by bearers or on ponieswith which the columns were supplied; such nursing as was possible beingundertaken at halts and in bivouacs as occasion arose. In the event ofan action and the number of casualties increasing, or if, for any otherreason, the carriage of patients became impossible, then arrangements wouldhave to be made to leave them in the care of friendly villages. If thiswas not possible then they were to be hidden in some secure place nearwater, with sufficient food, ammunition, and money to enable them to subsistas long as possible until help arrived, or they became sufficiently restoredto health to make their own way to safety. It was hoped that the abandoningof such casualties would never be necessary and medical officers were instructedto make every effort possible to get their men away by every means in theirpower.⁴²

³⁹The two-engine Dakota plane (designated C-47)was the workhorse cargo and troop-carrier plane of the war.
⁴⁰On the line of air evacuation behind Stilwell's Chinese Armyin India, the 151st Medical Battalion had the principal responsibilityfor establishing and staffing "air clearing stations." As ithad done at the trail aid stations in 1943 (see North Tirap Log),the Battalion dispersed its troops widely in relatively self-sufficientevacuation centers. Obviously, no such plan had been laid down for SpecialForce. Instead of diverting a suitable medical unit from its supportingechelons, the Fourteenth Army expected the Force to produce its own lineof evacuation as well as its combat medical services!
⁴¹The phrase in brackets has been supplied, conjecturally, asit is apparent that the typist of the Report omitted a line. Footnote 42indicates that the idea expressed by the conjectural insertion representsa misapprehension of General Officer, but it is consistent with the senseand tone of the remainder of his paragraph.
⁴²This picture is, of course, exactly accurate for the Chindit'scampaign of 1943. All sources agree, however, that the plan for 1944 includedthe intention to provide air evacuation, and that this intention was knownat least by the time the Force was in training. It is true, however, thatno clear notions had been formulated regarding evacuation from marchingcolumns, and it was only as the campaign began that the utility of thesmall L-1 and L-5 "cub" planes was demonstrated. See Masters,p. 137: During training maneuvers, an injured mule skinner was evacuatedby a light plane. "The commanders' hopes and the soldiers' moralerose sky-high. Now we would not have to make the choice between destroyingthe morale of our men or saddling ourselves with wounded who would slowour movements so much as to invite disaster, and failure." Mastersalso reports that Brigadier Lentaigne, while still in command of the 111thBrigade, sent two sick soldiers to the base by air shortly after the fly-in."They were not very ill but Joe had decided to send them out as ademonstration of the speed of our evacuation system" (pp. 178-179).Calvert, who had led columns of the Chindits in 1943, "had laid downthat we would never leave wounded behind" in the second campaign (p.32).

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As things turned out, evacuation to India did become possible, and wasin fact so successful in the early stages, that in many cases men wereback in the base hospitals within 12 to 24 hours of their being wounded.The jettisoning of casualties did, I regret to say, have to be resortedto in a few instances. The majority of these cases occurred in the courseof an unsuccessful action when withdrawal had to take place under heavyenemy fire without the opportunity allowing of the collection of the moreseriously wounded. At other times when the wounded were being carried andhad, for reasons of speed or insufficiency of bearers, to be abandoned,these were in the majority of cases so seriously wounded that their chancesof survival were of the slenderest. Such cases, in view of their seriouscondition, were put humanely out of their misery.⁴³

The policy of economy in manpower, the treatment of the individual withinthe column and his rapid return to duty, remained the basic principle throughoutthe campaign even when a successful method of evacuation was devised andin regular operation; and it was always understood that only the most seriouscases requiring skilled nursing would be evacuated out of Burma. Casesof malaria, diarrhoea, septic sores were all treated by column medicalofficers even when the malaria was sufficiently severe to necessitate theadministration of quinine intravenously. Every means available to get theman back on his feet was adopted, and gradually it became the acceptedpractice to treat nearly all cases of malaria with an initial dose of quinineintravenously.

Toward the end of the campaign when both men and medical officers werefeeling the strain both mentally and physically, there was a tendency formedical officers to forget their basic policy, and for them to send outmen for whom during normal times, evacuation from Burma would never havebeen considered.

The serious mental strain to which all ranks were being subjected andthe appalling conditions of weather and terrain in which they were compelledto operate were fully realized; at the same time, so long as an operationaltask remained and so long as those responsible remained deaf to the medicalreports of the state of the men's health and their consequent noneffective

⁴³Calvert led part of his brigade on a difficultflanking raid outside White City, hoping to relieve some of the pressureon it. As casualties accumulated, the force slowed down its pace to matchthe litter bearers. At one point, however, efforts to recover several woundedmen under heavy fire produced new casualties. The troops were forced toleave some of the wounded men behind (p. 134).
Masters, commanding the 111th Brigade at Blackpool, had to make a stillmore desperate decision. The stronghold was shattered. As the 111th withdrewunder enemy fire, too few mules remained to carry all the wounded. Somewere being carried on litters by other wounded men. Enemy pursuit was imminent.Masters' medical officer reported that at least 19 of the wounded men werevery near death. By shifting their litter-bearers to other cases, it appearedthat some 30 men might be evacuated and saved. Masters accepted the choicegiven him. The 19 hopeless cases were spared from falling alive into enemyhands, however (pp. 253-254), Crew, V, pp. 237-238, quotes Masters' accountof the grim episode.

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fighting state, this policy had to be adhered to as strictly as ever.Moreover, laxity with one brigade whose opportunities for evacuation weremore favourable, produced its serious repercussions in others whose positionwas less fortunate. The gravest instance of this occurred on the IndawgyiLake when, although the numbers awaiting evacuation from 111 Brigade werelarger than any of the other brigades, they were in no way so serious asthe [scrub] typhus cases in 14 Brigade, or the large number of battle casualtiesof 77 Brigade. As the means of evacuation became more uncertain and irregular,the attention of medical officers had again to be drawn to this basic policy,and the importance of a strict selection of the cases for evacuation, retainingwithin the column those with whom they could deal themselves, was againimpressed on them.

Although this basic policy of treatment was accepted and carried out,it was only done under the greatest difficulties; for the number of medicalpersonnel was quite insufficient to deal with even the small numbers occurringduring the premonsoon period. Numbers of medical personnel must be sufficientto carry out not only the numerous duties involved in the efficient nursingof the sick but also the fatigues necessary for their accommodation, protection,cooking, and sanitary wellbeing. The allotting of combatant personnel forthese duties when they are already fully employed in their own tasks oflocal defense and patrolling together with attending to their own personalneeds, is not possible and cannot be expected.

For strongholds the ideal would have been the establishment in themof some form of field hospital and no doubt the original idea of the brigademedical unit was that they should be so employed. However, lack of aircraftspace and the other duties to which they were already committed preventedthis being done. Whenever possible, column medical personnel were combinedwith a view to carrying out this duty, but their resources were insufficientand their usefulness restricted.

II. PERSONNEL, INTERCOMMUNICATIONS,AND EVACUATION

The medical problems produced by warfare in the tropics were compoundedby the difficulty in determining when and how to evacuate casualties. "Toconserve fighting strength" required that genuinely incapacitatedmen should be withdrawn, both for their own sake and for that of theirhard-driven comrades. In the strongholds or in the marching columns theywere a burden. Yet the grave limitations in air transportation facilitiesfor evacuees, and the absolute necessity of preventing losses in Forcemanpower precluded generosity in the evacuation plan.

For this dilemma, there were no happy resolutions. Painful compromisescharacterized the attitudes and practices of the medical establishment,from the Force Surgeon down to the Column medical

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officer. Those who were conservative or who could not secure evacuationfacilities on call were accused of cruelty. Those who were liberal wereliable to be reprimanded for weakening the Force, and for encouraging malingering.

Medical Personnel for the Columns--Officersand Other Ranks

It can be truthfully said that without exception all commanders werehigh in their praise for the medical personnel with their columns. Theywere keen and had the welfare of their men at heart. They worked underthe most extraordinary difficulties of climate, terrain, and insufficiencyof equipment. They carried out their work with cheerfulness and an enthusiasmwhich was beyond all praise.⁴⁴ The wonder is not that the MedicalServices did so well but that they functioned at all. With lack of communications,the loss of and at times the absolute absence of Medical Supply Drops,the appalling weather conditions, and the lack of cover made the nursingof some of the more acute fevers almost an impossibility. With the smallnumbers of medical personnel available and the multiplicity of tasks necessarybefore cases could even be received, made the proper care of the sick andwounded even more astonishing.⁴⁵

With it all a lack of training the arduous and important duties of theRegimental Medical Officer were in many cases painfully obvious.⁴⁶There was a disinclination by some, though these were in the minority,to realize the importance of the maintenance of a full frontline strengthand economy in manpower. There was at times a misplaced sympathy with thehard lot of the men and an assurance to them that they were not receivingthe attention they would like to give them. Such misplaced kindness hadnaturally a lowering effect on morale and it can truthfully be said itwas in those columns where the Medical Officers were most popular thatmorale was of the lowest.

There is no one who has more influence on the morale of the men thanthe Regimental Medical Officer. The operational task and the war effortin general compatible with the well-being of his men must be his primaryconcern. Firmness must be combined with sympathy, and the infusion of aknowledge that his treatment is of the best and that the fitness of theman to resume his place in the frontline for the task allotted must behis prime considerations. Only by this means will the morale of the menbe maintained at the highest.

⁴⁴This estimate is confirmed by the commentsof Fergusson, Masters, and Calvert. Majors Desmond Whyte, RAMC, James Donaldson,RAMC, and C. Roy Houghton, RAMC, were the Brigade Medical Officers of the111th, 16th, and 77th Brigades, respectively. Fergusson also praised the"outspoken and excellent" Force Surgeon, the author of this report:Masters, pp. 272-273; Fergusson, Earth, p. 202; Calvert, p. 168.
⁴⁵Sic. The word "with," which opens the sentence,should be deleted.
⁴⁶Sic. The sense of the sentence would be clearer if it read:"With it all, a lack of training in the arduous and important dutiesof the Regimental Medical Officer was in many cases painfully obvious."

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Pari passu with this and closely intermingled with it is the infusionof a knowledge of a healthy way of living. In other words constant educationin the maintenance of health and the prevention of disease--a high standardof Sanitation and Hygiene--amongst all ranks especially the leaders towhom the men look for example and guidance. Slackness in the former naturallyleads to slackness in the latter, and it is here where the Regimental MedicalOfficer can exert an enormous influence. Constant reminding during periodsof off duty of antimalaria precautions in which officers were notoriouslyslack, the digging of latrines, and the reporting of indiscipline in sanitaryhabits, while all tending to risk the loss of popularity, if done withtact and friendliness lead to an enormous improvement in health and efficiency.In fact it can be said that the influence that can be exerted by a goodRegimental Medical Officer with a sound knowledge of human nature and aset standard in discipline and morale is beyond measure, and it is onlyby training that the young Medical Officer can be made to realize it.⁴⁷

There was a tendency in the early days of the Force for Medical Officersto be sent to the Force as a punishment. The type of man who got into troubleat a guest night or at a dance night at the club for smashing the furnitureor laying out the most senior officer present, was considered, by virtueof his toughness, as the most suitable type for the hazardous operationsenvisaged for this Force; and in actual fact many of this type were postedand had to be changed. From what has been said above it can be seen howvery mistaken was this policy and it cannot be overemphasized that thestandard of Medical Officer for this type of formation must be of the bestavailable and imbued with the best traditions of the Profession and theService, and trained to the realization of the importance of the dutiesof the Regimental Medical Officer.

Intercommunication

It can truthfully be said that intercommunication⁴⁸ betweenColumn Medical Officers and Senior Medical Officers on the one hand andthe D.D.M.S. on the other did not exist. Medical messages were invariablyincorporated within the body of normal column signal messages for RearBrigade, and as the result these were seldom extracted and passed for theinformation of the Medical Branch. On one occasion at least action wasinitiated by the "G" staff on a purely medical signal withoutany reference to the Medical Branch, and it was only by virtue of a repeatsignal being received

⁴⁷The reader of these homiletic passages mayprofitably recall that such afteraction reports aimed immediately at affectingcurrent plans, training programs, and administrative policies. The lecturetteswhich sometimes intrude into General Officer's otherwise factual or historicalexposition are anything but gratuitous displays of sanctimonious militarydoctrine. In a rather severe self-criticism, based on the wartime experienceswith disease in India and Burma, another officer concluded: "We [inthe RAMC] failed prior to 1943-44 to appreciate the problems set us bywarfare in the tropics because of a lack in our basic medical trainingand because of our lack of use of the hygiene measures at our disposal* * * we failed to convince the combatant that hygiene was to him of vitalimportance": O'Dwyer, p. 122.
⁴⁸The brief section on "Intercommunication" appearsin the original Report between later sections on equipment and supply.For the general reader, however, an early acquaintance with the difficultiesof communication seems a valuable basis for appreciating the Force's problemsof medical evacuation.

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a month later, that any knowledge of the previous communication on thesubject was brought to light.

Much of the fault lay in the ignorance and lack of training of the MedicalOfficers, and from the fact that they were imbued with the realizationthat they were brigaded and dependent on their brigade for everything ratherthan that they were part of a medical organization directed by a D.D.M.S.

No arrangements had ever been made for keeping the Medical Directorateinformed at regular intervals of the state of health and of the numberof casualties in the columns. The result was that the Directorate was neverin a position to know at any particular time the medical condition of theForce or any part of it. An attempt was made to remedy this and MedicalOfficers were instructed to send in a Weekly Medical Situation Report givingthe necessary minimum details; and orders were given that a record of allmen reporting sick must be maintained.

The result was very disappointing. Medical Officers in many cases neverrealized the importance of doing this and that the help which they themselvesexpected and which was only too willing to be given [sic] was dependenton its prompt submission. Many, however, did make a real attempt to comply,and the Senior Medical Officer of the 14 Brigade sent in a daily sitrep⁴⁹--at one stage by a signal--none of which reached either the D.D.M.S.or his staff. In other cases reports when they were received were irregularand out of date so that a picture of the Medical situation at any one timewas never really known.

The whole system of Medical Intercommunication must be given very carefulthought for any future operations. Medical officers must be in a positionto contact and receive the help of their Service Chief and every assistancemust be given to them to this end.

Medical signals should be entirely separate and addressed to the D.D.M.S.and the Weekly Situation Reports must be rendered promptly and accuratelyin the form of some simple code by signal. Only in this way can the D.D.M.S.direct his services and be in a position to render the necessary technicaladvice to the G.O.C.

Evacuation

Fighting behind the enemy lines necessarily produces problems not metwith in other types of warfare.

This is putting it mildly. On occasions the problem seemed insolubleand it says much for the ingenuity and resourcefulness of those responsiblethat evacuation at times was ever made possible. No praise is too highfor the American pilots of the light planes who worked ceaselessly andunremittingly, often in appalling weather, and always with the risk ofbeing shot down, day in and day out; to the RAF and USAAF pilots of TroopCarrier Command who were never unwilling to undertake every reasonablerisk compatible with the safety of their crews and aircraft, and who didmagnificent work in the most appalling monsoon conditions of weather andterrain; and to

⁴⁹Situation report.

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the pilots, doctors, nurses, and medical technicians of the No. [sic]Air Evacuation Squadron⁵⁰ whose services were always willinglygiven and because of whose untiring efforts and loyal cooperation the evacuationwas at first made possible in the Ledo area; not least and not last, tothe "G" Staff and especially to Brigadier [H. T.] Alexander towhom most of the credit must be given for initiating many of the methodsof evacuation used and devised.

It was not known at the commencement how evacuation was to be achieved.It was hoped that light planes would be available for use in conveyingcasualties from the vicinity of columns to already existing airbases. Failingthis, the only method possible was for casualties to be carried with thecolumns when they would of necessity have to be left to the care of friendlyvillagers, or with sufficient food and water until they became well enoughto proceed on their way alone and able to look after themselves.

With the change in plan of operations, it was soon seen that evacuationby air would be possible, and in actual fact it became so and remainedthe sole method of evacuation throughout the whole premonsoon period. Whereverpossible, columns constructed light plane strips in the vicinity in whichthey were operating and casualties were evacuated by light plane to thenearest Dakota Strip. These light planes were of two types, L-1 and L-5.The former could carry four casualties (two lying and two sitting or onelying and three sitting). The L-5 on the other hand could evacuate onlyone sitting patient. Moreover, as the length of strip required by the L-5was greater than that required by the L-1, the former was rarely used.Dakota strips were for the most part situated in the strongholds and werebeing used nightly by incoming supply planes of Troop Carrier Command bringingsupplies and equipment into the strongholds. These were available for theevacuation of casualties on the return trip.⁵¹

This, then, was the method used, and proved highly successful rightup to the onset of the monsoon. No fighter opposition was ever experiencedand evacuation was carried out continuously and without interruption.

The conveying of casualties from columns to light plane strips was usuallycarried out with the help of the local inhabitants or by personnel of thecolumns acting as stretcher bearers. They were invariably escorted by anarmed guard.

With the onset of monsoon conditions and the consequent increase inthe risks involved in flying from the previous air base, the axis of evacuationhad to be changed. Many of the strips previously in use were now soft andunserviceable, so that other arrangements had to be made. As long as theweather held, the construction of light plane strips could still be continuedfor while the ground was too soft to allow of the landing of heavy planes,

⁵⁰The 803d Medical Air Evacuation Squadronof the U.S. Air Force was the only such unit in North Burma until July1944. Two flights supported the Stilwell front. The 443d Troop CarrierGroup, Tenth Air Force, provided some assistance, also. The light planes,so vital to the evacuation system, were flown by the 5th and 7th LiaisonSquadrons, Tenth Air Force.
⁵¹Brief published descriptions of the evacuation of sick andwounded are available: see Robinson; Wigglesworth; Rexford-Welch, I, p.570, and III, pp. 523-528; and Crew, V. pp. 190-195.

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there were places still dry enough to carry the weight of light planes,which worked from the all-weather strips of Tinkok [Tingkawk] Sakan andWarazup. This presented no difficulty except that it meant that our casualtieswould have to be evacuated through the American Operational Area and backalong their L. of C.⁵²

During the transitional period casualties were being evacuated to ourold bases at Sylhot, Agatala, Lalaghat, and Hailakundi as well as our newones at Tinkok Sakan and Warazup. This meant that our medical resourceswere going to be hard put to it to be able to staff all the airfields nowbeing used by the Force. It was quite evident therefore that reliance wouldhave to be put on the American Army Medical Organization which was brieflyas follows. The 20th General Hospital at Ledo, together with the AmericanHospital at Shingbwiyang were the two main base hospitals to which allAmerican and Chinese troops were evacuated.⁵³ Forward of thesewere the usual Field Medical Units through which American casualties wereevacuated from the frontline to the two main Dakota Strips of Warazup andTinkok Sakan. At each of these localities there was a field hospital witha medical detachment situated on the air strip for loading purposes.⁵⁴

Casualties were evacuated back to Ledo and Shingbwiyang by planes ofthe 803d Air Evacuation Unit based on Chabua, and it was with the helpof this unit that the casualties of the Force were evacuated from Dinjanfor admission to the hospitals in that area in accordance with the planof A.D.M.S 202 Area, and which had been prepared to meet the large numberof sick that were expected from the Force on its eventual evacuation fromBurma through this route.

⁵²By May 1944, the 151st Medical Battalionwas so widely dispersed that administration became very difficult. It wasreorganized into a Headquarters and Headquarters Detachment, 151st MedicalBattalion; and four separate companies: the 385th Medical Collecting Company,the 685th and 686th Medical Clearing Companies, and the 889th Medical AmbulanceCompany (Mtr). These units established air clearing stations as well asother evacuation stations on the North Burma front. Dr. Floyd T. Romberger,Jr., the original editor of North Tirap Log, was the chief officerin charge of the medical aspects of air evacuation
The size of the air clearing stations varied with the situation. From ahalf-dozen to 25 enlisted men and at least one medical officer usuallywere involved. The equipment list which became standard included a tent(if no local shelter was available), and litters, cots, blankets, and housekeepingitems for an average of 30 casualties. Normally, casualties were kept nomore than 24 hours. Heavy fighting nearby, or a delay in evacuation flightscaused by bad weather might result in an accumulation of up to 100 patients,however. Ambulance and trucks attached to the air clearing station broughtin casualties from all nearby medical and line units.
The station at Tingkawk opened on 17 May 1944. It became a major fieldhospital soon afterward. The 686th Clearing Company built a bamboo hospitalto accommodate up to 500 patients for short-term treatment. During thesummer, 190 British and Indian casualties were cleared through the hospital.
At Warazup, Air Clearing Station No. 7 received the bulk of Special Forceevacuees in June and July. Approximately 6,000 British casualties passedthrough it: see Stone, "Evacuation of the Sick and Wounded * * *,"and Stone, Medical Service in Combat, III, chapter 13.
⁵³The 73d Evacuation Hospital moved into Shingbwiyang in March1944, replacing elements of the 151st Medical Battalion which continued,however, to operate the important Air Clearing Station No. 3.
⁵⁴The American line of evacuation ran from the battalion andregimental aid posts to portable surgical hospitals or elements of the25th Field Hospital to the air clearing stations. In the immediate zoneof combat, the 13th Mountain Medical Battalion furnished ambulance service.As previously noted, the companies which formerly constituted the 151stMedical Battalion provided the air clearing stations and, if necessary,collecting and transient hospitalization (the "Field Hospitals"to which the Report refers).

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The air ambulance planes functioned backwards and forwards between Warazupand Tinkok Sakan on the one hand, and later Myitkyina, and Shingbwiyangand Ledo where they [the patients] were staged by the detachment of a brigademedical unit, until they were picked up in the evening by the returningempty ambulance planes and carried to Dinjan en route to their base atChabua. At Dinjan another detachment of the same medical unit was sitedto load the ambulance cars which conveyed them to the Combined MilitaryHospital, Panitola. The Combined Military Hospital, Panitola, thus becamein effect a casualty clearing station. All casualties were admitted therein the first place and later distributed to the hospitals at Digboi andDibrugarh. Any serious case which required immediate admission to hospitalon arrival at Ledo was admitted to No. 44 Indian General Hospital at Ledo,the principal function of which was the hospitalization of the personnelof the Indian Labour Units working on the Ledo Road.

The hospitals at Digboi, Panitola, and Dibrugarh were augmented by D.D.M.S.Fourteenth Army bringing to the vicinity of each a Malaria Forward TreatmentUnit.

At this stage of operations brigades had moved north from the two defendedlocalities of White City and Blackpool, in the areas of Renu and Hopinrespectively, and had concentrated in the general area of Indawgyi Lake;with the exception of 77 Brigade which had begun its move on Mogaung. Allbrigades had with them a considerable number of sick and wounded and itwas decided to attempt the evacuation of these in the Indawgyi Lake areaby seaplane. For this purpose a Sunderland Flying Boat was based on theBrahmaputra near Dibrugarh; and to this was later added a second one. Becauseof the limited flying ability of these machines it was arranged to evacuateonly the more serious cases by this means. The highest tribute must herebe paid to the R.A.F. pilots who, in spite of the risks attendant on flyingover mountainous country through the worst possible monsoon conditionsof low clouds, rain, and thunderstorms, and over a route which at firstwas quite unknown to them, never failed to fly whenever the slightest chanceof success presented itself.

As envisaged, this method of evacuation came to a sudden end, partlybecause of the damage sustained by each of the planes while moored on theBrahmaputra River, partly to the monsoon conditions of weather which madethe opportunities for flying few, and to the height and swiftness of theBrahmaputra which made mooring difficult if not impossible, and throughthe floating down of large logs, a danger to the aircraft. All this, combinedwith the fact that they were urgently required for their normal tacticalrole, decided those who were responsible to discontinue their employment.

