CHAPTER XII
Medical Department in China, Burma, and India
The responsibility for giving field medical training to thousands offoreign (Chinese) troops and for supporting them with a considerable portionof their hospitalization and medical supplies distinguished the MedicalDepartment`s experience in the China-Burma-India theater from that in otherareas. Besides supporting the U.S. Army Air Forces and the, relativelyfew ground troops in the area, the U.S. Army Medical Department was calledon to train and support medically Chinese divisions for the struggle againstthe Japanese in Burma and China. Army doctors in the theater labored undertwo handicaps which affected all U.S. Army effort there: the low priorityof the theater for supplies and personnel, and the isolation of the Chinaside of the theater from the India side by the Japanese invasion of Burma(map 13).
Map 13.- Area of operations, Asiaticmainland, 1942-45
With the lowest priority of all the theaters of World War II, the China-Burma-Indiatheater was treated like a "stepchild" from the outset, as thesurgeon of its Services of Supply put it.1 Throughout the period1942-44, the medical sections of its top commands lacked sufficient MedicalDepartment
1 Letter, Col. John M. Tamraz, MC, to Col.Joseph H. McNinch, MC, Editor, History of the Medical Department in WorldWar II, 13 Feb. 1950, and inclosure.
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officers qualified for major administrative positions. Other difficultiesderived from the Japanese invasion of Burma in 1942. As a result of Japaneseoccupation, the theater had two distinct areas of combat operations-onein northeast India and Burma, and the other in China. Only by the hazardousRight across the Hump could medical men and supplies be transferred betweenChina and India. The few U.S. Army doctors who served in an administrativecapacity in China could keep in touch with the medical plans of Chinesemilitary and civil authorities but it was hard to coordinate these withsupplementary medical resources to be furnished by British and Indian authoritieson the western side of the theater. The division of the theater into twoareas of military operations accounts in large measure for the unorthodoxlocation and functions of the top medical offices maintained by the AmericanArmy during the period 1942-44, as well as for the lack of centralizeddirection of medical service.
The Army`s medical work was also affected by the lack of unity in thetop commands. Although U.S. Army commands worked in close cooperation withcommands and governments of the various Allies throughout the area, theChina-Burma-India theater was never dominated by a strongly unified Alliedcommand as were the North African and European theaters and the SouthwestPacific Area. The Chinese and the British theaters of operations comprehendedareas distinct from those of the American China-Burma-India theater. Lt.Gen. (later Gen.) Joseph W. Stilwell was responsible to Generalissimo ChiangKai-shek as the latter`s chief of staff and later to Admiral Lord LouisMountbatten, Supreme Allied Commander, Southeast Asia, as Admiral Mountbatten`sdeputy. The divided responsibilities entailed by General Stilwell`s subordinationto commanders whose interests diverged at times from paramount Americaninterests- as well as from each other`s- have been frequently pointed out.2
Nor was the organization of the American theater a well-integrated one.During the early period of the theater`s existence, General Stilwell hadfour distinct and widely separated headquarters, each of which issued orders,sometimes in conflict with each other, to the theater surgeon in his name.Friction among the purely American commands- the theater command, the,Services of Supply, and the Tenth and Fourteenth Air Forces- was unceasing.This dissonance naturally hindered attempts to estimate theaterwide medicalrequirements and to maintain centralized control of medical service. Thefact that the Tenth and Fourteenth Air Forces constituted the major Americancombat forces in the theater (most other U.S. Army troops were those ofthe Services of Supply) abetted the characteristic effort of air forcedoctors to operate independently of a theater surgeon. It is interestingto note that such freewheeling "old China hands" as the commanderof the Fourteenth Air Force, Maj. Gen. Claire L. Chennault, had a few medicalcounterparts. Dr. (later Lt.
2 (1) Romanus, Charles F., and Sunderland,Riley: Stilwell`s Mission to China. United States Army in World War II.Washington: U.S. Government Printing Office, 1953, pp. 87-89. (2) Romanus,Charles F., and Sunderland, Riley: Stilwell`s Command Problems. UnitedStates Army in World War II. Washington: U.S. Government Printing Office,1956, pp. 28-31,138-139.
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Col., MC) Gordon Seagrave (fig. 112), the well-known "Burma surgeon,"whose hospital served at Ramgarh, India (fig. 113), and later along theLedo Road, struggled hard to maintain the separate identity of his missionhospital group within the complex U.S. Army medical organization.3
The geographic regions comprised in the theater varied greatly in climateand terrain. In this area of multitudinous diseases and much famine, medicalresources were meager. The variety of national and cultural types, militaryand civilian, thrown together during the campaigns in Burma made it difficultto effect uniform measures to prevent disease. The fighting forces wereAmericans, Chinese, British, Indians, and Africans; many local tribesmen-Nagas, Karens, Shans, Kachins, and others- were employed by the AmericanArmy. The total effect of this cultural heterogeneity upon U.S. Army medicalservice
3 (1) Interview, Brig. Gen. Robert P. Williams,MC, 22 Aug. 1951. (2) Diary, Col. John M. Tamraz, MC, vol. I, 29 Mar. 1942-1June 1944. (3) See footnote 1, p. 505. (4) Letter, Brig. Gen. R. P. Williams,MC, to Col. Calvin H. Goddard, MC, Editor, History of the Medical Departmentin World War II, 24 Dec. 1952, and attachments. See also Seagrave, Gordon:Burma Surgeon Returns. New York: W. W. Norton & Co., 1946, especiallypp. 199ff., for Seagrave`s own account of his experience with Army administration.In order to obtain a regular flow of medical supplies for the SeagraveHospital, it was necessary that it be carried, at least on paper, as anorthodox unit. The theater surgeon solved the problem by requesting assignmentto the theater of the 896th Clearing Company "minus personnel."Seagrave absorbed the equipment of the clearing company, and doubled asits commanding officer, although he continued to fear that his own unitmight lose its identity.
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is not measurable, but differences in dietary habits undoubtedly complicatedthe administration of Army hospitals, while customs and taboos of religionand caste sometimes hampered efforts at disease prevention. The fact thatunder the caste system in India only the lowest caste could engage in certainduties, such as the handling of water supplies, became an important factorto Army doctors in a theater where it was necessary to depend heavily uponlocal labor.
THE CHINA-BURMA-INDIA THEATER: 1942 TO OCTOBER 1944
When General Stilwell set up headquarters for the U.S. Army Form inChina, Burma, and India at Chungking, the wartime capital of China, inMarch 1942, he had at his disposal a few Medical Department officers whohad come to China with special missions. Two had accompanied the mis-sionheaded by Brig. Gen. John Magruder which had arrived in the fall of 1941to expedite the sending of lend-lease supplies to China. Two others hadaccompanied General Stilwell`s own American Military Mission which hadsuperseded General Magruder`s mission after the United States had enteredthe war.
No formal organization of medical service was possible at this date.The Japanese capture of Rangoon in March had closed the Burma Road, severingcommunication between China and India. China was practically cut off fromsupplies in every direction. General Stilwell, who had been made chiefof staff for Generalissimo Chiang Kai-shek and commander of Chinese troopsin Burma, as well as commanding general of the American theater, went intoaction with the Chinese troops in the First Burma Campaign. Three of theMedical Department officers who had come with the special missions wentto Burma to give direct care to U.S. Army troops serving there. The seniorofficer, Col. Robert
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P. Williams, MC (fig. 114), became General Stilwell`s staff surgeon.These officers accompanied General Stilwell during his retreat on footfrom Burma to India. During the trek out of Burma, Colonel Williams hadfirsthand experience with the health hazards of the region, treating casesof malaria, dysentery, sore feet, and other ailments of the weary forceaccompanying General Stilwell.
Major Medical Offices in 1942
Only after the return to India could Colonel Williams build up his medicalstaff. When he reached India in May, a medical section had already beencreated for the Services of Supply (established in April). It was headedby Col. John M. Tamraz, MC (fig. 115), who had been assigned to Brig. Gen.(later Lt. Gen.) Raymond A. Wheeler`s U.S. Military Mission to Iran andIraq and had been transferred with General Wheeler to the Services of Supplyfor the China-Burma-India theater. The Services of Supply headquarters,briefly in Karachi, was set up in New Delhi in May 1942 and remained therethroughout the life of the theater (fig. 116). Colonel Williams establishedhis own office at General Stilwell`s rear echelon headquarters, also inNew Delhi. His staff at this date consisted of only a, few Medical Departmentofficers who arrived in the theater in late May of 1942. Meanwhile oneof the officers who had come out with the
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Magruder mission had been left behind in Chungking to represent ColonelWilliams at General Stilwell`s forward echelon headquarters there.
During this period, the middle of 1942, the theater surgeon and theServices of Supply surgeon, both in New Delhi, were able to keep in closetouch with each other. Both Colonel Williams and Colonel Tamraz spent muchtime in 1942 in tasks that would customarily have been delegated to subordinatespersonal inspection of troop areas and hospital buildings being constructedby the British and Indian Armies under reverse lend-lease, investigationof the extent to which American troops sent to India had been immunizedagainst various endemic diseases, and other activities in preventive medicine.Colonel Tamraz` chief task was to establish the station and general hospitalsof a Services of Supply. During the first half of 1942, the British furnishedhospitalization to the 3,000 American troops in India.
For some time Colonel Tamraz had to use the Dental Corps officer whoheaded his dental service for the very uncommon assignment of chief medicalsupply officer as well. But Colonel Tamraz fared somewhat better as tostaff when his office was enlarged by the addition of 14 U.S. Public HealthService officers. These men had been sent as a commission, under the directionof Lt. Col. Victor H. Haas, late in 1941 to aid the Chinese NationalistGovernment with public health services for thousands of Chinese workersbuilding the
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Yünnan-Burma Railway. Financed with lend-lease funds, the railwayhad been designed to carry supplies into China from Burma. The U.S. PublicHealth Service officers had been forced out by the Japanese invasion ofBurma.
This group included men qualified in medical specialties, as well assanitary engineers, entomologists, epidemiologists, and malaria, controlexperts. Those trained in preventive medicine were the only experts inthat field available to the Army for about the first year of the theater`sexistence. The U.S. Public Health Service officers did not become permanentassets to the Services of Supply headquarters but were soon sent to itsarea commands. Most went to sites between Karachi and Chabua, India, tentativelyselected as bases for the Tenth Air Force, to make sanitary and malariasurveys, thus initiating the theater`s malaria control program. In 1942,trained personnel and antimalaria supplies were wholly inadequate.4
Medical intelligence work for the theater was carried out at New Delhiunder the auspices of the American Observer Group sent in March 1942 toget advance information on British and Indian experience which might beuseful to incoming American troops. This group was transferred within afew months to G-2 of General Stilwell`s command. Throughout 1942 and early1943 Maj. (later Col.) Earle M. Rice, MC, the medical officer originallyassigned, was engaged in appraising medical problems and practices of theBritish and Indian Armies. He prepared many intelligence reports on the
4(1) Van Auken, H. A. : History of PreventiveMedicine In the United States Army Forces In the India-Burma Theater, 1942to 1945. [Official record.] (2) Stone, James H.: Organization and Administrationof the Medical Department in the China-Burma-India Theaters, 1942-1946.[Official record.) (3) See footnote 1, p. 505. (4) Williams, Ralph C.:The United States Public Health Service, 1798-1950. Washington: U.S. PublicHealth Service Commissioned Officers Association, 1951, pp. 685-691.
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following subjects, among others: Yellow fever quarantine; the prevalenceof malaria, cholera, filariasis, and other tropical diseases in variousareas of India and Burma; methods of immunization against and treatmentof tropical diseases; medical problems connected with evacuating troopsand refugees from Burma during the retreat; and assessment of stocks ofquinine and other medical stores in various areas.
The Tenth Air Force was built up in India in 1942, around a nucleusof air force personnel newly arrived from Java and the Philippines, underthe command of Maj. Gen. (later Lt. Gen.) Louis Brereton. It, too, hadheadquarters at New Delhi at a later date. In these early days of theaterorganization, the Tenth Air Force constituted most of the American militaryestablishment in India. Its medical section, headed by Col. H. B. Porter,MC (fig. 117), worked in a dual capacity throughout 1942 as the headquartersmedical section for the Tenth Air Force and for the Air Service Command,India-Burma Sector, China-Burma-India theater.
In China, General Chennault`s American Volunteer Group, which eventuallybecame the Fourteenth Air Force, was still under the control of GeneralissimoChiang Kai-shek. In July 1942, what remained of it was inducted into theU.S. Army as the China Air Task Force, a, complement of the India Air TaskForce, both of which were elements of the Tenth Air Force. Dr.
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(later Col., MC) T. C. Gentry (fig. 118), who had been surgeon of theAmeri-can Volunteer Group, continued to head the medical work under GeneralChennault until the latter relinquished command of the Fourteenth Air Forcein August 1945. Throughout the life of the China-Burma-India theater, GeneralChennault`s air element constituted the bulk of the U.S. Forces in China-anelement greatly outnumbered by the troops of the Services of Supply andthe Tenth Air Force in India.5
In the fall of 1942, a shift of emphasis took place in the responsibilitiesof the theater surgeon. It had become clear that Chinese Government authoritiesat the wartime capital, Chungking, would not cooperate with the young majorwho was assistant to the theater surgeon. Indeed, Colonel Williams` ownlack of rank was a handicap in dealing, as he was constantly required todo, with lieutenant generals of the Chinese, British, and Indian Armies.6With the defeat in Burma, however, the urgency for on-the-spot action in
5 (1) Medical History of the Tenth Air Force,22 Aug. 1944. [Official record.] (2) Annual Report, Surgeon, FourteenthAir Force, 1943. (3) Medical History of the Fourteenth Air Force in China,28 Aug. 1944. [Official record.] (4) See footnote 4 (2), p. 511.
