CHAPTER X
The Southwest Pacific Area
The Army medical service which took shape in Australia under Gen. DouglasMacArthur in the spring of 1942 succeeded that which had existed in thePhilippine Department in the prewar period. While the Army was losing outin the Philippines it was building, up in Australia. Before the close of1942, a thoroughgoing medical service characteristic of a theater of operationshad been founded in the Southwest Pacific Area.
DECLINE OF MEDICAL SERVICE IN THE PHILIPPINES
The life of Army medical service in the Philippines after the UnitedStates entered the war was brief but dramatic. When the Japanese bombedClark Field on the day after their attack oil Pearl Harbor, the departmentsurgeon, Col. Wibb E. Cooper, MC (fig. 89), and his staff had to switchrapidly from the normal medical activities of an Army oversea departmentto those of a theater of operations. From that date on, the story was oneof medical service rendered under extreme difficulty. Although the withdrawalto Bataan and Corregidor accorded with long-established plans, the administrationof medical service in this time of retreat conformed to the exigenciesof rapidly shifting circumstances rather than to any repeatable pattern.
When the move out of Manila began in the latter part of December 1941,Colonel Cooper`s office moved to Corregidor with Headquarters, U.S. ArmyForces in the Far East, and was ultimately established in the Malinta Tunnel(fig. 90). An advance echelon of the surgeon`s office was simultaneouslyset up on Bataan initially sited with General Hospital No. 1 at Limay andlater with Services of Supply headquarters. Colonel Cooper served in thedual capacity of Philippine Department Surgeon and Acting Surgeon, U.S.Army Forces in the Far East, until 21 March 1942 when the latter commandwas superseded by U.S. Forces in the Philippines. Colonel Cooper was namedsurgeon of the new command by Lt. Gen. Jonathan M. Wainwright.1
In December 1941, Lt. Col. (later Col.) William J. Kennard, MC (fig.91), the senior flight surgeon in the Philippines, who was wounded by bombfragments during the attack on Clark Field, was surgeon of the Far EastAir Force and of its service command. The departmental medical servicefurnished medical supplies and hospitalization to the air troops. Excellentrelations, due in some measure to the proximity of Army and Air Forcesin-
1 (1) Cooper, Col. Wibb E. : Medical DepartmentActivities in the Philippines from 1941 to 6 May 1942, and Including MedicalActivities in Japanese Prisoner of War Camps. [Official record.] (2) Seealso Medical Department, United States Army. Medical Service in the Asiatic-PacificTheater in World War II, ch. 1. [In preparation.]
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stallations, existed between the department surgeon and Colonel Kennard.Medical Department officers were stationed at Clark and Nichols Fieldsto serve the air force squadrons which had arrived in 1940 and 1941, whilejust before the attack a few medical officers had moved out of Luzon withair force units to other islands as part of a dispersion program. Afterthe move to Bataan a number of the air force squadrons were transformedinto two regiments with regimental surgeons, The latter and the variousgroup and squadron surgeons were scattered over Bataan and Mindanao. Fromabout Christmas Day of 1941 to early April 1942, Colonel Kennard traveledseveral thousand miles from camp to camp, making sanitary inspections andaiding in hospitalization and evacuation.2
At the outbreak of war, Sternberg General Hospital in Manila and fivestation hospitals were the total assets of the Philippines in fixed Armyhospitals. The commander of the station hospital at Fort Mills, Corregidor,was also the Surgeon, Harbor Defenses, and had jurisdiction over all MedicalDepartment officers stationed at the fortified islands, including Corregidor,
2 Kennard, Lt. Col. William J.: Report on Philippineand Australian Activities, 1942. [Official record.]
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which protected Manila Bay. On 8 December, in accordance with a previousplan, the Manila Hospital Center was established by adding several annexes,some in college and university buildings, to Sternberg General Hospital.The care of the incoming wounded lasted only a month, as the move to Bataanbegan in the latter part of December. On Bataan were set up General HospitalNo. 1 at Camp Limay (later at Little Baguio), General Hospital No. 2 nearCabcaben Airfield, and the Philippine Army General Hospital near the PhilippineArmy headquarters in the rear of Bataan.
The Philippine Medical Depot in Manila, which housed the equipment fora number of tactical hospitals at the outbreak of war, furnished medicalsupplies by trucks and barges to both ground forces and air forces. Latein December 1941, it was transferred to a location near General HospitalNo. 2 on Bataan. In April shellfire destroyed it.
In the first bombing of Corregidor in late December 1941, the Fort MillsStation Hospital sustained several direct hits and was immediately movedto Malinta Tunnel. By 9 April, as the evacuation from Bataan to Corregidortook place, fixed medical service in the Philippines- care of the manycases of malaria, malnutrition, and dysentery- was concentrated in thetunnel, with Colonel Cooper in charge. Colonel Cooper remained in MalintaTunnel with his hospital staff and patients after the surrender of Corregidoron 6 May until 25 June, when the Japanese allowed them to move to the renovatedFort Mills Hospital. In early July all were transferred to Manila, thenurses
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finally to Santo Tomas University, converted to a prison, and ColonelCooper and the patients to separate quarters in Bilibid Prison. Any semblanceof medical organization of the U.S. Forces in the Philippines may be saidto have ended at that date. Colonel Cooper was shortly transferred to Tarlac,where he rejoined General Wainwright and his group and learned of the DeathMarch. In August, with other to ranking officers, he was sent to a prisoncamp on Formosa. 3
THE EARLY MONTHS IN AUSTRALIA
While medical officers in the Philippines were retreating with the Armyto Bataan and Corregidor, medical service in the Southwest Pacific wastaking shape in Australia. Its birth may be dated from the hasty formationof a headquarters staff, including a surgeon, for the provisional TaskForce, South Pacific, under command of Brig. Gen. Julian F. Barnes. Enroute from Hawaii to the Philippines, the force was diverted to Australiaand arrived at Brisbane on 22 December. Medical Department personnel aboardwere those
3 (1) See footnote 1 (1), p. 407. (2) Noell,Maj. Livingston P., MC: Report of Personal Experiences in the JapanesePrison Camps of the Philippine Islands, 8 April 1942-15 February 1945.[Official record.] (3) Interview, Marie Adams, Field Director, AmericanRed Cross, 7 June 1945, subject: Conditions at Santo Tomas.
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attached to a few tactical units, plus about a dozen casual medicalofficers. Most of the convoy`s troops, including most of the casual medicalofficers, went northward with the convoy toward the Philippines. Sincethey were unable to put in at any port in the archipelago, they landedat Darwin, in northern Australia, with the exception of a field artillerybattalion, which went on to Java.
The U.S. Army Forces in Australia,4 under command of Maj.Gen. (later Lt. Gen.) George H. Brett, had its headquarters in Melbourne.The theater organization began to take shape in January 1942. Four basesections were set up extending inland from the northern and eastern coastsof Australia, with headquarters respectively at Darwin, Townsville, Brisbane,and Melbourne (Map 8).5 No permanent surgeon was assigned toU.S. Army Forces in Australia until February, when The Surgeon Generalsent Lt. Col. (later Brig. Gen.) George W. Rice, MC (fig. 92), to be theatersurgeon. Col. (later Brig. Gen.) Percy J. Carroll, MC (fig. 93), had meanwhilearrived in Australia on the hospital ship Mactan carrying patients outof the Philippines. Since Colonel Carroll was Colonel Rice`s senior, thepost went to him on 7 February.6 During the spring and summerof 1942, Colonel Carroll requested additional medical personnel from theWar Department. About 230 nurses arrived in February, as well as the staffof the first complete hospital, the 4th General. He also urged the WarDepartment to send hospitals, airplane ambulances, dental laboratories,and various medical supplies, particularly dental. He had to meet urgentrequests for anesthetics, blood plasma, quinine, and other medical itemsfor General MacArthur`s hard-pressed forces in the Philippines. Some furtherdrainage of his supplies, and personnel as well, occurred when the taskforce for New Caledonia in the South Pacific Area. sailed from Melbourne,in March; nearly half the nurses accompanied the task force to New Caledonia.7
During the early months of 1942, the medical organization of the fourbase sections initially established, of two additional ones to the southand south- west-Base Section 5 with headquarters at Adelaide and Base Section6 with headquarters at Perth-and finally Base Section 7, established inApril with headquarters at Sydney, was taking shape (map 8). The earlytasks of staff surgeons sent to organize the medical service for the basesections were to set
4 For 2 weeks, from 22 December 1941 to 5 January1942, the designation was simply USFIA (U.S. Forces in Australia).
5 The operational base section established in the NetherlandsEast Indies, with headquarters at Soerabaja, Java, had some medical officersassigned, but with the collapse of the short-lived American- British-Dutch-Australiancommand under Field Marshal Sir Archibald Wavell in Java, Army medicalservice there underwent no further developments.
6 (1) Dairy, Col. Percy J. Carroll, December 1941-30 June 1942.(2) Annual Report, Chief Surgeon, Southwest Pacific Area, 1942. (3) Barnes,Maj. Gen. Julian F.: Report of Organization and Activities of U.S. ArmyForces in Australia, 7 December 1941-30 June 1942 (6 Nov. 1942). [Officialrecord.] (4) Military History of U.S. Army Services of Supply in the SouthwestPacific Area. [Official record.] (5) General Order No. 1, U.S. Army Forcesin Australia, 5 Jan. 1942. (6) Letter, Lt. Col. George W. Rice to Col.John Rogers, 20 Apr. 1942.
7 See footnote 6(2).
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Map 8.- Services of Supply in the SouthwestPacific Area, January 1944
up the surgeon`s office in some building furnished by the Australians,to establish and operate a dispensary, and to plan for hospital constructionand a permanent system of U.S. Army hospitals. Meanwhile, they obtainedmedical supplies from the Australians and arranged for hospitalizationof U.S. Army personnel in Australian hospitals. The number of U.S. Armypatients in these hospitals reached a peak of approximately 16,500 in Mayand June of 1942. Eventually the duties of the Australian base sectionsurgeons were to become the standard ones, but circumstances conspiredto make their tasks rather unorthodox in the early months of 1942. Theyhad to get acquainted with the Commonwealth and State medical agenciesin Australia, as well as with the Australian military medical organization,and local sources of medical
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supplies and facilities. The base section surgeon in Australia neededtalent for diplomacy in borrowing, for improvisation when supplies andfacilities were not to be had, and for adjustment to existing shortages-skills not mentioned in Army field manuals.
Moreover, the circumstances under which base section medical servicedeveloped varied markedly from one region to another. During the severeJapanese air raid on Darwin, where the headquarters of Base Section 1 waslocated, on 19 February 1942 several U.S. Army hospitals, as well as anAustralian hospital ship, were fired upon. U.S. Army troops evacuated Darwinand went southward. For some months all medical supplies and hospitalizationwere furnished by the Australians, and the base section surgeon`s officebecame a leaky tent in the bush. U.S. Army troop areas in Base Section1 were well within the Tropics, and roads and railroads were scarce.
At the large southeastern ports of Brisbane and Melbourne, on the otherhand, it was possible to get off to an earlier start. The Australian populationwas concentrated in the southeastern cities, and communications and facilitiesthere were superior to those in the north. In Brisbane, medical suppliesbrought in by the convoy which had arrived in December were available,and a medical supply depot was set up. The 153d Station Hospital arrived,was
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assigned headquarters at Queensland Agricultural College, and openedin March. In Melbourne, the surgeon of Base Section No. 4 soon had enoughpersonnel to make such orthodox assignments as dental officer and medicalsupply officer, and was able to set up a dispensary, an X-ray service,and an ambulance service for troops in the area. In addition to the basesection surgeon`s office, the offices of the Surgeon, U.S. Army Forcesin Australia, and the surgeon of the U.S. Air Forces in Australia, as wellas the 4th General Hospital, were in Melbourne. For some months, Army medicalservice was concentrated in that area. Base Section 2 in Queensland andBase Section 6 in western Australia each had a station hospital in operationby the end of March.8
In April, when the Allies had lost the Netherlands East Indies and werebottled up in the Philippines, U.S. Army elements in the Southwest Pacificwere reorganized. On the 18th, General MacArthur, who had arrived fromthe Philippines, assumed command of all forces of the United States, theUnited Kingdom, Australia, and the Netherlands in the Southwest Pacific
8 (1) See footnote 6(3), p. 411. (2) PeriodicReports for 1942 of Base Sections 1-7, variously dated. (3) General OrderNo. 38, U.S. Army Forces in Australia, 15 Apr. 1942. (4) Memorandum, Col.Percy J. Carroll, MC, for Civil Control Level of Information, Office ofThe Surgeon General, 15 Dec. 1942, subject: Medical Service in Australia.
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Area. Colonel Carroll continued as Surgeon of the U.S. Army Forces inAustralia, the highest U.S. Army command in the Southwest Pacific Area.With the creation of General MacArthur`s Allied command, the U.S. ArmyForces in Australia became primarily a service command and was supersededby the U.S. Army Services of Supply in July.