As there was still a considerable number of casualties awaiting evacuationand as the old method of evacuation by land-based aircraft could now nolonger be reinstituted owing to the constantly low lying cloud formations,as well as to the constantly wet ground, it was decided to make an attemptto evacuate them by river up the Indaw Chaung to Kamaing. As this, too,offered a means of supply to the forward troops and was a means of relievingthe already overstrained aircraft space, arrangements to implement thiswere

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instituted. Lt.-Colonel Howell [?]⁵⁵ was ordered to raisea force composed of Royal Engineer personnel to act as boat operators andto assemble as large a number of craft, assault boats, and country craft,as could be secured, with all necessary outboard motors for their propulsion.These were to be flown to Warazup which would be the Headquarters of theForce as well as the riverhead. Colonel Howell then made a recce of theroute from the air and made his appreciation. At this point, and on theinformation so received, the Medical Branch was asked to arrange for whatthey considered to be the minimum necessary medical support.

On the information received that the journey from the lake to Warazupwould take only 12 hours, it was suggested that two whole Brigade MedicalUnits would be necessary. One [was] to undertake the reception and dispatchof the casualties at Warazup and the other to divide into two parts andestablish staging posts en route, sited at approximately 4-hour intervals.As an Advance Party, one officer and eight RAMC other ranks with 400 poundsof equipment were flown into Warazup from Sylhot. The remainder were sentup to Dinjan by rail for onward dispatch by the more abundant air transportwhich was available in that area.

With the acute shortage of rail transport in the first place, the similarshortage of air transport in the second, there was a long and most unfortunatedelay in the implementation of this plan. To fill this hiatus, skeletonstaging posts had to be established by available column medical officersat the lake end of the route and a much reduced Brigade Medical Unit flownin by the American Air Evacuation Unit to Warazup. While this gave thebarest possible aid to the sick and wounded and was much below what hadbeen hoped for, it sufficed until the prearranged units and equipment couldbe sent in.

Arrangements were made for those casualties who were still awaitingevacuation from Indawgyi Lake to be moved up the Indaw Chaung to Kamaing,staging at Chaungwa and Manwe en route, at which places a medical officerand medical staff had been located. At Kamaing all serious cases were admittedinto the American Field Hospital until they were fit enough to stand thesecond stage of the journey to Warazup.⁵⁶

Evacuation from Kamaing was carried out by means of a shuttle serviceof American Assault Craft to Warazup. This part of the journey, being againstthe current, took about 12 hours, and was an extremely trying experiencefor these unfortunate men, as the construction of head cover which wasattempted in the early days made the boats topheavy and dangerous in thefast flowing current. They were thus exposed to the elements of the hotburning sun or the drenching from a heavy monsoon rain. No medical attentionwas available during the course of this long journey as sufficient medicalpersonnel to man each boat with a medical attendant were not to be had.In spite of the dangers and hazards of this long and arduous route,

⁵⁵The dittoed typescript is not clear: "Nowell"may be correct. The full name of the officer has not been identified.
⁵⁶The "Field Hospital" at Kamaing was a temporaryfacility provided by the 13th Mountain Medical Battalion.

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the numbers of casualties evacuated ran into many hundreds and withthe exception of one fatal accident, all were evacuated safely.

At Warazup a brigade medical unit was eventually established for theirreception and they were from there conveyed by planes of Troop CarrierCommand and of the Air Evacuation Unit to Dinjan. Prior to the BrigadeMedical Unit's getting into position, the casualties were admitted to andtreated in the American Hospital which had been sited there for the useof C.A.I. troops. Owing to the severe monsoon conditions there were occasionsduring which the Warazup Strip, which was not an all-weather strip, becameunserviceable, and the casualties had then to be transported by road toShaduzup and were admitted to the American Evacuation Hospital situatedthere. From this hospital they were conveyed by light plane to the all-weatherDakota Strip at Tinkok Sakan, as the intervening road was unserviceableowing to the rains, and thence by Dakota to Dinjan. As the monsoon progressed,the road between Warazup and Shaduzup was interrupted by the two main bridgesbeing swept away by floods. A ferry service, with shuttle system of ambulancecars between, had thus to be organized.⁵⁷

It can be seen, therefore, how very dependent we were on the cooperationof our American Allies; and without their assistance, which was alwaysvery willingly given, evacuation would never have been possible. To themand especially to the American Army Medical Services we owe an undyingdebt of gratitude.

By this time all brigades except 77 Brigade had reached the vicinityof Lakhren. Here a light plane strip was constructed and as long as thisremained serviceable casualties were evacuated by light plane to TinkokSakan. When this in its turn went out of action evacuation was carriedout through Manwe by river to Kamaing and Warazup. To the already tryingriver journey was thus added a long and tedious march, along mud-infestedmountain paths over the hills to Lakhren, from the area in which columnswere now operating.

77 Brigade had now reached the high ground south of Mogaung investingthis township. They had had no opportunity since their withdrawal fromWhite City of evacuating any of their sick and wounded. As the result ofthe many engagements in which they had taken part, the numbers of thoseawaiting evacuation at this time was in the region of 250. The area aroundMogaung was almost completely under water and with the railway linkingit with Myitkyina still in enemy hands, it was completely isolated fromall contact with the outer world. A recce was made with a view to seeingif an L-1 converted by the addition of floats could be landed on the wateror nearby river. Arrangements were put in hand, meanwhile, for this conversionto be carried out. Unfortunately this proposition was found to be unworkable.The float plane was however used for evacuating from the

⁵⁷American medical reports describe the sameprodigious effort. At Warazup, troops of the 686th Clearing Company operatedAir Clearing Station No. 7. At Shaduzup, elements of the 25th Field Hospitalreceived patients. If Shadazup airfield were also closed, casualties wenton to the temporary hospital of the 686th Clearing Company or to a branchof the 25th Field Hospital at Tingkawk Sakan.

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Indawgyi Lake to Tinkok Sakan. It being amphibious, it proved itselfa most excellent means of getting away some of the most serious cases fromthat area.

The situation then at this time was critical. The number of casualtieswas increasing and with the need for every available man in the front line,the protection of the sick and wounded became a problem. Something hadto be done and efforts were made with the help of tree branches and coconutmatting on a base of sandbags to produce a light plane strip. This provedsuccessful and evacuation by light plane to Myitkyina commenced.⁵⁸From Myitkyina they were carried by returning supply plane to Dinjan.

With the move of 111, 14, and the West African Brigades towards theline of Japanese withdrawal from Mogaung, evacuation to Lakhren becamemore difficult. It was decided therefore to use the Taungni-Pahok roadand the Kamaing-Pahok road. A detachment of No. 80 Parachute Field Ambulanceof the 51st (Parachute) Brigade operating in the Imphal Plain was requestedand, through the D.D.M.S. of Fourteenth Army and 4 Corps, permission totransfer this was granted. This detachment was eventually dropped at thePahok crossroads where it established a staging post. Evacuation was nowthrough Pahok by road to Kamaing thence by river to Warazup. As soon asthe remaining pockets of Japanese resistance in this area were mopped up,a light plane strip was constructed at the Pahok crossroads and seriouscases were evacuated by this means direct to Myitkyina. Eventually Myitkyinafell; the Myitkyina-Mogaung Railway was freed from all enemy and this becamethe main route of evacuation.

The problem now was to decide how best to make use of this; for thoughrolling stock was plentiful, motive power was nonexistent. To fill thisdeficiency Jeeps were converted by a change of wheels for use on rails.Each Jeep was capable of drawing one 20-ton flat and three such trainswere made and used to excellent effect. Later, two, then six Luda petrolmotor-driven trucks were flown in, each doing more reliably and more powerfullythe work which the Jeeps had been doing up to now.

As by this time the greater part of the sick had been evacuated andas the scene of operations had shifted southwards to Taungni, a medicalunit forward of Pahok was necessary. The medical unit from Warazup wastherefore brought forward to Milestone 15 on the Pahok-Taungni Road andarrangements made for a light plane strip to be prepared on the road itself.At this stage the remaining brigades of the Force were relieved by 36 Divisionand operations as far as this Force was concerned came to an end.⁵⁹

⁵⁸Stilwell had taken the airfield at Myitkyina,but his Chinese and American troops did not capture the town until August.Air Clearing Station No. 8 opened on 18 May, as soon as the attack on Myitkyinabegan.
⁵⁹In this description of evacuation during the last weeks ofthe campaign, it appears that systematic procedures like those of the Americanforces were developing. If light planes were to be used to take casualtiesfrom the combat area, an airfield for two-engined planes was needed notfar away. There, mobile medical troops were required for air clearing stationduty or to provide temporary hospitalization. In addition, reserve troopshad to be available to take over established clearing stations or collectingpoints when new airstrips were opened as the frontline advanced. The RoyalAir Force medical historian has commented that field commanders were slowto realize the need for ground medical support of air evacuation. On theother hand, no British air evacuation unit was assigned to the Burma frontuntil late summer, 1944. See Rexford-Welch, III, pp. 524-525.
The strongholds of Special Force provided some facilities for collectingand evacuating patients. However, they were inadequately supported by medicaltroops and systematic evacuation. Both White City and Blackpool were dangerousmost of the time, but casualties were sometimes evacuated very rapidly,if supply aircraft happened to be ready to return to their bases. In othercases, they collected for several days: Masters, p. 237; Calvert, pp. 54,57, 118.
During the attack on Mogaung, the wounded men of the 77th Brigade were"under a leaky improvised shelter, lying in two rows on the groundcovered in blood-stained parachute cloth. We had had a surgical team flownin by now, and they worked in appalling, but unavoidable, conditions ofmud and rain. A man wounded would first be treated on the spot by his battalion.Then he would be carried back as far as Pinhmi by his battalion stretcher-bearers.There [Captains John S.I'A.] Chesshire and [Theophilus C.] Thorne wouldtreat him. After that he would almost at once be carried on in the rainto the base by the Oriya Indians or Burmese Gurkhas, or Sikh stretcher-bearers.He would wait his turn, according to the seriousness of the case, beforebeing seen and operated on by the surgeon, meanwhile tended by other MedicalOfficers and looked after by less seriously wounded men. If light planeswere available, he would fly to Myitkyina that day--or the next day. Ifnot, he might wait days before evacuation. If he had a flesh wound he wouldstay at base, helping tend the more seriously wounded, and then rejoinhis battalion. Only the seriously wounded were evacuated. At Myitkyinahe would be treated again as necessary, and then flown by Dakota to ournew hospitals in the northern Assam Valley near Ledo. The fact of havingthis air evacuation sustained the morale of the troops, and the selfless,ceaseless work of the battalion Medical Officers, Major [C. Roy] Houghton,and the surgical team, reassured them that all that could be done was beingdone for them": Calvert, p. 209.

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It can be seen from the above account some of the difficulties whichwere encountered, and at times these were so great that they appeared almostwithout solution. It was not until one was again on an almost normal L.of C. that one began to realize how extraordinarily easy is the task ofsolving the numerous problems of normal evacuation. In no theatre of warwere the diversity of methods used probably so numerous and improvisationstretched to such lengths, as they were in this operation. With the meansavailable and the absence of any proper medical organization, the wonderis that evacuation to the extent achieved was ever possible.

III. SUPPLY, EQUIPMENT,AND RATIONS

The development of a medical supply system dependent upon aircraftproved as necessary and difficult as the institution of air evacuation.The columns carried a few days' supply with them. They called by radiofor replenishment. The calls were decoded at the airbase and passed toa detachment of the Force medical service. It assembled the needed itemsand turned them over to the Force Quartermasters for packing and deliveryto the Air Supply Company. To regularize the issue of medical supplies,5-day standard units were designed. They could be preassembled and packed,and the brigades could order them singly or in multiples, as required bythe tactical situation.

The lack of sufficient medical supply troops and depot facilitiesproduced confusion and inefficiency. The irregular movements of the Forceand the vagaries of jungle warfare made rational planning almost impossible.An important part of General Officer's responsibility,

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therefore, was the constant reevaluation of the medical supply andequipment system.⁶⁰

With so many links in a chain of supply, it was never possible to pindown the responsibility for any loss which might occur at any one link.It was quite evident that the only satisfactory method would have beenfor the medical unit concerned to be responsible for the packing and forthe medical responsibility not to have ceased until the stores were loadedon the aircraft. With the small size of the packages so common with medicalsupplies it was realised of course that this was impossible and uneconomical.At the same time the problem of a satisfactory method of medical supplymust be solved, as during these past operations it was far from satisfactory,and although all demands, exorbitant as some appeared, were always supplied,many column Medical Officers were frequently complaining that their QQs⁶¹were not being met.

Complaints, too, were now beginning to come in from the columns thatdeficiencies other than those acknowledged on the packing notes were existingwhen the stores were received by them. It can only be assumed that themissing items were either being mislaid or stolen after leaving the MedicalStore. This belief was furthered when occasional odd articles of medicalstores were handed back from the Packing Section undelivered with no indicationas to which column they were originally intended [for]. It may be added,however, that this trouble did not arise when dealing with the all-British61 Coy R.A.S.C.⁶² Packing Section.

With the responsibility of supplying additional brigades, difficultiesbegan to increase. Firstly the "5-day" system in use by 16 Brigadewas not being observed by 77 and 111 Brigades, and demands were being receivedfrom them at very short notice for immediate collection. As many as eightdemands from one brigade would be received in one day, whereas under the"five day" system no more than three separate demands were everreceived in 24 hours. To ensure the supply of stores without delay it wasnecessary to supplement the staff by two Privates (1 storeman and 1 clerk).A further addition to the staff, although desirable, could not be madethrough lack of personnel.

Although column medical officers realised that only items included inthe Code List were available at the airbase, it was at this time that otheritems started to appear in clear on the QQ signals. Every effort was madeto supply these articles from the unit dispensary or from the local hospital,but soon it was found necessary to indent on 16 Indian Depot Medical Storesto meet these demands. Unfortunately, the delay in obtaining these itemsprevented

⁶⁰These editorial notes summarize General Officer'sopening passages on supply. Stilwell's arrangements for the Chinese Armyin India may be cited, in comparison. One section of a medical supply companyat Ledo specialized in air supply. Field requisitions were relayed to itand it controlled the entire operation until packed supplies were turnedover to the air crews for loading. This is not to say that Stilwell's supplysystem was without fault. On the contrary, the sources of medical supplynearly dried up early in the Second Burma Campaign: See Tamraz Diary.
⁶¹"QQ" was the code word for a column medical supplydemand.
⁶²Royal Army Supply Corps.

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the immediate supply to the demanding column, and for the first timeitems had to be marked "N.A."⁶³ on the demands.

As operations continued, repeat demands became more evident. That isto say, a demand would be received in respect of one column one day, andthe next an identical demand would be had for the same column. When thiswas queried it was invariably found that it was in fact a repetition ofthe original demand due to nonreceipt of the stores which had been puton the wrong plane or dropped on the wrong column. Regardless of who wasresponsible for such errors, these duplicate issues were a drain on thealready diminishing stocks, apart from being additional work for the staff.⁶⁴

An "Air Base Set" of medical supplies was designed as astandard 3-month reserve for each brigade. Field experience revealed thatthe set was severely understocked in the drugs used to treat diarrhea anddysentery, foot diseases, and helminthic worm infestations. The specialmedical panniers and haversacks which the columns carried soon needed replacement.None were available and improvised substitutes had to be hurriedly produced.On the other hand, assemblages of supplies known as the "Ten-Day"and "Before and After Engagement" units proved to be wasteful.Brigades often ordered them to obtain a few scarce items. General Officerrecommends that such units be abandoned or carefully revised. His reviewof particular supply problems continues:

Suppressive Mepacrine.--Tabs Mepacrine Hydrochlor were alwaysavailable in sufficient quantities from 16 Indian Depot Medical Storesbut the issue to columns was perhaps the most difficult problem encounteredby the Brigade Medical Unit. Some brigades endeavored to include tabletsin ration drops whereas others left it to column medical officers to indentfor their requirements, but both of these methods led to a great deal ofduplication in issues and still reports were received that suppressivemepacrine was not being received by the columns. It is felt that the bestsolution to this problem is for suppressive mepacrine to be included inthe individual ration pack, e.g. in the "K" ration pack or inthe Delhi Light Scale⁶⁵ pack or its equivalent. This would ensurea constant supply to each man. The next best solution is for every manto start out with 1 month's supply in an individual container and for thecolumn medical officer to demand a month's bulk supply a week or two beforethe current issue is expended. Curative mepacrine was available on demandat any time.⁶⁶

⁶³Not available.
⁶⁴Several paragraphs which follow in the original Report havebeen covered in the introductory summary. The difficulty of obtaining suitablecontainers for airdrop packaging is noted, in addition.
⁶⁵The "K" ration was American; the Delhi Light Scalewas a field ration of the Indian Army.
⁶⁶This matter-of-fact note understates the case. Assuming thatmany men in the Force would contract malaria, the Force could survive onlyif its men took daily doses (0.1 gram tablets) of mepacrine. Fergussonreports an occasion when one of the columns exhausted its supply for ashort period of time. A notable upsurge of malaria cases followed soonafterward (Earth, p. 199). However, the massive breakout of malariain the Force occurred late in the campaign, when deficiencies in the supplyof mepacrine were unlikely.

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Tablets water sterilising individual.--Next to mepacrine, tabletsWater Sterilising Individual were a great problem. At the outset of operations,air base sets were found to contain an initial issue of this item, someof which were of English manufacture but the majority of which were ofIndian make. In most cases the latter were of very poor quality and haddeliquesced to a great extent. The English brands were therefore issuedin the first instance and indents were placed on 16 Indian Depot MedicalStores for a further supply to meet anticipated demands. These demandswere never fully met however, and even when issues were made the tabletswere of Indian make. This resulted in Water Sterilising Powder being issuedin lieu, much to the annoyance of column medical officers who found thatthe water bottle method of sterilising water in bulk quantity with W.S.P.was not convenient in Long Range Penetration, besides which it was tooheavy to carry.

Outfits water sterilising individual.--Every man was in possessionof an individual water sterilising outfit at the commencement of operations,but as the majority of these were of Indian make the tablets therein haddeliquesced. Demands were soon received on the majority of QQs for replacements.16 Indian Depot Medical Stores however could not supply anything like thenumber of replacements required, and those they did supply were of exceedinglypoor quality and really unserviceable.⁶⁷

Medical comforts.--When Medical comforts were appended to theMedical Code List they were intended for patients only and it was visualiseddemands for them would therefore be small. From many of the demands receivedit would appear that they were being used to supplement rations.

Although it is agreed that this was an excellent idea, neither the storagespace nor personnel were available to enable the medical store to functionas a F.S.D. as well.⁶⁸ * * *

⁶⁷Here also the supply situation was vital.Water contamination was inevitable. Supplies of water purified in bulkunder careful supervision could not be expected. Individual and small-unitwater purification discipline was absolutely necessary to prevent widespreadincapacity from diarrhea and from bacillary or amebic dysentery. Such disciplinewas difficult enough to maintain without the handicap of insufficient orobviously ineffective drugs and equipment.
Calvert recalls an incident in which an officer came upon a Gurkha soldierwho was drinking from his canteen. On seeing the officer, the soldier hastilytook out two chlorinating tablets and gulped them down (p. 188).
⁶⁸Force Supply Depot. "Medical comforts" includedconfections and other supplements to standard rations.
In an omitted passage, General Officer recommends that the medical branch,rather than Ordnance, control the supply of stretchers. He also notes thatthe ordinary stretcher proved to be unsatisfactory as an airdropped item.He recommends adoption of the U.S. collapsible model. Veterinary supplies,he reports, were handled by the medical depot crews. For the future herecommends that a separate veterinary supply outlet be provided. Finally,he reports that physical arrangements were inadequate in the medical partof the air depot, although the 16th and the 18th Indian Depot Medical Suppliesunits made commendable efforts to assist the Force. The principal suggestionsfor improving the medical supply program which General Officer makes arein accord with his preceding comments:
1. The establishment of a medical supply subdepot for (rather thanfrom) the Force, preferably by Army Headquarters.
2. Revision of the supply list of drugs and equipment in accordance withthe experience of 1944, and with a reserve level of at least 20 percentsurplus.
3. Reorganization of medical supply depot facilities and procedures toreduce waste of time and supplies arising from improper housing and fromthe passage of supplies through nonmedical hands.
His report is supported by a tabular presentation of the "BritishBrigade Medical Detachment (Special)"--personnel, transport, weapons,and the "Three Month" list of drugs, medical instruments, andother medical supplies and equipment. The supply and equipment lists ofthe Medical Officer's Haversack and of the Orderly's Haversack also arerecorded. These tabular exhibits appear as pages 10-22 of the originalReport.

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Equipment and Stores⁶⁹

Personal equipment.--The weight carried by the men was far toohigh and considerable thought must be given as to how this can be reduced.

It is one of the elements of Military Hygiene that the weight carriedby the man should never be more than one-third of his body weight. Anythingover that reduces the man's efficiency and capacity to physical effort.That, in the case of a soldier in battle, means the reduction in his powerto move, to seek out the enemy, and to successfully engage him in combat.

The average weight of the men in one column was 145 pounds and yet theweight carried by the Bren gun carrier amounted to 95 pounds--in otherwords, he was carrying about two thirds of his body weight or twice whathe should carry. The lightest weight carried was 67 pounds--the weightcarried by a rifleman armed with a carbine--which is nearly half of theman's body weight.⁷⁰ There is only one answer to this problemand that is that anything over the optimum "man-load" must becarried by someone or something else. It means increasing the tail butit also means increasing the fighting efficiency of the fighting soldier.

In the Chinese Army every third man is a porter.⁷¹ In theBritish Army the introduction of a porter element of Britishers would notbe feasible; the alternative then is a foreign porter element--say Dhotialporters--the whole or a proportion of whom could be armed, or alternativelyan increase in the number of mules. In 4 Corps, Dhotial porters--a proportionof whom were armed--proved most successful and crossed the most difficultcountry with incredible loads at amazing speed.

Whether this is practicable for L.R.P. is not for me to say.⁷²

The type of equipment is always open to criticism and all sorts of suggestionsare made to improve it. Suffice it to say that the '38 pattern of web equipment⁷³is the best available and has been devised after considerable thought andexperiment by the Army Hygiene Directorate at the War Office.

⁶⁹Although conveniently connected to the subjectof supply, this section on Equipment appears somewhat later in the originalReport.
⁷⁰Calvert reported that his men carried 65-pound packs on themarch from White City to the battlegrounds of Mogaung, after 2 months ofunremitting campaigning (p. 179). In the first Chindit expedition in 1943,the troops carried 72-pound packs: Fergusson, Chindwin, p. 249.
⁷¹Not in the reorganized Chinese Army in India. However, Stilwell'sheadquarters did design, among other things, a porter battalion as partof a Chinese corps organization.
⁷²Wingate, obviously, would have said no. Fortitude and primephysical condition were his substitutes for a baggage train of porters.Mules and horses were absolutely necessary, although they were troublesomefor troops relatively unused to anything but motor transport.
⁷³"Web equipment" included the haversacks and packs,shoulder harness and belts, and other carrying devices of the individualsoldier.

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Other types such as the Bergen Rucksack have all been tried and discarded.In spite of this, recommendations for its reissue are constantly beingreceived. The latest experiment in this connection was carried out by 17Division last summer, their conclusions coincided with all other investigations,and its use was discarded.

It is submitted that the present type of water bottle is most unsatisfactoryand should be changed. It has the following disadvantages: (a) the corkrapidly deteriorates and becomes dirty. (b) the string breaks and the corkis lost. (c) the cloth cover easily tears. It is recommended that a screwstopper secured by a chain similar to that in use by the American Armybe adopted.⁷⁴

Water sterilization tablets.--The Indian-made tablets are quiteuseless and their issue should be discontinued, and only those of Britishmake issued. The Detasting tablets were never used and their issue is notconsidered necessary.