The American Volunteer Group included, in addition to Dr. Gentry, two surgeons,a dentist, two nurses, and six medical orderlies.
6 Letter, Brig. Gen. Robert P. Williams, USA (Ret.), to Col.John Boyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. ArmyMedical Service, 22 Aug. 1955.
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India by the theater surgeon had subsided. U.S. interests were consistentlyfocused on China, and close cooperation with the Chinese Nationalist Governmentwas vital to the success of the medical training of the two Chinese divisionswhich had escaped from Burma. These young men, malnourished and ill withdysentery, malaria, and tropical ulcers, were to be rehabilitated in Indiafor the return to Burma. In addition, Colonel Williams was to plan themedical phases of the training program for 30 Chinese divisions which GeneralStilwell expected to mobilize in southwest China. Hence he transferredhis main office to General Stilwell`s forward echelon headquarters at,Chungking and placed his deputy in charge of the office at rear echelonheadquarters in New Delhi.
After the transfer, Colonel Williams` main effort was devoted for somemonths to liaison activities in connection with the training of Chinesetroops in India and China. Until July 1943, he was the only medical officeron duty at the Chungking headquarters. At first his office consisted ofa, typewriter at the foot of his bunk; he did his own typing. Housing wasscarce in the much-bombed Chungking, and at this date few men had beenflown over the Hump. After some weeks Colonel Williams had a battered deskand a few enlisted men to help him; he worked in a room with several othermembers of the special staff. It was not until 1944 that a, headquarterswas built and he got an office of his own.
Colonel Williams` main office remained in Chungking until the springof 1944, although most of his staff stayed at his rear office in New Delhi.The division of the theater medical section into two offices, one at Chungkingand the other at New Delhi, lasted until the theater was split into twotheaters in the fall of 1944.
At the end of 1942, the following major medical offices were locatedat New Delhi: The theater surgeon`s rear headquarters office (consistingof only two Medical Department officers and two enlisted men until earlythe following year), the Services of Supply surgeon`s office, and thatof the Tenth Air Force surgeon. The surgeon of the Indian Sector of theAir Transport Command`s Africa-Middle East Wing was then stationed at Karachi,the eastern terminal of the wing. The theater surgeon`s main office, wasin Chungking. General Chennault`s China Air Task Force, later incorporatedinto the Army as the Fourteenth Air Force, was also based in China at K`un-ming.7
Beginning in the autumn of 1942, the U.S. Army undertook at Ramgarh(Bihar Province) the rehabilitation and training of two divisions of Chinesetroops. These escapees from Burma, together with men later flown over theHump from China, made up the Chinese Army in India under General Stilwell`scommand. The Services of Supply was responsible for giving hospital careto the Chinese troops and for furnishing them medical supplies, obtained
7 (1) See footnotes 4 (2), p. 511 ; 5 (1) and(6), p. 513 ; and 6, p. 513. (2) History of the Medical Department AirTransport Command, May 1941-December 1944. [Official record.] (3) Letter,Brig. Gen. Robert P. Williams, MC, to Col. Joseph H. McNinch, MC, Editor,History of the Medical Depart-ment in World War 11, 21 Feb. 1950, and inclosure.
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from the British in India,. Under direction of the theater command,American staff officers and training instructors of the Chih Hui Pu, orheadquarters for the Chinese Army in India (activated in October 1942 andlocated at Ramgarh), developed and put into effect the training program.Over 53,000 Chinese officers and men, most of them flown in from China,were trained at Ramgarh between August 1942 and October 1944.
The office of the post surgeon at Ramgarh had charge of sanitation inand around the approximately 1,000 buildings on the post, which was locatedin partially cleared jungle and abandoned rice paddies. This office directedthe work in control of malaria and venereal disease. It also supervisedthe post hospital, which for some months was operated by Dr. Gordon Seagrave,the "Burma surgeon," who had accompanied General Stilwell onthe trek out of Burma. The same office was responsible for the work ofveterinarians on the post, both in animal care and food inspection. Asthe commander of the Ramgarh Training Center was directly responsible tothe Commanding General, Services of Supply, rather than to the commanderof the base section in which the center was located, the post surgeon reportedto the Services of Supply on the technical aspects of his duties.
A separate group of Medical Department officers, together with someEnglish-speaking Chinese medical officers and 11 European civilian doctorshired by the Chinese Red Cross, gave medical training to the Chinese officersand soldiers at Ramgarh. Chinese officers and men were trained as membersof field medical units; medical officers were given both basic and refreshercourses in anatomy, practical surgery, preventive medicine, and other subjects.Officers of the Pharmacy Corps were given dental training; in the ChineseArmy the pharmacy corps officer was responsible for dental as well as pharmaceuticalwork. The group of Army Medical Department officers in charge of trainingwas responsible to the theater surgeon, reporting to him through his deputyat his rear echelon office in New Delhi. Some were assigned as liaisonofficers with the larger Chinese units and helped Chinese surgeons to establishunit dispensaries and field hospitals, later accompanying them to Assam,where in the fall of 1943 the front was reopened for the invasion of Burma.8
Base and Advance Sections
Colonel Tamraz` office had responsibility, through surgeons assignedto advance, intermediate, and base sections, for the usual medical functionsof a Services of Supply in a theater of operations. Fixed hospitals forthe theater got under way when a station hospital began receiving patientsin May 1942. By October 1944, when the China-Burma-India command was dividedinto 2 theaters, 7 general hospitals, 22 station hospitals, 3 medical depots,and a
8 (1) See footnotes 4(1) and (2), p. 511; and7(3), p. 514. (2) History of the Services of Supply, China-Burma-India,28 Feb. 1942-24 Oct. 1944. [Official record, Office of the Chief of MilitaryHistory.] (3) Annual Reports, Camp Surgeon, Ramgarh Training Center, 1943and 1944. (4) Annual Reports, Medical Sub-section, Ramgarh Training Center,1943 and 1944.
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Map 14.- China-Burma-India theater,August 1944
medical laboratory were serving the Services of Supply organization;the great majority of these installations were in India. The Services ofSupply furnished medical supplies and hospitalization to the Tenth AirForce in India, a few U.S. Army ground troops, the Fourteenth Air Forcefighting in China., Air Transport Command personnel, the troops of theServices of Supply itself, and to patients of the Chinese divisions (orX-Force) based in India and committed in the Second Burma Campaign.
The area commands of the Services of Supply were created during andafter the summer of 1942 (map 14). The layout of the theater, with twoseparate fighting fronts, led to advance sections in both India and China.Some area commands were of brief duration, and the usual changes in namesand boundaries to accord with shifts in the tactical situation took place.Five regions of the theater remained fairly stable entities for Servicesof Supply administration, however, despite their shifting roles.
Army stations on the western half of India were organized into a basesection with headquarters at Karachi, the principal American military portin the early months of the theater`s existence. In 1942 the medical supplydepot at Karachi was very active; it had inherited many tons of lend-lease,medical supplies, including equipment for more than a dozen small hospitals,intended for the Yünnan-Burma Railroad. Several small station hospitalsand one general hospital served in this base section. But the base sectionin eastern India later became more important, for Calcutta, headquartersof the base section, became the major receiving port. Here troop concentrationbecame heavy with
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the buildup of the air forces for carrying supplies over the Hump toChina. At one time the base section surgeon had as many as 10 Army hospitalsunder his supervision. The provision of hospitals for XX Bomber Commandelements based west of Calcutta was a major project of 1944. An importantjob in Cal-cutta, requiring joint action with British and Indian authorities,was the, main-tenance of satisfactory sanitary conditions in the notoriouslyill-kept restaurants of the city. Toward the end of 1943, British and Americanmilitary forces created an Allied Hygiene Committee to make regular inspectionsof the restaurants and recommend as to whether they should be placed outof bounds to Allied troops. This work, important in the control of entericdiseases, continued to the end of the war.
In the advance section (later an intermediate section), located in theupper Brahmaputra valley of northeast India, the commander of the stationhospital at Chabua, headquarters of the section, doubled as section surgeon.In the spring of 1943 some veterinary officers and a Sanitary Corps officerwere added to the medical staff, but not until April 194:4 was the positionof section surgeon separated from that of hospital commander, This wasa highly malarious area and troops were greatly dispersed, both among theairbases and along the railway, pipe, and signal lines leading to Ledo.Some half dozen small station hospitals, a number of malaria control unitsand food inspection detachments, and a medical laboratory served the advancesection. Within the boundaries of the section, but not a part of its organization,was " the office of the Surgeon, India-China Wing, ATC (Air TransportCommand), which was also at Chabua, the western terminal of the Air TransportCommand`s route. over the Hump between India and China. The wing surgeonsupervised medical service for aircrews transporting men and supplies backand forth across the Hump, as well as for personnel stationed at the India-ChinaWing`s bases.
The base section which included the northeastern province of Assam eventuallybecame, with the advance into Burma, an advance section which embracedthe neighboring reconquered parts of Burma. Its headquarters was at Ledo,the starting point of the Ledo (Stilwell) Road, being constructed to connectwith the Burma Road to China. Its original surgeon, Lt. Col. Victor H.Haas of the U.S. Public Health Service, faced the difficulties posed bythe task of the base section and its location- at the end of a tenuousline of supply, in a region of enervating climate, many disease vectors,and contaminated water sources. The base section served the thousands oflaborers, as well as service troops, who were building and protecting theLedo Road- a. medley of British, American, and Chinese soldiers and Indianworkmen. The surgeon`s office, established toward the end of 1942, includeda "Chinese Liaison" unit and an "Indian Medical Service"unit to handle arrangements made with the Indian and Chinese Governmentsfor furnishing hospitalization and other medical care to Chinese and Indiantroops. The threat of malaria was recognized early; three specialists inmalaria control were assigned to the surgeon`s office. before malaria controland survey units arrived from the States. The small number
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of officers allotted to the medical section- only 5 in mid-1944- hadto be supplemented by 11 others attached for "special duty."Troops of the Chinese Army in India and the, Northern Combat Area Commandengaged in Burma received hospitalization at installations- including thelarge 20th General Hospital, a University of Pennsylvania-affiliated unitof 2,000 beds- maintained by the advance section. At the end of 1944, whenthe Ledo area had become part of the new India-Burma theater, the advancesection, as it was now termed, was responsible for medical service forabout 160,000 Chinese and American troops and 15,000 animals.
Units of General Chennault`s Fourteenth Air Force predominated throughoutthe advance section (Advance Sections 3 and 4 until January 1944) in China.The air force had its own dispensaries, actually small hospitals, at townssuch as K`un-ming and Kweilin, where its units were based. Since the ChineseGovernment supplied these rapidly shifting air units with food and lodging,and since the U.S. Army had no responsibility for supporting Chinese troopsin China with fixed hospitalization, the role of the Services of Supplyin China was a limited one. At K`un-ming, the eastern terminal of the Humproute, the India-China Wing, ATC, maintained the usual separate medicalservice. Hence the advance section surgeon at K`un-ming never had any extensivestaff. His duties- supervision of the section`s only hospital at K`un-ming,a small medical supply depot, and a few other medical installations- wereoriginally performed by a medical officer on General Chennault`s staffand later by the commanding officer of a station hospital. Only in March1943 was a Medical Corps officer separately assigned as surgeon. The SOS(Services of Supply) Advance Section in China later established a provisionalhospital at Kweilin, as well as the station hospital at K`un-ming; theseinstallations furnished fixed hospitalization to the troops of the FourteenthAir Force and to the XX Bomber Command elements that moved to China basesin 1944.9
Functions and Staffs in 1943
The tasks performed respectively by the theater surgeon and the Servicesof Supply surgeon, as well as their relations with each other, were affectedby a number of factors, some of which were mentioned at the beginning ofthe chapter: the split of the theater into two distinct regions; the numericalpreponderance of American air force and Services of Supply troops overground troops; responsibility of the Army Medical Department for largenumbers of Chinese troops in India, later in Burma; and the lack of coordinationand scattered locations of headquarters of the top commands. Close rapportbetween the theater surgeon and the Services of Supply surgeon was notpossible, although Colonel Williams conferred with Colonel Tamraz wheneverhe flew across the
9 (1) Annual Reports, Medical Department Activities,Base Section 1, 1943 and 1944. (2) Annual Report, Medical Department Activities,Base Section 2, 1942. (3) Annual Reports, Medical Department Activities,Base Section 3 (Advance Section 3), 1943 and 1944. (4) See footnotes 4(l),(2), and (4), p. 511; 6, p. 513; 7(2), p. 514; and 8(4), p. 515.
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Hump to inspect medical installations and units on that side of thetheater. During the 17 months that he was stationed in Chungking, ColonelWilliams made six flights over the Hump to India, conferring with ColonelTamraz on each occasion. Not until mid-1943 did Colonel Williams have anycommissioned assistant; thereafter he had only one or two officers andclerical assistants. His rear echelon office in New Delhi was headed bya number of deputies, most of whom served for short periods, several beingsent back to the United States because of illness. The frequent changeof deputy hampered effective coordination between the theater surgeon`stwo offices.