With the arrival of a group of medical officers and enlisted men fromthe States for duty in the surgeon`s office in Melbourne in early April,Colonel Carroll was able to construct a medical staff in general accordancewith the table of organization prescribed for the medical section of acommunications zone (T/O 8-500-1, 1 Nov. 1940). Besides his deputy, hehad a colonel of the Dental Corps, a lieutenant colonel of the VeterinaryCorps, and a captain of the Army Nurse Corps to put in charge of the Dental,Veterinary, and Nursing Sections. The remaining sections of the office,each headed by a major of the Medical Corps, were: Hospitalization, Supplyand Fiscal, Per-sonnel, Evacuation, and Sanitation and Vital Statistics.Most members of Colonel Carroll`s staff were reserve officers. At thisearly period his office was more completely staffed than that of Maj. Gen.Paul R. Hawley in the United Kingdom. On 24 April 1942 it included 27 officers.This situation resulted in part from the fact that some personnel alreadyin the area- escapees from the Philippines- were available to fill certainpositions in the surgeon`s office.9
By May, the roster of surgeons for the seven base sections was complete.A dental consultant was assigned to the staff of each, and base sectiondental laboratories were set up to fabricate prosthetic appliances forall units within the base section. In June, a Venereal Disease ControlSection was added to the office of the Surgeon, U.S. Army Forces in Australia,at Melbourne, and shortly afterward a venereal disease control officerwas appointed for each base section headquarters. Thus, by mid-1942 thebase sections were developing fairly full fledged medical offices at headquarters.10
Medical service within the air forces in Australia was also taking shapein the early months of 1942. Air force troops who had left Java and thePhilippines were reorganized in Australia with headquarters at Melbourne.A medical office was placed under the newly created Army Air Services inApril. The major territorial elements established by the air forces inAustralia, corresponding to base sections f or the ground troops, werethe Northeastern Area and the Northwestern Area; each had a surgeon. InSeptember, when air troops in Australia and New Guinea were amalgamatedinto the Fifth Air Force, medical service for air troops began shapingup accordingly.11
9 (1) See footnotes 6(2), 6(3), and 6(4), p.411. (2) General Order No. 1, General Headquarters, Southwest Pacific Area,18 Apr. 1942. (3) General Order No. 43, U.S. Army Forces in Australia,20 Apr. 1942. (4) Office Order No. 5, U.S. Army Forces in Australia, 24Apr. 1942.
10 See footnote 8(2), p. 414.
11 (1) Annual Report, Surgeon, Fifth Air Force, 1942. (2) Memorandum,Maj. W. C. Shamblin, Acting Assistant Adjutant General, Headquarters, U.S.Army Air Services, for Commanding General, Army Air Force, 7 July 1942,subject: Record of U.S. Army Air Services.
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The first 6 months` experience of Army medical officers in Australiabrought to light a problem which was to plague the Medical Department andhigher officers of the War Department, including the Chief of Staff, throughoutthe war, particularly in the last half of 1942 and the first 6 months of1943 a high incidence of malaria in the early stages of the Southwest PacificArea campaigns. Malaria was rare in Australia itself, even in the northerntropical regions where dengue fever was endemic, but by June 1942 about50 percent of the Australian forces around Port Moresby, New Guinea, hadbeen infected with malaria. Australian medical authorities were perturbedover the loss of the Netherlands East Indies as a source of quinine andtheir failure to get a quantity out of Java. At meetings, attended by U.S.Army medical officers, which Australian medical authorities held in Melbournein mid-1942, several aspects of the problem were discussed: the menaceposed by the entry of Allied troops infected with malaria into Australia,measures taken to conserve quinine, and the threat of mosquitoborne diseasesin general to Australia.12
MEDICAL OFFICES AT HEADQUARTERS OF THE THREE MAJOR COMMANDS
Theater organization in the Southwest Pacific Area underwent rapid changesin command structure. It is perhaps impossible to pick any period afterAdvance Base was established in New Guinea in August 1942 during whichthe Army`s many commands in the Southwest Pacific Area remained staticin name, location, and principal mission longer than a month. Many MedicalDepartment officers in the area noted the lack of a stable and centralizedcontrol of medical service as contemplated in Army manuals and pointedto its detrimental effect upon efficient operations. The nature of theconflict- amphibious operations against small islands, and hacking outof small bases in jungles, with enemy troops still at bases in the rear-together with the extended nature of the combat and communications zonesin the area, militated against any concentration of medical administration.Responsibility was thrown upon local commands.
The presence of a staff surgeon at General MacArthur`s Allied headquarters,with undefined duties, caused considerable confusion in 1942 and 1943.Two further developments, uncommon in other theaters of operations, hamperedcentralized control of medical service. One was the lack of any U.S. Armycommand with theaterwide responsibilities, and hence the absence of a true"theater surgeon" from July 1942, when the Services of Supplywas estab-
12 (1) Letter, Gen. George C. Marshall, Chiefof Staff, to Lt. Gen. Dwight D. Eisenhower, Allied Force Headquarters,Algiers, 13 July 1943. (2) Bass, Maj. James W. : Report of Meeting Heldat Royal College of Surgeons, 7 May 1942. [Official record.] (3) Fairley,N. H. : Malaria in South-West Pacific, With Special Reference to its ChemotherapeuticControl. M.J. Australia 2: 145-162, 3 Aug 1946.
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lished, to February 1943. The other was the absence of a surgeon atthe headquarters of the command with theaterwide responsibilities (thereestablished U.S. Army Forces in the Far East) from September 1943 toJanuary 1944, as the result of a shift of all the theater chiefs of servicesto Services of Supply headquarters. In other theaters a chief surgeon wasconsistently assigned to the headquarters of the theater command.
One feature that gave some continuity to administration was the factthat from February 1942 to December 1943, Colonel Carroll headed the medicaloffice which may be termed the theater medical office, since it was consistentlylocated at the highest level of U.S. Army command in the area. However,the shift of this office from Headquarters, U.S. Army Forces in Australia,to the Services of Supply headquarters in July 1942, then to Headquarters,USAFFE (U.S. Army Forces in the Far East), when it was reestablished inFebruary 1943, and once more to Services of Supply headquarters in September1943, led to uncertainty as to the responsibilities and authority of ColonelCarroll and his staff. These shifts in medical organization contrast withthe situation in other theaters where the top command structure remainedrelatively stable for long periods and the same surgeon continued as headof the medical service for a top U.S. Army command headquarters long enoughto acquire status.
Army doctors in this area encountered two essential difficulties inthe face of the periodic absence of any surgeon and medical section ata headquarters with theaterwide authority. One was in the allocation ofmedical personnel, supplies, and facilities- in a region which demandedquantities out of proportion to troop strength- to the areas and commandswhere they were most needed. The other was the problem of effecting measuresto prevent environmental disease throughout all the U.S. Army commandsin the theater.
An official history produced under General MacArthur`s auspices accuratelysums up the environmental threats to the health of troops in New Guinea:
The penetrating, energy-sapping heat was accompanied byintense humidity and frequent torrential rains that defy description. Healthconditions were among the worst in the world. The incidence of malariacould only be reduced by the most rigid and irksome discipline and eventhen the dreadful disease took a heavy toll. Dengue fever was common whilethe deadly blackwater fever, though not so prevalent, was no less an adversary.Bacillary and amoebic dysentery were both forbidding possibilities, andtropical ulcers, easily formed from the slightest scratch, were difficultto cure. Scrub typhus, ringworm, hookworm, and yaws all awaited the carelesssoldier. Millions of insects abounded everywhere. * * * Disease was anunrelenting foe.13
The climate and terrain of New Guinea called for strict applicationof preventive measures on a theaterwide scale to prevent high incidenceof disease among troops. The effort to prevent tropical disease, the greatestsingle menace
13 Historical Report, Allied Operations inSouthwest Pacific Area. Vol. I (Supplement), MacArthur in Japan, The Occupation.[Official record, Office of the Chief of Military History.]
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to maintaining an effective fighting force in the Southwest Pacific,almost constitutes a unifying theme for the entire history of Army medicalservice in that region during World War II. Surgeons at many levels ofcommand laid heavy emphasis on the urgent need for control of insectbornediseases; they frequently commented upon the lack of centralized directionof efforts at control during 1942 and 1943.
A chronological account of developments will throw light on the effectof the changing command structure upon medical administration. From December1941 to July 1942, U.S. Forces in Australia and its successor, U.S. ArmyForces in Australia, acted as a combined theater and Services of Supplycommand. In July 1942, when USASOS (U.S. Army Services of Supply) was establishedon the eve of the Papuan Campaign, Colonel Carroll was transferred to theMelbourne headquarters of the new command, along with the rest of the staffof the now defunct Headquarters, U.S. Army Forces in Australia. From July1942 to February 1943, no U.S. Army headquarters with administrative authorityover all U.S. Army elements in the area- ground, air, and service- existed.The functions normally assigned to a theater command were split betweenGeneral MacArthur`s Allied command- General Headquarters, Southwest PacificArea- and USASOS. Since General Headquarters at Brisbane at first had nosurgeon assigned to it, Colonel Carroll was the surgeon of highest positionin the theater, but USASOS headquarters could not issue medical directivesto the Army`s tactical ground and air force elements, since tactical operationswere the responsibilities of GHQ, Southwest Pacific Area (exercised throughAllied Land Forces, Allied Air Forces, and Allied Naval Forces). Its directiveswent only to its area commands- the Australian Base Sections and the developingNew Guinea bases.
In September, Colonel Rice was made Surgeon, General Headquarters, possiblyin recognition of the distance of General Headquarters from Services ofSupply headquarters (GHQ had moved to Brisbane, while USASOS remained behindin Melbourne) and continued in that position until the fall of 1944. Heaccompanied a forward echelon of General Headquarters which moved to PortMoresby for the New Guinea campaign and to sites further forward as theoffensive progressed. As surgeon for the Allied command, his duties seemto have been primarily those of coordinating the medical activities ofthe American Army with those of the Australian Army and other elementsof the Allied forces and of drawing up medical plans for forward movesof Allied task forces, which the medical sections of USAFFE and USASOSrefined and elaborated. Apparently GHQ never issued any written delineationof his duties or authority. In accordance with General MacArthur`s insistencethat his general and special staff sections remain small in order to keephis headquarters mobile, Colonel Rice never had any
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staff of medical officers, but only one or two enlisted men as assistants.He operated largely through G-4.14
In February 1943, shortly after the New Guinea campaign had got underway, USAFFE was established in Australia. General MacArthur was in commandof it as well as of the Allied command, General Headquarters, SouthwestPacific Area, to which it was subordinate; the headquarters of both commandswere in Brisbane (fig. 94). While General Headquarters continued to directthe operations of combat forces, USAFFE served as the higher administrativeheadquarters above USASOS, the Sixth U.S. Army, and the Fifth Air Force.It supervised the administrative organization of troops, the training conductedin the theater, the provision and adoption of equipment, and the movementof troops in other than the combat zone. Thus the responsibilities normallyassigned to a theater command were divided between GHQ and USASOS. TheU.S. Army Services of Supply, with headquarters at Sydney since September1942, became the typical Services of Supply in a theater of operations,with its responsibility for administration of medical service limited tothat within its own area commands. As the chiefs of technical serviceshitherto assigned to the Services of Supply were at this date transferredto the Brisbane headquarters of the new command, Colonel Carroll
14 (1) Rice, Maj. Gen. George W. : Accountof Activities in the Southwest Pacific Area, attached to 1st indorsement,9 Mar. 1950, to letter, Editor, Historical Division, Office of The SurgeonGeneral, to General Rice, 2 Feb. 1950. (2) General Order No. 36, GeneralHeadquarters, Southwest Pacific Area, 26 Sept. 1942. (3) Memorandum, Col.W. L. Wilson, for The Surgeon General, 20 Oct. 1943, subject: Visit toSouthwest Pacific Area. (4), Letter, Col. John F. Bohlender, MC, to theEditor, Historical Division, Office of The Surgeon General, 26 Feb. 1951.(5) Interview, Col. Gottlieb Orth, MC, 5 Mar. 1952. (6) Letter, Maj. Gen.George W. Rice, to the Editor, Historical Division, Office of The SurgeonGeneral, 19 June 1951. (7) Personal notebook, Col. Maurice C. Pincoffs,MC. (8) Compare appendix B, p. 562.
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became Chief Surgeon, USAFFE, and a few of his staff were shifted withhim. Col. Frederick J. Petters, MC, became Surgeon, Services of Supply,at this date. Most officers of the former Services of Supply medical sectionremained at USASOS headquarters under the new chief.