Mosquito repellent.--As the troops have developed a strong partialityto Dimethyl Phthallate, and because they have in it a complete faith, itis suggested that this drug be issued in future rather than the antimosquitocream in which they have no faith. It is hoped that by this means a morecooperative attitude will be adopted to the great problem of malaria prevention.⁷⁵

Containers, individual, for mepacrine.--These proved to be ofgreat value during the present campaigning seasons and should be made availablenext year for, even though the normal daily dose of this drug is to bepacked in the rations, there will be times when rations are short and nomepacrine available. On such occasions the troops will have then the opportunityof something to fall back upon and they will thus be deprived of any excusefor failing to take their daily dose.

Jungle hammocks.--During the monsoon, jungle hammocks were sentin to columns chiefly for the benefit of the sick. They proved such a successthat eventually as many personnel as possible were issued with them. Everyonespeaks very highly of them and although the weight is in the region of7 pounds, they proved such a boon that everyone is prepared to carry them.When men were tired and soaking wet, the haven afforded by a jungle

⁷⁴Obviously, individual water sterilizationdiscipline could be thwarted by a faulty canteen. Thus, bad equipment wouldnot only lead to thirst during the hot marches, but it also would preventeffective use of water sterilization tablets. The water problem was difficultenough in any case. Charlton Ogburn, Jr., who fought with the Merrill'sMarauders--the American counterpart to Special Force--recalls "theutter despondency, if we have been marching down a dry ridge all afternoon,of having to endure an evening, a night, and at least part of a morningwithout water or coffee and consequently without food either, for a drythroat will pass no part of a "K" ration": Marauders,p. 151. Among the associations that he still remembers is "the sweet,chlorinated taste of the treated water you seldom could get enough of;you were thirsty again almost the moment you had drained your canteen"(p. 150).
⁷⁵Standing orders were for troops to use repellents on exposedportions of the body at least in the dawn hours and from dusk onward. Atbest, most repellents seemed to add to the discomfort of tropical servicewithout instilling much confidence, as General Officer notes. Dimethylphthallate was a slightly oily, not unpleasantly-smelling liquid. Confidencein it was probably derived especially from the discovery that it was thebest repellent of the mites which carried scrub typhus.

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hammock was beyond description. It afforded a good shelter from therain as well as a protection from flies, mosquitoes, and other jungle pests,all of which, particularly in the region of Moxo Sakan, were unbelievable.

It is questionable whether hammocks would be necessary during the premonsoonperiod as at that time mosquitoes are neither so numerous nor so dangerous,and a hammock enclosed by a mosquito net is a difficult thing to get outof in an emergency. Throughout the year, however, the mere fact of theirbeing raised off the ground is a protection against the bites of typhus-carryingticks and mites.

The introduction of a jungle hammock as part of the personal equipmentof all ranks is strongly recommended and will, no doubt have a very definiteeffect on the reduction of malaria and typhus.⁷⁶

In brief notes on certain items of medical equipment, General Officercomments on the design or quality of stretchers, casualty saddles, andequipment and supply chests (panniers); leaky metal containers of liquidsand ointments; and badly constructed syringes, scissors, and forceps. Henotes, for future reference, such drugs and chemicals which were eithertoo limited or were excessive in amount. "Bandages," he writes,"must be coloured green or khaki. On more than one occasion a whitebandage has been made the target of a sniper's bullet and has been thedirect cause of more than one man's death." The section on technicalmedical equipment concludes:

Ambulance cars.--Having ridden in an Austin box Ambulance Caras a patient across the Western Desert and in a 4 x 4 Indian pattern AmbulanceCar along the tarmac roads of Burma and Assam, I can find little differencebetween them, and can truthfully say I know of no more uncomfortable methodof travel for a healthy, much less than for a seriously sick or woundedman suffering pain. The discomfort experienced in the Austin box AmbulanceCar in the desert was equivalent to that experienced in the Indian patternAmbulance Car running on a tarmac surface. On the other hand, a journeyin an American Dodge 4 x 4 Ambulance Car is one of real comfort. Even overa rough surface across country the amount of jolting experienced by a patientwith a careful driver is minimal.

With vehicle production in America as it is now, there would appearto be no reason why this ambulance car should not be adopted as the standardpattern by the British and Indian Services in the same way as the Jeepand the weapon carrier have been introduced.

It is strongly recommended that the American Dodge 4 x 4 Ambulance Carbe supplied to the medical units of this Force in future.

⁷⁶Once more, the problem of weight and mobilitywas involved. The tendency of the marching columns was to dispose of asmuch equipment as possible. If the enemy pursuit was vigorous, the Forcesacrificed convenience and comfort to speed. At the time to which GeneralOfficer refers, however, the Force was relatively stationary in the Kamaing-Mogaung-Myitkyinatriangle. The severe rains and flooded grounds made shelter a necessityfor prolonged operations. Calvert has high praise for the jungle hammock(p. 192).

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Rations

Although the importance of rations⁷⁷ has occupied the mindsof all army commanders since the beginning of modern history, there stillremains much to be done to bring those of present day issue up to a standardcommensurate with modern life and warfare. That an effort to this end hasbeen made during the present war no one will deny but it has come too lateand is far from complete. The result is that in this sixth year of warrations suitable for our particular type of warfare are not yet availableand will not become so before the beginning of the next campaigning season.

If it had not been for the "K" type ration--an American product--themodern ration would have differed in no way from that of the last war.While there is no doubt that the importance of a good ration for the fightingsoldier has been appreciated for more than a century--commencing with theworld famous Napoleonic dictum--little effort has been made by those responsibleto implement this. It has been left to the Medical Services to introducenutritional experts on to the staffs of Armies in an attempt to stimulateinterest and research in this important subject.

For this type of warfare certain principles in the provision of a dietare indisputable and absolutely essential. First, it must be light in weightand of reasonable size and shape. It must be packed in one-man one-mealunits. It must be calorifically sufficient, well balanced, and must containa full complement of vitamins. Lastly, it must be made in a sufficientnumber of variants to avoid monotony.

The importance of a sufficient diet with the necessary variability tostimulate interest in its consumption cannot be overemphasised and thereis no doubt whatsoever that diet in itself has an enormous effect on morale.

During the various phases of this past campaign, many varieties of rationhave been used in this Force with varying degrees of success. The experienceswith each are set out briefly below.

Rehabilitation ration.--Rehabilitation ration was used duringthe final training period in India in an attempt to maintain the men'sstrength at its peak level and to prevent their using up their reserveor "Hump," at this most strenuous time.

This ration, with certain modifications, was approximately one and ahalf the normal scale rations. While in the main it achieved the objectfor which it was designed, it produced two adverse results. The first ofthese was a mild degree of Avitaminosis, and secondly, it made the mendissatisfied with their normal ration when the time came for them to returnto it. Some of the units which had this ration considered that it was excessivein amount and that its issue was unnecessary. The Avitaminosis was dueto the fact that it was composed largely of tinned meat and biscuits andwas a poorly balanced diet. If the use of this ration is contemplated inthe future, care must be taken to ensure the issue of one Compound Vitamintablet to each man each day.⁷⁸

⁷⁷This section, also, has been relocated fromits original position in the Report, in order to relate it more obviouslyto other passages describing the provisions made for health and medicalsafety of the Force.
⁷⁸See pp. 216-217.

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Delhi light scale.--Although its components appeal more to theBritish troops' taste than many of the other types of ration do, it wasan almost uniform failure. The BOR far prefers Bully Beef to any of themeat equivalents found in other rations. They prefer, too, the biscuitsand cheese of this ration, but all of these components reached the menso often in such an advanced state of decomposition that they were quiteinedible. For this reason the use of the Delhi Light Scale ration was discontinuedas soon as the American "K" ration became available.

Though it is not possible to make any very definite assertion, I amconvinced that the inedibility of this ration so reduced the "Hump"of the men of 16 Brigade in the early days of their march into Burma thatit can be held partly responsible for their premature fatigue at the timethey reached the Indaw area.⁷⁹

In future, every possible effort should be made to avoid the use ofthis or any other diet produced in India under present conditions.

American "K" type ration.--American "K" typeration is without doubt the best that has been produced yet, and thoughmonotonous, is less so than any of the other types, for it does make someattempt at variety, which none of the others do, and after living on itfor 5 months the men can still speak well of it. For this I can conceiveno greater compliment.

In the early days the biscuits were over-sweet for the British palate,but, with that efficiency of which at times the Americans are capable,these were immediately changed when the defect was made known tothem. In place of the original type of biscuit three new varieties wereproduced and supplied in substitution. Now instead of having a single typeof biscuit, which was unpopular, for all meals, there are three types,a different one for each meal, and all three are excellent and well likedby the troops. This change has made all the difference, for it has madethe troops feel that not only were their complaints reasonable but also,and more important, that there was someone who was sufficiently interestedin their welfare to take action upon it. Now there are few who have anycomplaints at all.

There is, however, still room for improvement, and by the combinationof what is best in the jungle ration together with what already existsin the "K" ration an excellent ration with more modificationscould be substituted so that at each 5-day interval a variation in dietcould be supplied. Examples of how this could be achieved without any increasein size or weight are as follows:

Tinned sausage or bacon could be substituted for the eternal choppedham and egg yolk in the breakfast unit.

In the dinner unit the cheese could be halved and an equal quantityof one of the many varieties of jam substituted.

⁷⁹The march itself was very long and the routewas unimproved and hilly. The point General Officer makes can be put morecertainly in another fashion: on such a strenuous march into battle anyconsistent failure in rations was a dangerous misfortune. As notedin the prefatory summary, the brigade felt that Wingate did not let itrest sufficiently after it reached the operational area before he orderedit to attack Indaw. The attack failed and no really effective work wascarried out afterward by the brigade. It was the first to be evacuated.

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For supper, compressed roast beef, tongue, mutton, pork and even bullybeef could with advantage be substituted for the all too frequently occurringcorned pork loaf.

Certain additions should be made. In the dinner unit, some, if not all,of the sugar could be cut out and in its place, compressed salt tabletsand one tablet of mepacrine given. A tube of condensed milk such as isfound in the jungle ration might well be included, and so forth.

The packing of this ration seems excellent and is waterproof enoughto withstand dampness and most rain. It will not, of course, stand up toimmersion in water such as may occur in the crossing of deep rivers. Toachieve this would be desirable, but only provided that it does not involveincreasing the weight. The separation of the day's ration into three mealunits is excellent and should be continued, for on those not infrequentoccasions when rations are short and the men have to restrict themselvesto ²/3 or even ¹/3it can be done easily and without the wastage which occurs whena whole day's ration is put up in bulk.⁸⁰

Jungle ration-Mark 1.--Jungle Ration--Mark 1 has proved to bea great disappointment. When it was known that the Delhi Light Scale wasout forever and that a new British made ration, which was packed in England,was being produced, much was expected of it, and when it was found lacking,as indeed it was, great was the disappointment. Men who have been on "K"ration for 3 months, and, one would have imagined, would have looked uponany change with favor, liked the jungle ration so little that they threwmuch of it away. The faults found are:

1. It is too heavy. Five days' rations weigh 18 pounds as against 16pounds in the "K" if left packaged, or 12½ pounds if unpacked,as is the custom of most men.

2. Too many packages of different shapes and sizes for one ration. Itdoes seem extraordinary that, as this ration was something entirely newand specially designed, it had to be made up in bits and pieces insteadof being put up in one compact element which could be easily stowed andeasily carried. As it is, from their different shapes and sizes, each componenthas to be put in a part of the equipment and in consequence one or othercan easily be lost.

3. It was often impossible to open the large tin without having to resortto the use of a tin-opener, jackknife, bayonet, and so forth. The causeof this lay in the fact that the tongue of metal upon which the key operateswas so firmly bound down at the rim that it refused to strip. The key,if subjected

⁸⁰Hunger was a profound factor in the campaign,whether the troops were British or American. Ogburn's recollection of the"K" ration (which American troops, too, agreed was the best ofthe packaged field rations) occupies three eloquent pages. Hunger was "ourother enemy." "We had two conditions--one in which we felt unfed,the other in which we were unfed." One of his companions wrotean elaborate "treatise" on the "K" ration, which thesoldiers "learned to know * * * as intimately as a monk his rosary* * *." The arts of division and subdivision, combination and separationof the several components of the three meals became Byzantine in theirrefinement. The effect of careful management was not satisfaction, however,but the mere reduction of "gnawing in [the] belly" to predictableperiods of the day and nighttime (pp. 153-155). The brief remarks of Mastersare to the same point (p. 191). Calvert recalled "perpetual"K rations as "a hardship" but not a "great hardship."Whenever possible, extra tea and sugar, meat, stewed fruit, white bread,and rum were added. Occasionally captured food was eaten, and rice, buffalo,and pigs were sometimes purchased: Calvert, p. 193.

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to any force in consequence of the already mentioned fault, broke. Inthe "K" ration such a state never arose. All tins opened easilyand cleanly. The metal strip which was torn off by the key in opening wasso preweakened that it never failed. Further, if by chance the key waslost, this preweakening made it possible for the man to open the tin withhis teeth, a thing quite impossible in the jungle ration.

4. The cheese, though good and popular, is unattainable, for there isno means of getting into the container unless the top is smashed off bythe use of a bayonet or jackknife. When this method is used the resultingmessing up of the contents causes considerable wastage.

5. What has been said of the cheese applies equally to the jam container.In a majority of the containers which have come to personal notice a considerabledegree of fermentation had taken place in the tin, due to the fact thatit had not been completely filled, with the result that when opened withthe spike of a jackknife or tin opener, much of the jam spurted up by beingblown out by the raised internal pressure and very often soiled one's clothes.

6. The amount of sugar supplied is far too small. The men had a greatcraving for sugar and the amount supplied was barely sufficient for onecup of tea. On their evacuation from Burma it is not uncommon for one manto eat a one-pound pot of jam and a whole tin of tinned fruit without asecond thought and he would continue to do so two or three times a dayif given the opportunity. For men of this sort the jungle ration givesin a whole day only as much sugar as is found in each meal of "K"ration, i.e., four lumps.⁸¹

7. The compressed salt tablets are excellent, but are supplied in excessivelylarge numbers. There are approximately 32 tablets in each day pack. Ifthis number was reduced to 6-7 and mepacrine and water sterilising tablets,as well as sugar, packed instead, it would be an advantage.

8. The "oatmeal" (sic) cakes were unfortunately named. Theyare quite good if munched in their natural state, and if powdered down,make the basis for an edible and satisfying dish, but THEY ARE NOT OATMEAL,and when cooked they do not make porridge. The fact that the men were expectingporridge and did not get it was a great disappointment and turned themagainst this item completely. When it was suggested that it made a goodpudding they agreed. Real oatmeal in the same amount would however be appreciated.

9. The chewing gum should be omitted, for with regard to that packedin the American rations opinion is divided, but about that packed in thejungle ration there is no diversity--it is universally disliked.

10. With modern methods of canning and packaging there would appearto be no reason why meats such as those already enumerated in the reportof the "K" ration and in daily use by the American Army, shouldnot be supplied to the British.

⁸¹" 'Pack of Cavaliers for two lumps ofsugar, anyone?' 'Coffee for a fruit bar,' " (Ogburn p. 150, rememberingthe subdued voices at a rest-stop or in bivouac. The compressed chocolatebar--D-ration--was especially popular with those suffering from diarrheaor dysentery. They would trade it for an entire "K" ration meal).

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Road/rail rations.--Railroad rations are composed of a variousassortment of tins of bully beef, tins of sardines, tins of milk, bagsof sugar, bags of tea, loaves of bread, and cases of Delhi biscuits jumbledtogether in a gunny bag.

The tins of milk and of jam are all of such a size (11 pounds or 21pounds) that when they cannot be used at one time they must either be thrownaway or have the holes plugged with any dirty bit of paper that can befound. This is but one of the disadvantages of this ration, as it is now,and it is suggested that its use be discontinued and that the American10 in 1, or 5 in 1 rations be substituted. One has only to see these Americanrations to be convinced of the need for this change.

Special Force rehabilitation ration.--Special Force rehabilitationration has proved to be entirely satisfactory and should be retained forits special purpose in the future.

There are besides these, two points that might be well worth rememberingfor future operations. (1) A man who has been living on "K" typeor equivalent rations for long periods cannot tolerate and should not begiven full normal rations immediately after he gets out of Burma. He shouldhave for the first 2 days at least, sweet and easily digestible food, workinggradually up to a normal diet. A large number of men, thinking they couldtake normal food, took it, and suffered from an acute diarrhoea in consequence.(2) Every opportunity for giving a change should be seized, and whenevera column gets into a stronghold a ration other than the one upon whichit has been living should be sent in at once. Amongst the articles of this,pickles, sauces, etc., must be prominent.

IV. THE MEDICAL DISASTER

Statistically considered, Special Force met a more dangerous enemyin disease than in the Japanese Army. Clinically analyzed, it was moreseverely injured by malaria and dysentery than by bullets and grenades.Tactically appraised, its battle worthiness was determined by its medicaldiscipline more than by its courage.

During the first 45 days of the campaign, little evidence appearedthat health factors would affect combat maneuvers. Then the plight of thel6th Brigade offered an ominous but little heeded warning. The major causeof its inability to capture Indaw probably was its exhaustion after thelong and difficult march from India. But the inconsequence of its subsequentactions and its wholesale evacuation back to India were due to rapidlyrising rates of disease and disability.

The loss of the l6th Brigade apparently produced some regrets butno surprise or change in plans for Special Force. It had always been assumedthat long range penetration groups would be "used up." However,the brigade had not been severely engaged by the enemy. It had not encounteredspecial health hazards, such as a region from which scrub typhus infectioncould be acquired. It had not survived

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into the monsoon season, when admittedly bad environmental conditionsbecame infinitely worse. Therefore, it might have been asked whether itshigh sick rates could be sufficiently explained by exhaustion. This factor,it might have been thought, would lower the resistance of the brigade toall kinds of diseases. But as a matter of fact, malaria and dysentery wereso prevalent that all other conditions (including battle casualties) couldhave been ignored in determining whether or not to evacuate the brigade.Both diseases were controllable, if not preventable, by medical measuresand by military discipline.⁸²

The fate of the 16th Brigade notwithstanding, plans made at the endof April assumed the existence of a still-vigorous force. The strongholdswere to be evacuated. The Chindits were to move rapidly northward to assistStilwell. The 111th was to put down a strong roadblock south of Mogaung.The 77th and 14th Brigades, moving swiftly by different routes, were toreinforce the 111th if necessary, and to attack Mogaung. The 3d West AfricanBrigade was to be deployed as needed in conjunction with the other brigades.Although these brigades were depleted by about one-fourth, the planningdocuments and conference notes did not suggest any alarm or doubt. Tentatively,it seemed likely that the 77th Brigade--up to then the most strenuouslyactive unit of the Force--would be due for relief after the capture ofMogaung. The other brigades, however, were positively listed for continuedservice under Stilwell during the summer.⁸³

Two weeks later, these movements were in train, with no notice ofany particular health problems.⁸⁴ But in another 10 daysthe picture was rapidly changing. The 111th Brigade was in difficulty atits stronghold and the reinforcing columns of the 77th and l4th Brigadeswere still not in touch with it. In messages and then in conference, theForce Commander sought Stilwell's permission to give Masters, the 111thBrigade Commander, discretionary power to abandon Blackpool, if to do sowould mean the difference between destruction and survival.

Stilwell was suspicious. Was the 111th really so hard pressed? Wouldits situation be any better, really, if it left Blackpool and attemptedto scramble through the jungle, in an area where enemy strength was great?Were the 77th and 14th Brigades making all possible efforts to move intostriking position? Stilwell had already complained that the 77th failedto move northward immediately upon being ordered to do so, and was undulyslow in completing the march. In a climactic confer-

⁸²See General Officer's analyses below.
⁸³Documents in the Stilwell Papers, Folder 45, include a ciphermessage 28 April 1944 from Slim to Stilwell and Lentaigne; a memorandumby Stilwell on 30 April, which he used in conference with General Slim;"Report of Discussions taken at Conference held at Maingkwan 30 April1944," signed by Slim; and Boatner's notes on the same conference.Folder 4, Stilwell Papers, contains Hq 3d Indian Division, "Precisof Op. Instruction No. 8 dated 28 Apr."
⁸⁴Hq CAI, "Directive for Commanding General, 3d IndianDivision," 16 May 1944, in Stilwell Papers, Folder 7. However, Stilwell'soffice later noted that some dispute had occurred regarding whether SpecialForce was to continue in the field after the capture of Mogaung. Hq FwdEch NCAC, 25 July 1944 (no title), Stilwell Papers, Folders 4 and 160.

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ence on 25 May,⁸⁵ Lentaigne and Stilwell debatedthe issues. Stilwell reluctantly conceded discretionary power to the 111thBrigade Commander. Then Stilwell learned that on that very day, at an hourhe could not discover, the 111th had left the roadblock. He was convincedthat Lentaigne had deceived him to cover up the flight of the 111th inadvance of Stilwell's permission to leave its post.

No reasons exist to doubt the integrity of the 111th Brigade or theForce Commander. Although the brigade was reported to have had nearly 2,000effective troops when it left Blackpool, it had incurred 325 casualtiesin the preceding 24 hours, and it carried 200 men on litters when it wentinto the jungle. It knew that the Japanese were bent on eliminating theroadblock and had brought up enough troops and artillery to do so. Badweather and enemy action had severely reduced the air supply effort, andit was obvious that no relief could immediately be expected from the otherbrigades.

Equally, Stilwell's position was well justified. The roadblock seemedvital. All his success up to that time involved attacks on the enemy rearby a mobile striking force while the main body of the Chinese infantrydrove hard against the enemy's prepared positions. He believed the Mogaungarea to be vulnerable, and it was imperative to prevent the Japanese fromreinforcing it. If Special Force had not been created for just such a purpose,he thought, what, then, was its use?

On these terms, two determined men, Lentaigne and Stilwell, arguedinconclusively. But into the debate Lentaigne inserted a new point, thehealth of the troops. In addition to the perilous shortage of suppliesand ammunition which had developed as the Japanese (and bad weather) tookcommand of the airstrip, the 111th faced the inability to evacuate itsrapidly accumulating sick and wounded. Although this difficulty seemedto be less urgent than immediate tactical problems, Stilwell later mentionedit as one of the reasons for assenting to Lentaigne's arguments.

The point was more strongly advanced immediately after the conferenceof 25 May. Lentaigne suggested that Special Force had better wind up itsaffairs at once to avoid annihilation. It was no longer possible, he thought,for his troops to join the Chinese in a concerted attack on Kamaing andMogaung. The distance was too far for the weary Chindits to march intobattle, and the Chinese were not advancing fast enough to close the gap.Further independent action by Special Force was prohibited by the numbersand concentration of the enemy. The only recourse was for the brigadesto evade the Japanese and go as quickly as they could to Stilwell's linesof communication at Myitkyina airfield or north to Mogaung. Unless theydid so before the monsoon

⁸⁵"Summary of Conference held on 25 May44," signed by H. T. Alexander, Stilwell Papers, Folder 7; FE Hq NCAC,"Notes on 111th Brigade," 25 July 1944, Stilwell Papers, Folder4; untitled memorandum, Hq Fwd Ech NCAC, 25 July 1944, Stilwell Papers,Folders 4 and 160; Stilwell Diary, 25 May 1944.