Colonel Tamraz, lacking a medical inspector, had to spend much timein inspection of hospitals and medical supply depots throughout the basesections of India-at Calcutta, Gaya, Ramgarh, Chabua, Agra, and so forth.He handled problems of medical supplies and equipment, which entered thetheater at Indian ports, and of station and general hospitals. The theatersurgeon was chiefly concerned with developing plans, in conjunction withChinese governmental authorities in Chungking, for the medical trainingof the Chinese, troops in India and China and for furnishing medical carein U.S. Army field hospitals to the Chinese on the Assam front; he alsopersonally inspected the training and care furnished. Beginning in thespring of 1943, his responsibility for planning for Chinese troops wasgreatly expanded when the development of the Y-Force got under way in southwestChina. In this situation the Services of Supply medical office developedsomewhat independently of the theater surgeon.10
Largely through force of circumstances, Colonel Williams` job came tobe unlike that of the orthodox theater surgeon. His chief activities- planningin cooperation with Chinese authorities and inspection of the medical servicefor Chinese and American troops during the Second Burma Campaign- resembledthose of General Kenner at Supreme Headquarters in the European theater.Colonel Williams found that he encountered difficulty in swing GeneralStilwell and, since the latter did not readily delegate authority to subordinates,getting command decisions. Not until the advent of Maj. Gen. Daniel I.Sultan as General Stilwell`s deputy early in 1944 did Colonel Williamsfind it possible to got prompt command backing for his recommendations.11
In 1943, during periods of stay at the Chungking office, Colonel Williamshad conferences about once a week with the Surgeon General of the ChineseArmy and with the Director General of the National Health Administration.Both had offices near Chungking. With the former and with Madame ChiangKai-shek, then the Generalissimo`s representative on medical affairs, hefrequently discussed matters of lend-lease medical supply for the Chineseand medical training and hospitalization for Chinese troops. The task ofbuilding
10 (1) See footnotes 1, p. 505; 3 (1), (2)and (4), p. 507 ; and 4 (2), p. 511. (2) Letter, Col. John M. Tamraz, MC,to Col. Joseph H. McNinch, MC, Editor, History of the Medical Departmentin World War II, 27 Feb. 1950.
11 See footnote 3 (4), p. 507.
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up the Chinese Army`s medical service was arduous, both because of thedearth of doctors and because of the diffusion of responsibility.12
During 1943, Colonel Williams traveled to many areas of India and China,inspecting dispensaries, evacuation, station, and general hospitals, medicaldepots, and other medical installations, both American and Chinese, particularlyin Base Section 3, where work on the Ledo Road was in progress. After theopening of the Second Burma Campaign in October, he visited many sitesin the combat zone by plane, concentrating upon the "trouble spots"of medical service for the Chinese troops and conferring with Chinese andAmerican medical officers. During 1943, the chief surgical and the chiefmedical consultant of the Surgeon General`s Office, the chief of preventivemedicine of that office, General Fox of the U.S.A. Typhus Commission, andthe Secretary of War`s representative on bacteriological warfare (JohnP. Marquand, a novelist) visited the theater. Colonel Williams conferredwith all of these. The chief medical consultant, accompanied by ColonelWilliams, made a thorough study of American and Chinese hospitals in easternIndia.13
The theater surgeon had to make a special effort to exercise any supervisionover the medical service of certain subordinate commands; the geographyof the theater aggravated the difficulty of integrating their medical serviceinto a theater-wide system. Medical Department officers of the air forces,especially of General Chennault`s Fourteenth Air Force and of the Air TransportCommand wing, made the usual efforts to achieve am autonomous medical service.The XX Bomber Command, which was based in India and China from June 1944to March, 1945 during its long-range bombing of Japan, was a part of theTwentieth Air Force, which for some time was under direction of the Washingtonheadquarters of Army Air Forces; its headquarters medical staff dealt directlywith the Air Surgeon in Washington in outlining its medical requirements.Medical Department officers assigned to the infantry regiment known as"Merrill`s Marauders" and those of the "secret hospital"serving with Detachment 101 of the Office of Strategic Services workedentirely on their own for some months after their arrival in the theater,as the existence and missions of the outfits which they served were perforcekept highly secret. Colonel Williams was not informed of the arrival ofeither of these elements. When he learned of their presence by accidenthe sought out their surgeons personally and made special arrangements toassure them medical supplies and to evacuate and hospitalize their patients.14
The Services of Supply surgeon, Colonel Tamraz, found his assignmentdifficult, and the diary which he kept during the war years is tinged withmelancholy. In his opinion, his office was never properly staffed. He receivedcomplaints about some seven or eight Medical Department officers in adminis-
12 See footnotes 4 (2), p. 511; and 7 (3),p. 514.
13 (1) See footnote 4 (2), p. 511. (2) Letter, Col. Robert P.Williams, MC, to Lt. Gen. Daniel I. Sultan, 16 Apr. 1946, attached to lettercited as footnote 7(3), p., 514. (3). Diary, Col. Robert P. Williams, MC.
14 See footnote 3 (4), p. 507.
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trative positions in the Services of Supply (commanding officers ofhospitals in a few instances). The charges included drunkenness, malingering,undue harshness, and mental or physical deterioration. In some instanceshe shifted these officers to other localities or other types of work. InJuly 1943, he wrote to the Personnel Division of the Surgeon General`sOffice, complaining of the quality of Medical Corps and Medical AdministrativeCorps personnel being sent to the theater.
To Colonel Tamraz, the low rank of Medical Department officers- therewas no Medical Department general officer in the theater at any time duringthe war- compared with the rank held by officers of other services constitutedground for further dissatisfaction. He lamented, as did Medical Departmentofficers in all theaters in which the British were present, the higherrank commonly held by a British medical officer performing the same tasksas an American medical officer. Occasionally he recorded his objectionsto being bypassed on decisions on medical matters by line officers, toadverse decisions on his recommendations by line officers who seemed unsympatheticto the medical service, and to the shifting of Medical Department enlistedmen to duties other than medical. He noted the usual efforts by air forcecommands to set up their own medical supply depots and station hospitalsand deprecated duplications in medical service caused by the presence ofseveral commands within a given area. He experienced some of the usualdifficulties with medical supply: low priority in transport, losses whenships were sunk, and occasional theft. In May 1943, he reprimanded a MedicalDepartment officer for a reason not commonly recorded: in a station hospital`smonthly Sanitary report the officer "had criticized the activitiesof the Medical Department something scandalous."15
Although some additions were made to the, staffs of the theater andServices of Supply surgeons during 1943, no consultants were added to either.The chief trend in the organization of these two offices during 1943 wasthe transfer of personnel responsible for major phases of preventive medicine,particularly malaria control and venereal disease control, from the officeof the Services of Supply surgeon in New Delhi to the theater surgeon`srear echelon office in the same city. Colonel Williams wanted as completea staff as possible in his New Delhi office to prepare and issue theaterwidedirectives.
As a result of sending the U.S. Public Health Service officers to thebases where they had directly initiated malaria control programs, by early1943 malaria control had become largely a Services of Supply responsibility.The Services of Supply surgeon`s office had acquired a, Sanitary Corpsspecialist in food and nutrition and a venereal disease control officer.In early 1943, the theater surgeon transferred the venereal disease controlofficer to his own office in New Delhi and made a similar move with respectto the malaria control staff. When the standard type of malaria controlorganization recommended by the Surgeon General`s Office was under discussionearly in 1943, Colonel Tamraz`
15 See footnotes 1, p. 505; 3 (2), p. 507 and10 (2), p. 519.
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office drew up a plan for malaria, control organization under the aegisof the Services of Supply, to be supervised by a malariologist on ColonelTamraz` staff, with malaria control officers attached to the headquartersof base, intermediate, and advance sections.
With the assignment of Colonel Rice as theater malariologist in February1943 and the arrival about 3 months later of antimalaria units from theStates, the theaterwide program for malaria control got under way. ColonelRice was assigned to the theater surgeon`s office from the outset, andin June four assistant theater malariologists who had arrived with theunits were assigned to the same office. Thus by mid-1943, the theater surgeonbad concentrated in his office the direction of two important phases ofpreventive medicine- venereal disease control and malaria control. Thetrend continued in the fall when the Chief of Preventive Medicine, SOS,who had arrived in the theater early in the year, was transferred to thetheater surgeon`s office. In Colonel Williams` opinion it was preferable,in the absence of sufficient Medical Department personnel to staff bothoffices with preventive medicine specialists, to station those assignedto major control programs at the higher level in order to enable them tomake their policies effective throughout the theater. From this level theycould issue theaterwide directives and could enter the combat zone, whereGeneral Stilwell was unwilling for Services of Supply personnel to go.Colonel Tamraz, on the other hand, came to regard removal of personnelfrom his medical section to Colonel Williams` New Delhi office as interferencewith the medical work of the Services of Supply. By the end of 1943, thetheater surgeon`s New Delhi office had the following personnel engagedin preventive medicine: A medical inspector, a venereal disease controlofficer, a malariologist, and three assistant malariologists. One aspectof preventive medicine- nutrition -remained in the office of the Servicesof Supply surgeon throughout the existence of the theater; studies of thetroop ration, Army messes, and hospital diets were made by nutritionistsassigned to the base, intermediate, and advance sections. Since the Servicesof Supply was responsible for supply of rations, it was logical to handlethe medical aspects of nutritional problems through that command.16
At the end of 1943, Colonel Williams had in his office at forward echelonheadquarters in Chungking only an assistant dental surgeon (actually onduty as station dental officer at the K`un-ming headquarters of the FourteenthAir Force), an administrative assistant, and four enlisted men. As assistanttheater surgeon, Col. George E. Armstrong, MC (fig. 119), entered on dutyin the Chungking office early the following year. At his New Delhi office,Colonel Williams had, besides the preventive medicine group mentioned above,a deputy, a theater dental surgeon, a theater veterinarian, a medical supplyofficer, an executive officer, and seven enlisted men. At the same datethe Services of
16 See footnotes 3 (1), p. 507; and 4 (1) and(2), p. 511.
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Supply surgeon had in his office, besides the nutrition officer, thefollowing Staff: An executive officer; a dental surgeon; a chief of veterinaryservice, SOS; an administrative assistant and records officer; and a medicalsupply officer and four assistants.17
Training of Chinese Combat Forces
Plans for the training of Chinese troops contemplated two groups of30 divisions each; one group was to consist of the divisions being trainedin India, separately referred to as X-Force, and of the divisions, termedY-Force, which would be developed in Yünnan Province in southwestChina. The other group of 30 divisions, called Z-Force, would be assembledand trained in southeast China. The job of planning the medical phasesof this training fell to the small group of Medical Department officerswho comprised the theater surgeon`s Chungking staff during 1943 and 1944.As noted above, training of the X-Force took place at Ramgarh, India. Anoperation staff was established for Brig. Gen. Frank Dorn`s Y-Force inApril 1943 and one for Z-Force in Jan-uary 1944. To each staff a few U.S.Army Medical Department officers and men were assigned to aid in givingfield medical training to the Chinese and to act as liaison or staff officersin the field with Chinese units.
17 See footnote 4 (2), p. 511.
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A surgeon and a veterinarian were included in the medical section atY-Force Operations Staff headquarters in K`un-ming, other Medical Departmentofficers being assigned as liaison officers with the units. Medical traininggiven the Chinese was designed to supply medical personnel to accompanythe combat troops, and to staff units concerned with evacuation; that is,to equip the Chinese divisions with the first and second echelon medicalservice similar to that in the U.S. Army. The Infantry Training Centerat K`un-ming was the prototype of several centers at which medical trainingwas given. The Surgeon, Y-Force Operations Staff, with the aid of six U.S.Army officers and the same number of enlisted men, set up the medical sectionat this center. Medical, dental, and veterinary training was given to Chineseofficers and men of Y-Force at training centers at Kweilin, Tali, and Yenshan,as well as at K`un-ming.
At the outset of the Salween River campaign, one U.S. Army medical officer,one veterinary officer, one Medical Department enlisted man, and one veterinaryenlisted man were detailed to each army group, army, and division of theY-Force. Officers who had lived in China or who spoke Chinese were usedas American staff officers insofar as they were available. The ChineseArmy Medical Department supplied the chain of evacuation as the Y-Forcecleared the Burma Road and thrust westward to join the X-Force advancingthrough northern Burma. Ten U.S. Army portable surgical hospitals and threefield hospitals had to be used to strengthen this chain, for the ChineseArmy Medical Department was inadequately supplied with hospitals of thesetypes, chiefly because of the dearth of surgeons to handle emergency surgerynear the front. Eighteen U.S. Army veterinary detachments were used inthe care of thousands of pack animals transporting personnel and equipmentof the Y-Force. The field and portable surgical hospitals were among theunits moved by pack animals.