General Headquarters continued to exercise control over strategic andtactical operations of elements of the Allied armies, which still includedUnited States, Australian, British, and Dutch units. This command madethe requests to the U.S. War Department (and to the Allied Governments)for major combat and service units necessary for Allied operations, establishedpriorities for supplies for strategic and tactical operations, and formulatedpolicies governing the command`s relations with the various Allied forcesand Allied governmental agencies. Colonel Rice continued as the medicalrepresentative at General Headquarters. 15
During the period from February to September 1943, the presence of aSurgeon and a medical section at U.S. Army Forces in the Far East, whichcould issue medical directives to the Sixth U.S. Army and Fifth Air Force,resulted in more thoroughgoing centralized control of medical service thanhad prevailed since July of the previous year. Nevertheless, some difficultyresulted from the continued assignment to the Services of Supply of certainfunctions, which needed to be exercised on a theaterwide basis. For a fewmonths after the theater command and its medical section were set up, thestatistical section in the office of the Surgeon, USASOS (Colonel Petters),experienced difficulty in obtaining statistics from the Sixth U.S. Armyand Fifth Air Force, and later from the 14th Antiaircraft Command. In orderto establish the authority of the Surgeon, USASOS, to obtain statisticalreports from all Army elements in the Southwest Pacific Area, General MacArthurhad to issue a special directive to the Commanding General, USASOS, establishingit as the Central Medical Records Office. With this special authorization,the Central Medical Records Office, USASOS, was able thereafter to obtainand consolidate medical reports from all Army elements in the SouthwestPacific Area. 16
During the period from February to September 1943, the Chief Surgeon,USAFFE, had a small medical office, including a chief of professional services,Col. Maurice C. Pincoffs, MC (fig. 95), formerly commanding officer ofthe
15 Staff Memorandum No. 3, General Headquarters,U.S. Army Forces in the Far East, 19 Feb. 1943, subject: Allocation ofAdministrative Functions in USAFFE. (2) USAFFE Letter, 26 Feb. 1943, subject:Allocation of Administrative Functions within USAFFE. (3) Memorandum, theAdjutant General, Headquarters, U.S. Army Forces in the Far East, for CommandingGenerals, Sixth U.S. Army, Fifth Air Force, and U.S. Army Services of Supply,26 Feb. 1943. (4) See footnotes 6(4), p. 411; and 14(3), p. 419. (5) Orderof Battle, U.S. Army in World War II, The War Against Japan, Command, Administration,and Supply Organization. [Official record, Office of the Chief of MilitaryHistory.] (6) Letter, Chief Surgeon, U.S. Army Forces in The Far East,to The Surgeon General, 11 Mar. 1943. (7) General Order No. 1, U.S. ArmyForces in the Far East, 26 Feb. 1943. (8) General Order No. 11, U.S. ArmyServices of Supply, 23 Feb. 1943.
16 Memorandum, Preventive Medicine Division, U.S. Army Servicesof Supply, to Historian, U.S. Army Services of Supply, 10 Jan. 1944, subject:Relationships Between the Preventive Medicine Division, Surgeon`s Office,USASOS, Sections, SOS, and Other Commands in the Southwest Pacific Area.
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42d General Hospital; the theater malariologist; a lieutenant colonelof the Veterinary Corps; a Medical Corps major in charge of hospitalizationand evacuation; and a captain of the Medical Administrative Corps in chargeof administrative matters. The rest of the members of the usual staff medicalsection, including the chief consultants in surgery, neuropsychiatry, andorthopedic surgery, were in the medical section of the Services of Supplyin Sydney. Various observers emphasized the lack of a preventive medicinedivision, and of a consultants division, at the higher headquarters asserious defects in medical organization. Even in the medical section ofthe Services of Supply, where several officers were assigned to variousfunctions in the field of preventive medicine (for example, venereal diseasecontrol), these functions were not coordinated under a single chief ofpreventive medicine until late in 1943. This internal organizational defectwas responsible, according to Lt. Col. G. L. Orth, MC (fig. 96), assistanttheater malariologist, for the deficiencies in unit equipment for the chlorinationof water supply. No group with a comprehensive program for enlisting thecooperation of the Engineers in ordering the proper equipment existed inthe office of the USASOS surgeon.
The Chief Surgeon, USAFFE, noted problems posed by the position of consultantsin the theater setup. A consultants section developed in Colonel Carroll`soffice after July 1942, when a specialist in surgery and one in neuropsychiatrywere sent to the area by the Surgeon General`s Office. Most full-
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time consultants (that is, those who were not assigned to hospitalswith additional duties as consultants) were consistently assigned to USASOSheadquarters; hence they lacked authority to inspect hospitals of the SixthU.S. Army and the Fifth Air Force. Efforts which Colonel Carroll made totransfer the consultants to Headquarters, USAFFE, apparently met with arefusal to increase the number of Medical Department officers assignedto the higher headquarters. A duplicate assignment of consultants to bothUSAFFE and USASOS was considered undesirable, since it would have wastedscarce, highly specialized personnel. The Chief Surgeon, USAFFE, thereforeadvocated that consultants be placed on temporary duty with Headquarters,USAFFE, whenever it was desired that they inspect elements of the SixthU.S. Army and the Fifth Air Force. On the other hand, he sometimes placedconsultants assigned to Headquarters, USAFFE, on temporary duty with Headquarters,USASOS; the latter operated most of the large fixed hospitals needing consultants`advice, and consultants found that they could work more effectively whenthey were in close proximity. 17
17 (1) Check Sheet, Monthly Report, Chief Surgeon,U.S. Army Forces in the Far East, March 1943. (2) Memorandum, Chief Surgeon,USAFFE, for Deputy Chief of Staff, 31 May 1943. (3) See footnote 14(7),p. 419. (4) Interview, Lt. Col. G. L. Orth, MC, 12 June 1947. (5) AnnualReport, Chief Surgeon, Southwest Pacific Area, 1942, and supplement (1Jan.-28 Feb. 1943).
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In the Southwest Pacific Area divergent views were voiced as to the,true functions of consultants: for example, whether or not they shouldbe used farther forward and whether or not they should make inspectionsor restrict themselves to a consultative function. References by ColonelCarroll to "my veterinary consultant," to the chief of the DentalDivision, USASOS, as "chief dental consultant," and to officersin similar positions at the bases as "base dental consultants"show a loose use of the term "consultant" in the Southwest PacificArea in 1943 and 1944 that apparently resulted from lack of contact withthe Surgeon General`s Office.
In addition to the uncertainty as to the real purpose of the consultantsystem, several other factors militated against the establishment of afull-fledged consultant system comparable to that in the European theater,where as early as the end of 1942, 10 consultants representing a numberof subspecialities were on full-time duty in the theater surgeon`s office.Lack of a sufficient officer allotment in the office of the Surgeon, Servicesof Supply, Southwest Pacific Area, limited its roster to consultants inthe three major specialities of surgery, neuropsychiatry, and medicine(assigned in late 1943), and a consultant in orthopedic surgery. Only thechief surgical, medical, and neuropsychiatric consultants were sent tothe Southwest Pacific Area by the Surgeon General`s Office. A number ofofficers on duty with the general hospitals at the New Guinea bases were"attached" to the office of the Surgeon, SOS, as consultantsbut remained on duty at hospitals in the bases. Although senior consultantsof the office of the Surgeon, USASOS, spent weeks at a stretch visitinghospital after hospital in the field, the distances of the New Guinea basesfrom the office (located at Sydney throughout 1943), together with thedifficulties of travel, precluded complete coverage of units scatteredwidely throughout Australia and New Guinea. Some observers considered linecommanders in the South-west Pacific insufficiently receptive to the servicesof consultants, while others found the chief surgeons of USASOS and USAFFEnot fully informed as to their most effective use. Inadequacy in numbers,assignment at the Services of Supply level, lack of a clear concept asto their most effective employment, and the difficulties of travel overgreat distances, all combined to limit the effective use of consultantsin the Southwest Pacific Area. 18
In September 1943 the special staff sections, including the medicalsection of the U.S. Army Forces in the Far East, were returned to the Servicesof
18 (1) Hillman, Brig. Gen. C. C.: Report ofObservations of Medical Service in the Southwest Pacific Area and the SouthPacific Area, 12 July 1943. (2) Morgan, Brig. Gen. Hugh J.: Comments andRecommendations, Medical Departments, U.S. Army Forces in the Far East,12 Aug. 1943. (3) Letter, Surgeon, General Headquarters, Southwest PacificArea, to Col. Maurice C. Pincoffs, MC, 16 Sept. 1943. (4) Memorandum, Brig.Gen. Fred W. Rankin, for The Surgeon General, 2 Nov. 1943. subject: Remarkson Recent Trip Accompanying Senatorial Party. (5) See footnote 14(3), p.419. (6) Memorandum, Col. W. L. Wilson, MC, for Executive Officer, Officeof The Surgeon General, 1 Nov. 1943, subject: Visit to the Southwest PacificArea. (7) Memorandum, Lt. Col. G. S. Littell, MC, for Col. Arthur B. Welsh,MC, 31 Dec. 1943, subject: Report on Medical Department Activities in theSouthwest Pacific Area. (8) Memorandum, Surgeon, Services of Supply, forChief Surgeon, U.S. Army Forces in the Far East, 10 Sept. 1943. (9) AnnualReport, Chief Surgeon, U.S. Army Services of Supply, 1943.
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Supply. Colonel Carroll, once more Chief Surgeon, USASOS, headed whatwas still the top medical office in the Southwest Pacific Area, althoughit was under the Services of Supply. Thus from September 1943 to the endof the year, there was no surgeon or medical office at Headquarters, USAFFE,although a lieutenant colonel of the Medical Corps was assigned to G-4,USAFFE, for liaison with the Services of Supply. Colonel Carroll was againat the headquarters which could not issue medical directives to the SixthU.S. Army and Fifth Air Force. 19
During 1942 and 1943, confusion arose as to the responsibilities ofGeneral Headquarters versus those of the U.S. Army Forces in the Far Eastwith respect to Medical Department tactical units. Requisitions for unitsfrom the United States could originate with the Surgeon, GHQ, SWPA, orthe surgeon at theater headquarters. If they originated with the latter,they had to go through G-4, USAFFE, to G-4, GHQ, and thence through thesurgeon at General Headquarters before they were forwarded to the War Department.The existence of a surgeon at the higher headquarters, General Headquarters,above the level of the medical office which had the major responsibilityfor planning, led to some confusion in case of disagreement as to the typesor num-bers of units needed. In this area, a good many changes were madein the composition of the standard Medical Department units to fit theneeds of task forces created for taking small coastal areas and islands.The character of combat in the Southwest Pacific Area- amphibious landingoperations and jungle fighting with limited objectives rather than theopen land warfare stressed in the Army schools in the prewar period- calledfor specially designed task forces. It led likewise to changes in the compositionof some Medical Department units and to the use of units at different echelonsin the chain of evacuation than those for which they had been designed.Before the close of 1942, Colonel Carroll had developed 27 small portablehospitals for use by the combat forces along the New Guinea trails duringthe initial stages of invasion. Their personnel were taken from the staffsof general, station, evacuation, and other hospital units. Colonel Carrollnot only developed some new mobile units, including laboratory and pharmacyunits, but broke up some standard units and directed some to uses otherthan those for which they were designed. Mobile hospitals were commonlysubstituted for fixed installations.
The exercise of authority over the movements of Medical Department units,as well as their composition, by General Headquarters put special difficultyin the way of centralized control of medical service in 1943. At intervals,General Headquarters issued orders to theater or Services of Supply headquartersto assign specific medical units to task forces. In the fall of 1943, forinstance, it ordered, without consultation with the theater malariologist,the assignment of certain malaria control and survey units to the AlamoForce, in addition to ones already allotted by the malariologist. Colonel
19 (1) Staff Memorandum No. 74, U.S. Army Forcesin the Middle East, 27 Sept. 1943. (2) Staff Memorandum No. 155, U.S. ArmyServices of Supply, 27 Sept. 1943.
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Carroll pointed out that decision as to the proper assignment of unitsto areas where they were most needed should be made only by the theatermalariologist, who maintained a file of information on the current locationof the units and on rates of malaria incidence in the various regions andislands. About the same date, the Surgeon, USASOS (Colonel Petters), notedcases of arbitrary diversion by General Headquarters of hospital unitsto various task forces in New Guinea without reference to the Servicesof Supply. All hospital units, mobile as well as fixed, in the theaterwere under the aegis of the Services of Supply while they were being trainedand equipped. Colonel Petters noted that other factors besides the immediateneeds of the task force should be taken into consideration whenever unitswere assigned in order to have an effective distribution of hospitals inaccord with needs: the percentage of bed capacity available to the Servicesof Supply, the areas of greater patient load, and similar factors. 20
During 1942 and 1943, reports on difficulties with medical administrationin the Southwest Pacific Area. reached the Surgeon General`s Office from,a number of sources, both officers serving in the area and those sent thereon special missions. They emphasized several theaterwide administrativeproblems: insufficient number of consultants, nutritionists, and malariacontrol and survey units; inadequate training in malaria control of troopssent from the United States; insufficient beds in fixed hospitals in proportionto troop strength; and the poor quality and small number of Medical Departmentpersonnel trained in sanitation and tropical disease who were qualifiedfor administrative posts- for example, base section surgeons. Colonel Carrollnoted the lack of men qualified to fill key positions. The chief targetof criticism was the organizational scheme. The multiplicity of commandshad resulted in delay on decisions, in increase in the number of nonmedicalofficers through whose hands proposed directives must pass, and some medicaldirectives at variance with those of Colonel Carroll based on divergentviews of surgeons of many commands. Some observers thought that the postsof Surgeon, GHQ, and Surgeon, USAFFE, should be held by the same man. Criticsagreed that no unified control over medical service existed and that asingle highly placed Medical Department officer in full control was ofvital importance. 21
In January 1944, Brig. Gen. (later Maj. Gen.) Guy B. Denit, MC (fig.97), formerly surgeon of the Atlantic Base Section in North Africa, becamesimultaneously Chief Surgeon, U.S. Army Forces in the Far East, and ChiefSur-
20 (1) Letters, Col. George W. Rice, MC, toCol. Percy J. Carroll, MC, 13 Nov. 1942, 6 Jan. 1943, 12 Jan. 1943. (2)Letter, Col. George W. Rice, MC, to Col. John A. Rogers, MC, Office ofThe Surgeon General, 31 Jan. 1943. (3) Letter, Col. George W. Rice, MC,to Col. Maurice C. Pincoffs, MC, 16 Sept. 1943. (4) Letter, Col. GeorgeW. Rice, MC, to The Surgeon General, 14 July 1943. (5) Memorandum, ChiefSurgeon, U.S. Army Services of Supply, for Deputy Chief of Staff, 22 Sept.1943. (6) Memorandum, Surgeon, U.S. Army Services of Supply, for G-3, 24Sept. 1943. (7) Interview, Brig. Gen. George W. Rice, 13 July 1951.