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rains came down in earnest, they would be isolated and unable toevacuate their sick and wounded.⁸⁶

From this time onward the controversies regarding the fate of SpecialForce referred significantly to the increasing numbers of sick men andto the difficulty of evacuating them. When the 111th left Blackpool, Stilwellordered it to remain in the vicinity to harass the enemy. It shifted toIndawgyi Lake, north of its roadblock position. Whatever Stilwell expectedof it, its first concern was to send out its invalids. The 77th Brigade,criticized for alleged procrastination or disobedience late in May, notonly claimed ambiguity in the order Stilwell had given it, but also reportedthat its troops were incapable of sustained and rapid movement. As themonsoon closed down and the brigade took up positions below Mogaung, referencesto its sickness rates were invariably included in discussions of its plansand operations.⁸⁷

In the first week of June, Stilwell ordered the brigades to deployfor the final assault on the Kamaing-Mogaung line. The losses in SpecialForce were reckoned up before the movement began. The 14th Brigade hadlost 151 men to sickness; 71 had been killed, 95 wounded, and 27 missing.In 77th Brigade, 269 men had been evacuated because of sickness. Its battlecasualties numbered 172 killed, 415 wounded, 84 missing, and 11 captured.The 111th had had 58 killed, 157 wounded, and 49 missing; nearly as many--218--hadbeen lost to disease. The section of the 111th which operated separatelyin the east--"Morris Force"--reported that its sick evacueestotaled 100, in addition to 24 killed and 49 wounded. The 3d West AfricanBrigade, least heavily involved, reported 19 killed, 30 wounded, 33 missing,and 77 evacuated because of illness. The total came to 2,000 officers andmen, 40 percent of whom had been felled by disease--and the monsoon andthe hardest fighting had just commenced.⁸⁸

On 11 June, the 77th Brigade reported that its action in the Mogaungarea had become extremely costly. Five days later, it warned Stilwell thatit had little left to go on. Unless the Chinese soon arrived, it wouldbe forced to escape into the hills, perhaps with no more than 500 effectivetroops remaining.

Stilwell's headquarters was skeptical. It noted that the 77th Brigadecasualty figures of 3 June came nowhere near the losses being claimed bymid-June, and that the brigade strength report of 24 June listed 137 officersand 3,334 other ranks. The disparity, it appeared, could be explained bytaking account of the actual physical condition of the men in the field.Most of those still called fit were succumbing to the effects of

⁸⁶Memorandum by Lentaigne dated 2 [sic] May1944, Stilwell Papers, Folder 7. The contents indicate it was written onor within 2 days after 25 May.
⁸⁷See part II, regarding the 111th Brigade; also Masters. Onthe 77th as well as the 111th, documents cited are pertinent for particularoccasions in June and July. Stilwell's post mortem summary on 25 July (StilwellPapers, Folders 4 and 160), shows that the 111th had suffered 482 battlecasualties up to 3 June; two columns of the 77th had lost 216 by the samedate.
⁸⁸Hq CAI, "Orders," 8, 17, and 26 June 1944, StilwellPapers, Folder 7: Hq CAI, Field Order 16, 11 June 1944, and strength andcasualty reports, 3d Indian Division, 3 June and (for Morris Force) 14June 1944, Stilwell Papers, Folder 4.

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incessant rain and mud, were bone-weary, and were acutely or subclinicallysick.⁸⁹

Similar reports were coming in from the 111th Brigade, the 14th Brigade,and Morris Force, but these reports notwithstanding, Stilwell was increasinglydissatisfied with Special Force. Consultations between Mountbatten, Slim,and Stilwell from June 6 onward led to support for Stilwell in his argumentswith Lentaigne, but there was an increasing effort to persuade Stilwellto let most of Special Force leave Burma.⁹⁰ These interchangesled to another conference on 30 June. Special Force, Lentaigne insisted,was overdue for relief. The 77th and 111th Brigades were in a "veryexhausted state and their stamina so lowered that they were unable to resistdisease and sickness * * * Only about 350 men of these two brigades arereally effective."⁹¹Mogaung had fallen on 26 June.Mop-up operations should be left to the Chinese. Special Force had doneits duty.

To this representation Stilwell replied repeatedly that he had nointention of keeping sick men on the line. But the Mogaung area still containedenough enemy troops to reinforce the stubborn garrison at Myitkyina, andit was possible that the enemy might attempt to send in other forces torecapture Mogaung. Until the entire area was secure, the whole campaignwas jeopardized. He demanded that Special Force remain in the field, andpointed out that its currently-reported strength still warranted expectationsof effective, if limited, action.

The debate finally centered upon the question of the health of thetroops. With Mountbatten presiding, Stilwell and Lentaigne agreed to conducta medical survey of Special Force. The sick and "unduly weak"should be promptly removed. The remainder should help isolate Myitkyinaby patrol and roadblock operations below Mogaung.⁹²

While waiting to hear the results of the medical survey, Lentaigneirritated Stilwell by once more asking for immediate evacuation of the77th Brigade because of its ill health and fatigue. Rebuffed, he next askedStilwell to authorize the 77th Brigade Commander to cease operating andto send out all who appeared unfit. Stilwell replied by a terse messagethat Lentaigne was to carry out orders. Calvert's reaction, on behalf ofhis 77th Brigade, was the statement (as reported to Stilwell): "Cannot anyone realise that we are finished and fought frantically to the endbefore we defeated the Japs and that when we beat the Japs they remainbeaten."⁹³

⁸⁹FE Hq NCAC, 25 July 1944, "Notes on77th Brigade"; untitled memorandum, 25 July 1944, Stilwell Papers,Folders 4 and 160; Stilwell Diary, 15 June 1944. Also, see pertinent sectionsof Calvert.
⁹⁰Untitled memorandum, 25 July 1944, Stilwell Papers, Folders4 and 160; Stilwell Diary, especially 6 and 12 June 1944.
⁹¹Mimeographed memorandum, "Notes on meeting," 30June 1944, Stilwell Papers, Folder 4.
⁹²Ibid.
⁹³Untitled memorandum, 25 July 1944, Stilwell Papers, Folders4 and 160; "Notes on 77th Brigade," 25 July 1944, Stilwell Papers,Folder 4; Stilwell Diary, 1-5 July 1944; "Orders," 6 July 1944,NCAC Hq to 3d Indian Division, Stilwell Papers, Folder 7.

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At this juncture, the Force Medical Officer, Colonel Officer, summarizedthe medical situation. He had not, he wrote, been able to keep fully intouch with the brigades because bad weather had often prevented flightsto the combat area and because field officers failed to send weekly reportsdespite urgent reminders to do so. However, on the basis of such visitsas he had recently made to some brigades, to field hospitals, and to airclearing centers, he reported:⁹⁴

[The] state of health in all Bdes is very much the same and is, takenall around, extremely poor. All have lost anything from two to three stonesin weight. Morale, while high, is highest in 77 Bde which is accountedfor by their recent successes in action. The incidence of fever is steadilyrising and there are few men who have had less than three attacks of malaria.The majority have had as many as seven attacks, and all have been treatedwithin their columns.

With the onset of the rains men are constantly wet, both day and night,and have little or no chance of getting dry. Paths are in many cases waistdeep; and foot rot and prickly heat, which very quickly turns septic, havebecome rampant. Deaths from cerebral malaria and typhus fever are commonand on the upgrade, and the S.M.O. of the 14th Bde in a report says: --"ina week or two's time the number of deaths due to sickness will absolutelystagger the authorities. But we have sounded the warning, don't blame us.Soon the sickness will be quite beyond our control. Eleven deaths fromfever at Plymouth last week." While one of his M.O.'s in a reportof the same day says:--"General health is undoubtedly deterioratingat a rapidly increasing rate due to (1) the frequent occurrence of shortrations and (2) the continued wet weather."

Officer went on to say that since the l4th Brigade had left the areawhere scrub typhus was a threat, some improvement had occurred. He reportedthat the Morris Force near Myitkyina was severely debilitated. Weight loss,anemia due to malaria, and fatigue had reduced its marching capacity toabout 5 miles per day, with half-hour rest stops after every hour of exertion.

He concluded that the Force should be withdrawn as soon as possible.It was especially necessary to do so if the troops were ever to be redeployed.At best, he thought, they would need to recuperate for 3 months beforethey could return to duty.

The medical surveys were carried out between 11 and 23 July. Meanwhile,the controversies over the effectiveness of Special Force continued. Lentaignetook Calvert to meet Stilwell, hoping to obtain a better hearing for thecase of the 77th Brigade. Calvert explained that he had used his last 70effective troops to enter Mogaung; and that "after this my men werecompletely exhausted and flat on their backs." The

⁹⁴"Medical Report--3rd Ind Div,"10 July 1944, Stilwell Papers, Folder 4.

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disposition of the brigade afterward, which had not accorded strictlywith Stilwell's orders, resulted from the absolute inability of the brigadeto maneuver any longer. Calvert felt that he and Stilwell had come to anunderstanding. "All very polite," was Stilwell's dry comment.⁹⁵

On 14 July, Lentaigne asked Stilwell to relieve "Morris Force."It was wasting away. Its principal officers were sick and on the vergeof hospitalization, whereupon the Gurkha troops would be left without sufficientBritish leaders. He regretted that the unit would not be able to standby until Myitkyina fell, but it was merely using up air-supply potentialwithout results.⁹⁶

The Supreme Allied Commander, Mountbatten, sent Stilwell some pointedadvice next day. At Stilwell's "very earnest request," he wrote,he had "broken his promise to L.R.P. Brigades." He was "forcingthem to stay in long after Wingate, or his successor Lentaigne, consideredwas either right or feasible." On the original schedule devised byWingate, the 77th and 111th Brigades should have been relieved by 1 Juneand the 14th and 3d West African Brigades would have been out of Burmaby the end of that month. Mountbatten did not renege on the 30 June agreementto leave Special Force in Burma. However, he reminded Stilwell that thefall of Myitkyina should be the signal for removing whatever remained ofthe 77th and 111th Brigades, and that the other two units should be releasedsoon afterward.⁹⁷

Four days later, on 19 July, Stilwell summoned Lentaigne for a conferenceabout apparent disobedience of the 111th and 14th Brigades. He opened themeeting by reading an order Lentaigne had issued the day before, directingthe 111th Brigade to break off an attack and move to Kamaing, in orderto evacuate its sick and wounded, and instructing the 14th Brigade to changeits position in order to relieve the 111th. Lentaigne acknowledgedthat he issued the order on his own initiative.

Stilwell: I have never objected to getting out of the sick and wounded.I do object to a change in missions.

Lentaigne: I had to do it * * * I had to take action to safeguard mymen.

⁹⁵Typescript, "Comments of Brigadier Calvert,"11 July 1944, Stilwell Papers, Folder 4. The account is unsigned, but itis evidently out of Stilwell's office: a penned note on it says Lentaigneand Calvert were uneasy and anxious to leave before Stilwell raised certainquestions about obedience to orders. Also, Calvert, pp. 250-251. The hostilityin the air was partly due, the British believed, to the ignorance and maliceof one of Stilwell's staff officers. He persistently misrepresented thework and attitudes of Special Force, they believed. References scatteredamong the entries of June in Stilwell's Diary confirm this possibility.Calvert pp. 226, 230, 241-242, 247; Masters, pp. 244, 261-262, 282-283;Stilwell Diary, 11 July 1944.
⁹⁶Memorandum, Hq 3d Indian Division, 14 July 1944, StilwellPapers, Folder 4. The message from Lentaigne reflected one from the commanderof Morris Force, which, among other things, reported that half the unitwas "flat out" after a 4-mile march. The message was followedup by a conference between Lentaigne and Stilwell. Stilwell's feelingscan be surmised at a time when the siege of Myitkyina was at a standstill.Japanese reinforcements were filtering in, and his Chinese and Americantroops also were having medical problems. Stilwell Diary, July 1944, andThe Marauders and the Microbes, parts IV-VII.
⁹⁷Letter, 15 July 1944, Mountbatten to Stilwell, Stilwell Papers,Folder 45.

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Stilwell: Certainly. We must all look out after our own men. I intendto make a case out of this. You are not obeying orders. You have not madean effort to keep me informed.

Lentaigne: You have been away a good deal of the time.

Stilwell: Yes, but I do not recall any efforts to contact me. * * *

Lentaigne: I felt that I had to do it because it was desperate. * **

Stilwell: We have tried to get to Taungni. [Your] new orders have beenissued to relieve one unit making an attack and to move in another unitthat, I thought, was on another mission. I do not see why we should giveup the ghost when there are 5300 effective men [remaining in the two brigades].

Lentaigne: The 111th Brigade is absolutely finished.

Stilwell: It is agreed that the sick and wounded should be evacuated.I cannot see why you issued these orders.

Lentaigne offered to rescind the order, since the two brigades hadnot completed the change in position. Stilwell, in turn, acknowledged thiseffort to relax the tension by asking his chief of staff whether therewere any Kachin auxiliaries available who could help move sick and woundedmen. There were none, apparently, and all Chinese transport troops werein use elsewhere. * * *

Stilwell: I understand how you feel about the sick and wounded. We allfeel the same way.

Lentaigne: The big question at the moment is taking care of the wounded.The remaining effectives are in very bad condition themselves. The feetare absolutely raw on some of the men. They have been wringing wet fora month or more. There is no sunshine in those jungles. Another thing wehave just found is that almost every man is full of worms. This is probablybecause they have been on "K" rations ever since they have beenin. Malaria is a constant source of trouble, the men are taking from threeto four atabrine tablets every day. There are many deaths due to sickness.

Stilwell then asked about the reliability of the troop strength reportshe was receiving. Lentaigne answered that the reports were accurate asto numbers, but "they are all sick. On a recent visit to the [111th]Brigade they were actually rude to me concerning their condition of sickness.Those men are carrying 20 lbs on their back. They are nothing but skinand bones, plus all the other forms of sickness."

Stilwell said again that the unit must hold its position until orderedto do otherwise, but that the sick and wounded "will be withdrawn."

Lentaigne: The doctors would now say that the unit is 100% unfit.

Referring again to a recent strength report, Stilwell remarked, aproposof the picture Lentaigne had just drawn of the 111th Brigade,

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that it was the 14th rather than the 111th which seemed to have moreunfit troops. Why was that? he asked.

Lentaigne's chief of staff, Brigadier H. T. Alexander, answered:

That is because the doctors are not so strict in their inspection inthe 111th.

Lentaigne: The main trouble is the lack of officers. I will do my best.⁹⁸

Immediately after the conference, Stilwell issued orders to Lentaigneto proceed on the missions assigned "to the best of your ability ** * Ineffective, sick and wounded, will, as before, be evacuated. All effectives* * * will continue on the mission assigned."⁹⁹

Still later on 19 July, Lentaigne sent Stilwell a new strength report,incorporating the results of the medical surveys.¹⁰⁰According to the column medical officers, the figure of 5,300 effectivesused earlier that day was erroneous. No more than 3,700 officers and menwere fit for action. Three-fourths of the 77th Brigade was permanentlyor temporarily incapacitated; the latter, too, should be hospitalized assoon as they reached India.¹⁰¹The 111th Brigade hadonly 722 officers and men listed as fit for duty; over 1,100 were seriouslyor temporarily unfit because of sickness. The 14th Brigade was down toa strength of 60 officers and 1,100 men, not counting those ready for evacuation.The 3d West African Brigade, much better off than the others, still hada sick list equal to one-third of its strength. Comments by medical officerson the statistical picture included such remarks as: "near mentaland physical breakdown", 50 percent of the fit have foot rot; thefit men are at 40-60 percent efficiency; "Coln comd states men willnot attack further. Only outstanding officers can lead them", 70 percentof the fit are weak from previous diseases; sick rates "rising alarmingly."¹⁰²

In view of these circumstances, Lentaigne again gave priority tothe problem of evacuating the sick. He notified Stilwell he was, in effect,reinstating the cancelled order to relieve the 111th and replace it bythe 14th Brigade. Once more, Stilwell reacted angrily. But Mountbattenimmediately sent him a radio message in which he confirmed the need toevacuate the 77th Brigade and Morris Force in their entirety, as well asall who were unfit in the other brigades. He did not consider the 111thBrigade should remain any longer, either, and he instructed Stilwell toremove the 14th and 3d West African Brigades as soon as the British 36thDivision--already under movement orders--appeared.

⁹⁸"Record of Meeting between General Stilwelland General Lentaigne," 19 July 1944, Stilwell Papers, Folder 4. Lentaigne'sdisputed order of 18 July 1944 is also in Folder 4. Stilwell's diary entryfor 19 July 1944 is terse and unfriendly.
⁹⁹"Orders," Hq CAI, 19 July 1944, Stilwell Papers,Folder 4.
¹⁰⁰"Orders," Hq 3d Indian Division, 19 July 1944,Stilwell Papers, Folder 4.
¹⁰¹Calvert, p. 282. (Lentaigne had already "written off"the 77th Brigade and did not mention it in his statement of 19 July.)
¹⁰²"Orders," Hq 3d Indian Division, 19 July 1944,Stilwell Papers, Folder 4.

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Finally, he called for another conference to clear up "misunderstandings."Under the eye of Gen. Albert C. Wedemeyer, who represented Mountbatten,Stilwell and Lentaigne compromised their differences reluctantly. No oneof the 77th Brigade remained except the "muleskinners"; theywere to be sent out forthwith. The 14th Brigade would cover the 111th whileit evacuated its casualties, but the attack on Taungni would continue.The 14th and 3d W.A. Brigades were to remain with Stilwell until afterthe fall of Myitkyina, but Lentaigne was to keep Stilwell fully informedregarding their physical condition.¹⁰³

So ended the history of Special Force. It was overwhelmed by disease.The few not actually sick enough for hospitalization were despondent and,in fact, had all the conditions for acute sickness--malnourishment, skindisorders, vitamin deficiency, utter fatigue. The statistics used on 25July 1944 to reach the final decisions, are printed in the notes.¹⁰⁴They vary in detail, but not materially, from those presented in the concludingsection of General Officer's Report, and from those elsewhere published.The number of troops admitted to hospital for sickness was one-third ofthe troop strength; the number of sick who were hospitalized was threetimes the number who were admitted for wounds (and, of the latter, a largenumber were also ill); and of the troops still classified as "fit,"the majority were ill and would be hospitalized after leaving Burma.

¹⁰³Stilwell Diary, 20, 21, and 25 July 1944;radio message, Mountbatten to Stilwell, 22 July 1944, Stilwell Papers,Folder 4. The untitled memorandum of 25 July 1944, with its "Notes"on the 14th, 77th, and 111th Brigades, apparently was designed to indicatethe salient actions of the several parties to the various controversies.A memorandum of the conference, dated 25 July 1944, is signed by Stilwell,Lentaigne, and Wedemeyer, Stilwell Papers, Folder 4.
¹⁰⁴"Status report 22 July 3d I.D.," in Stilwell Papers,Folder 4.

Brigade	Fly-in strength	Replacements	Total strength	Killed	Wounded	Sick	Captured	Missing	Sick and wounded for evacuation	Total loss	Total effectives
14: Officers Other ranks	176 3,295	9 153	185 3,348	12 99	14 162	39 381	0 0	2 27	29 1,098	96 1,967	89 1,481
111: Officers Other ranks	163 3,553	30 398	193 3,951	15 186	34 373	49 1,182	1 10	8 171	78 1,853	175 3,375	8 176
3 WA: Officers Other ranks	120 2,505	8 50	128 2,555	5 50	15 174	20 157	0 0	3 2	29 395	72 778	5 1,777
Morris Force: Officers Other ranks	44 1,279	2 43	46 1,322	3 18	2 100	36 1,152	0 0	0 8	0 0	41 1,278	5 44
TOTAL: Officers Other ranks	503 10,632	49 644	552 11,276	35 354	65 809	144 3,072	1 10	13 208	136 3,346	384 7,798	158 3,478

The summary figures in Mountbatten's final report wereas follows: 1,035 killed; 2,531 wounded; 473 missing; 7,217 hospital admissions,75 percent of which were due to disease. Of those examined in the medicalsurvey, 50 percent were declared unfit for active service: South-East Asia,p. 75. Crew, V, p. 195, gives 944 killed, 2,434 wounded, and 452 missing.

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The health of the command diminished precipitously after the middleof May, even before the monsoon rains aggravated the dangers of the environment.Tactically, the key to the situation seems to have been the deploymentof the brigades in relatively stationary positions. After the engagementsaround White City, the 77th Brigade showed signs of deterioration. At Mogaung,it collapsed rapidly, although the victorious end to the battle kept upmorale.¹⁰⁵The 111th Brigade never recovered from thepunishment it took at Blackpool.¹⁰⁶Its morale was low.After it evacuated its casualties and went into action around Kamaing itwon little but criticism. The 14th Brigade lost men to disease at a rising,but relatively even rate, while it was patrolling and marching south andwest of the Kamaing-Mogaung area, as was also the case for Morris Force,southwest of Myitkyina. But when these units were called upon in June andJuly to settle down to relatively immobile tactics, their effectivenessdropped markedly.

¹⁰⁵According to Calvert, p. 170, "Ourhospital had been filling with sick and a few wounded," during theinterval between leaving White City and attacking Mogaung. In this period,the Brigade was maneuvering northward in an effort to contact the 111thBrigade at Blackpool. When the 77th left White City, its strength was calculatedto be 2,277; the White City operation had cost it 748 killed, wounded,and missing. In addition to these casualties, there were 279 sick men whowere evacuated (Calvert, p. 144). Calvert also furnishes the figures forthe operations between White City and Mogaung, and at Mogaung (p. 282):

	Before Mogaung operations	Mogaung operations	Total
Killed or died of wounds: Officers Other ranks	28 162	19 241	47 403
Wounded evacuated: Officers Other ranks	23 297	27 450	50 747
Wounded not evacuated: Officers Other ranks	12 50	10 102	22 152
Died of sickness Officers Other ranks	0 4	1 13	1 17
Sick evacuated: Officers Other ranks	15 350	8 139	23 489
Missing: Officers Other ranks	5 68	1 83	6 151

The figures show that the 77th lost 572 killed and woundedin its march and patrol actions between the engagements at White City andMogaung. The severity of its combat efforts at Mogaung is shown by thecasualty figure of 849 killed and wounded. Its sickness rates were high,compared to those of the White City operations. To get to the Mogaung areacost the 77th 369 men who died or were evacuated with disease. In the Mogaungarea, prior to the complete withdrawal of the 77th, almost 44 percent ofthat number--161--was added to the sick-evacuated list. But in addition,as Calvert and others testified, over 50 percent of those remaining weresubject to medical evacuation when they were finally surveyed en masse.And of the men still listed as "fit," another 50 percent (25percent of those who were surveyed) were hospitalized after returning toIndia.

¹⁰⁶Masters reported that at Blackpool the situationwas complicated by a rapid increase in malaria and dysentery cases, andthat afterwards, while evacuating patients at Indawgyi Lake and in themaneuvers for position around Kamaing, the 111th failed rapidly. Immediatelyupon leaving Blackpool, Masters reported he had 150 men for evacuation.Actually, at Indawgyi Lake, some 600 men were sent out, evidently becauseof sickness in two-thirds

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Three reasons may be offered to explain this phenomenon. First, themorale of the Force was derived from its conception of itself as a hit-runstriking team. Associated with the Chinese and American forces in moreconventional and sustained warfare, late in the cam-

of the cases. At this point, there occurred "a fearfulfalling off in general health," although the unit was inactive. Malariacases, while still relatively low, doubled in number compared to earlierweeks. The medical officers began to speak of near-fatal depths of "exhaustion,undernourishment, exposure, and strain." Ordered again into action,Masters began asking for medical relief. Probably not knowing that Lentaignewas making similar demands for the entire Force, he believed that it washis reiterated messages which finally resulted in action (Masters, pp.260-262, 272-273, 276). A strength report of Special Force (quoted below)covering the period from March through May indicated that the 111th hadlost 264 killed, wounded, and missing, and 218 sick evacuees. Between thefall of Blackpool, then, and the medical survey of mid-July, all but 118officers and men among 2,200 troops succumbed to medical disabilities.