The 30 Chinese divisions planned in southeastern China never reallydeveloped; the Japanese offensive toward K`un-ming in the summer of 1944suppressed Z-Force in its infancy. The significant medical work undertakenby U.S. Army Medical Department officers assigned to this force was theconduct of a training program similar to that for Y-Force. Medical trainingfor Z-Force was centered in the Infantry Training Center at Kweilin, whereZ-Force had its headquarters, from late 1943 to the summer of 1944. Dentaland veterinary training were also given. When the school closed on 25 July1944 it had graduated 535 Chinese medical officers, 24 pharmacy officers(given dental training), and 412 veterinary officers, enlisted technicians,and horseshoers. The coordination of procedures for handling medical supplybecame, as in Y-Force, a major problem. Again the U.S. Army had to takeover.Beginning in July 1944, two medical maintenance units per month were deliveredto Chabua and flown over the Hump to K`un-ming for the use of Z-Force.By October 1944, the Japanese drive had doomed Z-Force to extinction asan effective fight-ing force. In November, the Y-Force and Z-Force OperationsStaffs combined
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to make up the Chinese Combat and Training command of the newly formedChina theater. 18
The Air Forces
The medical section of Tenth Air Force, the chief American combat elementin the theater, was at New Delhi in 1943; it doubled as the medical sectionof the air force service command. Until March 1943, when the FourteenthAir Force was created, the Tenth Air Force theoretically supervised themedical activities of two major fighting components- India. Air Task Forcewhich protected the air route between India and China from its bases inAssam, and General Chennault`s China Air Task Force based at K`un-ming.Because of the remoteness of General Chennault`s component from the NewDelhi headquarters of Tenth Air Force, little effective control was exercisedover its medical service by the Tenth Air Force surgeon, although the TenthAir Force Service Command gave medical support to the Fourteenth Air Force.
In August 1943 the Army Air Forces, India-Burma Sector, was createdwith three major components: the China-Burma-India Air Service Command,China-Burma-India Air Forces Training Command (engaged in training of Chinesepersonnel at Karachi), and the Tenth Air Force. First surgeon of the newIndia-Burma Section was former Tenth Air Force Surgeon, Col. Hervey B.Porter. He was relieved in March 1944 by another former Tenth Air ForceSurgeon, Col. Clyde L. Brothers, MC (fig. 120). At this time the medicalsection consisted of five officers- two Medical, two Veterinary, and oneDental- a warrant officer, and eight enlisted men. This office served alsoas the medical section for the China-Burma-India Air Service Command. Boththe, training command and the Tenth Air Force had Separate medical sections.The China-Burma-India, Air Service Command furnished medical supplies tothe Fourteenth as well as to the Tenth Air Force.
In October 1943, the Tenth Air Force medical section moved with itsheadquarters to Calcutta. The following April the Medical Section, ArmyAir Forces, India-Burma Sector, made the same move. While the latter medicaloffice remained there, that of Tenth Air Force went forward to varioussites in Burma during the Northern Burma Campaign in 1944. The chief diseasesfaced by air force troops on the India-Burma side of the theater were malaria,the gastrointestinal diseases, and venereal disease. During the summerof 1943, unit and group surgeons of the Tenth Air Force took refreshercourses at the Tropical School of Medicine in Calcutta.19
On the China side, of the theater was the Fourteenth Air Force, as GeneralChennault`s fighting force was named after March 1943. Its K`un-ming head-
18 Smith, Robert G.: History of the Attemptof the United States Army Medical Department to Improve the Efficiencyof the Chinese Army Medical Service, 1941-1945. [Official record.]
19 (1) See footnote 5(l), p. 513. (2) Medical History, Headquarters,Army Air Forces, India-Burma Sector, and Headquarters, China-Burma-IndiaAir Service Command, 8 Nov. 1944. [Official record.] (3) Annual Report,Medical Department Activities, Headquarters, Army Air Forces, India-BurmaTheater, and Headquarters, India-Burma Air Service Command, 1944.
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quarters and its China bases, amounting to 28 by the end of 1943, werefar removed from Services of Supply and the various air force headquartersin India. Medical supplies had to be flown to Fourteenth Air Force overthe Hump. The complete dependence upon air transport prohibited the constructionof the usual living facilities at the bases, and Fourteenth Air Force unitshad to live off the land. The Chinese Government maintained hostels closeto the airbases to house and feed Fourteenth Air Force troops. Throughoutthe life of the theater this dependence upon the Chinese for food and lodgingsubjected Fourteenth Air Force personnel to the unsanitary conditions anddiseases prevailing among the Chinese people. The refusal of the Chineseto accept pay for the services rendered made it difficult to insist uponU.S. Army standards of diet and sanitation. Another factor affecting itsmedical service was the extreme mobility of the air force. General Chennaultshuffled his squadrons from base to base. As bases outnumbered squadrons,most bases were occupied only a part of the year, and maintenance of astable medical service was correspondingly difficult.
An interesting feature of the Fourteenth Air Force was its Chinese-AmericanComposite Wing (Provisional) which was composed of from 30- to 40- percentAmerican and from 60- to 70- percent Chinese personnel. It was createdand trained in Karachi, whence its squadrons were fed to the FourteenthAir Force in China. Although Chinese patients from this unit were
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usually cared for in hospitals of the Chinese- air forces, the closecooperation of Chinese and American medical personnel in the outfit affordedsome experience with the process of building up an integrated medical serviceamong Allied air troops.
The Fourteenth Air Force had, of course, the usual flight surgeons assigned to units. By the end of 1943, 10-bed dispensaries operated by asurgeon and a few enlisted men were being established at each base. Besidesreceiving emergency cases arising from accident and combat, these installationstook care of minor cases which would otherwise have had to be evacuatedby air to the station hospital maintained at K`un-ming for air force personnel.Dental officers were scarce and were rotated among the base dispensaries.Nursing service was provided by nine Chinese nurses; General Stilwell opposedthe use of American nurses in China, although the air force surgeon stressedthe need for American nurses. By July 1944, the medical strength of theFourteenth Air Force, which had been served by 10 Medical Department officers(including a dentist) and 34 enlisted men when it was created in March1943, amounted to about 50 Medical Department officers, including 10 dentalofficers, and approximately 150 enlisted men. The strength of the commandwas then a little over 8,000.20
Elements of the XX Bomber Command that came into the theater in 1944with the mission of bombing enemy-held industrial targets in Japan, Manchuria,and southeast Asia, settled into bases in the Kharagpur area west of Calcutta,in Assam and northern Burma, and in China between K`un-ming and Chengtu.The command`s medical section was located at command head quarters at Kharagpur.The usual air force dispensaries served XX Bomber Command bases. Patientsrequiring hospitalization were sent to the fixed hospitals maintained bythe Services of Supply base, advance, or intermediate sections.21
The air forces in the China-Burma-India theater never developed suchspecialized means of coping with special stresses to which flying personnelwere subject as did the air forces in some oversea, areas, probably becauseof their small size and lack of the necessary medical resources. They developedno central medical establishment, and instead of creating convalescentcenters they sent men who had been under severe physical and mental strainfor long periods to mountain resorts to recuperate. The Tenth and FourteenthAir Force surgeons agreed with the Air Surgeon in Washington that the airforces in the theater should control hospitals caring for air force personnel.Colonel Gentry voiced the most telling argument, basing his objection tohospitalization of troops of his air force in Services of Supply hospitalson the remoteness of the Fourteenth Air Force from the India bases wherethe hospitals of the
20 (1) See footnote 5(2) and (3), p. 513. (2)Annual Report, Surgeon, Fourteenth Air Force, 1944. (3) Medical Historyof the Fourteenth Air Force in China (second submission), May-October 1944.(4) "Stilwell Report": History of the China-Burma-India Theater,21 May 1942-25 October 1944. [Official record.]
21 Monthly Reports, Medical Section, XX Bomber Command, November1943-June 1945.
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Services of Supply were located. The Services of Supply maintained nogeneral hospitals in China, and only one station hospital. Colonel Gentrystated that delays had occurred in returning Fourteenth Air Force patientshospitalized in India back over the Hump to China.
Colonel Gentry expressed the opinion that the theater surgeon had treatedMedical Department officers of the Fourteenth Air Force like stepchildrenin consonance with the policy of the theater organization toward all ArmyAir Force activities. This charge reflected not only the Air Force`s usualtendency toward autonomy; it was also a faint echo of the quarrel betweenGeneral Stilwell and General Chennault over the combat role of GeneralChennault`s Fourteenth Air Force in the theater. Air force surgeons alsocomplained of insufficient medical supplies. As late as June 1944, shortagesstill existed in some items of basic equipment for air force medical units.Their protests led to the sending of the Voorhees mission to the theaterto investigate the situation in 1944.22
The India-China Wing of the Air Transport Command, a semiautonomouscommand within the theater, was first established under that name in December1942. It originally had headquarters at Chabua, where the headquartersof Advance Section 2 was located. About a year later, it moved to New Delhiand in April 1944 to Calcutta. Its primary mission was the transportationof sup-plies and personnel from India over the Hump to China. During 1942,after the disaster in Burma, the air shipments into China over the Himalayashad been accomplished by planes of the China National Aviation Corporation,the Tenth Air Force, and the First Ferrying Group, a forerunner of theIndia-China Wing. These agencies had also undertaken air evacuation ofthe sick and wounded from Burma into India. They had flown out thousandsof men and dropped supplies by parachute to those retreating on foot. Withina few months after the newly created India-China Wing assumed the ferryingtask, a wing dental officer was assigned, and Lt. Col. (later Col.) DonFlickinger, MC, was appointed surgeon. The strength of the wing was thenonly about 300 officers and 1,500 enlisted men. As in other Air TransportCommand wings, the wing surgeon supervised the aviation medical dispen-saries-inreality small hospitals-assigned to the wing. Six such units arrived inJuly 1943 and were located at wing bases in Assam. The chief health menaceswith which Medical Department officers of the command had to cope weremalaria and dysentery, unsatisfactory food and water supplies, and neurosesamong the aircraft crews flying at the extreme altitudes of the Hump route.The surgeon of the Air Transport, Command`s Washington headquarters, whovisited the wing in May 1943, labeled Colonel Flickinger`s task as the"toughest job in the Air Transport Command." Colonel Flickingerestimated that 70 pilots of his wing would need replacement monthly formedical reasons.
22 (1) Letter, Surgeon, Army Air Forces, India-BurmaSector, to Deputy Air Surgeon, 2 Oct. 1944. (2) Memorandum, Lt. Col. LamarC. Bevil, for the record, 10 June 1944. subject: Interview With ColonelDeWitt.
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The India-China Wing came to have heavy responsibility for air evacuationof the sick and wounded. It handled air evacuation of casualties en routeto the United States and intratheater air evacuation from station hospitalsto general hospitals along Air Transport Command routes from China to Indiaand within India. A medical air evacuation transport squadron, the 803d,stationed at Chabua, performed this phase of the wing`s work, while another,the 821st, evacuated thousands of wounded Chinese, Burmese, Kachins, Gurkhas,and Japanese from airstrips near the Assam and Burma fronts to U.S. Armyhospitals in India. The terrain and flying conditions in the Himalayascalled at times for spectacular efforts on the part of medical personnelof the wing. In August 1943, for instance, Colonel Flickinger and two enlistedmen landed by parachute in a remote area southeast of Chabua to aid a group(including the war correspondent, Eric. Sevareid) who had to bail out ofa C-47 after motor trouble over the Hump. All except the copilot, killedin the landing, came out alive. In a number of instances, missionariesstationed in remote areas of China aided in rescuing downed aviators andnursing them back to health.
Provision of pure food and water at the wing`s bases proved to be a,major problem. In 1944, a sanitary engineer was given the task of insuringa pure water supply, and a nutritionist was assigned to the wing to analyzefoods received at the various bases and to make recommendations to improvethe healthfulness of the diet. Trained entomologists carried on experimentsin malaria control in the wing laboratory.
By August 1944, the India-China Division (as the wing was now called)had 17 stations in the theater- 12 in India, 4 in China, and 1 at Colombo,Ceylon. At this date, the strength of the command amounted to about 15,600men, including approximately 1,600 attached personnel. Medical Departmentofficers serving the command totaled 81 near the end of July. Nearly 400Medical Department enlisted men served the wing.23
The Allied Chain of Command
Col. Earle M. Rice, MC, was the only U.S. Army doctor assigned to theMedical Advisory Division on the staff of Admiral Mountbatten`s SoutheastAsia Command, created in the fall of 1943.24 The Allied commandhad operational control over United States and British land, sea, and airforces in Burma, Siam, Malaya, Sumatra, and Ceylon, and the northeasternfighting front in
23 (1) See footnotes 7(2), p. 514; and 20(4),p. 527. (2) Memorandum, Brig. Gen. Fred W. Rankin, for The Surgeon General,2 Nov. 1943, subject: Remarks on Recent Trip Accompanying Senatorial Party.(3) Report, Col. I. B. March, MC, Office of Air Inspector, 21 Aug. 1944,subject: Summary of Medical Inspection of Air Transport Command and Stationsin the China-Burma-India Wing.
24 When Maj. Gen. Raymond A. Wheeler, under whom Colonel Tamrazhad served as Services of Supply surgeon, was made principal administrativeofficer to Admiral Mountbatten, General Wheeler proposed to take ColonelTamraz with him as surgeon for the Southeast Asia Command, with the rankof brigadier general. Orders for the transfer were actually published,but were rescinded when it became known that the Quebec Conference, insetting up the Allied command, had agreed upon a staff of British and Americanexperts in tropical medicine. (See footnote, 3 (2), p. 507.)