21 (1) Letters, The Surgeon General, to the Chief Surgeon, U.S.Army Services of Supply, 22 Jan. and 12 Feb. 1944, and replies, 16 and26 Feb. 1944. (2) Letter, Chief Surgeon, U.S. Army Forces in the Far East,to The Surgeon General, 11 Mar. 1943. (3) For reflections of confusionin medical administration, see documents cited in footnote 14, p. 419.
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geon, U.S. Army Services of Supply. From then on, control over medicalservice was somewhat more centralized, although continuation of the theater`spolicy of placing most of General Denit`s staff (as well as the staffsof other chiefs of technical services) at Services of Supply headquartershampered centralized control to some extent. The role of the Surgeon, GHQ,continued to be a somewhat ambiguous one. 22
General Denit and The Surgeon General (General Kirk) made a concertedeffort in 1944 and 1945 to build up a stronger medical section for administeringthe medical affairs of the Southwest Pacific Area, an effort that resultedin exercise of somewhat more influence by the Surgeon General`s Officein the selection of General Denit`s staff. Efforts to raise rank and increasenumbers, on the other hand, ran into a good deal of opposition. When GeneralKirk attempted to elevate the rank of General Denit`s staff dental officer(as well as that of his counterpart in each of the major theaters) to brigadiergeneral, General Denit found himself unable to have the dental officerassigned to theater headquarters. He noted that any recommendation forpromoting the dental Surgeon at USASOS headquarters to brigadier generalwould arouse resent-
22 (1) General Order No. 4, U.S. Army Forcesin the Far East, 17 Jan. 1944. (2) General Order No. 18, U.S. Army Servicesof Supply, 30 Jan. 1944.
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ment among some of the chiefs of technical services who were only colonels,as well as among the surgeons (also only colonels) of such commands asthe Sixth U.S. Army and Fifth Air Force. When General Kirk wanted to assignhis chief consultant in medicine, a brigadier general, who had requestedoversea duty, to General Denit`s office, the latter objected on the groundthat the senior officer at each headquarters in the Southwest Pacific Areaautomatically became the chief of his technical service; that is, he wouldhave supplanted General Denit. General Denit stated that he could not "sell"the command on another general officer for any of the headquarters there.23
Throughout the period under discussion (mid-1942 to August 1944), thenumber of Medical Department officers in the medical sections of Servicesof Supply and of theater headquarters did not vary greatly in spite ofa steady increase in troop strength, with concomitant increases in MedicalDepartment strength, and in combat activity. The total (including officersof the Army Nurse Corps) in the Services of Supply medical section, thelarger of the two, apparently never amounted to more than 35. The sizeof this medical section, plus that of the medical section at Headquarters,USAFFE (during the time when such a section existed), may justifiably becompared with the office of "theater surgeon" in other theaters.Apparently no more than 9 or 10 Medical Department officers were ever assignedto Headquarters, USAFFE. Thus de- spite an increase in troop strength (from105,295 in September 1942 to 664,508 at the end of July 1944), the topmedical office in the Southwest Pacific Area never underwent the steadygrowth in officer personnel that the theater medical section of the NorthAfrican and European theaters experienced. The rank of officers headingmajor organizational elements in the Services of Supply medical sectionalso remained low compared with that of some other theaters. In July 1944,for instance, only five colonels were assigned to that office, most branchesof the medical section being headed by lower ranking officers. 24
SERVICES OF SUPPLY IN AUSTRALIA AND NEW GUINEA
In September 1942, Headquarters, U.S. Army Services of Supply, movedfrom Melbourne to Sydney, following General MacArthur`s move of GeneralHeadquarters from Melbourne northward to Brisbane. From its Sydney headquarters, where it remained for a year, the Services of Supply operatedthe base sections in Australia and bases newly established with the advanceof troops westward through New Guinea. Some additional Medical Departmentunits arrived in the theater during that year; hospital trains were obtainedfrom the
23 (1) Letter, The Surgeon General, to Surgeon,U.S. Army Forces in the Far East, 1 Apr. 1944, and reply, 17 Apr. 1944.(2) Letter, The Surgeon General, to Surgeon, United States Army Forcesin the Far East, 26 Apr. 1944, and reply, 25 May 1944.
24 (1) Lists of personnel in the Office of the Chief Surgeon,U.S. Army Services of Supply, 14 Nov. 1942 and 6 Oct. 1943. (2) OfficeMemorandum No. 3, Chief Surgeon, Headquarters, U.S. Army Services of Supply,5 Mar. 1943. (3) Office Memorandum No. 1, Chief Surgeon, Headquarters,U.S. Army Services of Supply, 3 Mar. 1944. (4) See footnote 17(l), p. 422.(5) Letter, The Surgeon General, to Surgeon, General Headquarters, SouthwestPacific Area, 2 Nov. 1943. (6) Memorandum, Assistant Chief, Personnel Section,for Surgeon, United States Army Services of Supply, 8 Oct. 1943.
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Australians to take care of evacuation among the base sections in Australia,and ships were prepared to receive patients to be transferred from oneNew Guinea base to another.
By the end of July 1943, USASOS still had only four general hospitals(two of 1,000 beds and two of 500 beds), all in Australia, but 26 stationhospitals (ranging from 50 to 500 beds each) were serving in the Australianbase sections and at the New Guinea bases. The platoons of two medicalsupply depots were also distributed among the base sections and bases,while detachments of two medical laboratories served in several. 25
The medical section at Services of Supply headquarters faced the difficultyof maintaining control over medical installations and units dispersed alonga single line- from southeastern Australia along the northern coast ofNew Guinea and later to the Philippines- rather than a true zone of communications.It had to modify the standard composition and equipment of units to fitjungle, mountain, and amphibious warfare. Far removed from the San FranciscoPort of Embarkation (about twice as far as its counterparts in the Europeanand Mediterranean theaters were from New York), it was beset with difficultiesof communication and transport. Because of shortages of manpower and materials,USASOS made but slow progress in 1943 in constructing buildings for hospitals.
Shortly before the transfer of the Surgeon, USAFFE, to the Servicesof Supply in September 1943, USASOS headquarters was moved again, thistime from Sydney to Brisbane, where Headquarters, USAFFE, was already located(map 8). A rear echelon of USASOS, including a medical office, remainedbehind in Sydney for about a month to handle local procurement of equipmentand supplies in Australia and Tasmania. Headquarters, USASOS, stayed atBrisbane until near the close of the New Guinea campaign (31 December 1944).Its advance headquarters kept in close proximity to the advance echelonsof General Headquarters; of Headquarters, USAFFE; and of the Sixth U.S.Army, Fifth Air Force, and 14th Antiaircraft Command. In November 1944it shifted from Brisbane to Hollandia (Base G), New Guinea; in February1945 to Tacloban, Leyte (Base K); and in April 1945 to Manila. Its frequentmoves and concomitant splits into an advance and a rear echelon led tosegmentation of its headquarters medical office. The Chief Surgeon, USASOS(who after January 1944 was also Chief Surgeon, USAFFE), seems usuallyto have headed the small group of Medical Department officers familiarwith problems of hospitalization, evacuation, and medical supply who wentforward with the advance echelon. As the advance echelon had charge ofthe so called "ADSOS Fleet," consisting of ships operating interportservice at the forward bases, medical personnel assigned to the advanceechelon, as well as those at the forward bases in New Guinea, had a gooddeal of work to do in inspecting vessels to assure that sanitary conditionswere satisfactory and that
25 Civil Control Level of Information Reportfor 16-31 July 1943, Headquarters, U.S. Army Services of Supply.
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their safety equipment was in good order. The Deputy Chief Surgeon,USASOS, was in charge of the medical section at the main, or rear, headquartersof the Services of Supply during the periods when the advance echelon wassplit off from it. The frequent moves created a special problem in theadministration of medical records. The large Central Medical Records Officeat Services of Supply headquarters relied heavily upon civilian employeesas a means of releasing soldiers for duty on the New Guinea front. Witheach move, numbers of civilian personnel had to be replaced and new employeestrained. 26
Australian Base Sections
Until late in 1943, the principal areas of U.S. Army medical work inAustralia continued to be Base Sections 1, 2, 3, 4, and 7 (map 8). Theoriginal Base Sections 5 and 6, in southwestern Australia, were disbandedabout the end of 1942, because few U.S. Army troops had ever been stationedin that area. In September 1943, however, the northward movement of troopstowards New Guinea and the concentration of medical units and installationsaround Cairns, led to the establishment of a new Base Section 5, by dividingBase Section 2. By August 1944, the decline in Australian base sectionshad set in, and Base Sections 1 and 4 had been disbanded.
The headquarters of the Australian base sections contained at the peakof their development in 1943 about 10 or 12 Medical Department officerseach, including a dental officer, a veterinary officer, a venereal diseasecontrol officer, and a chief nurse. Officers assigned to other functions(medical supply, hospitalization, evacuation, and so forth) were oftenformally assigned to Medical Department installations in the vicinity-most commonly general hospitals. About mid-1943, Base Sections 2, 3, and7 were each assigned a newly arrived food and nutrition officer. Thesemen investigated the conditions under which food supply was procured inthe base section, as well as the methods of handling it and issuing itto troops, analyzed menus, and inspected messes. Both the veterinary andvenereal disease control officers worked in close cooperation with theappropriate Australian civil and military authorities. Dental clinics andlaboratories and medical supply depots were established for each base section.Very few base or base section surgeons appear to have appointed a preventivemedicine officer to coordinate the several activities in this field (sanitation,venereal disease control, medical inspection, malaria control, and so forth)under a single head, officers being assigned to these functions individually.One observer attributed the lack of coordination of preventive medicine.
26 (1) Interview, 2nd Lt. C. W. Wilson, MAC,5 Dec. 1945. (2) Letter, Headquarters, U.S. Army Services of Supply, toCommanding General, Advance Echelon, Services of Supply; Commanders ofSections, Bases, and so forth, 5 Feb. 1944, subject: Water Transportation,Control, and Responsi-bilities. (3) Annual Report, Chief Surgeon, U.S.Army Services of Supply, 1943. (4) Memorandum, Surgeon, U.S. Army Servicesof Supply, for Deputy Chief of Staff, 31 May 1943, subject: Movement ofMedical Records Section.
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functions of the surgeons` offices of subordinate commands of the Servicesof Supply to a similar lack in the office, of the Surgeon, USASOS. 27
After October 1943, some of the Australian base sections (as well aslater-established bases in New Guinea and the Philippines) were organizedin accordance with a scheme advocated by Headquarters, Services of Supply,SWPA. Three commands were established at a base section or base: A servicecommand, a port command, and an area command. Theoretically, a surgeonwas assigned to each, but in a number of instances one man held two ofthese assignments. In some cases, the commanding officer of a hospitalacted as port surgeon or area surgeon in addition to his hospital duties;or one officer might act as port surgeon and at the same time have chargeof the work in sanitation and vital statistics for the base section. Thesedual assignments were frequently assigned to lack of personnel, but presumablythe duties of a surgeon in such a restricted command were often insufficientto warrant an officer`s full-time duty.
The surgeon of the base service command (which had under it the basechemical service, ordnance service, and so forth, as well as the base medicalservice), had the usual base surgeon`s duties with respect to medical supply,hospitalization, and evacuation, and the usual base medical personnel wereassigned to his office. The port surgeon inspected Army-controlled vesselsfor sanitary conditions and operated a port dispensary. At the port ofBrisbane, for instance, where many ships moved in and out during 1943,60 ships carrying troops to the advanced base in New Guinea were inspectedby the port surgeon`s office in the last 3 months of the year. The areacommand controlled all personnel not assigned to the service command orto the port command. These were chiefly personnel temporarily assignedto the base while staging or in transit. The area command surgeon workedout an areawide system of garbage removal, inspected kitchens and drainage,and cooperated with unit commanders of ground and air forces in the commoneffort. 28
Some common features and problems, as well as some significant variationsin medical administration, in the Australian base sections may be noted.Malaria was indigenous only in the tropical regions of northern Australia(Base Sections 1, 2, and 5), but in late 1942 and early 1943, medical officersin Base Sections 3 and 4 were confronted with the problem of preventingthe introduction of malaria into the southeast. During that period themalaria-ridden troops of the 1st U.S. Marine Division arrived from Guadalcanaland those of the 32d Division from New Guinea for hospitalization and convalescence,presenting the possibility of spread of the disease to nonmalarious areas.Malaria control at Brisbane and Melbourne was, like the control of venerealdisease,
27 (1) Memorandum, Col. Percy J. Carroll, MC,for The Surgeon General, 29 Aug. 1942, subject: Medical Services in Australia.(2) Annual Report, Chief Surgeon, Southwest Pacific Area, 1942. (3) RegulationNo. 1-10, U.S. Army Services of Supply, 13 Nov. 1942, subject: The Mission,Organization, and Methods of Operation of Base Sections. (4) See footnotes15(4), p. 420; 16, p. 420; and 17 (4), p. 422.