Finally, the effects of the campaign after the White Cityand Blackpool engagements may be suggested by comparing the following tableof casualties up to June with the final table of 25 July. The figures aregiven in "Strength and casualty reports 3d Ind Div," StilwellPapers, Folder 4:

Morris Force, 22 May-10 June:
Killed (1-10 June, none killed before)	24
Wounded (1-10 June, none wounded before)	49
Sick evacuated	100
Total	173
14^th Brigade, 20 March-3 June:
Killed	71
Wounded	95
Missing	27
Sick evacuated	151
Total	344
77^th Brigade, 5 March-3 June:
Killed	172
Wounded	415
Missing	84
Captured	11
Sick evacuated	269
Total	951
111^th Brigade, 8 March-3 June:
Killed	58
Wounded	157
Missing	49
Sick evacuated	218
Total	483
3d West African Brigade, ca. 1 April-3 June:
Killed	19
Wounded	30
Missing	33
Sick evacuated	77
Total	159

Such a comparison suggests that units which fought mostlost fewer men because of disease. One reason might have been that battlecasualties received priority in evacuation; another that treatment of minordiseases in the field was more common than treatment of minor wounds. Butwhile these factors would affect the ratio of evacuation due to woundsversus disease for short periods, in the long run it would seem sound tosuggest that the operational health of the troops remained highest whenthey were in combat. The 77th Brigade is the example. Similarly, the wholeForce was more nearly a mobile striking unit prior to 3 June than afterward.Up to that time, as the figures just cited show, the ratio of battle casualtiesto sick evacuees was 1,294 to 815. In the more nearly static operationsin the Kamaing-Magaung area, and in the same monsoon conditions which besetall units, 77th Brigade, the most heavily and successfully engaged, maintainedthe primacy of battle casualties over sick evacuees (although by a muchsmaller margin than before). But in the rest of the Force, the ratio wasrapidly reversed until it was overwhelmingly weighted toward disabilitydue to sickness.

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paign, the officers and men felt misused. In turn, medical as wellas other forms of discipline were relinquished. The will to stay well diminishedmore rapidly than did the will to fight well.

Second, the monsoon rains produced severe tests of Force morale andmedical discipline. Insect carriers of disease, contamination of watersupplies, difficulties in disposing of fecal wastes, and conditions producingskin disorders rapidly multiplied. These increased odds against healthappeared at the time when, for other reasons, the Force was least preparedto resist them.

Finally, the accumulated strains of the campaign, appearing in thegeneralized form of weight loss, listless appetite, avitaminosis, and fatiguewere, of course, concentrated in the late weeks of action. With mentaland physical powers depleted, environmental hazards sharply increased interms of discomfort as well as disease, and the sense of mission and self-respectdiminished by conventional deployment, Special Force broke down. Its lossesto malaria and dysentery especially revealed the relationships among environment,battle-weariness, and morale. With respect to dysentery and allied conditions,low standards of sanitation had already cost the troops dearly by the endof May. As they entered the relatively static phases of action, opportunitiesfor self-contamination greatly increased, as compared to the situationwhen the troops were on the march most of the time. With discipline declining,sanitation suffered. Only the most rigorous care, backed by training anddesire, could have held down the rates of enteric disorders to acceptablelevels.

The situation is even clearer in the case of malaria. Here, infectionwas difficult to prevent under the field conditions which were imposedon the Chindits. But even accepting the troops' belief that total suppressionof the clinical manifestations of the disease could not be produced evenby perfect Atabrine discipline, still, according to overwhelming medicalevidence, wholesale breakthroughs could be explained only by the failureof morale. The malaria rate became appreciably high in April. In May andJune, limitations on the facilities for evacuation, plus treatment "inthe line," kept down the reports on the disease, although its incidencewas actually rising. In July, however, the rate ran twice as high as inthe May-June period. In August, the rates were from six to nine times higherthan they had been in April. There is no possible conclusion except thatSpecial Force broke medical discipline and deliberately, or as a consequenceof despondency and indifference, gave up the suppressive benefits of Atabrine.

Like their predecessors of 1943, the Chindits of 1944 deserved allthe praise they ever received for a bold venture in jungle warfare. Butwhat more might they not have achieved had as much care been taken withtheir health as with their honor?

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Hygiene and Sanitation

The mention of this subject [hygiene and sanitation]¹⁰⁷ toofficers and men more often than not produces in them a sense of tolerantamusement intermingled with boredom. It is not sufficiently realised, evenby the more senior officers, that hygiene is not only a matter of discipline,but is in fact one of the basic factors upon which discipline is built.It is personal discipline as opposed to collective discipline, and itsabsence in the individual merely produces an absence of it in the aggregate,which is the unit.

Further, it is a matter of man management, and in the same way as theproper grooming and care of a horse or the regular care and maintenanceof a vehicle is essential to its efficient running so with the man. Unlesshis welfare receives constant attention sickness and ill-health are boundto ensue. It can be said without any chance of contradiction that in thoseunits where hygiene and sanitation is poor or lacking, the officer commandinghas neglected the interest and welfare of his men and is unfit to command.

Finally, the standard of hygiene and sanitation is not only an indicationof the discipline within the unit but also the standard of upbringing andhabits to which the individual is accustomed, and is consequently a directpersonal reflection on the commanding officer and his officers.

General Sir Archibald Wavell when Commander-in-Chief stated--"Diseaseand especially malaria is a more dangerous factor than enemy resistance.We must be prepared to meet malaria by training as strict and earnest asthat against enemy troops. We must be as practiced in our weapons againstit as we are with a rifle." The truth of this statement with regardto malaria applies equally to all diseases.

It has been proved that the defeat of the German Armies in North Africawas in a large measure due to their appalling sickness rate as a resultof their complete lack of sanitation and sanitary conscience. Their incidenceof enteric and dysentery was over 50 percent of their strength whereasthat of the victorious Eighth Army as a result of the constant attentiongiven to this important aspect of warfare was infinitesmal, and one ofthe deciding factors of the whole campaign.

The truth of this is amply borne out in this Force from a study of thedetailed analysis of the casualties during the campaign under review.

As will be seen, the incidence of preventable disease far exceeded thenumber of casualties inflicted upon us by the enemy. Training thereforein the prevention of disease must be given top priority and be treatedas any other battle drill, the object of which is the attainment of theobjective with the least number of casualties, and training must be sufficientlyintensive to ensure that all personnel can be relied upon to maintain itunsupervised during the period of active operations.¹⁰⁸

¹⁰⁷Rearrangements by the editor have broughttogether these sections of the Report on hygiene, battle casualties, andsickness. The editor has supplied the chapter title.
¹⁰⁸This indictment is supported independently by O'Dwyer andMarriott. O'Dwyer's statement, attaching blame to the medical forces aswell as the line troops, is quoted, n. 47, p. 224. The ratio of diseaseto battle casualties in the British forces in India and Burma was 121 to1 in 1943, 19 to 1 in 1944, and 3.4 to 1 in 1945: see Girdwood, p. 1. Marriottstates that in 1944 hospital rates for the British forces ran to 1,000per 1,000 average troop strength per annum. Officer's Report shows a lesssevere relative toll from disease, compared to battle casualties, in SpecialForce, but his figures relate to hospitalized troops and not, he says,to total disease rates. Crew, V, p. 195, asserts that 30 percent of thetotal force was evacuated with disease, versus 9.9 percent with wounds.

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Hygiene and sanitation.--During the training period the standardof sanitation in the Force was exceedingly poor. The necessity for therapid training of personnel in Long Range Penetration tactics absorbedthe attention of commanders to the exclusion of almost all other considerations,and sanitation was one of those which had to occupy a subordinate role.The trained sanitary personnel of a unit, if fit, were removed from theirordinary duties to increase the fighting strength of the columns. Unfortunatelyno adequate provision was made for their replacement, and the cleanlinessof camps became the responsibility of fatigue parties, which were constantlybeing changed. This resulted in a lack of interest which, combined withtheir ignorance of even the elementary principles of sanitation, led toa disgraceful state of affairs. Every excuse was seized upon to providean explanation--the nonavailability of wood and nails, the shortage ofmanpower to attend to sanitary duties, and the difficulties experiencedin constructing latrines and soakage pits owing to the rocky nature ofthe subsoil stratum. That these explanations were indefensible was shownby the higher standard of sanitation existing in adjacent campsites, whereimprovisation and ingenuity had been used to overcome these obstacles.Moreover, the filthy state of cookhouses, and the gross negligence displayedin the disposal of kitchen refuse and mule litter, heightened this impression.It was not realised by Commanding Officers that if sufficient time andconsideration had been directed in the first few days of occupation tothe erection of proper sanitary structures their maintenance would haveentailed much less labour than the constant repair of already defectiveinstallations.

This lack of consideration for the fundamental rules of sanitation wasalso apparent in regard to antimalaria precautions. At one time duringthe training phase 70 percent of the personnel of one brigade were admittedto hospital from malaria in a period of 6 weeks.

It is regrettable to state that the medical officers meeting with adifficult situation which appeared to them insurmountable gave up the unequalstruggle of trying to improve things and allowed themselves to fall tothe low standard set by the men.

After perusal of the January report of the D.A.D.H.¹⁰⁹onthe hygiene and sanitation of the Force, the D.M.S.¹¹⁰ in Indiaexpressed his strong disapproval of the appalling state of sanitation withinSpecial Force. Some attempt was made to rectify the existing position,but only a few weeks elapsed before the brigades had to move to the operationalarea, and little change could be effected in the attitude of officers andmen.

Hygiene and sanitation during operations.--During operations,as was to be expected, the observance of the principles of hygiene waseven less than in the training area if such were possible. The exampleset by officers was extremely low and this is not surprising in view ofthe policy laid down in re-

¹⁰⁹Deputy Assistant Director, Hygiene.
¹¹⁰Director of Medical Service, the highest medical authorityin India.

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gard to this important subject by the late Force Commander¹¹¹inhis training pamphlet, which reads:

"(m) Comfort in Bivouac.
(i) Sanitation.

Except when the bivouac is occupied and evacuated within the same night,strict orders must be issued regarding use of latrines. The object of thiswill be to prevent flies and other annoyances. It will, however, be a wasteof labour to dig latrines unless the bivouac is to be occupied for morethan one week. Men should carry out their functions at distances not lessthan 100 yards from the perimeter."

This lack of attention to hygiene was no less marked in regard to antimalariameasures and the resultant sickness rate reached a high level, even greaterthan an estimation of the statistical data outlined below relating to hospitaladmissions, would appear to indicate. Many of the patients who contractedany of the principal preventable diseases, were treated in the columnsand were not evacuated to hospital, [and] therefore do not appear in thestatistics outlined below.

Battle Casualties

The following observations were made by Majors Kelly, I.M.S. and Evans,R.A.M.C., the surgical specialists at the C.M.H.¹¹² Panitolaat which hospital the majority of battle casualties were received.

General conditions.--This on the whole was surprisingly goodalthough almost all the patients were very thin and many were infectedwith malaria. The general condition of the wounded was often better thanthose men who were admitted to hospital with conditions not due to enemyaction, i.e., medical cases and jungle sores. The most outstanding featurehowever was the contrast between the British and the Gurkha casualties.

The British wounded had obviously been through an ordeal. They weregenerally underweight and haggard in appearance. Jungle sores and tineainfections were complications in a high percentage of the wounded seen.¹¹³

¹¹¹General Wingate. In this matter, Wingatewas as up-to-date as Moses (Deuteronomy 23: 10-12). The spirit of the patriarch'scommand regarding camp sanitation seems more positive than Wingate's.
¹¹²Combined Military Hospital, i.e., serving both British andIndian Army forces. Complete identification of Kelly and Evans could notbe secured from available records of the War Office, London. Crew, V, pp.206-216, uses the same survey of hospital cases.
¹¹³An independent report on 401 hospitalized Chindits describeda characteristic "Chindit syndrome"--the troops were unkemptand dirty, weary and hungry, pale and gaunt. They struck their doctorsas being "superior" in intelligence, morale, and decorum. Inthe 401 patients, there were 19 officers and 382 other ranks with 1,085distinct disorders, omitting consideration of minor matters when more seriousconditions had been diagnosed. Ninety percent of the men had lost over10 pounds in weight. Among the patients who had diarrhea or dysentery theweight loss and dehydration were severe. This "outstanding clinicalfeature" did not seem due to gross inadequacy in the K ration, butthe rations were evidently insufficient to sustain weight during severeoperational stresses.
There were only 21 battle casualties among the 401 patients. Three mensuffered from mild psychoneuroses, of which two, the doctors believed,were not directly related to the campaign. All three cases improved rapidly.From 20 to 22 percent of the men had diarrhea, dysentery, or infectivehepatitis. A third of them had malaria. Ten percent suffered from worminfestations. Fifty-four percent had skin disorders--106 with indolentulcers and 111 with severe cases of tinea, impetigo, and other disablingconditions.
The medical staff made careful efforts to describe and identify the exactcauses of the weight losses. They also attempted to discover whether therewas a positive correlation between the status of officer rank and the incidenceof hepatitis (as had appeared to be true in the Middle East campaigns).They concluded, however, that in Special Force no such correlation couldbe demonstrated on the basis of the patients they studied. If officersand men shared approximately the same stresses and conditions of fieldaccommodations, the incidence of the disease was approximately the same.See Morris; also Crew, V, pp. 201-202.

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The Gurkha on the other hand appeared little affected by the hazardsof the campaign. Skin complications and jungle sores were seldom seen andtheir general constitution appeared not to have suffered.

West African troops fell midway between the two categories. Their generalcondition was good, but boils, ulcers, and skin infections were frequentlyseen.

Dehydration in lesser or greater degree was evident in most of the woundedin all three races.

Between 6 June and 15 August 1944, 706 battle casualties from 3 IndianDivision were admitted to the C.M.H. Panitola. The evacuation of casualtieshad been carried out by air entirely. This rapid and efficient method ofevacuation from the battlefield enabled many casualties to arrive in hospitalthe same day as they were wounded. This was not the general rule, as mostof the cases had been wounded 2 or 3 days before admission and even onoccasions as long as a week previously.¹¹⁴

Type of wound.--As would be expected in jungle fighting, shellwounds were extremely uncommon and grenade wounds of different varietiesoutnumbered the gunshot wounds by about two to one. The great majorityof surgical casualties comprised wounds of the extremities, including compoundfractures.

Wounds involving the thorax were next in order of frequency, followedclosely by wounds of the head and neck. Penetrating or perforating woundsof the abdomen as usual constituted a very small proportion of the whole,the reason probably being that the high mortality in these cases occurredbefore they could reach the base.¹¹⁵

One case of tetanus occurred with a fatal termination.

¹¹⁴The fighting at this time occurred in theKamaing-Mogaung-Myitkyina area, in which air evacuation occurred only onan irregular basis: see pp. 228-232.
¹¹⁵These findings on the cause and site of wounds in part coincideand in part vary from those of Capt. James E. T. Hopkins, who studied Americanbattle casualty cases in New Georgia and Burma. Among troops similarlyengaged in jungle warfare and in penetration maneuvers, grenades and fragmentationweapons ranked well below rifles and machine guns in causing casualtiesand in producing serious wounds or death. In addition, casualties werereturned to duty by first line medical facilities more frequently whentheir wounds had been caused by fragmentation weapons (mortars, grenades,artillery).
On the other hand, the distribution of casualties according to the siteof the wound was approximately the same in hospitalized Chindits and theirAmerican counterparts. Immediate death from wounds in the head, abdomen,and thorax was far more frequent than from wounds of the extremities. Consequently,those with wounds of the extremities who needed hospitalization accumulatedmore rapidly than those with wounds in other locations. See U.S. Army MedicalService, Wound Ballistics, chapter IV and appendixes A, B, and C.

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Treatment in the forward areas.--This in the main was extremelygood considering the general lack of facilities and was rightly confinedto first aid treatment.¹¹⁶

In the early stages an occasional ambitious attempt at primary excisionand suture had been made. The results were deplorable and in the majoritydisastrous. Excision was always inadequate and in some cases the skin andsuperficial fascia had been carefully excised but nothing had been doneto the deeper tissues. Skin at all times is precious and in war woundsis relatively resistant to infection, and excessive removal is to be deprecated.Only badly damaged skin should be excised. On the other hand devitalizedmuscle which offers little resistance to infection was often left in situand was doubtless the cause, with primary suture, of gas gangrene.

The value of incision of the skin and deep fascia above and below thewound, particularly in leg wounds, to allow of thorough inspection andremoval of devitalized muscle, did not appear always to be fully appreciated.

As was always being impressed on column medical officers, the only surgerythat should be attempted in the forward area is major surgery in the formof a lifesaving emergency, such as perforation of the peritoneum.¹¹⁷Other surgery should be reduced to an absolute minimum and confined tofirst aid treatment, the arrest of haemorrhage, sprinkling with sulphanilamidepowder and a Vaseline gauze covering and where necessary immobilisation.In this connection plaster slabs which are an excellent method of immobilisation,were in many cases too thin to be efficient. The suturing of war woundsin forward areas is only to be mentioned to be condemned.

The simple treatment mentioned above had in the majority of cases beencarried out and proved on the whole satisfactory.

Records.--These in general were bad. If there were any notes,these were recorded on any available piece of paper. The importance ofnotes did not seem to be fully appreciated and their absence caused a greatdeal of inconvenience to the surgeons. In almost all cases it was impossibleto find out if A.T.S.¹¹⁸ had been given and in consequence ithad to be repeated in almost every case. Excision or nonexcision of thewound, the dosage of A.T.S., Antigas Gangrene Serum, and prophylactic sulphonamideshould be clearly stated. In this connection the amounts actually givenas opposed to the amounts ordered are of interest to the M.O.s who subsequentlyhave to treat the case.

¹¹⁶When casualties from 77th Brigade at WhiteCity became numerous, they were sent to the stronghold Aberdeen for airtransportation. Fergusson, the 16th Brigade Commander, requested and obtainedthe services of a surgical team at the brigade aid station. A supply ofwhole blood also was flown in (Earth, p. 92). In the 111th, Mastersrecalls the case of an officer with a serious head wound who had to becarried with the column for 5 days before air evacuation was possible.The medical officer improvised a bamboo travois pulled by a mule. The woundedman was unconscious all of the time. He was fed by a tube and catheterized."They did it with dirt-stained hands, in dusty jungle, among the blowingmules and the sweating men, for we came across little water at this time"(p. 209).
¹¹⁷The text is a little garbled. The commentators mean, apparently,that major surgery should be attempted at the battalion (or column) levelonly in an absolutely major emergency, as when there had been perforationof the peritoneum.
¹¹⁸Antitetanus serum inoculations were to be given as soon aspossible to wounded men. A doctor in a second echelon medical unit wouldknow that a wounded soldier might have had his shot at the aid stationwhich first treated him. Unless a note to that effect were on his evacuationrecord, however, there was no alternative but to inoculate him.

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It is not understood why Field Medical Cards were not used as the supplywas adequate and they were available on demand. It can only be thoughtthat the constant rain prevented them from being written up.

Treatment in the base hospital.--This followed the usually acceptedprinciples of traumatic surgery, viz:--

1. Shaving and thorough cleansing of the surrounding skin.

2. Adequate wound excision, extraction of foreign bodies, manipulationand immobilisation of fractures.

3. Impregnation of the wound with sulphonamide powder and insertionof Vaseline gauze drains.

4. Immobilisation in plaster of paris.

Anesthesia.--Intravenous sodium pentothal proceeding to openether if necessary was almost routine, and from the point of view of bothsurgeon and patient was eminently satisfactory and no theatre deaths occurred.

Resuscitation.--The majority of patients on arrival in hospitalexhibited signs of dehydration and in many cases this delayed operation.While there was no lack of plasma the absence of an adequate supply ofwhole blood was markedly felt. Some form of blood bank service would havebeen of great assistance. With local units and personnel constantly changing,whole blood is not readily available.¹¹⁹ * * *

Statistics of the Operations

General considerations.--It must be emphasized at the commencementthat the statistical data included in this report are based on admissionsto base hospitals, and not on the actual number of sick and wounded whichoccurred in the operational area. Cases, which under normal circumstanceswould have been evacuated to Field Ambulances of C.C.S.¹²⁰ weretreated by the medical officer and retained with the columns. This appliesespecially to such diseases as malaria, dysentery, and minor maladies,for example, I.A.T.,¹²¹ tonsillitis, and so forth, which normallyconstitute a high proportion of the admissions to field medical units.In spite of numerous requests, information regarding these casualties was,with few exceptions, not forwarded by medical officers or was lost in transit.

Moreover, owing to the interference with the channels of evacuationby enemy action, several patients died before admission to hospital orwhen evacuation became possible had sufficiently recovered to rejoin theirunit.

Consequently in any comparison with the sickness rate of other activeformations, due consideration must be given to the above factors and allow-

¹¹⁹These remarks on hospital care of the woundedare excessively condensed, but it may be recalled that the subject laybeyond the immediate purview of the Force Surgeon, and that even Crew,the official historian, goes no further into the matter. It is unfortunate,however, that no details were collected from the column and brigade medicalofficers regarding their handling of casualties, except, apparently, thosereported by Whyte of the 111th (Crew, V, pp. 216-232). General Officerconcludes this section of his Report with a few notes on certain itemsof hospital supply and equipment which had not been satisfactory.
¹²⁰Casualty Clearing Station.
¹²¹Inflammation of the Areolar Tissue. The abbreviation appearsusually as the heading of reports on skin ailments.

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ances made for a much higher incidence of sickness and battle casualtiesthan the following statistics represent. It is conservatively estimatedthat the actual number of men who suffered from malaria alone was at least60-70 percent greater than the admission rate to hospital would indicate.

The second factor mentioned above, namely the interruption on the longlines of evacuation through enemy action, and the impossibility of removingcasualties by air on account of inclement weather, must be taken into accountwhen correlating these statistics with the various actions, localities,and general incidents of the campaign. For on occasions a delay of 2-3weeks occurred between the onset of disease or the infliction of casualtiesand the subsequent admission of these patients to hospital.

Incidence of casualties from all causes.--The total number ofcasualties from disease and enemy action admitted to hospital during operationswas 7,217. This represents an admission rate of 40.1 percent of the personnelengaged.

Of the total casualties, sickness accounted for 5,422 or 75.1 percentof the hospital admissions; battle casualties amounted to 1,795 or 24.9percent of cases requiring hospitalisation. Sickness was therefore responsiblefor 30 percent of the whole Force requiring to be evacuated, and war injuriesfor 9.9 percent.

Incidence of casualties by ranks and nationalities.--The compositionof the Force with regard to personnel was very cosmopolitan, and at varioustimes contained the following nationalities: British, West African, Gurkha,Indian, Burmese, and Kachins. The last three nationalities, however, wererepresented by so small a minority that their numbers were insignificant,and their casualties have been included among those of the Gurkhas forthe purpose of these statistics. The officers, almost without exception,were European. As will be observed from table 1, there was considerablevariation among the casualties sustained by the various nationalities.

TABLE 1.-Incidenceof casualties from all causes among officers and other ranks

Personnel	Strength	Admissions		Total sickness		Total battle casualties
Personnel	Strength	Actual	Ratio/1,000	Actual	Ratio/1,000	Actual	Ratio/1,000
Officers	1,050	259	246.7	201	191.4	58	55.2
Other ranks:
British	10,800	4,770	441.6	3,760	348.2	1,010	93.5
Gurkha	3,450	1,391	403.2	902	261.5	489	141.7
West African	2,700	797	295.1	559	207.0	238	88.1
Total	18,000	7,217	401.0	5,422	301.2	1,795	99.0

The total admission rate of battle casualties for the Gurkhas is markedlyhigher than for other personnel. This is in no way surprising when it isremembered that only four battalions were engaged in the campaign, and

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all took part, at some time or other, in more than one of the majoroperations; the garrisoning of Broadway, the protection and defence ofBlackpool and White City, and the successful capture of Mogaung. Whereaswith the exception of the British Columns of 77 Indian Infantry Brigade,few other battalions participated in more than one major engagement.