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India. Its jurisdiction did not extend to American forces in China orto those with the Services of Supply in India. The group of experts intropical medicine and hygiene who made up the Medical Advisory Divisionwas headed by a British medical officer, Maj. Gen. Treffery Thompson. TheSoutheast Asia Command operated medical facilities for the British andAmerican forces (ground, naval, and air) assigned to the command, but thechief work of this medical staff was to investigate the best means of diseaseprevention and recommend measures to be adopted. It met with the headsof medical service of the various commands of the Allies operating in Asiaand with their senior experts in malaria control and sanitation. It keptin touch with such special projects as the control of scrub typhus, undertakenby a team of the U.S.A. Typhus Commission in cooperation with British andIndian experts.
Although Colonel Rice was stationed at the headquarters of the commandat Kandy, Ceylon, he spent a good deal of time at various critical areasof malaria control. He took a leading part in experiments which the U.S.Army made with airplane spraying of DDT in India. In 1944 and 1945, hemade trips to England and the United States to got sanction for large quantitiesof antimalaria supplies for the theater.
The Southeast Asia Command appears to have left the administration ofmedical service within the individual commands largely up to those commands.Although the existence of Admiral Mountbatten`s Allied headquarters mightpresumably have caused some confusion as to medical responsibilities ofsubordinate commands of the Allies in Asia, as it did with respect to militaryresponsibilities in general, no record has been found of any serious conflictover medical matters arising from its activities. Since the Southeast AsiaCommand did not have jurisdiction over the U.S. Forces in the China-Burma-Indiatheater, the office of the surgeon of the latter command had little contactwith the Medical Advisory Commission except with the American representative(Colonel Rice) at Admiral Mountbatten`s command in connection with malariacontrol among the troops fighting in Burma.25
American, British and Indian forces-service and ground troops-reinvadingBurma were organized into the Northern Combat Area Command, created inFebruary 1944. Commanded by General Stilwell, it was subordinate to AdmiralMountbatten`s Southeast Asia Command. Combat Troop Headquarters had beenformed in October 1943 as an American headquarters for the American serviceunits in the Chinese Army, and Col. Vernon W. Peterson, MC, was made itssurgeon. He continued in this capacity for the final Allied tactical command.Colonel Peterson`s medical section was never large. At its peak it containedan assistant surgeon, who acted as forward echelon sur-
25 (1) See footnotes 3(2), p. 507; and 4(2),p. 511. (2) Letter, Lt. Col. Hardy A. Kemp, MC, to Col. Robert P. Williams,MC, 21 Nov. 1943. (3) Letter, Earle M. Rice, M.D., to Col. Calvin H. Goddard,MC, Editor, History of the Medical Department, U.S. Army, in World WarII, 6 Dec. 1951, and attachment. (4) Letter, Lt. Col. B. L. Raina, ChiefCollator and Editor, Official [India-Pakistan] Medical History of WorldWar II, to Col. R. G. Prentiss, Jr., MC, Executive Officer, Office of TheSurgeon General, 25 Mar. 1952.
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geon and medical inspector, a company grade officer in charge of medicalsupply, and a few enlisted men. Certain officers in the field handled specialproblems for the surgeon. The commander of a malaria control unit, forexample, acted as malariologist for the command, and Veterinary Corps officersassigned to Chinese troops acted as sector veterinarians. Colonel Petersonobtained his medical supplies from the medical supply officer at advancesection headquarters in Ledo. On technical medical matters he dealt withthe theater surgeon, or with his deputy in New Delhi. The U.S. Army MedicalDepartment units assigned to Northern Combat Area Command treated over20,000 Chinese patients for diseases, injuries, and battle casualties duringthe period 1 January- 26 October 1944. Except for a continued shortageof personnel, which placed exceptional demands on the endurance of theNorthern Combat Area Command Surgeon and his staff, no particular organizationalproblems occurred in this element of the medical service.26
Disease Control: Malaria
Among the insectborne diseases which menaced U.S. Army troops in theChina-Burma-India theater were malaria, scrub typhus, and dengue. Otherdiseases which occurred among the civilian populations of the theater werethe diarrheal diseases, which gave the U.S. Army serious trouble; the venerealdiseases; typhus; cholera; plague; smallpox; typhoid and paratyphoid; andacute meningitis. Epidemics of several of these occurred at intervals amongthe civilian populations. Approximately 25,000 troops in the Calcutta areawere menaced by a cholera epidemic during the period February-June 1945.Another cholera epidemic raged during the summer of that year in citiesand towns of the Yangtze River Valley, resulting in six cases among Americantroops of the Fourteenth Air Force. The prompt institution of. preventivemeasures prevented epidemic rates among troops, but rates of incidenceof the dysenteries, malaria, and scrub typhus were high enough to demandextra efforts.27
Malaria incidence never became as serious a problem in the China-Burma-Indiatheater as in some other theaters where ground troops were engaged in combatin highly malarious areas for long periods. In 1943, this theater`s rateswere appreciably below those for other theaters of comparable malaria incidenceamong the civilian population. On the other hand, the rate did not undergoa decline comparable with that of other theaters, and the lack of centralizedauthority for the antimalaria program led, as in some other theaters, tocertain administrative difficulties.28
26 See footnotes 4 (2), p. 511 ; and 20 (4),p. 527.
27 (1) See footnotes 4 (1), p. 511 ; and 8 (4), p. 515. (2)Memorandum, Brig. Gen. Raymond A. Kelser and others, for Commanding General,U.S. Army Forces, India-Burma Theater, 9 Nov. 1944, subject: Report ofMedical Department Mission.
28 Memorandum, Chief, Preventive Medicine Service, Office ofThe Surgeon General, for The Surgeon General, 29 Aug. 1944, subject: PreventiveMedicine Program in China-Burma-India Theater.
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As noted above, initial attempts at malaria control in the theater wereundertaken by the group of U.S. Public Health Service officers assignedto the office of the Surgeon, Services of Supply, who went to the variousbases. The full malaria control organization for the theater- malariologistsand control and survey units- was not established until early in 1943,concurrently with its development in other theaters. The three controland survey units which the Surgeon, Services of Supply, requested, togetherwith some assistant malariologists, arrived within a few months. By late1944, when the theater was divided into the India-Burma and China theaters,6 survey units and 15 control units were in operation. Additional oneshad just arrived, and still others were scheduled to go to the two newtheaters.
In mid-1943, final responsibility for malaria control rested with theoffice of the theater surgeon. The theater malariologist, Colonel Rice,and the assistant malariologists were assigned to that office. The assistantmalariologists and the units were attached to the Services of Supply butwere responsible to the theater organization rather than to the base, intermediate,or advance section commanders in the areas where they were operating.
In August 1943, advance and base section commanders were given somewhatmore authority over the men doing antimalaria work when a new directiveauthorized them to move malaria control personnel about within their areaswithout reference to higher authority. The Services of Supply commanderwas authorized to transfer them from one section to another, with the concurrenceof the theater malariologist or his assistants. Thus the theater organizationand the Services of Supply shared responsibility for the personnel engagedin malaria control. Similar dual control existed with reference to antimalariasupplies; Services of Supply depots procured and stored them, while theassistant theater malariologists supervised their allocation and distribution.Although the need for placing ultimate control at the highest level wassatisfied by this organization, the interposition of two command head-quartersbetween personnel supervising antimalaria work and those engaged in operationswas awkward. Theoretically, in order to give a command to a malariologistattached to the staff of a Services of Supply section commander, the theatermalariologist would have had to recommend that the theater commander advisethe Services of Supply commander to direct his section commander to givethe order to the malariologist. "Except, for the fact that matterswere commonly handled much more informally, it was a confusing house thatJack had built."29
The theater malariologist developed a plan, never put into effect, fora tactical type of organization designed to give administrators of theantimalaria program the power of command over antimalaria personnel. Heproposed a malaria control "regiment" to be, commanded by thetheater malariologist and to be made up of battalions, each headed by amalariologist; the battalions would consist of malaria survey and malariacontrol companies. The regiment
29 See footnote 4 (1), p. 511.
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would carry out the entire program in the theater, while the Servicesof Supply would come into the picture, merely as the, source for the, necessaryitems of supply. This scheme went by the board when Colonel Rice proposedas an alternative an increase in the number of control units for the theater,to which the War Department agreed. His scheme is of interest in that itreflects the conviction of some malaria control personnel that the programcould be more effectively run by a military type of organization whichwould exercise the power of command.
In August 1943, the Chief of the Tropical Disease Section of the SurgeonGeneral`s Office, Lt. Col. Paul F. Russell, MC, declared that that officewas still giving insufficient emphasis to the planning of an effectivemalaria. control program for the China-Burma-India theater. He wrote thetheater surgeon that a large group of Medical Department officers to besent to the theater under the leadership of Col. George E. Armstrong, MC,to train Chinese doctors in military medicine included 10 dentists butnot a single man with special training in malaria control. With the exceptionof Colonel Armstrong, none had had experience in tropical medicine. "Apparentlythe idea, is that the Chinese troops shall bite their way through the Japanese."30
By the spring of 1944, the antimalaria drive had received fresh impetus.The more vigorous program of that year reflected greater consciousnessof the need for it both on the part of the War Department and by the theaterorganization; it also marked clearer emergence of Atabrine, as the preferredmalaria suppressive and of DDT as the outstanding insecticide. AdmiralMountbatten`s headquarters in Ceylon, where Colonel Rice had entered onhis new assignment, had clearly stated the responsibilities of commandfor antimalaria discipline. Experimental spraying of DDT by planes wasundertaken in the spring of 1944, and the first use of Atabrine, as a suppressiveamong large numbers of troops in the theater took place in April amongthe X- and Y-Forces in the combat zones. Neither Atabrine nor DDT was yetbeing received in quantities sufficient for large-scale use, however.
At this juncture, except for the theater malariologist who remainedon the staff of the theater surgeon and some units which were assignedto the Northern Combat Area Command, authority over most elements in themalaria control organization was turned over to the Services of Supply.Malariologists and units assigned to the Services of Supply were reassignedto base, intermediate, and advance section commanders. The new scheme wasnot to the liking of the theater organization, the Services of Supply,or the Air Forces. In the first place, no control or survey units wereassigned to the Air Forces, which were responsible, under War Departmentdirectives, for education of air troops in malaria control, for the individualairman`s conformity to antimalaria precautions, and for enforcement ofcontrol measures around barracks
30 Letter, Lt. Col. Paul F. Russell, MC, toCol. Robert P. Williams, MC, 21 Aug. 1943. Since the Chinese Army lackeddentists, a good deal of emphasis was placed on training the Chinese infirst aid dentistry in order to reduce the number of casualties due topreventable conditions.
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and troop areas of the air forces. As a result of the farflung dispersalof air force troops in the theater, an air force unit might be locatedin several territories under different command jurisdictions. The theatermalariologist also objected to the new arrangement, believing himself toofar removed from the personnel engaged in the control work to direct theprogram effectively. Finally, the Services of Supply encountered the usualdifficulties resulting from the fact that the Army Air Forces was its coequalin the chain of command; in China the Fourteenth Air Force, with separatisttendencies, was the prominent American command. From the point of viewof the Services of Supply, a poor feature of the latest realinement ofauthority was the fact that no malariologist was assigned to the officeof its surgeon.
The consolidation of the staffs of the theater surgeon and Servicesof Supply surgeon in August 1944 largely solved the problem. After theServices of Supply surgeon became deputy theater surgeon, the f act thatthe top malariologist was assigned to theater headquarters and other elementshandling malaria control to Services of Supply headquarters was of littleimportance.
After Colonel Rice observed experiments with airplane spraying of DDTduring a return visit to the United States in the spring of 1944, he conductedsimilar experiments around Chabua in order to determine the most suitableequipment for spraying, the desirable weather conditions, and types ofterrain where spraying from planes would be most effective. DDT began cominginto the theater in greater quantities, and an organization for theaterwidespraying was worked out by fall. It consisted of 1 malaria survey unitto make entomological investigations, 2 control units to handle DDT, 10pilots and ground maintenance personnel and the necessary modified planesand equipment. The "India-Burma Spray Flight," as the organizationwas called, was fully developed only by February 1945, after the new India-Burmatheater was established. The Services of Supply was responsible for theprogram and controlled the units; the Air Forces had the planes and pilots;the Northern Combat Area Command was in charge of the combat area in Burmawhere large-scale spraying was done to keep down the mosquito populationof newly captured areas. The "India-Burma Spray Flight" ran intothe usual problems resulting from the participation of several top commandsbut apparently worked effectively. The large-scale use of insecticidesto control malaria contributed to the control of the mosquitoborne dengueas well.31
By midsummer of 1944, 4 malaria survey and 15 control units had createda beehive of antimalaria activity in the theater:
The anti-malaria units were deployed from the ports ofdebarkation at Calcutta and Karachi to the most forward point in the Theater(the Jap-surrounded Myitkyina airstrip). They were protecting the longlines of communication, the newly constructed B-29 Bases, the old "Hump"bases, the advance depots at Ledo and Shingbwiyang, the engineering outfitscarving out the Ledo Road, and the combat bases at Shaduzup, Mogaung, andMyitkyina.