28 See quarterly reports of the various Southwest Pacific Areabase sections for 1943.
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a problem common to the large ports; it called for close liaison betweenU.S. Army doctors and Australian authorities, as well as close cooperationof base section medical officers with surgeons of the divisional units.In April 1943, a malaria control school was organized in Brisbane for medicalofficers of the 32d Division. The course, given to line officers as wellas medical officers, consisted of lectures at the 42d General Hospital,work at the 3d Medical Laboratory, and practical field exercises in malariasurvey and control work at an Army camp. Nearly a thousand officers, andmany nurses and enlisted men, received training at the school before itwas discontinued in July 1944.
Melbourne, Sydney, and Brisbane were the sites of the four general hospitals(two were in the Brisbane area) which served evacuees from New Guinea during1943. The large eastern ports of Australia had responsibility for the initialreception of many Medical Department units, including dispensaries, varioustypes of hospitals, medical supply depots, and medical lab oratories arrivingfrom the United States. Throughout 1943, the port of Brisbane (Base Section3) received the bulk of medical supplies and was the chief distributionpoint for all parts of the Southwest Pacific Area. The base section surgeonhad a relatively large office of 35 officers, 35 enlisted men, and 25 civilians.Its work included supervision of an industrial health program for Australiansemployed by the U.S. Army in the base section. Closely resembling similarwork in service commands in the United States, this program covered about10,000 employees by the end of 1943. Medical examinations were given toprospective employees, industrial health inspections were made of plantsoperated by the U.S. Army, and Australian employees were treated in Armydispensaries and hospitals.
The medical situation in the tropical, undeveloped Northern Territory(Base Section 1) differed greatly from that in eastern Australia. Herethe base section surgeon was located under tentage in "the bush"south of Darwin after the Japanese bombed Darwin early in 1942 until April1943. He supervised the medical service at five troop locations scatteredalong the thousand mile stretch between Darwin in the north and Alice Springsin the south. 29
The New Guinea Bases
The establishment of U.S. Advance Base at Port Moresby, New Guinea,in August 1942 was the first move in the extension of the Services of Supplyorganization to New Guinea; during the succeeding 2 years, seven bases,preceded by a number of subbases, were developed. By June of 1943, fourso-
29 (1) Quarterly Reports, all Australian BaseSections, through 3d Quarter, 1944. (2) See footnotes 14(6), p. 419; and16, p. 420. (3) Memorandum, Surgeon, Base Section 3, for The Surgeon General,7 July 1944, subject: History of Base Section 3 Malaria Control School.(4) Letter, Col. C. R. Mitchell, to Dr. Maurice Pincoffs, 9 Dec. 1946.(5) Memorandum, Commanding General, U.S. Army Services of Supply, for Chiefsof General and Special Staff Sections, no date, subject: Plan for Organizationof Base Section, USASOS and Reduction of Headquarters, USASOS. (6) Minutes,Conference of General and Special Staff Sections, Headquarters, U.S. ArmyServices of Supply, 2 May 1944. (7) Monthly Historical Summary, MedicalSection, Base Section, U.S. Army Services of Supply, June 1944.(8) MedicalHistory, 32d Infantry Division, 1 Jan.-30 June 1943.
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Called "advance subbases," three of which were forerunnersof three New Guinea bases, Bases A, B, and D 30 (map 8), hadbeen established under the control of U.S. Advance Base. Col. J. M. Blank,MC (fig. 98), with three other Medical Corps officers, one Medical AdministrativeCorps officer, and eight enlisted men undertook the task of setting upthe office of the Surgeon, Advance Base, at Port Moresby in September 1942.Small U.S. Army tactical hospitals were already serving troops close tothe front, but Colonel Blank`s office was the first element of the Servicesof Supply medical organization to be established there. As a result ofJapanese bombing around Port Moresby, buildings were ramshackled, and theoffice used furniture improvised from empty ammunition cases and packingcrates. The surgeon`s staff faced many difficult tasks during the earlymonths: inspection of canned food in ration dumps, investigation of watersupply, arranging storage for medical supplies shipped from Brisbane andTownsville, and delivery of medical supplies and hospital units and theirequipment to forward areas by ship, plane, and parachute during the OwenStanley-Buna campaign. Medical Department officers of Advance Base, surgeonsof the 32d Division and Fifth Air Force, and medical
30 Advance Subbase C on Goodenough Island lastedonly from April to July 1943 and never developed into a base.
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officers of the Australian forces cooperated in planning measures toprevent insectborne diseases and dysentery and in adopting uniform standardsof sanitation for Australian and American troops. In February, a malariacontrol committee of representatives of the American and Australian forceswas organized, and in the following month the Australian Army medical servicestarted a school in malaria control for men from each force in the U.S.Advance Base. The Advance Base Surgeon alluded to the usual complexityof coordinating efforts at sanitary control among air forces, ground forces,and troops of different nationalities when he stated that he was fightingsimultaneously the American Air Force, the Royal Australian Air Force,the Australian Imperial Force, and the Japanese. 31
The establishment of the first three bases in New Guinea, Bases A, B,and D, 32 at Milne Bay, Oro Bay, and Port Moresby, respectively,largely set the pattern for all the New Guinea bases, the last of whichwas established on Biak Island as Base H in August 1944. Medical officersaccompanied the task forces to some bases, while in other cases the nucleusof the surgeon`s office went to the new base from an Australian base section,from. U.S. Advance Base at Port Moresby, or from an already establishedbase in New Guinea. A number of Medical Department officers who were consistentlyassigned to the New Guinea bases, and later to the Philippine bases, werefrequently shifted, often remaining only a month or so at one place.
Initial tasks of the medical group at a New Guinea base were to establishthe base surgeon`s office, a headquarters dispensary, and a medical supplydepot, all usually under tentage, and to select sites for hospitals. Inthe New Guinea bases, malaria was a serious problem from the outset. AtMilne Bay the rates were terrific in late 1942, at times amounting to 4,000cases per 1,000 men per year. Some control work was undertaken in the earlymonths. An Australian antimalaria control unit, for example, arrived atOro Bay in January 1943 and began work with the aid of native labor, butthe U.S. Army Medical Department`s formal campaign against the diseasebegan only in March with the arrival of control and survey units sent bythe Surgeon General`s Office.
Base organization in New Guinea was continually shifting in 1943 and1944. As the Allies moved northwestward through New Guinea, forward baseswere in various stages of building up, those to the southeast were in fulloperation, perhaps at their peak, while rear bases were in the processof
31 (1) Memorandum, Acting Surgeon, U.S. AdvanceBase, for The Surgeon General, 11 Apr. 1943. (2) Letter, Surgeon, U.S.Advance Base, to Col. Percy J. Carroll, MC, 19 Sept. 1942. (3) Memorandum,Surgeon, Advance Base, for the Commanding General, Advance Base, 15 Oct.1942, subject: Conference on Sanitation and Hygiene. (4) Letter, Surgeon,Advance Base, to Surgeon, U.S. Army Services of Supply, 20 Oct. 1942. (5)Day by Day Account of Inspection Trip to Advance Base, New Guinea, andBase Sections 2 and 3, 6 November-25 November 1942, no signature.
32 There were various changes of designation from the date ofthe first establishment at Milne Bay in November 1942 to November 1943,when the terminology became "Base A," "Base B," andso forth. Down to August 1943, they were consistently referred to as "subbases."The final designation "base" is used throughout the text.
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"rolling up," as the Army`s popular usage puts it. Changesin functions assigned and units and installations controlled were rapid.In August 1943, Advance Section, USASOS (replacing Advance Base, whichwas disbanded), wits set up, with headquarters first at Milne Bay (BaseA) and shortly afterward at Port Moresby (Base D), to exercise direct controlover the three New Guinea bases in existence (Bases A, B, and D). In November,Intermediate Section, with headquarters briefly at Port Moresby and thenat Oro Bay (Base B), exercised control over the same bases. A new AdvanceSection established in November had headquarters at Lae (by January 1944at Finschhafen) and controlled two newly established forward bases, BaseE at Lae and Base F at Finschhafen (map 8). The job of the offices of thesurgeons of both Advance and Intermediate Sections was largely that ofsupervising and coordinating the medical activities of the bases underthe control of their respective sections. 33 By March 1944,both Base E and Base F had passed to the control of Intermediate Section,and Advance Section was disbanded. Bases A, B, and D continued active throughoutthe war. A full story of the medical work at Base A would include an accountof its struggle to reduce malaria rates, handling of casualties from theMilne Bay air raids in 1943, and the great expansion of hospital beds therein 1943 and 1944. It was the site of the Second Medical Concentration Center,a pool for Medical Department units held in reserve, which by early 1944was being expanded to a troop capacity of 5,000.
Bases E and F at Lae and Finschhafen were both established in November1943 after these towns had been taken from the Japanese in September andOctober, respectively. The medical section of Binocular Force, which establisheda base at Lae for supplying the Fifth Air Force base at Nadzab, landedat Lae on 18 September. As a result of previous experience at the New Guineabases, strict measures for the control of insectborne diseases, includingthe burning of kunai grass which harbors the mite- vectors of scrub typhus,were instituted from the start. Medical units began arriving by 1 October.By the end of March 1944, personnel handling base medical duties included,in addition to the base surgeon, a medical inspector, a. dental officer,a veterinary officer, an evacuation officer, a plans and operations officer,and a chief nurse. In early April, a nutrition officer and a venereal diseaseand statistics officer were assigned.
Medical personnel went from Base E to the future location of Base Fin late October to make sanitary surveys and choose hospital sites. A surgeon`soffice was set up in early November and began operating a dispensary. Hospitalsbegan arriving at Finschhafen at about the same time. By the end of
33 (1) General Order No. 75, U.S. Army Servicesof Supply, 15 Nov. 1943. (2) General Order No. 73, U.S. Army Services ofSupply, 14 Nov. 1943. The Advance and Intermediate Sections in New Guineadiffered in concept from commands of the same name in other theaters. Theydid not include a geographic area but were merely headquarters establishedto supervise and coordinate the activities of two or more bases. Each wasusually located at the same town as one of the bases which it controlled,and part of the personnel staffing the base also staffed the section. Decentralizationof responsibility to the individual bases was the guiding principle inthe administration of Services of Supply in New Guinea.
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April 1944, medical installations at Base F included a general hospital,four station hospitals, two field hospitals, seven dispensaries, a medicallaboratory, and medical supply depots. Eight malaria survey and controlunits and a sanitary company were functioning. 34
Base G was established at Hollandia, Dutch New Guinea, in June 1944,to operate as an advance base directly under the control of Headquarters,USASOS, but in about 2 weeks it became an intermediate base under the controlof Intermediate Section. In the Hollandia area the major headquarters-General Headquarters of the Southwest Pacific, Area, and the headquartersof U.S. Army Forces in the Far East, Allied Land Forces, Allied Air Forces,Fifth Air Force, and the Sixth and Eighth U.S. Armies, as well as of theU.S. Seventh Fleet- settled down during the months before the launchingof the campaign for the Philippines. The last established of the New Guinea.bases, Base H on Biak Island, was developed in August 1944 after the hardsummer campaign for the island.
Most medical problems encountered at the New Guinea bases, especiallythose which called for early solution on an area basis, were intensifiedin New Guinea by conditions of climate and terrain and the fact that combatpreceded the establishment of the base. The undeveloped character of thecountry made it difficult to select satisfactory hospital sites and locategood water sources. Surgeons` offices, as well as medical installations,were usually under canvas or housed in temporary construction. Hospitalpersonnel frequently had to clear hospital sites of trees and brush, makeroads, and build their own hospitals, all the while caring for the sickand the wounded. The larger hospitals proved of less value at the New Guineabases; to the end of 1943, no general hospitals served there, and patientsneeding general hospital treatment were evacuated to the large easternports of Australia where the general hospitals were located. As for insectbornediseases- malaria, dengue, and scrub typhus and other tropical maladies,these were much more prevalent in New Guinea than in the tropical regionsof Australia; their control was rendered difficult by the fact that somecases occurred during combat before the base section organization couldput areawide environmental control measures into effect.
Assignments and duties of officers in the medical sections of New Guineabases differed little from their counterparts in the Australian base sectionsexcept for the employment of more venereal disease control officers inthe Australian base sections; less emphasis on control of venereal diseasewas necessary in New Guinea. where troops had relatively little contactwith native women. The surgeons` offices of New Guinea bases seem to havesuffered a more rapid turnover of personnel than those of Australian basesections,
34 (1) Quarterly Reports, Surgeons, Bases A-H,4th quarter 1942 through 3d quarter 1944. (2) Quarterly Reports, Surgeons,Advance and Intermediate Sections, U.S. Army Services of Supply, 4th quarter1943 through 3d quarter 1944. (3) History of USASOS and AFWESPAC Base atLae Until March 1944. [Official record, Office of the Chief of MilitaryHistory.] (4) History of USASOS and AFWESPAC, Finschhafen, New Guinea,Since Activation 1943 Until April 1944. [Official record, Office of theChief of Military History.]