The sickness rate was lowest among officers and West African other ranks.While in the case of officers this calls for little comment, the mannerin which the West African personnel underwent the rigorous physical andmental strain of 6 months' campaigning behind the enemy lines, was oneof the outstanding features of the operation from the medical point ofview. This fact became even more apparent on examination of the troopsafter their evacuation from Burma. The gaunt, sallow, emaciated conditionof the B.O.R.s and the G.O.R.s was nowhere apparent among the West Africans.

Distribution of Principal Diseases by Ranksand Nationalities

British.--The incidence of every principal disease was highestamongst B.O.R.s (see table 2). The greater prevalence of malaria and dysenteryin B.O.R.s in comparison with the incidence of these diseases among officerscan only be attributed to the much lower standard of antimalaria and sanitarydiscipline amongst the former. This would appear to be substantiated bythe more equal prevalence of infective hepatitis, typhus, and I.A.T., diseasesagainst which little if any preventive measures can be undertaken.

TABLE2 .--Comparisons by ranks and nationalities of the principal diseaseswhich required admission to hospital

Disease	Admissions
	Officers		Other ranks						Total
	Officers		British		Gurkha		West Africa		Total
	Number	Ratio/1,000	Number	Ratio/1,000	Number	Ratio/1,000	Number	Ratio/1,000	Number	Ratio/1,000
Malaria and not yet diagnosed fevers	78	74.3	2,265	209.7	609	176.5	156	57.8	3,108	172.6
Dysentery and diarrhea	27	25.7	349	32.3	30	8.7	77	28.5	483	26.8
Infective hepatitis	10	9.5	139	12.9	55	13.0	16	5.9	220	12.2
Typhus	10	9.5	89	8.2	---	---	17	6.3	116	6.4
Inflammation of areolar tissue	28	26.7	332	30.7	67	19.4	104	38.5	531	29.5
Other causes	48	45.6	586	54.3	141	43.8	189	70.0	964	53.6
Total	201	191.4	¹3,760	348.2	902	261.5	559	207.0	5,422	301.2

¹The original typescript erroneously shows2,760.-Ed.

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The absolute necessity for the strictest observance of antimalaria precautionsis amply demonstrated by the fact that one out of every five B.O.R.s engagedin the campaign required to be evacuated with malaria.

Gurkhas.--The incidence of malaria was appreciably lower amongthe G.O.R.s in comparison with the B.O.R.s. This could hardly be the resultof a more efficient antimalaria discipline, as the standards observed byall ranks and nationality were poor in the extreme. A nonspecific immunityfrom numerous attacks in their lifetime together with acquired abilityto tolerate the incapacity arising from attacks of this disease and therebyavoiding the necessity for evacuation, offers a more acceptable explanation.The occurrence of dysentery among the Gurkhas in comparison with the B.O.R.swas even less frequent than the incidence of malaria. The previous remarksprobably apply with greater force to dysentery as the immunity conferredwould probably be of a more specific nature. It is of interest to notethat no case of [scrub] typhus fever was diagnosed among the G.O.R.s. Fromthe available evidence, this may be accounted for by the fact that thebrigades most affected with this disease did not include Gurkha regimentsand presumably did not pass through typhus infected areas.

The incidence of skin lesions among the Gurkhas showed the same prevalenceas in other nationalities. However, there was a very high proportion oftinea corporis which proved much less incapacitating than such varietiesas jungle sores and other widespread septic ulcerations and lesions. Inconsequence, the number of personnel requiring evacuation was smaller thanamong other troops.

West Africans.--Attention has been drawn previously to the relativelylow sick rate among the W.A.O.R.s and from a perusal of table 2 it willbe observed that this was principally due to the much lower incidence ofmalaria as compared with other nationalities. This again cannot be attributedto excellent antimalaria discipline, but rather to a nonspecific immunity,in conjunction with an acquired ability to carry on while undergoing anattack of the disease. In this, they were probably helped, to a great extent,by the magnificent physique which most of the troops possessed. The dysenteryand diarrhoea incidence was comparatively high, but this was to be expectedfrom the poor standards of sanitation displayed in the training area. Althoughthe general health of the West Africans remained good throughout the operations,after the monsoon commenced, I.A.T. became a problem of some magnitude,and at one time was responsible for more evacuations from this brigadethan any other disease.

Incidence of Total Casualties by Brigades

The total number of casualties from disease and enemy action were distributedamong the various Brigades as shown in table 3. As the strength of theseformations and the period during which they were actually in the operationvaried to a considerable extent, the figures are given in ratios per thousandper month for the purpose of comparison.

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TABLE3.--Total admissions to hospital due to sickness and battle casualtiesfrom the brigades comprising Special Force

Brigade	Approximate strength	Total admissions		Total sickness		Total battle casualties		Ratio sickness to battle casualties
Brigade	Approximate strength	Number	Ratio/ 1,000	Number	Ratio/ 1,000	Number	Ratio/ 1,000	Ratio sickness to battle casualties
14	3,600	1,433	79.61	1,271	70.61	162	9.00	7.8/1
16	3,600	1,038	96.11	888	82.22	150	13.90	5.9/1
77	¹5,100	1,759	65.69	940	35.11	819	30.59	1.2/1
111	2,900	2,033	127.46	1,650	103.45	383	24.01	4.3/1
3 WA	2,800	954	56.79	673	40.06	281	16.73	2.4/1
Total	¹18,000	7,217	66.83	5,422	50.20	1,795	16.62	3.0/1

¹The figures should probably be 4,100 and 17,000.A change would require recalculation of the ratios: 1,759÷5.25 (monthsin action) ÷ 4.1 (thousands of troops) = 81.71; and so forth, throughout.-Ed.

111 Brigade.--Of the brigades which were required to undergo5 months' campaigning, 111 Brigade had the highest admissions to hospital,principally due to their very high rate of sickness. The evacuation ofcasualties from both enemy action and disease mounted rapidly after theretreat from Blackpool, especially with regard to sickness. The lattercan in part however be ascribed to forced marching through quagmires alongswampy paths, and partly through a lowering of morale and discipline witha subsequent increase in malaria, dysentery and other preventable diseases.¹²²It is of interest to note that 68 percent of the casualties from malariaand 60 percent of those from dysentery in this brigade were evacuated afterthe fall of Blackpool.

16 Brigade.--The monthly evacuation rate from 16 Brigade wasthe second highest in the formation principally due to the high incidenceof sickness (82.2 per 1,000). As this Brigade was engaged in the operationalarea for little more than 3 months in comparison with the 5- and 6-monthlyperiods during which the other brigades were operating, and was evacuatedbefore the onset of the monsoon, this high figure of sickness is all themore surprising. Some consideration, however, must be given to the factthat this was the only brigade to march to their objective over steep jungle-cladmountains and along tortuous tracks, the surface of which greatly impededmovement and made marching an extremely arduous task. Consequently whenthese troops eventually contacted the other brigades, which had been flownto their objective, they were in the majority suffering from extreme exhaustionwith its concomitant--a lowered resistance to disease. As a result, thesickness to the battle casualty ratio was the second highest in the Force.

14 Brigade.--From table 3, the ratio of sick to battle casualtieswas greatest in 14 Brigade. This was in a large measure due to the roleallotted to this brigade during the campaign; continual arduous marchingalong tracks knee

¹²²See pp. 252-255 the editor's view is a strongerone.

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deep in mud, with only occasional skirmishes with the enemy, a pitchedbattle occurring as a rare exception. This is shown statistically by thisformation's having the lowest evacuation rate of battle casualties. Moreover,this brigade suffered greatly from several minor epidemics of typhus incomparison with other brigades where the incidence was negligible.¹²³

77 Brigade.--With regard to 77 Brigade, this ratio was highlycreditable, almost as many battle casualties being evacuated as casualtiesfrom sickness, owing to the fact that this brigade adhered more strictlyto the policy laid down that only those personnel who were unlikely tobe of any further use for some considerable time, were to be flown out.While this policy was followed by the other brigades, it was much morestringently enforced by this brigade, to such an extent that some caseshad suffered 12 attacks of malaria before they were evacuated, and a substantialnumber had 5 to 7 attacks. In consequence the hospitalisation of sick from77 Brigade was the lowest recorded. In contradistinction, the battle casualtyrate was the highest, owing to this formation's being engaged in more operationsagainst the enemy than the others.

3 W.A. Brigade.--3 W.A. Brigade had the lowest admission rateto hospital of any brigade in the operation owing to the very small incidenceof disease. In addition, the occurrence of battle casualties in any largenumber was rare as these troops were never engaged in any full scale operationapart from the defense of White City.

Distribution of Principal Diseases by Brigades

Table 4 shows the monthly distribution of the principal diseases amongthe various brigades.

14 Brigade.--Although of minor significance as far as the numberof casualties which were evacuated was concerned, the disease which causedthe greatest uneasiness in 14 Brigade was [scrub] typhus. The disease first

TABLE4.--Average monthly incidence of principal diseases, by brigades, requiringhospital admission

Brigade	Total incidence	Malaria and not yet diagnosed fever	Dysentery and diarrhoea	Infective hepatitis	[Scrub] typhus	Inflammation of areolar tissue	Other diseases
14	70.61	40.94	5.61	1.78	4.33	8.28	9.67
16	82.22	52.31	11.30	---	---	1.39	17.22
77	35.11	20.47	2.39	1.01	0.15	3.92	7.17
111	103.45	64.01	6.14	9.09	1.00	10.84	12.04
3 WA	40.06	14.11	5.57	0.95	1.05	5.30	13.10
Total	75.3	43.2	6.7	3.1	1.6	7.4	13.4

¹²³Arriving in the combat area several weekslater than the 16th, 77th, and 111th Brigades, the 14th Brigade lost muchof its time and energy trying to catch up with the other columns, ratherthan engaging the enemy.

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made its appearance towards the beginning of May, with a few sporadiccases which gradually increased in number during the month until approximately40 cases had been evacuated, while another 12 died or recovered beforeevacuation was possible. Cases continued to occur in small numbers intermittentlyuntil the middle of August when a fresh outbreak occurred mainly confinedto one battalion. From the evidence at present available it would appearthat of the 60 cases which occurred from this period to the time when thebrigade was withdrawn from operations, the mortality was over 30 percent.The serious nature of this disease with its prolonged fever, severe prostration,and general debility, together with its high death rate, was quickly recognizedby the troops and caused a considerable degree of anxiety and loss of morale.Fortunately at no time did it assume epidemic proportions, although thepossibility remained a constant threat throughout the campaign. Malariaaccounted for 68 percent of the casualties from sickness evacuated fromthis brigade and I.A.T. was becoming a serious problem towards the endof operations, almost 250 cases being flown out during the last few weeks.¹²⁴

16 Brigade.--Attention has already been directed towards thevery high sickness rate in 16 Brigade although it participated in the campaignfor only 3 months. Analysis of this sickness rate shows that over 75 percentof cases admitted to hospital from this formation was evacuated for malariaand intestinal disorders, two of the main preventable diseases.¹²⁵In spite of the allowances that must be made for the exhausted conditionof the troops after their strenuous approach march, and the consequentlowering of the bodily resistance to disease, the statistical data wouldappear to indicate that the standard of sanitary discipline and antimalariaprecautions leave room for considerable improvement in future campaigns.There were no cases of infective hepatitis or typhus, and I.A.T. was oflittle import as a cause of evacuation, as this brigade was withdrawn beforethe commencement of the monsoon.

77 Brigade.--In spite of the policy adopted by 77 Brigade toevacuate casualties from disease only as a last resort and when it wasevident that the patient would be of no further use to the brigade, malariawas still responsible for over 50 percent of the cases requiring hospitalisation.Most of these patients had innumerable attacks of the disease and werein an extremely debilitated state. Dysentery was the lowest recorded inany brigade, but it is felt that this could be accredited more to the abovepolicy regarding

¹²⁴On scrub typhus, see Chinese LiaisonDetail, n. 153, p. 123. The first cases encountered by M. H. P. Sayersand I. G. W. Hill were doubtless from the 14th Brigade; of 50 cases evacuatedin May, 15 died in the hospital. Between May and September, 132 cases werereported from British troops in Burma; a number of these were from the36th Division, which relieved Special Force in the late summer. A reportby J. R. Audy is a thorough review of all aspects of the disease as itwas encountered in Burma. The brief account of the disease in United KingdomMedical Series, Medicine and Pathology, pp. 18-20 and chapter VII,relates to the entire British Army in Southeast Asia, as does that in Raina,Official History, Medicine * * *, p. 548.
¹²⁵The picture conforms to that for Special Force as a whole,as reported by Marriott; Girdwood; U.K. Medical Series, Medicine andPathology; and Raina, Official History, Medicine * * *. Thelow rate of skin diseases is atypical of the Force as a whole, however.

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evacuation than to a higher standard of sanitation. Moreover, this brigadewas continually on the move in comparison with other brigades, and theiritinerary generally passed through areas where fouling of the ground hadnot yet occurred from the previous passage of other troops. The incidenceof I.A.T. was also lower than that of any other brigade which remainedin Burma during the monsoon.

111 Brigade.--The highest sickness rate was recorded in 111 Brigade.Of these casualties, 61 percent were due to malaria. Dysentery and I.A.T.were also more prevalent in comparison with other brigades. The greaterincidence of disease in this brigade can hardly be attributed to any specialcircumstance which other brigades did not experience. It is generally appreciatedthat the amount of sickness in any unit or formation has a direct relationshipto its morale and discipline, and there was abundant evidence that themorale of this brigade was extremely low on its withdrawal from Burma.After their expulsion from Blackpool, and subsequent long marching throughquagmires in drenching rain, their fighting spirit was at a low ebb, andevacuation of the sick increased in inverse proportion. In sharp contrastwas the casualty rate recorded in 77 Brigade, whose morale after theirsuccessful defence of the Renu block [White City] and the capture of Mogaungwas at a very high pitch. A minor epidemic of 145 cases of infective hepatitisoccurred in 111 Brigade, the cases appearing in a sporadic fashion at thecommencement, and gradually increasing in frequency until approximately90 cases required to be evacuated during the last month of operations.

3 W.A. Brigade.--The incidence of malaria was only 30 percentof the sickness casualties in the West African Brigade, and this was theonly brigade in which a figure below 50 percent occurred. The Europeanofficers and NCOs of this formation were responsible for the majority ofthese cases. This surprisingly low malaria rate among West African otherranks cannot be attributed to any greater strictness or observance of antimalariaprecautions and can only be explained by a nonspecific immunity of thisdisease already postulated elsewhere in this report. Dysentery and I.A.T.were comparatively high but 33 percent of the sickness casualties cameunder the heading of nonpreventable disease.

It should be here noted that in comparing the sickness rate from malariain the European personnel of the West African Brigade with that of theBritish personnel in the Force, the incidence of this disease was 30 percentlower. This is attributed to the far better mepacrine discipline whichthrough long usage had become a habit and there is no doubt that if thishad been combined with the other necessary precautions the incidence ofmalaria would have been even lower.

Discussion of Principal Diseases During Campaign

Before entering upon a discussion of these diseases separately, thetime at which they occurred during the campaign as shown in table 5 deservesconsideration. Their incidence is shown in table 1.

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TABLE 5.--Fortnightlyincidence of principal diseases throughout the Second Burma Campaign, 1944

[Ratios per 1,000]

Disease	Week ending--
Disease	18 Mar.	1 Apr.	15 Apr.	29 Apr.	13 May	27 May	10 June	24 June	8 July	22 July	5 Aug.	19 Aug.
Malaria and not yet diagnosed fever	1.12	3.23	11.14	26.24	22.45	4.30	13.52	12.16	33.67	43.71	98.40	60.06
Diarrhea and dysentery	0.16	1.61	1.60	2.06	6.00	0.23	2.08	1.04	3.12	6.24	16.48	14.18
Infective hepatitis	0.16	---	---	0.30	1.33	0.30	1.12	1.12	1.29	4.88	11.84	4.65
Typhus	---	---	---	0.18	1.04	0.15	4.08	0.43	0.64	0.69	3.36	1.40
Inflammation of areolar tissue	---	---	---	---	1.49	0.38	2.96	1.64	7.80	8.98	27.68	21.10
Other causes	3.59	4.20	5.38	6.30	10.81	1.90	4.00	2.85	6.60	7.02	25.27	20.00
Total	5.02	9.03	18.12	35.09	43.11	7.25	27.76	19.23	53.12	11.51	183.52	155.72

When the columns entered Burma and the evacuation of sick and wounded to base hospitals in India became feasible, the policy adopted was to retain personnel until disease lowered their efficiency to such an extent that they were of no further use to their unit. In this manner, manpower was maintained at its maximum level, and owing to the very high standard of health and endurance required in order to remain with the columns during its long and arduous marches, patients were evacuated before their general constitution was seriously affected. However, in spite of the gruelling nature of their task, the excellent training and physique of the men allowed brigades to carry on with a high proportion of men who, in other formations would have been immediately sent to a field medical unit.

This policy proved admirable for the first 10 weeks of the campaign.Then the strenuous nature of the operations carried on under extremelyadverse conditions in conjunction with a diet which was becoming increasinglymonotonous, began to exact its toll on the physical condition of the troops.Disease now became more rampant and the evacuation rate rose from 5 per1,000 during the first fortnight of March to 43 per 1,000 in the firstfortnight of May.

I am convinced that if the Force had been removed from operations atthis period, before the onset of the monsoon, the appalling deleteriouseffects on the general constitution of the majority of the troops wouldhave been avoided.

During the second fortnight of May the evacuation rate dropped to itslowest, apart from that of the initial fortnight. This was entirely dueto the loss of the only available airstrip suitable for Dakotas, whichwere necessary for evacuation in any large numbers. Thereafter, casualtiescould only be removed from the columns by light planes, the activitiesof which were themselves seriously curtailed by the monsoon, so that reliancecould no longer

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be placed upon their regularity. Consequently, the monsoon adverselyaffected the health of the formation, in two ways:

1. Directly, by increasing the difficult conditions under which thetroops were living and fighting--constant marching in drenching rain andsleeping on sodden ground with no opportunity for drying clothes and boots.Not only did these conditions further undermine the general health butcaused an alarming incidence of infected skin lesions.¹²⁶

2. Indirectly, by preventing the evacuation of personnel who requiredhospitalisation and who by having to remain with their units underwenta still further deterioration in health.

When more effective methods of evacuation were ultimately establishedin the middle of June, the operational commitments of the Force had greatlyincreased and made it essential that every available man should remainin order to maintain sufficient firepower in an attempt to carry out thetasks allotted to them, the most important of which was the capture ofMogaung.

By the time these tasks had been accomplished, almost another monthhad elapsed, and in spite of the very low standard of health to which thesepersonnel had to be reduced before they were sent out, the evacuation rateincreased to 115 per 1,000 per fortnight by the middle of July.

Medical recommendations for the withdrawal of the Force met with littlesuccess and it was not until the end of August that this was ultimatelycarried out. In consequence, troops arrived at the reception camp in Indiain a very emaciated condition, covered with sores and many on the pointof collapse. It is my opinion that at least 30 percent of these men havebeen so undermined constitutionally, that they will be unfit for frontline operations for at least a year.

One definite lesson learnt from this campaign is that 3 months is thevery maximum period during which personnel can undertake this typeof operation, and even this period must be reduced if carried out undermonsoon conditions.

Malaria.--Of the 5,422 patients evacuated from sickness, 3,108(57.3 percent) belonged to the group "NYD Fever" and Malaria,that is to say more than half of the patients considered sufficiently illto require hospitalisation suffered from these diseases. This number represents17.3 percent of the total engaged.¹²⁷

¹²⁶Calvert, commanding the 77th Brigade, askedForce Headquarters to send in 1,000 pairs of "gum boots"--becausehis men were up to their knees in water. "I received a reply saying,'It is the medical opinion that the wearing of gumboots injures the feet,and that the best insurance against trench feet is to keep the feet dry'!"p. 211. Although medically correct, the advice obviously risked a deteriorationin morale on the calculation that boots and wet feet would produce moremedical casualties than shoes and wet feet! Calvert notes several timesthat his evacuation policy was stringent with regard to malaria cases,and that officers periodically visited the base to see that the sick andwounded returned to duty as soon as possible. "In actual fact persuasionwas rarely necessary; the spirit of the men, with their resolve to defeatthe Jap at all costs, was so amazing that they would return without, oreven against, the doctor's orders, still with their wounds unhealed"(pp. 212-213). The Report, be it noted, independently confirms Calvert'sclaims regarding morale and casualty evacuation policy.
¹²⁷Crew, V, pp. 196 ff., follows the Report in discussing theincidence of various diseases and in reporting the psychiatric survey ofSpecial Force.--"NYD": Not Yet Diagnosed.

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At first sight it would appear that the incidence of malaria in thisForce compares very favorably with that occurring in other formations.When, however, the difference in policy regarding evacuation is taken intoaccount then it can be appreciated that the true incidence of malaria inthis Force would be very much higher than would at first sight appear,and would very likely be higher than in other formations fighting undersimilar conditions.

As the period of operations lengthened, other, less obvious deleteriouseffects of malaria became apparent, in addition to the more evident lossof manpower from evacuation. Firstly, the fighting efficiency and moraleof personnel who had suffered from three or four attacks of malaria, diminishedconsiderably. Secondly, a further diminution in health occurred insidiouslyand indirectly from these repeated attacks of malaria. The general resistanceof the troops to infection was lowered, and other diseases such as dysentery,diarrhoea, respiratory infections, and skin diseases had a much more cripplingeffect than they would have had otherwise. This in combination with thechronic malaria made evacuation sometimes an urgent necessity whereas,if this constitutional weakness had not been present, these patients couldhave remained with their columns. Thirdly, an even more serious sequelto the above combination of malaria and another concomitant disease thanthe mere loss of manpower was debility, anaemia, cachoxia, and other indicationsof a very grave undermining of the efficiency and health of these men.This became even more pronounced during the course of these secondary diseases.In many cases, similar constitutional defects were produced by repeatedattacks varying in individuals from four to twelve.

It is perhaps convenient at this point to discuss the policy which shouldbe adopted in future operations, regarding the evacuation of patients sufferingfrom malaria. From experience gained in this campaign, it has been foundthat even a B.O.R. is capable of continuing to march and of retaining hisplace in the column provided the initial temperature is treated at oncewith intravenous quinine and the response satisfactory, as it was in thegreat majority of cases. Routine administration of quinine by mouth, mepacrine,and pamaquin can then be carried out along the lines of march without anydeleterious effects to the patient. The only adjuvent treatment requiredwas the liberal intake of fluids and the carriage of the man's equipmentby mule during his feverish stages.

Column medical officers are of the opinion that while the necessityfor evacuation of the patients must be decided individually, personnelcan generally withstand at least two attacks, either fresh or relapse,but after the third attack debility and anaemia make their appearance andefficiency and general health suffer as a result. Consequently, it is suggestedthat the optimum policy would be to evacuate all cases suffering from theirthird attack. Such a policy would on the one hand avoid the serious depletionin the ranks such as occurs when the normal method of immediate evacuationto a field medical unit is adopted, and on the other hand avoid the destructionof a healthy constitution from frequent intermittent attacks which wouldoccur

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if these men were retained beyond this period. Naturally this policywill require certain modifications according to the tactical situationat the time, for example, lack of opportunity for evacuation, from clinicalconsiderations such as the ability of certain individuals with a more robustphysique to withstand at least three attacks, during which the constitutionis allowed some degree of recovery to combat the next infection. Moreover,these men if evacuated are available to fly in again as reinforcementsafter a short period of hospitalisation and convalescence.

Although the above treatment of malaria, while in actual contact withthe enemy, may seem somewhat harsh and peremptory, the present campaignhas proved its efficiency empirically. To such an extent is this so thatit is felt that it should be given serious consideration as to whetheror not it should be adopted under certain circumstances in normal warfareby battalion medical officers where the usual medical L of C¹²⁸is in existence. Personnel, especially officers and key men, could thenbe retained with their units at times when the maintenance of that unitat its maximum strength is a matter of urgent necessity. This advantagewould easily counteract any wastage of antimalaria drugs through faultydiagnosis. Moreover, the dangers attached to the procedure are negligible,no fatalities occurring among the patients who were treated in this mannerduring the campaign.