31 See footnotes 3(4), p. 507; 4(l) and (2),p. 511; and 8(4), p. 515. See also Medical Department, United States Army.Preventive Medicine in World War II, Volume VI. Communicable Diseases:Malaria. [In press.]
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They were using thousands of coolie laborers digging ditches,cleaning out tanks, and larviciding breeding areas. They were putting uproadside signs warning of the dangers of malaria, they were supervisingmosquito-proofing projects, distributing mosquito repellent at outdoortheaters, and trucking supplies into forward areas. The survey men wereout locating breeding areas, making blood and spleen surveys, and workingin their laboratories. In the latter part of the season there was someDDT, and some experiments with its use, both from the ground and the air,were started. There was a constant educational program in progress utilizingradio, movies, GI newspapers, signs, posters, and personal contact. Therewas a degree of protection for every one, much more than in previous years,but still not all that was desired. More personnel, more equipment, moresupplies, and more DDT were ordered for the next year.32
Critical Problems of 1944
The latter half of 1944 was the crucial period for medical service inthe theater. By the middle of the year, serious problems had developedwith regard to medical supply, hospitalization, personnel, certain aspectsof pre-ventive medicine, and the organization of, and relations between,the theater surgeon`s office and the Services of Supply surgeon`s office.Concern over these difficulties was shared by the theater surgeon and theSurgeon General`s Office. Although staff surgeons of the theater`s topcommands had observed certain deficiencies in the course of inspectiontrips in 1942 and 1943, the lack of person-nel had prevented remedial measures.
It was one thing to discover that messes were operated without adequateprotection from flies, or with help of native personnel who were probablyvectors of intestinal diseases, but it was another thing to procure screeningor to persuade commanders, already overworking their personnel, to do awaywith civilian labor or use enough Americans to supervise the native kitchenhelp.
On the other hand, two special missions sent from Washington in 1944and a visit of the theater surgeon to Washington to emphasize the theater`smedical needs had a salutary effect.33
By the spring of 1944, it became clear that the theater lacked sufficienthospital beds to cope with casualties to be anticipated from the, fightingin Burma and the expected rise of incidence of malaria and other diseaseswith the impending monsoon season. By midyear the situation in hospitalsaround Ledo and in northern Burma became critical. The medical resourcesof the Chinese forces fighting in Burma were inadequate to provide evacuationand hospitalization behind the regimental rear boundary, and the U.S. Armyhad been called on to provide the necessary units; that is, the usual fieldand evacuation hospitals of the combat zone, as well as the station andgeneral hospitals which the Services of Supply operated in the base andadvance sections. The U.S. Army hospitals had become crowded with disabledChinese, as well as those requiring long periods of convalescence beforethey could return to combat.
32 See footnote 4 (1), p. 511.
33 (1) Memorandum, Director, Epidemiology Division, for Chief,Preventive Medicine Service, 27 Aug. 1944, subject: Preventive MedicineProgram in CBI Theaters. (2) For the quotation, see footnote 4 (2), p.511.
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For reasons which remain obscure, the theater`s reports to Washingtonhad included statistics on the hospitalization of American troops, butnot of the Chinese, in Services of Supply hospitals. Hence, although theWar Department had authorized beds in proportion to Chinese as well asAmerican troop strength and the theater`s beds were well below the authorizationWashington authorities were unconvinced of an immediate need for more hospitalbeds, since statistics seemed to show that a goodly proportion of the availablebeds were unoccupied. Moreover, the transfer of additional divisions ofthe Y-Force from China to the X-Force in Burma increased the number ofChinese troops for whose fixed hospitalization the U.S. Army was responsible.U.S. Army support of the X-Force with medical units behind the regimentalrear boundary had been agreed upon, but this force had been augmented bythree divisions flown from China into Assam and committed in the battlesof Myitkyina and Bhamo. When the theater surgeon was called to Washingtonto explain requests for increases in hospital beds and medical personnelfor the China-Burma-India theater, he found that the Operations Divisionof the General Staff recognized only 57,000 Chinese troops under GeneralStilwell- the authorized number- although the strength of General Stilwell`sChinese Army had reached approximately 83,000 by the close of July 1944.Colonel Williams` trip eventually bore fruit in 4,300 additional beds forthe theater.34
Deficiencies had also developed in the handling of medical supply. Astatement by an air surgeon returning to Washington that the Services ofSupply in the theater had failed to fill air force requisitions for medicalsupplies led The Surgeon General to send a mission to investigate the medicalsupply situation in the China-Burma-India theater. The group, headed byCol. Tracy S. Voorhees, JAGD, inquired not only into the medical supplysystem, which by that date had suffered an acute breakdown, but also thestatus of hospitalization, the effectiveness of the preventive medicineprogram, and the quality and sufficiency of personnel in key administrativepositions.
The Voorhees mission backed up statements which the theater surgeonhad made in Washington on the need for more hospital beds and the needfor more medical personnel. It traced most deficiencies in medical servicein the theater back primarily to the lack of well-trained personnel inkey positions, particularly in the theater surgeon`s office and in postsin the medical supply system. Most of the incumbents in the, theater surgeon`soffice were unqualified for the positions they then held, the report declared,either because they lacked the necessary training or experience, had attainedan age which prevented extensive travel to the front, or lacked initiativeor some other desirable trait. The report sized up the theater surgeon`sstaff as generally inadequate both as to numbers and as to qualifications.It noted that a list of positions proposed by the theater surgeon for hisstaff had recently been cut in Washington. A de-
34 (1) See footnotes 3(4), p. 507; 13(3), p.520; and 20(4), p. 527. (2) Stone, James H.: The Hospitalization and Evacuationof Sick and Wounded in the Communications Zone, CBI, and India-Burma Theaters,1942-1946.[Official record.]
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cision by the Surgeon General`s Office to restrict consultants to therank of lieutenant colonel made it difficult to get qualified men for thoseposts.
The Voorhees report stated that the theater surgeon had left responsibilityfor fixed hospitalization almost solely up to the former Services of Supplysurgeon and that the latter had failed to give adequate supervision bothto the hospitals and to the medical supply system. The Services of Supplymedical section had also been inadequately staffed, and its present chief,Col. Alexander O. Haff, MC (fig. 121), had so far been unable to get thelarger allocation of personnel which he had requested. The medical officesof the three base sections and the two advance sections were for the mostpart satisfactorily staffed. The major problem, as the mission`s reportsaw it, was that the Services of Supply surgeon lacked control over thebase and advance section surgeons because of a tendency towards decentralizationof administration to the base and advance section commanders. The reportadvocated merging the theater surgeon`s office with that of the Servicesof Supply surgeon (without indicating whether the combined medical sectionshould be located at theater or at Services of Supply headquarters). Alternatively,it proposed, if the existence of a separate Services of Supply organizationshould preclude such a merger, to transfer all operating personnel fromthe theater surgeon`s office
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to the medical section at Services of Supply headquarters and to makethe Services of Supply surgeon deputy theater surgeon.
The Voorhees report did not pin down responsibility for choice of incumbents.Some assignments had been made in the theater, while in other cases theindividuals had been selected by the Surgeon General`s Office. Accordingto the report, the Surgeon General`s Office lacked adequate knowledge ofthe men occupying posts in the China-Burma-India theater.
The Voorhees report stressed weaknesses in various phases of preventivemedicine, terming the poor protection afforded to the food of troops andthe unsanitary handling of food in messes the "most striking medicalweakness" in the theater. It noted the commonness of acute diarrheaand stressed the danger of returning men with amebic dysentery to the UnitedStates. Unsanitary food conditions were ascribed to the lack of veterinarypersonnel to inspect food and supervise native personnel who handled foodin the messes and to the lack of basic directives, bolstered by strongcommand support, f or methods of eliminating improper food. In this theaterthe care of animals- and the training of the Chinese in their care- hadloomed large as a veterinary responsibility because of the extensive useof animals for transport on fighting fronts in Burma and China. The availableveterinarians had been needed for this work; hence, the number to copewith the unsanitary conditions surrounding the preparation of food hadbeen insufficient. Since troops of the Fourteenth Air Force in China werehoused and fed by the Chinese Government, rather than at bases maintainedby the U.S. Army`s Services of Supply, it was more difficult to insureproper protection of food for U.S. Army troops in China. than in India.
The investigating group also called attention to special problems connectedwith air force medical service. Contrary to War Department policy, thereport stated, aviation dispensaries were acting as hospitals, and oneor two regular hospitals were being operated by the air forces in China.The Air Surgeon was currently demanding that additional hospitals be turnedover to the Air Service Command.
The Voorhees report attempted to point out certain observed deficienciesrather than to appraise the total Medical Department program in the theater.It advised the dispatch of another special mission to the theater to investigatethe following matters: The appointment of a surgeon to relieve ColonelWilliams who had already been in the theater 2 years; consolidation ofthe offices of the theater and services of supply surgeons; the sendingof consultants to the theater; status of the preventive medicine program,especially in control of diarrhea and dysentery; adequacy of food inspection;a survey of hospitalization in India and along the Ledo Road; and personnelproblems.35
35 (1) "Miscellaneous Notes" as toMedical Department Matters in CBI Theater Outside the Scope of the SupplySurvey, 17 Aug. 1944, by Col. Tracy S. Voorhees. [Official record.]. (2)Memorandum, Col. Tracy S. Voorhees and others, for Commanding General,U.S. Army Forces in China-Burma-India, 25 July 1944, subject: Medical Supplyin CBI. (3) Letter, Col. Tracy S. Voorhees, to Deputy Theater Surgeon (ColonelArmstrong), 18 Aug. 1944. (4) See footnote 8(4), p. 515. (5) Account ofVisit to China-Burma-India Theater to Survey Medical Supply, 11 Sept. 1944,by Col. Tracy S. Voorhees. [Official record.]
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As a sequel to the Voorhees survey, The Surgeon General sent a missionheaded by Brig. Gen. Raymond A. Kelser, Chief of the Veterinary Corps,to the theater in October and November 1944 to survey sanitary conditionsand Veterinary and other professional services. Since a reorganizationinto two theaters was then under way, this mission did not tackle the morepurely organizational problems to which the Voorhees report had calledattention. The theater commander informed the Kelser mission that he wouldconcur in the reassignment of the present theater surgeon and that, notdesiring to replace him with any medical officer then in the theater, hepreferred that The Surgeon General select a new theater Surgeon.36
The members of the mission inspected many Army Medical Department offices,including those of base and advance section headquarters, Northern AreaCombat Command headquarters at Myitkyina, and Fourteenth Air Force headquartersat K`un-ming. They surveyed the situation as to hospital beds, and inspectedmedical laboratories and supply depots, veterinary dispensaries, butcheries,piggeries, ice cream plants, egg candling plants, chicken slaughterhouses,and even a puffed-rice plant run by the Services of Supply. The group concentratedon problems of disease prevention, with particular stress on the procurement,inspection, and handling of food and the care of animals; that is, thetasks of Veterinary Corps officers. The mission`s report pointed out thatreliance on local sources of food was necessary in the China-Burma-Indiatheater, because of the distance from home sources of food supply, coupledwith slow transit, local climatic conditions, and poor facilities for storageand refrigeration. As the Voorhees mission had noticed, unusually heavyresponsibilities for food inspection and supervision of food-producingestablishments, as well as for care of animals and the training of theChinese in animal care, had fallen to the lot of the Veterinary Corps inthis theater. Some major reforms urged by the Kelser group were the reductionto a minimum of foodhandling in messes by native personnel, together withclose supervision of the, necessary native foodhandlers by American personnel;the assignment of a Sanitary Corps engineer to the headquarters of eachbase and advance section to train personnel in the processes of water purificationand to advise each Army installation on problems of pure water supply,and the assignment of a few additional malaria control units to the theater.The report also emphasized the immediate need for medical, surgical, andneuropsychiatric consultants.37
Results of the Voorhees and Kelser Missions
As long as the theater surgeon`s medical section was divided betweenthe Chungking and New Delhi offices, the functions of the two offices wererather distinct from each other and their work was not well integrated.The Chung-
36 Memorandum, Brig. Gen. R. A. Kelser andCol. R. H. Kennedy, for The Surgeon General, 18 Nov. 1944, subject: ConfidentialNotes for The Surgeon General.
37 (1) Memorandum, Brig. Gen., R. A. Kelser and Col. R. H. Kennedy,for The Surgeon General, 18 Nov. 1944, subject Report of Medical DepartmentMission to CBI and inclosures. (2) See footnotes 4 (1), p. 511 and 36.
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king office formulated theater medical policies and worked closely withChinese authorities, while the New Delhi office gave technical supervisionto Army medical service in India, developed medical supply policy for thetheater, conducted a theaterwide program in preventive medicine, and preparedvital statistics. Although frequent interchange of letters and transmissionof "information copies" of important papers had taken place betweenthe two offices, the usual problems arose. Typical of them all were separateinstructions from the commanding general in Chungking and his deputy inNew Delhi as to the same project: and the necessity for completion of plansby the deputy theater surgeon in India before he had time to submit themto the distant theater surgeon.