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building up to a greater strength and declining rapidly as troops andunits were moved forward or the lines of evacuation shifted, bypassingthe hospitals of the base.
THE TACTICAL FORCES
For some months, the highest tactical command of the U.S. Army groundforces in the Southwest Pacific Area was I Corps. Its staff medical sectionand that of the 32d and 41st Divisions in Australia and New Guinea werethe principal offices supervising medical service for the U.S. Army groundforces in the area. Not until early in 1943 did a field army- the SixthU.S. Army- build up in the Southwest Pacific Area.
Air force units were originally stationed in northern Australia aroundDarwin and Townsville, but as early as May 1942 some moved up to New Guinea.The Fifth Air Force was established to comprise these units in September1942.
Air Forces
The Fifth Air Force was constituted on 3 September 1942 with headquartersat Brisbane. By the end of the year it had been organized into the threemajor commands typical of a numbered air force- a service, a bomber, anda fighter command- each with a staff surgeon. Col. Bascom L. Wilson, MC,was made Surgeon, Fifth Air Force. In order to conserve medical officers(venereal disease control officers and dental officers especially wereneeded in tactical units), the office of the air force surgeon and of theair service command surgeon, which had the larger staff, were combined.When the advance echelon of the Fifth Air Force was established in NewGuinea, Maj. Dan B. Searcy, MC, became its surgeon; after his death ona bomber mission in January 1943, Lt. Col. Alonzo Beavers, MC, took hisplace. From the fall of 1942 to February 1944, the advance echelon wasat Port Moresby; then it moved to the Nadzab Air Base (near Lae, headquartersof Base E) and remained there until June 1944, when it went to Owi Islandin the Schouten group off northwestern New Guinea.
In March 1943, both the Fifth Air Force surgeon and the advance echelonsurgeon had small staffs of two Medical Corps officers, a veterinarian,and a few enlisted men and civilian clerks. In succeeding months the threemain task forces of the Fifth Air Force, later made bombardment wings,were organized with flight surgeons assigned to each. By the end of 1943,about four-fifths of the approximately 5,000 troops of the Fifth Air Forcehad moved northward to the Darwin area of Australia or to New Guinea-themajority beyond the Owen Stanley Mountains. 35
35 (1) See footnote 11 (1), p. 415. (2) AnnualReport, Medical Department Activities, Fifth Air Force, 1943. (3) AnnualReport, Surgeon Advance Echelon, Fifth Air Force, 1942. (4) Memorandum,Surgeon Fifth Air Force for The Air Surgeon, 1 Mar. 1943, subject: Reportof Medical Activities.
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During 1942 and part of 1943, the lift of thousands of patients overthe Owen Stanley Range to Port Moresby was accomplished by Australian andAmerican transport planes without benefit of medical personnel. Althoughvarious official reports noted the lack of an effective system of air evacuationfrom New, Guinea, no basic change took place until the arrival of the 804thMedical Air Evacuation Transport Squadron in June 1943. This unit was originallyassigned to the Services of Supply, but the Fifth Air Force soon succeededin getting all personnel of the squadron except the nurses transferredto the jurisdiction of its 54th Troop Carrier Wing. By the end of the yearit had gained control of the nurses as well. Nevertheless, air evacuationcontinued to be hampered by difficulties in coordinating the efforts ofGeneral Headquarters, Services of Supply, and the air force elements. Problemscontinued under discussion throughout 1943. 36
Like other air forces, the Fifth Air Force possessed a number of dispensariesequipped with beds. By the end of 1943, it had 12 with from 3 to 40 bedseach in northeastern Australia and eastern New Guinea. Five of the 25-bedportable surgical hospitals (with capacity for expansion to 50 beds each),which the Services of Supply had designed for use by task forces far forward,were assigned to the Fifth Air Force and were operating at Finschhafenand in the Markham Valley of New Guinea. The Fifth Air Force surgeon voicedthe common complaint of some oversea air force surgeons that the hospitalizationof patients in fixed hospitals of the Services of Supply was unsatisfactoryin some respects. Officers no longer fit for flying were returned to dutyin New Guinea, lie averred, by hospital boards unversed in the factorswhich should be considered in determining fitness for flying. Fifth AirForce patients discharged by general hospitals in Australia (no generalhospitals were operating in New Guinea in 1943) were not returned promptlyto their units in New Guinea. In order to maintain more effective controlover air troops in general hospitals in Australia, the Fifth Air Forcestationed a medical officer in Brisbane and one in Sydney. These men keptthe air force units informed on the status and disposition of their troopshospitalized in Australia. They served as effective links for the air forceelements in New Guinea with base section surgeons in Australia, as wellas with Australian medical authorities. 37
In June 1944, the Far East Air Forces and its service command were establishedwith headquarters at Brisbane including not only the Fifth Air Force butalso the Thirteenth Air Force, which was being transferred from the SouthPacific. Col. R. K. Simpson, MC, who had served briefly as Fifth Air Forcesurgeon, became Surgeon, Far East Forces, when the headquarters of theFifth
36 Air Evaluation Board, Report No. 35, TheMedical Support of Air Warfare in the South and Southwest Pacific, 7 December1941-15 August 1945.
37 (1) See footnotes 6(4), p. 411; 18(9), p. 423; 27(l), p.430; 35(2), p. 436; and 36. (2) Report of Inspections, 4 to 24 Oct. 1943,by Chief, Operations Division, Office of the Air Surgeon. (3) Letter, HeadquartersAdvance Echelon, Fifth Air Force, to Commanding General, Fifth Air Force,20 Apr. 1944, subject: Request for Assignment of Hospitals.
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Air Force became headquarters for the new top air force command. Heheaded a small coordinating medical office. The Advance Echelon, FifthAir Force, then at Owi Island in the Schouten group off northwestern NewGuinea, was made Headquarters, Fifth Air Force, and Lt. Col. Alonzo Beaversthus became surgeon for the entire Fifth Air Force. Towards the close of1944, personnel of the Far East Air Forces totaled about 135,000.
During the stay of the Thirteenth Air Force in the South Pacific Areathe medical sections of its headquarters and its service command headquartershad functioned jointly at a single office. In June, the office of the airforce surgeon moved from Guadalcanal to Los Negros in the Admiralty Islands.Col. Kenneth J. Gould, MC (fig. 99), succeeded Colonel Frese as surgeonin September 1944. The service command surgeon`s staff remained at Guadalcanal,performing medical tasks connected with the shift of air force units tothe Southwest Pacific Area. In January 1945, it moved to Morotai, whereit undertook medical planning for the move of Thirteenth Air Force unitsinto the Philippines. The frequent moves of commands and subordinate elementsto scattered islands led to the same demand for large numbers of MedicalDepartment officers for administrative positions which was evident in theaterorganization and which the Thirteenth Air Force had experienced since itsearly days in the South Pacific.
Intratheater air evacuation was handled by three medical air evacuationtransport squadrons assigned to the 54th Troop Carrier Wing of the FifthAir Force. Besides the unit already assigned to the Fifth Air Force, asecond air evacuation transport squadron (the one which had performed alarge share of the evacuation by air which the South Pacific Combat AirTransport Command had accomplished) became available when it accompaniedthe Thirteenth Air Force to the Southwest Pacific Area. A third squadronarrived from the United States in mid-1944. The wing level from which thesquadrons were controlled was too low a level from which to effect coordinationof air evacua-tion with General Headquarters and U.S. Army Services ofSupply. The problem of theaterwide coordination was not solved until mid-1945.
As of August 1944, when personnel of the air forces comprised about17 percent of the theater`s troop strength, of the 32 malaria survey unitsin the theater, 5 were assigned to the Fifth Air Force and 3 to the ThirteenthAir Force. Of the 55 control units, 10 were assigned to the Fifth and 5to the Thirteenth Air Force. The Thirteenth had had no malaria controlor survey units under its control until it moved to the Southwest PacificArea, as the Malaria and Epidemic Control Board had exercised full directionover the operations of all such units in the South Pacific Area. In theSouthwest Pacific, air elements were located on islands where no Servicesof Supply bases existed (Morotai, for example), and the air forces neededsuch units for a preventive program among its own troops.
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One unusual development occurred in medical administration for the airforces when the theater command took over, late in 1943, several medicalsupply platoons (aviation) originally requested by the Fifth and ThirteenthAir Forces, as well as the single medical air evacuation transport squadron(the 804th) then in the area. Only one of the supply units was assignedto the Fifth Air Force and none to the Thirteenth. Instead, the SouthwestPacific Area command, finding the units which the air forces had designedmore suited for handling medical supply during the early stages of amphibiousoperations than were the larger medical supply units, assigned them tothe Services of Supply and to Sixth U.S. Army. After repeated requeststhe Fifth Air Force received a second medical supply platoon (aviation),and when the Far East Air Forces was created in June 1944 the two unitsassigned to the Fifth Air Force were transferred to the Far East Air ServiceCommand. Other such units arrived in the theater but were assigned to thearmies and to the Services of Supply. The Air Evaluation Board, which wassent by the War Department to the Southwest Pacific Area in 1944 and 1945to appraise the effectiveness of air operations there, sustained the claimsof the Far East Air Forces that the number of medical supply platoons (aviation)assigned to it was insufficient. In the case of these units, as with thefirst. medical air evacuation
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transport squadron sent to the Southwest Pacific Area, the air forcesactually lost control of their own specially developed units to the Servicesof Supply. 38
Sixth U.S. Army
The man originally chosen for the position of Sixth U.S. Army surgeon,,Col. John Dibble, MC, was killed en route to the Southwest Pacific Areain a plane, crash off Canton Island. Col. (later Brig. Gen.) William A.Hagins, MC (fig. 100), who arrived in Australia in early March 1943, tookhis place. During the early months in Australia, Colonel Hagins and hisstaff were located at the army`s headquarters at Camp Columbia near Brisbane.His medical office included an executive officer, operations and trainingofficer, officers to head supply and statistics, and a Dental Corps officerand a Veterinary Corps officer to lead their respective branches. In May,a venereal disease control officer was added at the instance of the theatercommand.
With the exception of special features for malaria control, the SixthU.S. Army`s medical organization at army, corps, and division level differedlittle from that of armies in the Mediterranean and European theaters.Below the office of the army surgeon were the staff of the Surgeon, I Corps,at Rockhampton, Queensland, and the surgeons` offices of several divisionsin eastern New Guinea and northeastern Australia. In the middle of 1943,the 24th, 32d, and 41st Infantry Divisions, and the 1st Cavalry Divisionwere assigned to Sixth U.S. Army, which also had operational control ofthe 1st Marine Division at this date.
At intervals, the medical staff of Headquarters, I Corps, or of thevarious divisional headquarters, as well as those of Sixth U.S. Army headquarters,were split between a forward and a rear echelon. The division surgeon`soffice typically included a division medical inspector, a division dentalsurgeon, a veterinarian, and perhaps an executive and a medical supplyofficer.
Malaria, and at times scrub typhus, was a. serious problem to medicalofficers serving with Sixth U.S. Army. Prevention of malaria in forwardareas called for tremendous efforts in spraying ponds and other breedingplaces in New Guinea, filling holes, and clearing out undergrowth and brushin camp areas, as well as training divisional troops in methods of control.In 1943, the menace of malaria hung like a pall over divisional elementsrecalled to Australia from combat in New Guinea. Convalescent areas andrest camps were set up in Queensland to care for men recovering from thedisease. Many chronic, debilitated, relapsing cases of malaria of the 32dand 41st Divisions were. reconditioned in the Sixth U.S. Army TrainingCenter at Rockhampton.
38 (1) General Order No. 5, Headquarters, FarEast Air Forces, 15 June 1944. (2) General Order No. 53, Headquarters,U.S. Army Forces in the Far East, 14 June 1944. (3) Annual Report, MedicalDepartment Activities, Fifth Air Force, 1944. (4) Monthly Reports, ThirteenthAir Force Service Command, May 1944-April 1945. (5) See footnotes 14(3),p. 419; and 36, p. 437. (6) Quarterly Report, Medical Department Activities,Far East Air Forces, 2d quarter 1944. (7) Quarterly Report, Surgeon, ThirteenthAir Force, 3d quarter 1944.
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In June 1943, Colonel Hagins and a few of his staff joined the forwardechelon (known as the Alamo Force) Sixth U.S. Army in New Guinea near MilneBay. Thereafter Colonel Hagins` staff, usually split into two and sometimesthree echelons, moved to many locations in the course of the war. The forwardechelon remained at Milne Bay until October 1943, moving then to GoodenoughIsland and early in 1944 to Cape Cretin on the Huon Peninsula of New Guinea.Throughout all this period, a rear echelon remained behind at Camp Columbia,joining the forward echelon at Cape Cretin in February 1944. The reunitedsurgeon`s office moved to the vicinity of Hollandia (Base G) in June. Thereit remained until fall when the move into the Philippines began.