Prevention.--Each man was eventually supplied with thefollowing equipment for the prevention of malaria: green battle-dress,a tin of mosquito cream, a head veil, a pair of cotton gauntlets, and acontainer to hold 30 tablets of mepacrine. If these articles had been putto effective use, the incidence of malaria would have been greatly reduced.Unfortunately, as has been repeatedly stressed throughout this report,antimalaria discipline was of a very low standard.

Owing to the manner in which movement of the knees was restricted, especiallywhen climbing hills, by slacks tucked into puttees or anklets, and thegreater discomfort experienced in comparison with the wearing of shorts,some men cut off the greater part of the trouser legs from their battle-dress.Little attention was paid to the rolling down of sleeves. Veils and gauntletswere rightly soon discarded owing to the discomfort they produced. Theveil was completely ineffective as it offered little protection duringsleep and so restricted vision at night as to offer a serious handicap.

At the commencement of operations, oil of citronella in a greasy basewas issued to the Force as an antimosquito cream. The discomfort producedby this obsolete repellent, and the manner in which it failed to repelculicines, resulted in its falling into disrepute. Consequently littlefaith was placed in its nongreasy counterpart when its supply became possible,and no organised parades were held to ensure its proper and regular use.Greater trust was placed in Dimethyl phthallate and this liquid was generallyused in a more conscientious fashion. Unfortunately, supplies of this chemicalwere limited and could not be supplied in the necessary quantities.

¹²⁸Line of Communication. The position heretaken is that the existing policy of advancing malaria treatment unitsas far as possible could be even more sharply developed by reducing oreliminating malaria patient evacuation from the combat line.

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Suppressive treatment could not be carried out with a 100 percent efficiencyfor various reasons. In spite of the fact that large quantities of mepacrinewere issued to rear brigades for distribution to the columns, their arrivalwas a matter of extreme uncertainty and some columns were forced to suspendits issue to conserve supplies for curative treatment. No regular paradeswere held to ensure that the drug was being taken when it was available,and one medical officer had the experience of discovering that the mepacrinecontainers of two of his patients who had just died of cerebral malariastill contained their original quota of tablets at a time when they shouldhave been almost empty.

In order that the loss of manpower from malaria should be reduced toa minimum, and the chronic ill-health and disablement resulting from numerousattacks avoided, the strictest antimalaria discipline must be enforcedduring the training period and any breach of this discipline severely punished.Methods of personnel protection must be practiced repeatedly until theirobservance becomes a conditioned reflex set in motion at the first indicationof sundown. The application of mosquito cream and the administration ofmepacrine must be ensured at an evening parade.

Owing to the inefficiency of the mosquito veil, a portable mosquitonet is considered essential. The jungle hammock provides excellent protectionbut suffers from the disadvantage that it is heavy and bulky. An effectivesolution to the problem can probably be reached by some modification ofthe existing hammock to reduce its weight and bulkiness. Moreover, therewould be a compensatory decrease in the weight of the total equipment asthe groundsheet and blanket could probably be dispensed with.

Dimethyl phthallate would appear to be the best repellent at the moment,and ample stocks should be guaranteed for future expeditions. If antimalariacream is supplied in lieu, it must be of the nongreasy variety.

Suggestions have already been made in this report for the issue of mepacrineto ensure its regular supply. From the manner in which malaria continuedto appear during the operations, the dosage of the drug when administeredfor suppression would appear to require further investigation.¹²⁹

From experiments recently undertaken in Australia¹³⁰ on alarge scale, it would appear to have been conclusively proved that if mepacrineis taken regularly and without interruption at the dosage of one tabletper day, malaria will be completely suppressed during the exposure to infection.

In this Force, suppressive mepacrine was taken, and during the firstfew weeks of the campaign supplies were regular. It is not known, however,with what regularity and conscientiousness the tablets were taken. It wasnevertheless an outstanding observation not confined to any one columnthat at the end of 6 weeks this dosage of suppressive mepacrine appearedto lose its efficiency and the malaria commenced to rise. This would appearto be due to

¹²⁹Subsequent investigations supported Fairley'soriginal conclusions. True clinical "break-through," althoughnever entirely ruled out of possibility, was deemed entirely negligible,compared to the factors of discipline, supply, and tactical situations:See U.S. Army Medical Service, Malaria.
¹³⁰See Fairley "Chemotherapeutic Suppression * * * *."

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some change in the metabolic process of the drug in the body leadingto an increased excretion rate. If this is so, then some information inregard to the concentration of the drug at this period would be of valuein assessing the efficacy of the standard dosage of mepacrine over a longperiod.

Although the experiments in Australia appear to have been carried outin a most exhaustive and thorough manner, they are open to the criticismthat the men were subject to a limited series of bites, and it is a matterfor argument whether or not the effect would have been the same if thishad not been so; for it is reasonable to suppose that suppression dependson the ratio: concentration of mepacrine to the number of malarial parasitesin the blood; suppression only being successful when the concentrationis sufficient to overcome the degree of infection. As the latter is anunknown quantity, varying presumably from day to day, it is open to doubtwhether the Australian experiments have proved whether the concentrationresulting from one tablet of mepacrine per day is sufficient to overcomeall degrees of infection.

During this campaign, the periodic rises in the incidence of malariaoccurring at intervals of 6 weeks were very successfully overcome by increasingthe dosage to three tablets per diem for 5 days before they were expected.Other columns on discovering the inadequacy of the standard dosage increasedthe consumption to two tablets per day with similar beneficial results.

In spite of this large intake of mepacrine over a prolonged period,no toxic effects were recorded, although some individuals exhibited anidiosyncrasy to it at the commencement and required quinine for suppression.

Unfortunately, there was a somewhat widespread belief that mepacrineproduced impotence, and in one battalion the administration of the drugwas suspended before troops went into action as it was considered by thecombatant officers to reduce the fighting efficiency of the unit. As suchfallacies have a tendency to spread rapidly and become exaggerated andgain greater credence during circulation, every opportunity must be seizedto discredit them.

Clinical consideration.--Most B.O.R.s on admission tohospital gave a history of intermittent attacks of fever during a periodof 2 to 3 months. The number of attacks varied up to sixteen, the averagebeing four or five. Although this information is based on the statementsof the patient, corroboration of the medical officer was received on numerousoccasions verifying the fact that many had undergone at least twelve attacks.

As was to be expected, the general health condition was poor. In spiteof the large quantities of mepacrine administered for suppression and quinineat the commencement of treatment, a large percentage still had positiveblood slides on admission. Five percent remained positive after a fullcourse of treatment, although only one patient was recorded as remainingpositive after two courses.

It is estimated that approximately 40 percent of the cases admittedfor malaria were evacuated ex-Assam as being unfit for active service withina minimum of 3 months, owing to the debility and anaemia resultingfrom recurrent attacks and in many cases aggravated by the presence ofsome other concomitant disease. Reference has already been made to theweakening

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of the constitution and general physique. In addition it must be stressedthat many of these cases will require to be recategorised B or C,¹³¹as they are almost certain to have further relapses.

Owing to the absence of any information regarding the deaths from malariainside Burma, it is impossible to give an accurate estimate of the mortalityfrom this disease. It is considered unlikely however to have been morethan 3 percent.

Treatment.--Attention has been directed to the modificationsof the standard treatment which were found necessary during operations,especially the more frequent administration of intravenous quinine, andthe absence of any untoward effects from its use. The difficulty of clearingthe blood of parasites and the necessity for repeated courses has alsobeen mentioned. Another fact of considerable importance regarding treatmentalso emerged a month or two after the commencement of operations. Althoughcases responded to treatment during the first 2 months, much greater difficultywas experienced in controlling the temperature as the campaign proceeded,probably due to the parasites beginning to acquire a resistance to mepacrine.In these cases, large doses of quinine, prolonged for a week, were requiredto bring the fever under control.

Dysentery and diarrhoea.--This group of diseases was responsiblefor the evacuation of 483 patients, or 9 percent of the total casualtiesfrom sickness.

Causes.--The main reasons for the above incidence weremainly poor water and sanitary discipline. The attention given to watersterilisation was indifferent and various factors contributed to this.Not the least important of these was the lack of faith resulting from theuse of the Indian manufactured water sterilising tablets, which on analysisproved to have little or no free chlorine. Again troops arriving at a waterpoint with empty water bottles after a long and strenuous march were notprepared to wait half an hour for the water sterilising tablets to takeeffect, nor would the operational situation always allow of this.

Moreover, the proper siting of water-points in regard to bathing wasnot always observed.

A plentiful supply of English water sterilising tablets was not alwaysavailable, and rather than send in nothing at all, resort was made to theuse of water sterilising powder. As this was packed in 7-pound tins, itproved itself worse than useless, first because of the difficulty in carriageand secondly because constant opening and contact with the air reducedthe available free chlorine content.

Another factor of importance in the causation of this disease was thelack of attention paid to conservancy. It was not sufficiently realisedthat the site occupied by one column might, and actually was in some instances,soon to be occupied by another. As a result, strict sanitary disciplinewas not imposed and succeeding columns were forced to live in the acutestdiscomfort under the most insanitary conditions possible through no faultof their own. This

¹³¹Degrees of limited duty status.

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selfish attitude is another aspect of the subject which must be impressedon all ranks.

Moreover, this lack of discipline was in effect lack of security, aslitter from K rations and latrine paper gave ample evidence of the routetaken by columns. For this reason in the case of one brigade, orders wereissued that latrine paper would not be used--an astonishing order when,if any thought had been given to the matter, strict sanitary disciplinewith the burial of faeces or at worst, the covering over of excreta witha layer of earth, was all that was required.

In strong points, trench latrines were frequently used but conformedto no known plan, for they were too shallow for deep trenches and too deepfor shallow trenches. Further, seldom if any attempt had been made to coverthem with any sort of superstructure. The excuse given for this was thatthere was no wood available. Training in the construction of a simple superstructurewhich can always be easily done from locally available materials must beone of the high priority items in all future training programmes.

Another cause of diarrhoeas, although of more mild type, was prolongeduse of the K ration. After consuming this ration for a week or two, stoolsbecame loose, watery and light yellow in colour. Fortunately, only on veryfew occasions did it prove incapacitating and generally cleared up withadequate doses of chalk and opium.

Prevention.--Any future decrease in the incidence of dysenterywill depend on the success with which a proper respect for the elementaryprinciples of sanitation is instilled into the minds of all ranks. Theymust learn to appreciate the fact that a low standard of sanitary disciplinewill not only result in a loss of manpower in their own columns but thatit may have similar effects on the strength of other units. This particularlyapplies to officers, to whom other personnel turn for example and guidance.

The necessary knowledge for maintaining a satisfactory standard is possessedby all medical officers, but it is only on rare occasions that his adviceis sought, and his recommendations and suggestions carried out. A verycommon excuse is the inability of the combatant officer to supply the necessarymaterials and personnel. On active operations little material is requiredwhich cannot be acquired from the neighbouring jungle. It is essentialthat at least two men in each column are trained in the basic elementsof field hygiene so that they can advise on the proper construction ofsanitary fieldworks and act as Sanitary police for the officer commandingand medical officer of the column.

When elements of the Force become static, as occurred in the last expeditionat strong points and roadblocks, the necessity for the strictest sanitarydiscipline in these confined areas becomes even more pronounced. Boreholelatrines into which a charge of gelignite was dropped to increase theircapacity were found eminently satisfactory but only on the too-rare occasionswhen the lid was kept closed.

The importance of perfect water discipline was generally realized toa greater extent than sanitary discipline, but extreme thirst on many occasionsforced men to drink before the water sterilising tablets had ensured com-

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plete effective sterilisation. Owing to the time factor which must elapsebefore chemical sterilisation is effective, resort must be made to mechanicalmethods to shorten this period. The common methods, filtration, sedimentationor boiling, are impracticable on account of a variety of reasons, mostof which are self-evident. There is one method, however, which has beenused with satisfactory results in the provision of a safe water supplyin Assam labour camps, and the necessary apparatus is extremely portable,consisting of two silver plates and an ordinary torch¹³² battery.The only other equipment required for its introduction in future campaignswould be 1- or 2-gallon canvas tanks. The efficiency of this method ismeantime under investigation.

Clinical considerations.--Bacteriological investigationsof the cases of dysentery admitted to hospital revealed the fact that thebacillary type was much more prevalent than amoebic. Both types respondedsatisfactorily to specific treatment and evacuation was not necessary unlessthe general health of the patient had been weakened by malaria or someother debilitating disease.

Sulphaguanidine was not always available in the quantities required,and there should be an adequate stock of this drug held at air base. Emetineproduced no untoward effects, but injections were omitted if the patientwas likely to be engaged in action within a few days. This bears out acontention that I have always put forward that, although emetine is a potentiallydangerous drug, it is not so dangerous as has been held heretofore, providedalways that it is administered with proper care and supervision. The presenceof an idiosyncrasy can easily be discovered after the administration ofan initial minimal test dose.

Infective hepatitis.--Two hundred twenty cases, or 4 percentof the total evacuation from sickness, were admitted to hospital from thisdisease. The incidence was mainly confined to 111 Brigade from which 145cases were recorded.

The source of infection was easily traced, as two cases had to be evacuatedfrom one battalion in this brigade 2 days after their arrival in Burma.Moreover, several officers were flown in during their convalescent periodat their own request. One medical officer developed the disease 2 daysbefore the operation commenced and refused to be evacuated when a replacementwas eventually found.

Although the mode of transmission is still a matter for conjecture,from the evidence available from the minor epidemic which occurred in thisbrigade, the disease would appear to be conveyed by droplet infection.The manner in which each soldier was supplied with individual rations,the absence of communal use of mess tins, and the impossibility of preparingmeals collectively probably excludes the possibility of transmission byfoodstuffs and cooks, the mode of infection which [was] previously postulated.The outbreak commenced with a few isolated cases, the incidence graduallyincreasing until the average weekly number of evacuations was approximately50 during the last month of the campaign. This mode of occurrence is stronglyindicative of a respiratory infection.

¹³²Torch--British; flashlight--American.

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No conclusive evidence was furnished regarding the incubation period,but it is considered that it is lengthy, at least 3 weeks, and in the majorityof cases 4 weeks.

Clinical manifestations.--The severity of the symptomsincreased as the campaign progressed, and together with the very acuteonset gave medical officers the impression that they were dealing withan outbreak of spirochaetal jaundice. One West African medical officerwho had had some experience with yellow fever was struck by the resemblanceand requested that this possibility should be investigated in hospital.The clinical manifestations soon allayed this fear. One case proved bacteriologicallyto be of the spirochaetal variety, the organism being found microscopicallyin the urine. Unfortunately, agglutination tests in this [case] could notbe undertaken from lack of facilities.

In view of the many factors which together tended to tax the liver inan already debilitated individual, it is not surprising that the clinicalmanifestations of this disease were of such a severe nature.

Consequently, it was found that these cases had to be evacuated at thefirst opportunity. With even healthy personnel becoming nauseated at thesight of their never varying rations, little could be done to overcomethis symptom and the anorexia which accompanied it. This equally appliesto other symptoms such as the marked pyrexia, and intense malaise and headache,which occurred in these patients.

I.A.T.--This did not prove troublesome until the onset of themonsoon when it became a problem of increasing magnitude. Five hundredthirty-one cases, or almost 10 percent of the total casualties from sicknessrequired to be evacuated from this cause, 350 of these being flown outin the last month of the campaign.

These skin infections were not confined to any particular nationalityand even the West African troops who had managed to withstand to a greaterextent the rigorous conditions under which the Force was required to operate,were compelled to send out a substantial number of men in the later stages.Attention has already been directed to the high percentage of ringwormamong the Gurkhas; as this variety of skin disease proved less incapacitatingthan the other forms, their evacuation rate from this cause was smaller.

The following were the commonest varieties of skin affections occurringduring this operation: Jungle sores, septic prickly heat, widespread tineaof the feet and groins, which proved very disabling owing to the mannerin which it restricted marching, and bullous impetiginous lesions generallyaround the flexures. These bullae collapsed leaving raw skin, which rapidlyulcerated with further chafing. Boils and carbuncles were also common,and the surrounding cellulitis was often a marked feature of these lesions.

It is considered that one of the major causes of these skin infectionswas the constant marching through swamps in pouring rain or in a warm clammyatmosphere, together with the absence or nonavailability of clean, dryclothing and socks. Nevertheless, there was in most columns an absenceof

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organised arrangements for bathing and washing of clothes to ensurethat the more lax members of the column maintained the necessary basicstandard of cleanliness. It is realised of course, that such arrangementscan be implemented from time to time in accordance with the local tacticalsituation. Regular medical inspections to ensure the medical officer isup-to-date in his knowledge of the state of health of his men, is one moremethod of maintaining the effective manpower of their columns. Minor lesionscan then receive immediate treatment to prevent them from increasing inseverity until the patient requires hospitalisation.

It is not known to what extent foot inspections were carried out bysubordinate commanders, but there is no doubt that a lot can be accomplishedin the prevention of casualties from bad feet if frequent inspections ofthe feet, socks, and boots together with sound foot hygiene is carriedout conscientiously. In this way, many of the more severe cases of foot-rot,which occurred during the monsoon period could have been prevented by earlyrecognition and treatment. The number of cases of lice infestation wassurprisingly few. The reasons for this can only be attributed to a strictmedical inspection prior to entering Burma and the absence of lice in thevillages. This is in marked contrast to the experience of General Wingateon his original expedition.

Typhus.--One hundred sixteen cases or 2.1 percent of the totalevacuation from sickness were admitted to hospital from this cause. Interrogationof medical officers after their return from Burma would indicate that afurther 49 cases were diagnosed but were not flown out owing to recoveryor death occurring before evacuation of the patient could be undertaken.

The majority of the cases (77 percent) belonged to 14 Brigade, in whichsporadic outbreaks occurred from the beginning of May to the second weekin August. In the other brigades, cases commenced to appear intermittentlyduring the last 2 months of the campaign but mainly in July.

The type of terrain in which these cases were infected varied considerably.The area in which infection must have occurred in the first outbreak, estimatingthe incubation period as 12 days, was mainly scrub jungle interspersedwith open paddy-fields. The second minor epidemic broke out during theoccupation of a village (Nammum) in which the troops were static for almosta month. However, the greater part of it was overrun with elephant grassand this location more closely resembled a jungle clearing than an inhabitedlocality. The third and most explosive outbreak could be traced to infectionoccurring during the occupation of a chaung in which the banks of the riverwere covered with thick elephant grass. In general from the evidence available,the type of terrain in which the majority of cases became infected wasopen country abounding in elephant grass and in the neighbourhood of water.No cases occurred in dense bamboo jungle, only in the scrub variety.

No conclusive proof regarding the vector could be discovered from investigationof these cases. Typical tick eschars were present in only 10 percent ofthe cases, and there were no medical officers willing to admit that they

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had detected mites or their bites on any of the patients. From enquiriesregarding the fauna in the areas where infection occurred, the most probablereservoir was the field mouse. Even in the village, few rats were to beseen.

It is a point for consideration and investigation whether mules maynot carry ticks or mites from infected areas, thus prolonging an epidemic,and in addition furnishing an explanation for cases who develop typhusafter having left the affected locality for some days in excess of therecognised incubation period. The evidence from the above outbreaks suggestedsuch a possibility, although the incidence of the disease was no greateramong muleteers than among other personnel of the columns. Moreover asthe typhus virus is transmitted from one generation of the mite to thenext, infected areas may be considerably extended in this manner, and casescommence to appear in formations occupying areas previously understoodto be free from the disease.¹³³

Clinical considerations.--The first cases to appear weregenerally diagnosed as glandular fever, being mild with little more thancomplaints of headache, feeling out of sorts, and some glandular enlargement.Several of these cases, especially during this early period and at a timewhen the possibility of typhus had not yet been fully appreciated, remainedambulatory throughout the whole of their attack, and recovered; this evenoccurred later when the disease had been fully recognised and diagnosed.

It was not until the onset became more abrupt with a high temperature,which failed to respond to quinine, that typhus was fully suspected. Thereafterthe severe constitutional upset, the red bloated face with intensely congestedconjunctives; the prolonged fever without the intermittency of malaria,pyrexia, and the appearance of a macula-papular rash on the trunk 3 or4 days later, left no doubt regarding the diagnosis in the minds of themedical officers.

The progress of these cases caused generally grave anxiety. Pulmonarycomplications were generally severe, mental depression so profound thatthe patients appeared to have no desire to recover. This apathy was counteractedin the Black Watch to a very considerable extent when someone conceivedthe idea that the sound of the pipes might do much to dispel this apathy.Moreover, in the absence of specific treatment little could be done forthese patients under the existing circumstances. Proper and efficient nursingwas quite out of the question. Protection from the monsoon had to be improvisedwith indifferent success; fever became unbearable in the warm moist climate,and some patients lapsed into delirium; water was warm and brackish andgreat difficulty was experienced in forcing these patients to maintaintheir water and salt balance and avoid dehydration, diet was restrictedto articles upon which the patients had existed for many months and whichnow produced intense nausea; the number of nursing orderlies was limitedand they could not cope adequately with the number of cases.

¹³³See citations in n. 124, p. 267. GeneralOfficer's observations conform generally to more thorough investigations,although his "hunch" that mules might carry the mite vectorswas not confirmed.

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Under these circumstances, and in men already debilitated with prolongedmarching and recurrent attacks of malaria, it is not surprising that mortalityfrom this disease reached the high figures of 29.7 percent. This high deathrate was quickly appreciated by all ranks, and the subsequent fear of contractingthe disease resulted in a substantial decrease in morale.

The Weil-Felix reactions in all cases admitted to hospital showed agglutinationwith OXK strains, although high titres were not reached until the eighthday after the onset of the disease. Agglutination with OX 19 and OX 2 strainswas insignificant.

Prevention.--It has now been definitely established fromseveral epidemics of scrub typhus that certain types of terrain are closelyassociated with epidemics of the disease. Experience gained from this campaignindicates that the following areas should be skirted and other routes selectedwhenever possible. Only in exceptional circumstances when the tacticalsituation permits no alternative, should camps be situated or troops allowedto bivouac in these localities.

(1) Scrub jungle, in contradistinction to thick wooded jungle with denseoverhead cover.

(2) Jungle clearings, especially deserted villages which have becomeovergrown with elephant grass and small trees. This applies equally tothe periphery of dense jungle.

(3) Rivers or streams bordered by tall grass. If camps must be situatedin the vicinity they must be at least 1 mile from water.

If a suspicious area must be traversed or in which a camp requires tobe sited [sic], strict personal precautions must be enforced. As it isnot possible in this type of operation to fire the grass and undergrowthof such areas, every possible individual precaution must be taken. Allexposed areas of skin should be protected by clothing while passing throughsuch localities and if the night has to be spent in them, then improvisedcharpoys¹³⁴ to raise the sleeper off the ground are essential.No padding with brushwood or grass must be allowed, the charpoy being coveredonly with the groundsheet whose edges have been smeared with dibutylphthallate.

It is strongly recommended that adequate stocks of dibutylphthallateshould be available for any future operations, and all ranks trained inits proper application to the edges of the clothing and exposed parts ofthe skin.

Malnutrition.--Approximately 1 month after their withdrawal fromBurma, 34 cases of deficiency in the vitamin B complex had been admittedto hospital, seven cases from 14 Brigade, the remaining 27 being distributedbetween 77 and 111 Brigades. All cases occurred among B.O.R.s.

Of the seven patients admitted from 14 Brigade, all suffered from multipleneuritis. A previous history of malaria was volunteered in six cases, andthree had suffered from jungle sores.