In the fall of 1943 and the first half of 1944, Colonel Williams madeefforts to increase his medical section, including both the New Delhi andChungking offices, to 34 Medical Department officers, 2 warrant officers,and 36 enlisted men-numbers greatly in excess of those then authorized.War Department restrictions on allotments of personnel for the theaterprevented official approval. In the spring of 1944, General Stilwell decidedto turn over all operating functions to the Services of Supply, restrictinghis special staff, including the theater surgeon, to an advisory capacity,and transfer his personal headquarters to New Delhi; these changes affectedthe responsibilities of the theater surgeon`s two offices. Colonel Williamsmoved to General Stilwell`s personal headquarters in New Delhi, leavingonly three officers, including an assistant theater surgeon, at forwardechelon headquarters in Chungking. This move eliminated problems whichthe separation of Colonel Williams from the bulk of his staff had broughtabout.
Although replacements arrived during this period to relieve MedicalDepartment officers due for return to, the States, restrictions on personnelallotments forced the theater surgeon to forego offers from the SurgeonGeneral`s Office to send him -specialized personnel, including a directorof nurses and professional consultants. Surveys made within the theaterby personnel survey boards approved the positions of director of nursesand of consultants but did not approve as large sections for theater andServices of Supply headquarters as their respective surgeons considerednecessary to accord with the expanding strength of the theater and copewith casualties expected from the fighting in Burma.
The merger of the offices of the theater surgeon and the Services ofSupply proposed by Colonel Williams prior to his trip to the United Statesin June 1944, and endorsed on the Voorhees report, proved to be the solution.Since neither of these surgeons had succeeded in enlarging his staff, theyagreed willingly to the proposal, and a semimerger was effected. All personnelof the theater surgeon`s medical section, except Colonel Williams himselfand his assistants in Chungking, were transferred to the office of theServices of Supply surgeon; the latter was made, the theater surgeon`sdeputy. The addi-
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tional assignment as deputy strengthened the position of the Servicesof Supply surgeon, and the consolidation gave him the bulk of the staff.At the same time it preserved the superior authority of Colonel Williamsas theater surgeon. Finally, it achieved the result contemplated in theVoorhees report- a more efficient use of the Medical Department personnelavailable for the top administrative offices. The combined staff totaled23 officers and 1 U.S. Public Health Service officer.38
The theater surgeon and his new deputy, Colonel Haff, began to buildup the quality of the combined staff as replacements became available forofficers who had spent two or more years in the theater, and for thosewho had been chosen for their positions by reason of the scarcity of betterqualified men. Col. Karl R. Lundeberg, MC (fig. 122), who bad come to thetheater with the Kelser mission, was retained as the head of preventivemedicine for the theater and built up a largely new staff in this field.Development of the professional services staff, long contemplated, continuedto incur delay on account of the limitation on rank of consultants to thatof lieutenant colonel and insistence by the Surgeon General`s Office thatavailable officers of lower rank were not
38 (1) See footnote 3(1), p. 507. (2) GeneralOrder No. 104, Headquarters, U.S. Army Forces, China-Burma-India, 22 Aug.1944.
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qualified for these posts. No consultants ever reached the, area untilafter it was divided into two theaters.39
THE INDIA-BURMA AND CHINA THEATERS
In October 1944, shortly after General Stilwell`s recall to the UnitedStates, the theater was split into the India-Burma theater and the Chinatheater. At this date, over half of the approximately 204,000 U.S. Armytroops in the theater were air troops (including the Air Transport Commandand XX Bomber Command) ; less than a third, or about 57,000, were of theServices of Supply, while only about 25,000 were ground troops. MedicalDepartment personnel serving in China, Burma, and India totaled approximately13,700.40
After the capture of Rangoon in May 1945, the India-Burma theater wasno longer an area of combat, but India continued to serve as a supply basefor operations against the Japanese in China, and the India-Burma theaterfurnished medical supplies to the China theater. In China the U.S. Armycontinued its training and support of Chinese troops, its chief task there.For the most part, medical problems were not as acute as they had beenduring the days of the China-Burma-India theater.
The India-Burma Theater
After consolidation of the offices of the theater surgeon and of theServices of Supply surgeon in August 1944, a single medical section locatedat Services of Supply headquarters in New Delhi served as the staff forboth surgeons. A few officers at General Stilwell`s Chungking headquarters,who represented the theater surgeon for the China side of the theater,still acted in only a theater capacity. When the India-Burma theater cameinto existence in October, the combined staff, which served immediatelyunder the Surgeon, Services of Supply, included his deputy (who acted inaddition as executive officer), a personnel officer, a chief of professionalservices, a dental officer, two veterinarians, two medical supply officers,a nutrition officer, a venereal disease control officer, a malariologist,an epidemiologist, a statistical officer, a sanitary engineer, and enlistedassistants. This medical section was inherited by the India-Burma theater,the theater surgeon`s small staff in Chungking being transferred to theChina theater. The theater surgeon for the former China,-Burma-India theater,Colonel Williams, and the Services of Supply surgeon, Colonel Haff, whohad served additionally as Colonel Williams` deputy in the former setup,had precisely the same assignments in the new India-Burma theater. In November1944, a director of nurses (lieutenant colonel, Army Nurse Corps) was addedto the medical staff of the India-Burma theater, and a colonel of the MedicalCorps took charge of preventive medicine activities. In January 1945, consultantsin
39 (1) Letter, Col. Alexander O. Haff, MC,to Col. Tracy S. Voorhees, JAGD, 6 Dec. 1944. (2) See footnotes 4 (2),p. 511 ; and 35 (3), p. 538. (3) Letter, Col. Alexander O. Haff, MC, toThe Surgeon General, 8 Sept. 1944.
40 See footnote 20 (4), p. 527.
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surgery, medicine, neuropsychiatry, and reconditioning arrived, butthey held only the rank of major or lieutenant colonel.41
The usual theoretical distinction between the medical functions of thetheater organization and those of the Services of Supply organization prevailedin the new India-Burma theater. The following subordinate commands furnishedfield medical care and hospitalization to ground and air forces: the NorthernCombat Area Command, the Tenth Air Force, and the Air Transport Command.The theater headquarters gave general supervision to their activities.The Services of Supply was responsible for the procurement of medical personnelfrom the United States, for fixed hospitalization, for the preventive medicineprogram, and for the procurement of medical supplies. The most active territorialcommand of the Services of Supply during the Second Burma Campaign latein 1944 and the following year was the advance section in Assam and India.In January 1945, it contained 3 general hospitals, 3 evacuation hospitals,11 malaria survey and control units, and various other Medical Departmentunits and installations.
On 9 December 1944, the War Department suggested to the commanding generalof the India-Burma theater (General Sultan) that Col. John M. Hargreaves,MC, then Surgeon, Air Technical Service Command, whom the Air Surgeon considered"one of the most outstanding Regular Army doctors in the be made theatersurgeon. Apparently The Surgeon General Air Forces, (General Kirk) intervenedat this point, for 2 days later the War Department asked the theater commanderto disregard this former offer and to consider instead Brig. Gen. JamesE. Baylis, MC (fig. 123), whom The Surgeon General had recommended. GeneralBaylis was made theater surgeon, replacing Colonel Williams who had servedas theater surgeon for about 3 years, in February 1945.42 Hebecame Services of Supply surgeon as well and was located with the entiremedical section at Services of Supply headquarters. Colonel Haff becameDeputy Surgeon, Services of Supply, and remained in that position untilMay when illness forced his return to the United States.
When the India-Burma theater was established, the top air command inthe former theater took over the same role in the India-Burma theater.The
41 Except as otherwise noted, discussion ofthe India-Burma Theater is based on the following documents: (1) Historyof The India-Burma Theater, appendix 19, Medical Section, 21 May 1945-1December 1945. [Official record, Office of the Chief of Military History.](2) History of the India-Burma Theater, 25 Oct. 1944-23 June 1945, vol.II. [Official record, Office of the Chief of Military History.] (3) Historyof the Medical Department, Services of Supply, India-Burma Theater, 24October 1944-20 May 1945. [Official record.] (4) See footnote 4 (2), p.511. (5) Annual Report, Medical Department Activities, Tenth Air Force,1944. (6) Final Report, Medical Department Activities of Tenth Air Forcein India-Burma Theater, 17 July 1945. (7) Periodic Report, Medical DepartmentActivities, Headquarters, Army Air Forces, India-Burma Theater, and Headquarters,India-Burma Air Service Command, 11 Apr. 1945. (8) Memorandum, Chief, OperationsService, Office of The Surgeon General, for Commanding General, Army ServiceForces, 22 Apr. 1944, subject: Professional Consultants for CBI Theater.(9) Memorandum, Col. William C. Menninger, MC, for The Surgeon General,28 Aug. 1944, subject: Neuropsychiatric Consultant for CBI.
42 Radios, Gen. George C. Marshall, to Lt. Gen. Daniel I. Sultan,9 Dec. 1944 (War 75068), 11 Dec. 1944 (War 75639); Sultan to Marshall,17 Dec. 1944 (CM-IN-16707); Marshall to Sultan, 17 Dec. 1944 (War 78757).
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medical section at the Calcutta headquarters of Army Air Forces, IBT(India-Burma theater), served also for the large India-Burma Air ServiceCommand, which in April 1945 had a strength of 35,148. During the campaignin northern Burma (July-November 1944) the medical section of Tenth AirForce the chief combat component of Army Air Forces, IBT, shifted to forwardareas along with the air force headquarters. It was at Myitkyina, shortlyafter the fall of this city in November 1944. Later it moved southwardto Bhamo and then back again to India briefly before Tenth Air Force wastransferred, in July 1945, to the China theater.
By the spring of 1945, responsibilities of the air commands in the theaterfor the various stages of air evacuation had been clearly defined. TheSurgeon, Army Air Forces, India-Burma Theater, was theater air evacuationcontrol officer and had the job of coordinating all phases of evacuatingcasualties by air within the theater. The Tenth Air Force was responsiblefor routine, emergency, and mass evacuation by air within the area of tacticaloperations, the rugged mountainous terrain of eastern Assam and Burma,having taken over the previous unorthodox responsibility of the India-ChinaWing, ATC, for air evacuation from the front. The 821st Medical Air EvacuationTransport Squadron (minus Flight C, which went to China), operating outof
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Ledo, carried out this task, using two C-47`s placed on shuttle runsbetween Ledo and the frontlines in northern and central Burma. The India-ChinaDivision Air Transport Command was charged with air evacuation of sickand wounded back to the United States, as well as with intratheater airevacuation from station to general hospitals, both along its routes inIndia and from India to China. The 803d Medical Air Evacuation TransportSquadron, stationed at Chabua, carried out this mission.
Efforts to prevent disease-especially scrub typhus (tsutsugamushi disease),the dysenteries, and malaria- in India and Burma in late 1944 and 1945were supported by additional experts and further supplies. Pursuant tothe recommendations of the Kelser mission, a dozen veterinary food detachmentsarrived from the United States early in December 1944; eight more wereorganized within the theater. The aid of the U.S.A. Typhus Commission tocombat scrub typhus was enlisted by the theater surgeon after a Dumberof cases of this disease occurred among Merrill`s Marauders fighting throughthe Hukawng Valley to Myitkyina in the spring and summer of 1944. The groupknown as the India-Burma field party of the commission arrived in the fallof 1944 and began work around Ledo in December. The field party made itsheadquarters at Myitkyina,, which was the center of occurrence of the diseaseas well as the location of Tenth Air Force headquarters. It grew into alarge research team of 50 individuals. The group made studies of ratesof incidence, the seasonal distribution of cases, and the probable sitesof contraction of scrub typhus. A total of 1,098 cases, with a case fatalityrate of 8.9 percent, was reported among United States and Chinese troopsduring the period 1 November 1943 to 1September 1945. The field party remainedin the theater until November of 1945, following along with the advanceon the Stilwell Road.43
In 1944 and early 1945, 32 malaria control and survey units were inthe India-Burma theater. By the fall of 1944, Atabrine began arriving inquantities sufficient to place all troops east of the Brahmaputra on suppressivedosage. The theater surgeon (Colonel Williams) took his cue from the successfulcontrol program of 1944 among American and Australian troops in the SouthwestPacific Area, where in 1944 rates of incidence had dropped more rapidlythan in the China-Burma-India theater. In December 1944, he personallyexplained to line and medical officers in northern Burma theories formulatedin the Southwest Pacific Area on the use of Atabrine as a suppressive.He also called a conference at New Delhi of representatives from his office,the Southeast Asia Command, Northern Combat Area Command, the Air TransportCommand, the India-Burma Air Service Command, and the Quartermaster Corps.As a, result, various directives extending compulsory Atabrine suppressivedosage to additional troops and areas were issued in 1945. Both ColonelRice, who
43 Maxcy, Kenneth F.: Scrub Typhus (TsutsugamushiDisease) in the U.S. Army During World War II In Rickettsial Diseases ofMan. Washington: American Association for the Advancement of Science, 1948,pp. 36-46. (2 See footnote 4(l), p. 511. (3) Letter, Brig. Gen. James S.Simmons, to Brigadier Gordon Covell, Director, Malaria Institute of India,6 Oct. 1944.
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had brought copies of the Southwest Pacific Area studies on Atabrinesuppression to the theater surgeon, and an officer, who had done pioneerwork with Atabrine in the Fijis during 1943 and early 1944, participatedin the preparation of the new antimalaria. directives. Suppressive treatmentand the mosquito control program, both furthered by greater cooperationfrom the War Department and the Surgeon General`s Office, together withthe cessation of combat, led to a marked decline in malaria rates in controlledareas in the summer and f all of 1945. In the Tenth Air Force, a sharpdrop occurred in 1945, enduring even through the summer malaria season.44
By May 1945, the Services of Supply of the theater was abolished. Itsarea commands were placed directly under U.S. Army Forces, India-BurmaTheater; their surgeons were under the direction of the theater surgeon.Thereafter, the theater medical section declined markedly.