By 1 July 1944, when the entire medical section of Sixth U.S. Army wasnear Hollandia, it had enlarged to 16 Medical Department officers and 1warrant officer. These included, besides the surgeon and his executive,two supply officers, a personnel officer, a statistical officer and hisassistant, a hospitalization and evacuation officer and his assistant,a dental surgeon and his assistant, a combined veterinary officer and medicalinspector and his assistant, a malariologist, an operations officer, atask force surgeon, and a surgeon for the Alamo Scouts. The two last namedwere special assignments of Medical Department
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officers in an army on the move. The Eighth U.S. Army surgeon also servedtemporarily with the office. Throughout 1944 many gains and losses occurredin Sixth U.S. Army`s medical staff, several malariologists being added.
To the task forces (typically a reinforced division) which operatedin New Guinea and the small outlying islands, units over and above theorganic medical service, including many mobile units devised by ColonelCarroll and his staff, had to be added. Whenever a task force was set upfor a specific operation, a surgeon, sometimes the commanding officer ofa medical unit, was chosen, and a member of the medical section at SixthU.S. Army`s forward echelon acted as liaison officer with the task forcesurgeon. 39
CONTROL OF MALARIA AND OTHER TROPICAL DISEASES
The program for malaria control in the Southwest Pacific Area got offto a late start. No malaria control or survey units arrived until March1943 after high malaria rates had occurred in New Guinea. At the closeof 1942, a rate of over 1,000 cases per 1,000 men per year occurred amongtroops at Milne Bay. About 30.3 percent of the hospitalized cases amongU.S. Army troops between 3 October 1942 and 3 April 1943 were due to malaria;battle casualties accounted for only 2.75 percent. 40 Rateswere lowered at a later date, but the antimalaria program in the SouthwestPacific Area was characterized by considerable administrative confusionduring 1943 and was never under strongly centralized control until latein the war.
A number of factors influenced the effectiveness of antimalaria efforts:the degree of familiarity of individual Army doctors with malaria, thesupport given the program by line officers, the numbers of trained personneland quantities of antimalaria supplies and equipment available, and theadvance planning done by the Surgeon General`s Office. In July 1943, theWar Department Chief of Staff (General Marshall) made the following appraisal:"Apparently the trouble in the past has been that priorities for munitionsoverrode those for the necessary screening and other materiel to provideprotection at the bases, also there has not been sufficiently rigid sanitarydiscipline as to the individual soldier." Medical Department officerswho had a major share in administering the program also pointed to lowpriorities for antimalaria supplies and to inadequate support of the programby some line officers. Many, including Colonel Carroll and the Chief ofthe Tropical Disease and Malaria
39 (1) Periodic Reports, Medical DepartmentActivities, Sixth U.S. Army, 1943, 1944. (2) Report of Medical DepartmentActivities, Alamo Force, June-December 1943. (3) Quarterly Reports, MedicalDepartment Activities, Headquarters, I Corps, 1943. (4) Annual Report,Surgeon, 24th Infantry Division, 1943. (5) Annual Report, Surgeon, 32dInfantry Division, 1943. (6) Annual Report, Surgeon, 41st Infantry Division,1943. (7) Annual Report, Surgeon, 1st Cavalry Division, 1943. (8) History,U.S. Army Forces In the Far East, 1943-1945. [Official record, Office ofthe Chief of Military History.] (9) Letter, Maurice C. Pincoffs, M.D.,to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit,U.S. Army Medical Service, 1 Sept. 1955, and inclosure.
40 Memorandum, Lt. Col. Paul F. Russell, MC, for The SurgeonGeneral, 1 July 1943, subject: Malaria in South and Southwest Pacific Area.
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Control Section of the Surgeon General`s Office, ascribed a good dealof the difficulty to the lack of centralized control over the program.41
The high command in the Southwest Pacific Area adopted several measures,beginning in September 1942, designed to cope with the malaria threat.In an interview with Colonel Rice, who had just been appointed Surgeon,GHQ, General MacArthur stressed the part which malaria had played in hisdefeat in the Philippines and urged intensive effort to prevent high malariarates in New Guinea. In the same month, Gen. Sir Thomas Blamey, Commander,Allied Land Forces, sent Col. N. Hamilton Fairley, Director of Medicine,Australian Army Medical Corps, and an Australian chemist to London andWashington to convince British and American authorities of the gravityof the malaria threat to Allied forces in the Southwest Pacific Area; inthe United States they pressed for large-scale manufacture of antimalariasupplies, especially Atabrine. This drug became the chief substitute forquinine as a suppressant of malaria among U.S. Army troops in malariousareas, but was still in short supply during the early months of 1943. 42
Early in 1943, General MacArthur took a further step to deal with themalaria problem. The arrival of the 1st Marine Division, with high malariarates, from the South Pacific Area and the high incidence of malaria introops of the 32d Division in New Guinea made it clear that a control programshould be directed from General Headquarters, whence control over the operationsof tactical forces was exercised. General Blamey and General MacArthuragreed that cooperation between Australian and American forces fightingin close proximity in New Guinea was essential. In March, General MacArthurappointed the Combined Advisory Committee on Tropical Medicine, Hygiene,and Sanitation, made up of specialists from the military forces of bothcountries. The committee`s function was to advise him on measures for theprevention and treatment of tropical diseases in the Allied forces, on"medical implications in any present or future theaters of operations,"and on means of preventing the introduction and spread of tropical diseasesinto Australia by troops returning from malarious regions. In recognitionof the strong interest
41 (1) See footnotes 12(l), p. 416; and 40,p. 442. (2) Lt. Col. Paul F. Russell, MC, Chief, Tropical Disease and MalariaControl Section, Office of The Surgeon General: Abstract of Report andRecommendations Regarding Malaria and Its Control Among American Forcesin the Southwest Pacific Area, 25 May 1943. (3) Letter, Col. Percy J. Carroll,MC, to Lt. Col. Paul F. Russell, MC, 18 June 1943. (4) Memorandum, ChiefSurgeon, U.S. Army Services of Supply, for Commanding General, U.S. ArmyServices of Supply, 7 Oct. 1943, subject: Organization for Malaria Control,Southwest Pacific Area. (5) Parrish, Susan F.: Summary, Preventive Medicineat USAFFE Level, Organization for Malaria Control, no date. [Official record.](6) For greater detail, see Medical Department, U.S. Army, Preventive Medicinein World War II. Volume VI. Communicable Diseases: Malaria. Washington:U.S. Government Printing Office. [In press.]
42 (1) Letter, Maj. Gen. George W. Rice, to Editor, HistoricalDivision, Office of The Surgeon General, 19 June 1951, and inclosure. (2)Fairley, Col. N. Hamilton: Results of Mission to USA and UK regarding Malaria,Anti-Malarial Drugs, and Other Essential Supplies for the Control of Malaria,no date. [Official record.] (3) Combined Advisory Committee on TropicalMedicine, Hygiene, and Sanitation: Review of Activities From the Inceptionof the Committee to 30 June 1944. [Official record.] (4) See footnotes12(3.), p. 416; and 41(6). (5) Walker, Allen S.: Australia in the War of1939-1945. Clinical Problems of War. Canberra: Australian War Memorial,1952, p. 84.
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of the Australians in keeping tropical disease out of the continent,Colonel Fairley was made chairman. Col. Maurice C. Pincoffs, MC, Chiefof Professional Services, Headquarters, USAFFE, served as secretary tothe end of the war. He and Colonel Fairley were the committee`s most activemembers; they worked in close cooperation. The theater malariologist andthe Fifth Air Force surgeon also served on the committee.
The Combined Advisory Committee devoted itself to the considerationof the total problem of control of tropical diseases, giving attentionto cholera and other diseases, including some which are not solely tropical,such as smallpox. It was concerned with control by environmental means,suppressives, vaccines, or other methods. It issued broad directives applicableto the ground, naval, and air forces of all the Allies. By virtue of itslocation at General Headquarters, it was able to press for priorities forshipment of antimalaria supplies to the Southwest Pacific Area. A serioushandicap to the committee`s work, on the other hand, was its lack of aregular source of information on the incidence of tropical diseases amongtroops. Since the separate commands were not required to furnish statisticalreports to it on disease incidence, it had to depend upon committee membersto make available whatever information they gleaned in the course of theirother official duties. Nor was it regularly informed of impending operations.Hence whatever knowledge it possessed of tropical diseases to be expectedby Allied troops invading enemy-held areas could not be put to effectiveuse for planning preventive measures during specific campaigns. The committeeencountered no major difficulties in getting its general recommendationsaccepted, since it was located at General Headquarters and since membersof the committee served the subordinate commands in other capacities. Inthe opinion of its secretary, the committee filled in some measure thegap in the medical section at theater headquarters resulting from the lackof a preventive medicine division. However, the committee`s functions wereadvisory; it never had control over the actual operations of the men andunits engaged in malaria control- the malariologists and the malaria controland survey units. After General Headquarters had moved to Hollandia in1944 and was poised to go on to Leyte, it became difficult for the committeeto hold effective meetings, since some of its members had primary dutieswith headquarters of commands located elsewhere. 43.
The malariologists and control and survey units came into the theaterin early 1943. In answer to the request of the Surgeon General`s Officefor the number of these needed in Southwest Pacific Area, General Headquartersasked the War Department on 1 December 1942, on the recommendation of ColonelCarroll (then at U.S. Army Services of Supply headquarters), for 1 malariolo-
43 (1) Suggested Combined Advisory Committeeon Tropical Medicine and Hygiene, 19 Feb. 1943, by Gen. T. A. Blamey. [Officialrecord.] (2) See footnotes 14(l) and 14(7), p. 419; and 42(3), p. 443.(3) Letter, Adjutant General, General Headquarters, Southwest Pacific Area,to Commander Allied Land Forces, Commander Allied Air Forces, and CommandingGeneral, U.S. Army Forces in the Far East, 2 Mar. 1943, subject: CombinedAdvisory Committee on Tropical Medicine, Hygiene, and Sanitation.(4) Minutes,Meetings of Combined Advisory Committee, 13 Mar. 1943-31 Aug. 1944.
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gist, 6 assistants, 3 survey units, and 12 control units. At this datenone of the units were ready, but after War Department approval of theproposed organization late in the year, some of the malariologists andparts of units were sent to Australia by air. By February 1943, three fullsurvey units had arrived at Brisbane, but more than a month`s delay ensuedbefore they reached New Guinea on 22 March. Control units did not arrivein New Guinea. until June. Meanwhile, in February, Col. Howard F. Smithof the U.S. Public Health Service, who had worked on quarantine problemsin the Philippines and was General MacArthur`s family physician, was madetheater malariologist at Headquarters, U.S. Army Forces in the Far East.44
As a result of shifting top commands, the organization for malaria controlin the Southwest Pacific Area was less stable than that in the South Pacific.Originally, the theater malariologist appointed in February 1943 was assignedto the office of the Surgeon, U.S. Army Forces in the Far East. He remainedthere until the following September, when the special staff, USAFFE, wasdiscontinued. From September to the end of the year, he was in the officeof the Services of Supply surgeon. Malaria records and reports were handledall this time by the office of the Surgeon, USASOS; thus from Februaryto September 1943, the theater malariologist was at a headquarters otherthan that where statistics on malaria incidence among troops were maintained.45
The Chief of the Tropical Disease and Malaria Control Section of theSurgeon General`s Office, Lt. Col. Paul F. Russell, MC, was sent to theSouthwest Pacific Area (as well as the South Pacific) by The Surgeon Generalin mid-1943, shortly after the malaria control organization there got underI way, to investigate control measures. By then, the 32d U.S. Divisionhad been incapacitated for some months by high malaria rates (includinghigh relapse rates) after being evacuated from combat in New Guinea, anda similar fate threatened the 41st Division in the Buna-Gona area. Malariahad also forced the evacuation of the 6th and 7th Australian Divisionsfrom New Guinea, and of the Americal Division and the 1st and 2d MarineDivisions from Guadalcanal, in all six Allied divisions in the Southwestand South Pacific Areas. At this date, the organization for malaria controlconsisted of 1 malariologist, 7 assistant malariologists, 3 malaria surveyunits, and 12 malaria control units, with additional trained personneland units requested. The buildup of the malaria control organization wasslow because antimalaria units could not be activated and sent from theUnited States until the theater organization had become convinced of theirvalue and had requested them. 46
44 (1) Memorandum, Capt. Harold M. Jesurun,Assistant Malariologist, for Division Surgeon, 41st Infantry Division,29 Apr. 1943, subject: Medical History, Malaria Survey Units in New Guinea.(2) See footnote 14(5), p. 419. (3) Letter, Col. George W. Rice, MC, toCol. Percy J. Carroll, MC, 13 Nov. 1942, and attachment. (4) Interview,Thomas A. Hart, M.D., formerly of 6th Malaria Control Unit, June 1951.(5) Staff Memorandum No. 3, U.S. Army Forces in the Far East, 27 Feb. 1943.
45 See footnote 41 (5), p. 443.
46 McCoy, Lt. Col. Oliver R. The Tropical Disease Control Division,1 July 1946. [Official record.]
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Colonel Russell noted that the Surgeon General`s Office had designedthe network for malaria control in the expectation that it would functionas a single entity under a theater surgeon, with authority stemming fromthe theater commander through the theater surgeon; it was meant to undertakecontrol measures in the ground, service, and air forces alike. He notedsome Past failures of commanding officers to carry out the official directivesfor malaria control. In his opinion malaria control personnel in the SouthwestPacific Area could not function effectively, for they were split betweentwo headquarters. The chief `malariologist, who was also medical inspector,and his assistant were at this time assigned to the Chief Surgeon, USAFFE,while the other assistant malariologists and the control and survey unitswere assigned to the Chief Surgeon, USASOS. Although the chief malariologistand his assistant had technical control over the assistant malariologists,the latter group had no authority to deal with the air forces or the armieson malaria control problems. Colonel Russell remarked that the anophelesdid not respect command channels and that it infected men within specificareas regardless of the command to which they were assigned.