It is of interest to note that the neuritis did not develop until almost1 month after the substitution of "Compo"¹³⁵ and laterthe Rehabilitation, scales of rations. It is difficult to assess whetherthe above indications of

¹³⁴Bed frames.
¹³⁵Composite.

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malnutrition in these personnel of 14 Brigade were due to complicationsappearing after malaria, or were the sequelae of postdiphtheritic ulcerations.It is considered more likely, however, that the manifestations were occasionedby the bodily reserves of vitamin B becoming depleted during the lengthyperiod of existence on K rations, and the failure of the later diets toreplace it in sufficient quantity.

In the other brigades the symptomatology showed greater variety as willbe seen from an analysis of the symptoms of the 27 patients belonging tothese brigades:

Lassitude and muscular weakness	24
Atrophic glossitis	19
Heartburn	16
Flatulence	20
Anorexia	22
Vomiting	19
Diarrhoea	9
Pain in legs	24
Muscle cramps	14
Paraesthesia of limbs	10
Impairment of memory and concentration	3

One of the most striking manifestations was the extreme degree of mental depreciation in these patients. Lassitude and, in some cases, even inability to move was marked. Depression was severe, and orientation and concentration were also affected.

No significant abnormality was found in the pulse rate but in 21 casesthe blood pressure was below 120 m Hg. In the C.N.S.¹³⁶ thedeep reflexes were altered in 18 cases, and there was some impairment ofsensation in seven.

Five cases gave a history of malaria, and another six had suffered fromdysentery.

These cases appeared more rapidly after evacuation from Burma than thoseof 14 Brigade. This is probably due to the fact that 77 and 111 Brigadeshad lived almost entirely on K rations until their arrival in the RehabilitationArea, and the rations issued during their travelling period had littletime to replace the body reserves of vitamin B Complex, so thoroughly depletedin Burma. The same discoveries [sic: difficulties?] of postulating theaetiological factors involved, postmalarial complications, postdiphtheriticparalysis, or failure of intestinal absorption after dysentery or gastroenteritiswas experienced. It is considered however, that these were probably precipitatingfactors in patients suffering from avitaminosis in a subclinical form.

No frank cases of scurvy were found on examination of these brigadesafter their evacuation, but again the disease may have been present inits subclinical form.

Although the discovery of these cases of avitaminosis would seem toindicate that the vitamin content of the K ration is deficient, this isin fact not so,

¹³⁶Central Nervous System.

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and those cases of avitaminosis which did occur, can only be attributedto the well-known fact that the men threw away or failed to eat some vitamin-containingpart of the ration. While this cannot be condoned it can never be avoided,and it does indicate the absolute necessity of the inclusion in the rationof a separate multi-vite tablet.

Condition of Personnel on Termination of Operations

All brigades on their withdrawal from Burma, with the exception of 16and 23 Brigades, concentrated in the reception camp at Tinsukia. Here theywere placed on a special convalescent scale of rations--received theirfirst hot bath for months, and were given a complete new issue of clothingand necessaries.

At this camp the psychiatrist¹³⁷attached to the Force waslocated, and as the various brigades passed through, he was in a positionto take a cross section of each brigade and assess their general conditionand morale, and at the same time was available to see any special casesconsidered by the medical officers to require psychiatric advice and treatment.

The reports on his observations are attached and are of considerableinterest and show clearly that morale was highest in those units and formationswhich finished on a high note, with a recent success in battle--and thelowest in those where a reverse had led to acute disappointment.

Morale on the whole--considering the length of time the men had beenin and the hardships to which they had been subjected--was surprisinglygood.

Psychiatric Report on 77 Ind Inf Bde, SpecialForce¹³⁸

Examined at--69 Ind. Rest Camp, 6 A.B.P.O. July'44.¹³⁹

Procedure. In conducting this investigation twoaims were formulated:

(1) To assess the morale of the Brigade as a whole, and
(2) To estimate the percentage of psychiatric casualties.

To accomplish the latter the co-operation of the CampMedical Officer and the local hospitals was enlisted to supplement personalinterviews.

In assessing morale an essay was made to garner data undertwo sub-headings:

(1) Factors favourably influencing morale
(2) Factors influencing morale unfavourably

In the two to three days available, as many as possibleof the British personnel of the Brigade were interviewed immediately onarrival at camp from the local air-strip.

In all 189 men were examined. The number more or lessequally divided between the South Staffs and Lancashire Fusiliers.

Psychiatric Casualties. Not one case of mentalillness was seen on personal contact. Neither was any case referred bythe Camp Medical Officer or to the hospitals in the neighbourhood.

Relative the present evacuees the mental health is 100percent sound.

¹³⁷J. S. Dawson, Captain, RAMC, who signedeach of the reports quoted below.
¹³⁸The report on the 77th Brigade is second in sequence in theoriginal Report. Its introductory section, however, indicates that it wasintended to be first in order.
¹³⁹Ind.--Indian; A.B.P.O.--overseas postal office designation.

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Factors influencing Morale Unfavourably.

(a) Promises. Officially promised out before theMonsoon and again after "White City" in May. Undivided opinionof the men here gave it that these promises dashed their hopes considerablywhen not implemented and they would much rather they had not been given.

(b) Monsoon Equipment. Non-existent. The gas-capesissued were useless after a fortnight's rain. Loss of sleep and consequentexhaustion were attributed to lack of this equipment. American hammockswould have been appreciated.

(d) Rations. Monotonous and depressing. Three monthson "K" rations is enough for any man.

(e) Repatriation. A sore point with those concerned.Men with five years service overseas and more before entering Burma, resenthaving been detailed to go in. An ominous bond of sympathy exists betweenthese and many of the remaining men, strengthened by the assertions thatmany of those who were due repatriation have been killed.

(f) Medical Attention. Uncivil and inadequate.By far the greater majority of men expressed this view and said they wereultimately afraid to go sick for fear of being accused of "scrounging."Men with fevers and dysenteries had to continue fighting. The absence ofdetailed stretcher bearers in the columns was also bemoaned. These complaintswere largely mitigated however, by the almost unanimous opinion that theconditions obtaining were due to lack of medical personnel. (N.B. Surgicalcases interviewed could not speak too highly of the attention receivedfrom M.O.s and orderlies alike.)

(g) Length of Campaign. Much too long. None wouldhave minded being in twelve weeks.

(h) Chinese. Very unpopular. Described as an undisciplinedcollection of looters and thieves. Very difficult to distinguish from Japanesetroops owing to the variety of clothing they wore. W.O.s and N.C.O.s sharedthe same opinion as the men. All would have preferred to have continuedto fight as an independent Chindits Force.¹⁴⁰

Factors Favourably Influencing Morale.

(a) Officers. Apart from a few isolated instances,the officers had the unbounded confidence of the men. Brigadier [Michael]Calvert was extremely popular and the admiration of the men without exception,stopped a little short of hero-worship. One wit expressed the opinion that"we would follow the Brig. through Burma into Hell."

(b) Evacuation of sick. Air-personnel's work inevacuating the sick much appreciated. All felt confident of getting outif wounded.

(c) Self-appreciation. Stated un-reservedly thatthey had had their fair share of fighting in this campaign and hadn't doneso badly either.

(d) Japanese. Not the invincible myth he was conjuredup to be. All feel they have got his measure in jungle warfare, both inattack and defence.

Summary. The general tone is one of satisfaction,with one thorn, that of repatriation, in the flesh of an otherwisehealthy body. Even considering the "unfavourable influences"listed above, there was the encouraging observation that these were givenin the nature of constructive criticisms in a co-operative effort to improvethings to come.

The morale of this Brigade is excellent.

Sd/-J. S. Dawson, Capt., R.A.M.C.
Specialist in Psychiatry, Special Force

¹⁴⁰The allusion here is to the last stage ofthe campaign when the 77th Brigade and the Chinese were attacking Mogaung,and when the former (like the latter) were parts of the total force commandedby General Stilwell.

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Psychiatric Report on 111 Ind Inf Bde, Special Force

Examined at--69 Ind Rest Camp, 6 A.B.P.O., July-Aug.'44.

Procedure--This investigation was conducted withtwo formulated aims:

(1) To assess the morale of the Brigade as a whole
(2) And to estimate the percentage of psychiatric casualties.

In assessing morale an attempt was made to gather relativeinformation under the sub-headings:

(1) Factors favourably influencing morale
(2) Factors influencing morale unfavourably

British personnel only were concerned in this review,and, in all, 273 men were examined, 97 of these from the Cameronians andthe remainder, including 17 Royal Artillery other ranks, from the King'sOwn Regt.

Psychiatric Casualties. None of the men personallycontacted showed any signs of mental illness. No cases were referred tothe Camp Medical Officer or the local hospitals.

Factors influencing Morale Unfavourably.

(a) Promises. Before the campaign promised "out"before the monsoon. Four to five days after the evacuation of "Blackpool"(3rd-4th June) officially told they had no further commitments and werethen going out, but two days later ordered to advance and assist in theattack on Mogaung. Morale fell considerably, and the King's Own gave itthat they had 17 desertions as a result.

M.O.s and Chaplains confirmed the men's assertions thatthe promise after "Blackpool" had a very deleterious effect onthe morale of the Brigade.

(b) "Blackpool." Complaints were numerousand bitter regarding this block and were shared by almost every man. Whywas it called a "block" at all? It was too far from the roadand railway to act as such. Many regarded it merely as a "decoy"and little better than a death-trap. Why wasn't the railway put out ofaction, and why were Jap troop-trains allowed to come beyond the blockunmolested? Where were the floating 14 and 77 Brigades promised?

W.Os, N.C.Os, and men all believed the air-strip on whichthey depended entirely for supplies and ammunition to be inadequately defended.Part of the strip was actually outside the block and had no defence atall.

The continual shelling, to which they had no reply, ultimatelygot most of the men down, and they had had about all they could take whenthe block came to be abandoned.

(c) Officers. The rationale of this observationis obscure, but it is an undisguised fact that before "Blackpool"the officers as a whole had the confidence of the men, but after the blockthat confidence almost completely vanished. After the block administrationwas described as chaotic, recces were said not to have been carried out,no-one knew what was going on and leadership was considered poor.¹⁴¹

(d) Nature of campaign. Not one man but complainedof having been ordered to participate in "Static warfare" forwhich he was not equipped. Wingate had intended the Chindits to functionas L.R.P. troops and as such they had done everything asked of them. HadWingate lived they felt sure they would have continued to fight in theirintended capacity.

Until "Blackpool" morale was 100 percent throughoutthe Brigade. There were insufficient, if any, rest periods during the campaign,marching was excessive and the campaign as a whole was much too long.

¹⁴¹Masters describes the affair at Blackpoolin great detail, pp. 240-262, 282-283. He was not entirely happy aboutthe idea of establishing the block, nor with the site; he too was impatientwhen neither the 14th nor 77th Brigades reached the perimeter to reinforcehim. The punishment the Japanese gave with artillery as well as reinforcedinfantry became intolerable. Repeated declarations that the position hadbecome untenable brought no command to retreat. Using, finally, the initiativeof the local commander to estimate the situation, Masters ordered the strongholdto be abandoned in the face of obviously imminent destruction of the Brigade.See also the introductory section of part IV.

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(e) Medical Attention. Inadequate, with the depressingprospect of having to continue marching when suffering from a fever. Notmany held any great hopes of speedy evacuation when sick. All the MedicalOfficers were extremely popular, however, with one exception, who depressedthe column with his uncivil barrackroom attitude.

(f) Repatriation. A considerable number of N.C.O.sand men were due repatriation before they entered Burma, and resent havingbeen detailed to go in. Many due repatriation lost their lives during thecampaign.

(g) Public Flogging of B.O.R.s. Greatly resented.Nothing but an exhibition of slavery. All agreed that the guilty men deservedtheir punishment, but the punishment should not have been implemented publiclyin front of natives and coloured troops.¹⁴²

Factors favourably influencing morale.

After "Blackpool" the men could instance nothingwhich raised their morale in any way.

Medical Administration. Certain criticisms, ofsufficient magnitude to occasion concern, were served on the D.D.M.S. andA.D.M.S. by medical officers of the Brigade. A statement by the D.D.M.S.to the effect that too many fit men were being evacuated engendered greatindignation amongst the M.O.s concerned and in their opinion, showed alack of appreciation of the true conditions obtaining in the columns andreflected seriously on their judgment. As neither the D.D.M.S. nor theA.D.M.S. contacted them in the columns they consider the above statementunjustified.¹⁴³

Medical supplies were considered so inadequate during"Blackpool" as to seriously influence the morale of the men.One Medical Officer of No. 3 W.A. Fd Amb¹⁴⁴ gave it as his opinionthat the medical arrangements lacked organization, which would have beenmaterially improved if the A.D.M.S. had "lived in" with the Brigades.¹⁴⁵

The S.M.O.¹⁴⁶ was dissatisfied with the supportreceived from the D.D.M.S. and harboured criticisms which he intended tomake personally.

Summary. Of the 273 men examined not one expressedhis willingness to participate in another Burma campaign, and of this total,184 declared they would do detention rather than face a second campaignunder similar conditions. The 184 figure comprised 69 Cameronians, 17 Gunnersand 98 King's Own personnel. Despite the histrionic quality, in severalcases, of the avowal to do detention, the incubus of discontent pervadingthis Brigade is none the less obvious and alarming.

Morale is low.

¹⁴²The only reference to corporal punishmentanywhere in any sources available to the editor.
¹⁴³See Officer's expressed attitudes on the point, which evidentlyhad been previously stated directly to the 111th Brigade medical officers.Masters: "Certainly a few of these men [being evacuated during the"fearful falling off in general health" at Lake Indawgyi, afterBlackpool] were taking the easy way out, but Desmond Whyte was a fightingdoctor and, when I called all the medicos together for a conference, heand the others assured me that a high proportion of the British troops,officers and men, were in fact on the threshold of death from exhaustion,undernourishment, exposure, and strain" (p. 262).
¹⁴⁴Field Ambulance (unit).
¹⁴⁵See pp. 215-216, for difficulties which the A.D.M.S. encounteredwhen he tried to establish proper administrative relationships with thetroops in the columns.
¹⁴⁶The Senior Medical Officer of the brigade was Maj. DesmondWhyte. Masters had great confidence in Whyte, whom he recommended for theVictoria Cross. The Distinguished Service Order, which Whyte received instead,was "not good enough" (p. 273). The reference may well be tothe incident in which Desmond, annoyed by a message from the Force Surgeon(presumably Officer) regarding the prescribed methods of preventing footdisorders, sent back a tart and skeptical reply. "The chief doctorwanted to court martial Desmond for that, although the message was fromme, but fortunately for him [Whyte? Officer?] thought better of it"p. 272. The atmosphere is indicated by the fact that Masters was then repeatedlydemanding a medical inspection of the Brigade as a basis for its reliefand evacuation on medical grounds (p. 276). Crew, V, pp. 216-232, quotesWhyte's brigade medical report.

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Psychiatric Report on 14 Inf Bde, Special Force

Examined at--69 Ind Rest Camp, 6 A.B.P.O. Aug-Sep'44.

Procedures--As adopted with 77 and 111 Ind InfBdes 372 men were examined comprising 126 Black Watch, 88 Leicesters, 84Bedfs Herts and 74 Y & L.¹⁴⁷

Psychiatric Casualties--No case of psychiatricillness was seen on personal contact or referred by Camp. M.O., Bn. M.O.sor local hospitals.

Factors influencing Morale Unfavourably

(a) Promises. Black Watch and Y & L personnelcomplained bitterly of official promises of their "going out,"which never materialized. Every job after May was their last job and moraledropped considerably with each promise.

In marked contrast the other two bns stated they neverhad one official promise throughout the campaign and suffered no loss ofmorale in consequence.

(b) Reinforcements. All stated they were neverup to full strength and an increased burden was thus thrown on remainingpersonnel of unit. Many of the reinforcements received were untrained injungle warfare and had never seen a heavy pack.

(c) Length of Campaign. Much too long. If the campaignhad terminated before the monsoon many deaths from illness would have beenavoided and all felt they would have been in a better mood to face a secondcampaign than they are now.

(d) Rations. "K" rations monotonous andalmost unbearable after three months.

(e) Officers. "Class-distinction" toomuch in evidence, particularly regarding monsoon equipment and medicalevacuation.

(f) Medical Inspections. Not one individual butcomplained of having had no proper medical "over-haul" beforehe went in. Some had none at all. Others were actually checked for fitnessby a Sgt-Major consulting pay-books.

They have had no medical inspection, not even an F.F.I.¹⁴⁸since leaving Burma.

The general feeling, resultant on this, is that they areof the opinion that no one cares how they feel and that they have beenneglected.

(g) Medical Treatment. Despite the admirable effortsof the M.O.s (with two exceptions) treatment was described variously asinadequate to ridiculous to call it treatment at all. It was common forsick to be turned away by the M.O. with the apology that he had nothingto give them. On occasion it was impossible to get even a bandage, parachutecloth having ultimately to be torn up to serve the purpose.

Coln. 16 of Bedfs Herts complained of having no M.O. atall for 6 weeks. A L/Cpl.¹⁴⁹ (from the Bn) carried on in hisabsence and it was rather alarming to learn from the Cpl himself that hewas giving intravenous quinines, pentothals¹⁵⁰ and performingminor operations on his own.

(h) Unknown Fever (Scrub Typhus). Without exceptionthis affected the morale of the men considerably. They saw friends "dyinglike flies" with the fever and in cases they were even afraid to visitthose stricken with the fever for fear of contracting it themselves.

(i) Medical Evacuation. None had any great confidenceof getting evacuated if sick. Indeed the one concern in the mind of eachindividual was the fear of falling sick with the disturbing prospect ofhaving to endure hardships in the coln were he unfit.

Age and Weight. A considerable bond of sympathyexisted between the men and those they considered overage and underweight.Men of 38 and 39 they believe should never have been sent in, and it wasridiculous to have included men of little more than 8 stone in weight.Giving the weight of the heavy pack as 69 to 81 lbs. this meant those menwere carrying over half to three quarters of their own weight. They blamethis on the lackadaisical medical inspection prior to entering the campaign.

¹⁴⁷Abbreviations: Leicesters--7th Battalion,Leicestershire Regiment; Bedfs Herts--lst Battalion, Bedfordshire and HertfordshireRegiment; Y & L--2d Battalion, York and Lancaster Regiment.
¹⁴⁸"Free from Infection"--that is, a health inspectionof the troops.
¹⁴⁹Lance Corporal.
¹⁵⁰A commonly-used anaesthetic.

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Defective Vision. Those wearing glasses definitelydid not possess the confidence of the men whose visual acuity was good.They went in constant fear of either losing or breaking their glasses,and even with them on the glasses were often little better than uselessowing to rain and perspiration dimming the lenses. (An M.O. from personalexperience gave it as his opinion that this latter observation was a veryreal one.)

Syphilitics. A disgruntled few were interviewedbut of such a mental make-up to spread dissension through any unit. Theycomplained of being neglected and of having no treatment for their conditionwhile in Burma.

Factors Favourably Influencing Morale.

Self-appreciation. All bns could point with somepride to the part they had played in the campaign. They feel they haveachieved what they set out to accomplish and are solid in their assertionsthat the Jap is anything but invincible and "has it coming to him."

Addendum. Prior to the campaign a considerablenumber of men were put up by S.M.O. and Bn. M.O.s for regrading, but manyof these were turned down by Medical Boards. S.M.O. maintains that Specialistsin hospitals are not fully conversant with the true conditions obtainingin the field and that less stress should be put on their findings and moreon those of Bn. M.O.s. Those originally put up for regrading by him andhis staff were ultimately evacuated as unfit during the campaign.

Summary. It was obvious from the outset that medicalproblems occasioned the chief concern in each Bn., yet criticisms were,on the whole, positive and constructive, particularly regarding treatmentsand evacuations.

That the "conditions and diseases" have notundermined the morale of the Brigade to any serious degree is evidencedby the unanimous opinion of the men that they think they would be ablefor another "go" in six months time.

Morale is good.

V. CONCLUSIONS

Certain very definite points arise from the experience of this lastcampaign and require earnest attention before embarking on further similaroperations. These can be numerated as follows:

(1) A Medical Organization capable of dealing with the casualties likelyto be encountered. Such an organization has been requested.

(2) Medical Personnel who are in their technical training above theaverage and so able, in any Medical Emergency, to act on their initiative.As well as this they must be fit enough to withstand the rigours of LongRange Penetration Warfare.

(3) Combatant leaders who realise that preventable disease is, unlesscountered, liable to take a heavier toll in casualties than the Japaneseand who, in consequence, must be prepared, by ensuring strict discipline,to do everything in their power to train their men in preventive measuresand, by personal example, ensure that sickness from this unnecessary andavoidable cause is kept to an absolute minimum.

(4) A diet that is not only sufficient but which is interesting enoughto stimulate a desire and enthusiasm for eating it and thereby maintainmorale at its highest. For probably no single factor plays a bigger partin the maintenance of morale than good food. While this is a truism inall conditions of life it is even more so under conditions in which thisForce must operate and when everything else is looking blackest and bleakestit is amazing what

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good food can do to counteract acute depression. If the answer to allother problems was as easy as it is to this one, then all difficultieswould disappear. Knowing what is wanted, as everyone does, it should beeasy at this stage of the war to produce it.

(5) The preliminary to the regular taking of Suppressive Mepacrine isthe regular supply of it to the columns. If this is not Fool-Proof thenno amount of discipline nor desire on the part of the men to take it canovercome its deficiency. The only safe way of ensuring this regular supplyis the inclusion of the requisite dose in the men's individual ration.No other method can be Fool-Proof.

In conclusion, I would repeat what I have had to say so often before,and that is that without a very close co-operation between the MedicalBranch and the Planning Branch, whether this be before or during operations,it is impossible to run a good Medical Service with that efficiency which,unlike that of any other service, is so open to adverse criticism.

The habit of looking upon the doctor as a Fifth Columnist likely toblab the merest piece of confidential information which is vouchsafed him,is still all too prevalent. Apart from the fact that we are all of thesame nationality, holding the same Commission in the same Army and fightingthe same enemy for the same reasons, a doctor, by the very virtue of hisprofession and his training, probably holds more secrets and informationof a personal and confidential nature than any other individual. This beingso, and it is agreed, as it must be, that the inclusion of a Medical Servicein the planning of a campaign or operation is essential then the most TopSecret information can safely be disclosed to the head doctor withoutany fear of it being repeated. So often one finds that information of thissort is known to a junior "G" officer but is not told to theMedical Service until it is too late to be of use in the making of an efficientMedical Plan.

With the increased speed and tempo of modern warfare the time has passedwhen the D.D.M.S. of a Corps or the A.D.M.S. of a Division received hisinformation through the head of the "A" [Administration] Branch.Every means by which Red Tape and unnecessary effort and time are dissipatedshould be cut ruthlessly. When it is realised that the head of the MedicalService of such a formation is, as the representative of the D.M.S. ofthe Army, the Commander of all Medical Units and Personnel in it, thensurely it is right to assume that he should be treated in the same wayas the C.R.E. [Chief, Royal Engineers] and the C.R.A. [Chief, Royal Artillery]and that he should, by his attendance at all conferences, receive his informationfirst hand direct from his Commander.

The best units and formations are always those which are most Medicallyminded and where the doctors are in the closest confidence with their respectivecommanders, and it is in these units where discipline is of the highest.The reason for this very definite statement needs no further elaborationexcept to say that such close cooperation leads to a mutual trust and confidencewith a realisation of the other's difficulties. The all too ready attemptsto criticise adversely treatment and procedure which are a feature

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of a certain type of officer are eliminated and the realisation thatsuccess at all times and in every undertaking is no more possible by adoctor than by a commander is more fully appreciated.

It is with no attempt to make out that this Force is more culpable ofmore breaches in this respect than any other that this truism is included.It is repeated only in an effort to eliminate it altogether and to remindsenior Staff Officers of the need of continuing to imbue their less experiencedofficers with this fact.

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