Colonel Russell advised separating the position of chief medical inspectorfor the theater from the job of chief malariologist and making the latterresponsible solely for malaria control. He advocated making the theatermalariologist, Colonel Smith, "chief medical inspector" and hisfirst assistant malariologist, Colonel Orth, "medical inspector (special)malariologist." Both were to remain at USAFFE headquarters in theirnew assignments, but the theater malariologist, who should have directoperational control over antimalaria personnel, could best function fromthe Advance Base, New Guinea. The theater malariologist and the Surgeon,USAFFE, concurred in the main with Colonel Russell`s recommendations. Theybelieved that the Services of Supply should furnish malaria control personneland units with rations, quar-ters, and supplies but that the U.S. ArmyForces in the Far East should retain full control over the assignmentsand operations of all elements of the malaria control organization. 47
In June 1943, Colonel Russell`s recommendations were largely put intoeffect, although no such separation of the duties of medical inspectorand theater malariologist as he suggested appears to have been carriedout. Colonel Smith- sometimes termed "medical inspector special (malariologist)" and sometimes "theater malariologist"- and Colonel Orth-variously termed "chief malariologist" and "assistant theatermalariologist"- and the other malariologists, called "assistantmedical inspectors special (malariologist),"
47 (1) See footnote 41(2), p. 443. (2) CheckSheet, Theater Malariologist, for Chief Surgeon, U.S. Army Forces in theFar East, 31 May 1943, subject: Comments in Reports by Lt. Col. RussellRelative to Malaria Control. (3) Memorandum, Chief Surgeon, U.S. Army Forcesin the Far East, for Assistant Deputy Chief of Staff, United States ArmyForces in the Far East, 31 May 1943. (4) Memorandum, Adjutant General,United States Army Forces in the Far East, for Commanding General, U.S.Army Services of Supply, Southwest Pacific Area, 28 Feb. 1943, subject:Assignment of Malariologists and Malaria Survey Units.
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were all assigned to the office of the Surgeon, USAFFE. Any of the malariologists(except the theater malariologist and his assistant) might be attachedto the staff of a commander to advise him on control measures and to supervisethe control work undertaken within his command. Although the control andsurvey units were assigned to the Services of Supply for administrativepurposes, jurisdiction over their operations and movements was vested inUSAFFE headquarters. Normally they would be assigned -to area commandsof the Services of Supply (that is, base sections or bases), but they mightbe attached to various other commands. Movements of antimalaria units withina base were to be effected by the base commander on request of the seniormalariologist, USAFFE, on duty in the base. USAFFE headquarters would directthe movements of the units from one base to another. Regardless of thecommand to which they were attached or assigned, both malariologists andantimalaria units were to remain under the direct supervision of the theatermalariologist.
These arrangements satisfied Medical Department officers immediatelyconcerned with the malaria control program, but difficulties persisted.The Fifth Air Force surgeon, for instance, wanted all antimalaria. unitsoperating with the air force assigned to it, and General Headquarters attimes demanded the assignment of these units to task forces. Tactical commandsshowed unwillingness to recognize the desirability of distributing antimalaria.units on the basis of theaterwide needs. 48
In any case, the scheme mapped out in June was short lived. When thesegments of the offices of the chiefs of technical services assigned toHeadquarters, U.S. Army Forces in the Far East, were transferred in thefall of 1943 to Services of Supply headquarters, the malariologists weretransferred with Colonel Carroll. The latter pointed out the division ofauthority that the transfer produced; responsibility for malaria controlwas now vested in the headquarters of three mutually independent commands,the Services of Supply, the Sixth U.S. Army, and the Fifth Air Force, eachof which had charge of the program within its own command. In the combatareas of New Guinea, Colonel Carroll noted, troops of the Sixth U.S. Army,the Fifth Air Force, and the Services of Supply were commonly stationedclose to each other; mosquitoes bit all impartially. Colonel Carroll emphasizedthe need for uniformity in discipline and education with regard to malariaand for standardization of treatment of the disease. He recommended thattheater headquarters give authority, by formal statement, to the organizationalelements for malaria control, now entirely under the Services of Supply,to operate throughout all areas of the theater occupied by American troops,regardless of command. Headquarters, U.S. Army Forces in the Far East,issued such a statement in November 1943. The Commanding General, USASOS,was to have control of
48 (1) Memorandum, Adjutant General, U.S. ArmyForces in the Far East, for Commanding Generals, Sixth U.S. Army, FifthAir Force, U.S. Army Services of Supply, 15 June 1943, subject: Organizationfor Malaria Control. (2) See footnote 41(3), p. 443. (3) Letter, Lt. Col.G. L. Orth, MC, to Lt. Col. D. A. Chambers, MC, 21 July 1943, and reply,9 Aug. 1943. (4) Letter, Lt. Col. D. A. Chambers, to Lt. Col. G. L. Orth,MC, 22 Sept. 1943.
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the movements of personnel and units of the organization for malariacontrol, not only those assigned to the Services of Supply which he couldmove about freely within and among bases but also of those attached tothe Sixth U.S. Army and the Fifth Air Force. In the case of the lattertwo commands the concurrence of the respective commanding general had tobe obtained in order to move a unit. The Commanding General, USASOS, wasto publish the official instructions on malaria control, discipline, standardsof suppressive and curative treatment, and on investigations of malariaamong Army troops; be was to receive all formal reports on malaria fromother commands.
Some difficulty continued, however, as long as the heads of the malariacontrol organization were under the Services of Supply- that is, throughoutthe last 3 months of 1943- in spite of additional official utterances assertingthe independence of the malaria control organization and reemphasizingthe obligations of commanders for carrying out malaria control measures.The Sixth U.S. Army wanted the assistant theater malariologist, ColonelOrth, then located at Advanced Section headquarters in New Guinea, assignedto that army. Late in the year, the assistant malariologists were unableto visit tactical units of the Sixth U.S. Army or Fifth Air Force untilthey obtained permission for each trip from those commands. At that date,all assistant malariologists were assigned to the 8th Medical Laboratorybecause of the desire of the Commanding General, USASOS, that they notbe carried as part of the overhead of his headquarters. Their commandingofficer was too low in the hierarchy to permit effective appeal wheneverthe assistant malari-ologists encountered stumbling blocks. 49
In January 1944, when General Denit was made both theater surgeon andServices of Supply surgeon, Colonel Smith was made "chief malariologistand medical inspector," U.S. Army Forces in the Far East. Directionof the antimalaria program continued to be exercised from the USAFFE levelthroughout the life of that command. During 1944, an adequate number ofskilled personnel and units arrived in the theater; some were transferredfrom the Central and South Pacific Areas. Near the close of August 1944,the Southwest Pacific Area had 18 malariologists and 32 survey and 55 controlunits, a considerably higher number than were sent to any other theaterof operations during the course of the war. Ten more units were en routeto Hollandia at that date. As the Services of Supply received additionalunits, it became, more amenable to releasing them to the tactical forces.
49 (1) See footnote 41(4), p. 443. (2) Memorandum,Chief Surgeon, U.S. Army Services of Supply, for Chief of Staff, 22 Oct.1943. (3) Memorandum, Assistant Adjutant General, U.S. Army Forces in theFar East, for Commanding Generals, Sixth U.S. Army, Fifth Air Force, U.S.Army Services of Supply, 24 Oct. 1943, subject: Organization for MalariaControl and Amendment of 1 Nov. 1943. (4) Memorandum, Assistant TheaterMalariologist for Chief of Professional Service, Office of the Chief Surgeon,U.S. Army Services of Supply, 17 Nov. 1943. (5) Letter, Chief Surgeon,U.S. Army Services of Supply, to Assistant Theater Malariologist, 1 Dec.1943., (6) Memorandum, Assistant Adjutant General, U.S. Army Forces inthe Far East, for Commanding Generals, Sixth U.S. Army, Fifth Air Force,U.S. Army Services of Supply, 14 Antiaircraft Command, 22 Dec. 1943, subject:Operation of Malaria Control. (7) Letter, Director, Tropical Disease ControlDivision, Office of The Surgeon General, to Chief Surgeon, U.S. Army Forcesin the Far East, 26 Jan. 1944.
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The assistant theater malariologist- Colonel Orth, until late, 1944,when he relieved Colonel Smith- functioned under the Services of Supply,which employed the bulk of the antimalaria personnel at the New Guineabases, With the aid of a few enlisted men and an occasional officer, hedirected malaria control operations in New Guinea from Headquarters, IntermediateSection, located at Oro Bay, and later from other bases in Now Guinea andthe Philippines. His office issued a monthly bulletin, Malaria, which keptantimalaria personnel informed of the latest measures being taken in NewGuinea, of the location of personnel and units engaged in the preventionprogram, and of new developments in the control of mosquitoborne diseasesin other oversea theaters. Its chief task was to move antimalaria personneland units to the areas where they were most needed- the New Guinea bases,intermediate towns along the northern coast of New Guinea, and to GoodenoughIsland, New Britain Island, and Manus Island in the Admiralties. During1944, many were concentrated around Oro Bay (Base B), Lae (Base E), atthe important base of the Fifth Air Force at nearby Nadzab, and at Finschhafen(Base F). 50
Additional campaigns to control dengue, scrub typhus, and other endemicdiseases were undertaken by the malaria control organization. Since dengueis mosquitoborne, antimosquito efforts contributed to the prevention ofdengue fever as well as malaria. Army experience with miteborne typhus,or so-called "scrub typhus," in Now Guinea was more serious thanthat with louseborne epidemic typhus in the Mediterranean and Europeantheaters, for both the sick rates and the mortality rates for scrub typhusin New Guinea were higher than for louseborne typhus in these other theaters.Scrub typhus assumed more of a threat temporarily than even malaria, whenrelatively high mortality rates occurred during a few of the New Guinea,operations. Cases appeared during the early days of combat before destructionof the mite vector throughout an invaded area, could be undertaken. During1942-43, 957 cases of scrub typhus, with a case fatality rate of 5.9 percent,occurred among troops in bases north of Australia.. On Goodenough Island,a small epidemic of 75 cases occurring during the period 1 November 1943-15January 1944 resulted in 19 deaths. Small outbreaks continued with theadvance along the northern coast of New Guinea, two of the more seriousdeveloping during the Owi-Biak and Sansapor landings in the period May-August1944.
Army doctors lacked a thorough acquaintance with scrub typhus and withvarious fevers of undetermined origin, as many fever cases were diagnosed.
50 (1) Memorandum, Chief Surgeon, U.S. ArmyForces in the Far East, for The Surgeon General, 23 Sept. 1943, subject:Medical Department Units. (2) See footnotes 44(4), p. 445; and 49(2), p.448. (3) Memorandum, Lt. Col. G. L. Orth, MC, for Surgeons, Sixth U.S.Army, Fifth Air Force, and others, 22 Nov. 1943, subject: Movement of Organizationfor Malaria Control. (4) Assistant Theater Malariologist for Surgeon, AdvanceEchelon, General Headquarters [Southwest Pacific], 1 Jan. 1944. (5) Memorandum,Maj. Donald S. Patterson, Malariologist, U.S. Army Services of Supply,for U.S. Army Services of Supply Malaria Control Components, 28 June 1944,subject: Standard Operating Procedure. (6) News Letter: Malaria? Headquarters,Malaria Control, South-west Pacific Area, monthly from 15 Dec. 1943 throughJuly 1945. (7) Circular No. 34, U.S. Army Forces in the Far East, 19 Apr.1944, subject: Malaria Control.
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A special group of investigators, headed by the president of the ArmyEpidemiological Board, was sent to New Guinea by the Surgeon General`sOffice in conjunction with the U.S.A. Typhus Commission. It began investigationsof scrub typhus near Buna and Oro Bay in the fall of 1943 and continuedwith the advance along the New Guinea coast and neighboring islands tothe Philippines and Japan. An intensive control program was instituted;the use of clothing impregnated with dimethyl phthalate and the burningof the kunai grass which harbors the mite carrier, at as early a stageduring the combat phase as possible, became the chief means of preventingthe disease. The malaria control and survey units carried it out with theaid of the Engineer Corps, unit commanders, and others. The rates of incidencefor scrub typhus among U.S. Army troops in the area never became as highas those for malaria. 51
51 (1) Maxey, Kenneth F.: Scrub Typhus (TsutsugamushiDisease) in the U.S. Army During World War II. In Rickettsial Diseasesof Man. Washington: American Association for the Advance-ment of Science,1948, pp. 36-46. (2) Report on Activities of the Army Epidemiological Boardfor 1943. (3) Memorandum, Director, U.S.A. Typhus Commission, for the Secretaryof War, 26 Nov. 1945, subject: Termination of the U.S.A. Typhus Commission.(4) See also Medical Department, United States Army. Preventive Medicinein World War II. Volume VII Communicable Diseases: Arthopodborne DiseasesOther Than Malaria. [In preparation.]