China Theater
The small medical section at the forward echelon of the China-Burma-India theater in Chungking, which became the medical section of the newChina theater headquarters, was headed by Col. George E. Armstrong, MC,who became theater surgeon. In early December 1944, Colonel Armstrong`soffice moved to K`un-ming, where the rear echelon of China theater headquarterswas located. It remained there until this headquarters was dissolved inJuly 1945. By the end of 1944, the office contained five Medical Departmentofficers and five enlisted men. Besides the normal tasks of a theater surgeon`soffice, it had to maintain close liaison with the office of the surgeonof the India- Burma theater in New Delhi. Medical supplies and personnelfrom the United States came by way of the India-Burma theater, and theNew Delhi office was a link in the chain of evacuation of patients fromChina to the Zone of Interior. The New Delhi office also arranged for prolongedhospitalization of U.S. Army patients sent from China theater to hospitalsin India. On its own side of the mountains, Colonel Armstrong`s officecooperated closely with the Chinese Army medical administration in effortsto promote the health of Chinese troops with various Chinese medical authorities(particularly the National Health Administration) in the prevention ofdiseases among civilians, and with foreign philanthropic organizationsgiving medical aid to the, Chinese.
Very shortly after becoming theater surgeon, Colonel Armstrong joinedwith Colonel Gentry, the Fourteenth Air Force surgeon, and with the Surgeon,Y-Force Operations Staff, in insistent demands for nurses for the Chinatheater. General Stilwell`s opposition no longer stood in the way. By March1945, 62 American nurses were in China, the majority serving with the 95thStation Hospital in K`un-ming.
44 (1) See footnotes 3 (1) and (4), p. 507; and 4 (1), p. 511. (2) Memorandum, Col. Robert P. Williams, MC, for TheSurgeon General, 5 Oct. 1945, subject: Medical Service in India-Burma.
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A Services of Supply was established at K`un-ming for the China theater;it had five base sections, which by June 1945 had boundaries tallying withsimilar area commands of the Chinese Army`s Services of Supply. The medicalsection at Services of Supply headquarters, headed by a separate surgeon,had a relatively large staff; at its height early in the summer of 1945,it contained 19 Medical Department officers, including the theater malariologistand the theater medical supply officer, and 22 enlisted men. Since it waslocated in the same city, K`un-ming, as the theater surgeon`s office, thetwo staffs worked closely together. A medical officer and a veterinaryofficer were assigned in a liaison capacity with the Chinese Services ofSupply.
The surgeon for each of the five base sections was concerned with medicaland sanitary service for troops within his base section; district surgeonshad the same responsibility for the districts into which the base sectionswere subdivided. In each base section was a general depot which containeda medical section to handle medical supply. The Services of Supply controlledthe small amount of fixed hospitalization necessary for U.S. Army personnelin the theater- a general hospital, two station hospitals, and severalfield hospitals and dispensaries.
After the rout of the Z-Force in southeastern China in the fall of 1944,the Chinese undertook the retraining of a volunteer army of 100,000 mento stem the Japanese advance. Colonel Armstrong worked closely with theDirector General of the Chinese Army Medical Services (Gen. Hsu Hsi Lin)in 1945 in creating a fresh medical training program. A system of "emergencymedical service schools" which the Chinese had devised in the latethirties had been overshadowed by the training centers for Y- and Z-Forces.The director of the chief emergency medical service training school atKweiyang, Gen. Robert Ko-Sheng Lim (later Director of the Chinese ArmyMedical Administration), had studied at the Medical Field Service Schoolat Carlisle Barracks, Pa., in the fall of 1944. This school was selectedas the prototype for expanding the Chinese system of emergency medicalservice training schools.
The Chinese Training and Combat Command, created in November 1944, wasthe American command concerned with training the newly planned Chinesedivisions. Its staff was formed by merging the "operations staffs"of Y- and Z-Forces; the former surgeon of Y-Force operations staff, Lt.Col. Eugene J. Stanton, MC, became its surgeon. This command, termed merelyChinese Combat Command after January 1945, paralleled, as did the Servicesof Supply, its counterpart Chinese command. Six subordinate commands correspondedto Chinese Army groups. The Medical Department followed the same pattern,with a surgeon at general headquarters and a surgeon for each subordinatecommand. The theater surgeon assigned another former Y-Force operationsstaff surgeon who spoke fluent Chinese as liaison officer to the officeof the Chinese Surgeon General to advise on medical matters, includingtraining. A somewhat more effective job of medical training was possiblethan in the days of the
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China-Burma-India theater, for Chinese doctors had been drafted intothe army, for the first time during World War II, in October 1944.
At the request of the Director General of the Chinese Army Medical Administration(then General Lim), U.S. Army Medical Department officers also aided inreorganizing the Chinese Army Medical Administration. This assistance,requested in May 1945, was not forthcoming until after the Japanese surrender.In September, five officers were assigned to the task for a 6-month periodunder the direction of Col. Ralph V. Plew, MC. Colonel Plew drew up recommendationsfor changes in the central office of the Chinese Army medical service,using the Surgeon General`s Office in Washington as a model at points whereit seemed an improvement over the Chinese setup. Other Medical Departmentofficers aided in establishing a model rehabilitation and reconditioningcenter at Yunnanyi, delivered lectures on organization and administrationof the U.S. Army Medical Department to the training staff of the ChineseArmy Medical Administration, supervised the creation of model supply depotsand a medical battalion, and aided with the training of medical supplyofficers at K`un-Ming.45
The loss of Fourteenth Air Force bases in south central China late in1944 during the Japanese drive to separate east China from west China madefor rapid changes in the always mobile medical service of Fourteenth AirForce units. They now had to wing over enemy-held territory in order tocarry supplies to the eastern bases and to evacuate patients westward.One flight of a medical air evacuation transport squadron, serving withthe Fourteenth Air Force, bore the burden of air evacuation in China.
In May 1945, a Fourteenth Air Force Service Command was organized andwas assigned a separate surgeon, while Colonel Gentry remained staff surgeonof the Fourteenth Air Force. Base medical service was then put under theair service command. The various service groups of this command fur-nishedmedical officers and enlisted personnel to staff the 10-, 20-, and 40-beddispensaries-some of which were housed in mission hospitals and ancienttemples-maintained by four air service centers. Five medical dispensary(aviation) units operated the larger base dispensaries. One such unit,aug-mented by medical officers from other sources, had maintained a stationhos-pital of 150-bed capacity at Chengtu to serve the northern air basesfor about a year. The Services of Supply, China Theater, furnished regularmedical supplies to the Fourteenth Air Force, but in order to get itemspeculiar to the air forces the medical supply officer at the headquartersof the air force`s service command placed a requisition with the appropriateair medical depot of the India-Burma theater.
In June 1945, General Chennault`s Fourteenth Air Force had assignedto it a total of 60 medical officers, 12 dental officers, 1 medical administrativeofficer, 1 veterinary officer, and 162 enlisted men. The surgeons of various
45 (1) See footnote 18, p., 525. (2) Historyof Services of Supply in the China Theater, 19 Sept. 1945. [Official record.]
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tactical units of four wings, which covered about the same territoriesas the four air service centers, were also available for hospital and otherduties. Since personnel of the air force were widely scattered, about 10dental officers assigned to the air force traveled to various outpostsfrom time to time. Dispersal also led to close cooperation between dentalofficers of the Fourteenth Air Force and its air service command and thoseof the Services of Supply. Dental officers treated as many men as possiblein the neighborhood of their own stations, regardless of the command towhich they or their patients were assigned.
In July 1945, when the Tenth Air Force moved into China from the India-Burmatheater- to be built up as a transport air force- the usual higher airforce command, Army Air Forces, China Theater, was created. The small medicalsection at its Chungking headquarters coordinated the medical work of theTenth and Fourteenth Air Forces with that of the ground forces in the theater.The medical section of the new China Air Service Command (a redesignationof the Fourteenth Air Service Command) was at K`un-ming. A medical supplyplatoon (aviation) assigned to it issued medical supplies to all air forceinstallations in the China theater, obtaining regular items from Servicesof Supply Base General Depot No. 1 in K`un-ming and special air forcesmedical items from the Bengal Air Depot in India. The China Air ServiceCommand was responsible for air evacuation until September, when this taskwas turned over to the Air Transport Command. The China Air Service Commandmaintained the dispensaries at the air bases, and undertook to reestablishmedical service at bases in southeast China recaptured by American andChinese forces in the latter half of 1945.
When General Chennault relinquished command of the Fourteenth Air Forcein August 1945, his surgeon, Colonel Gentry, also left and was replaced.During the last months of the year many personnel and units, includingmedical dispensaries (aviation), of the Tenth and Fourteenth Air Forceswere moved out of China. In December both air forces were disbanded; onlyunits remained.46
In July 1945, the office of the China theater surgeon at the rear echelonof theater headquarters at K`un-ming reached its zenith. It then includedthree assistant theater surgeons, a theater veterinarian, a theater dentalsurgeon, a medical inspector, an executive officer and one assistant, adirector of nurses, a venereal disease control officer, a historical recorder,a medical supply officer, and eight enlisted men. In the same month, whenthe theater rear echelon was dissolved, this office was transferred totheater headquarters at Chungking, but after the collapse of Japanese resistancein August it was temporarily returned to K`un-ming, where it was mergedwith the medical section at Services of Supply headquarters.
46 (1) Medical History of the Fourteenth AirForce in China, 10 March 1943-10 March 1945. [Official record.] (2) PeriodicReport, Medical Department Activities, Fourteenth Air Force, 1 Apr. 1945-30Nov. 1945, and inclosure. (3) Periodic Reports, Medical Department Activities,Headquarters, Army Air Forces in the China Theater, July 1945-January 1946.
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From the date of the surrender, the military activity of the China theatercame to be concentrated in the area around Shanghai. Medical tasks includedrendering medical aid to the Chinese troops taking over areas occupiedby the Japanese in north and east China; giving medical examinations andcare to thousands of Allied prisoners of war and internees, largely concentratedin the Shanghai area; disposing of American medical supplies and equipment;and transferring or dissolving Medical Department units. Hence ColonelArmstrong`s medical section was relocated in Shanghai. In September, someof the staff went there to establish dispensaries, a field hospital, andprophylactic stations the rest arriving by early October. This group servedas the medical staff both for theater headquarters, newly relocated inShanghai, and for the Shanghai Base Command, until the latter was dissolvedin November.
When the theater was dissolved on 1 May 1946, the medical section wastransferred to a newly established China Service Command, having undergonepossibly more shifts in location and jurisdiction than any other top medicaloffice overseas in a comparable length of time. Colonel Armstrong retainedhis responsibility as senior surgeon for all U.S. Army troops in China.At Nanking, another medical section served with the Army Advisory Group,where it aided the Director General of the Chinese Army Medical Administrationin reorganizing the Chinese Army medical service. This project involvedsetting up a large military medical center near Shanghai and arrangingfor a year`s medicomilitary training for about 130 Chinese medical officersin the United States. 47
SUMMARY: MEDICAL ADMINISTRATIVE PROBLEMS IN CHINA-BURMA-INDIA
No firm direction of medical service in the China-Burma-India theaterwas ever achieved by the theater surgeon and his medical section. The splitof the theater into two areas, until the fall of 1944, with transport ofmen and supplies possible only by flight over the Hump, and the scatteringof subcommands and bases, made it difficult to distribute Medical Departmentpersonnel, supplies, and facilities effectively. These features abettedthe characteristic claims of the air forces that they should control medicalsupplies and facilities for their personnel. They also hampered the achievementof uniformity in policies for the prevention of disease.
The need to deal firsthand with the Chinese Nationalist Government ledthe theater surgeon to maintain his headquarters, from late 1942 to thespring of 1944, in Chungking far from the Indian bases where most of theArmy`s medical resources were located. Separation of the theater surgeonfrom the majority of his staff, coupled with the lack of a fully developedstaff and frequent changes in the person of the deputy theater surgeon,made centralized control by the theater surgeon virtually impossible. ColonelWilliams conceived of his re-
47 (1) See footnotes 18, p. 525; and 45(2),p. 548. (2) Medical History of the China Theater for April 1946. Officeof the Surgeon, Headquarters, China Service Command, 1 May 1946. (3) Letter,Col. George E. Armstrong, MC, to The Surgeon General, 2 May 1946.
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sponsibility as one of assisting Chinese authorities to develop an adequatemedical service for their troops which were under American control andof supervising and inspecting the U.S. Army medical service throughoutthe theater, especially the medical service being furnished to the Americanand Chinese troops in combat. In filling what he considered to be a necessaryrole, he undertook duties quite different from those of a theater surgeonwhose responsibilities were limited to U.S. Army troops and who maintainedcentralized control by means of a large and specialized office staff.
The China-Burma-India theater had insufficient Medical Department officerstrained and experienced in administrative work. It was particularly illsupplied with men qualified to staff the medical sections of the top commands,serve as surgeons of base, intermediate, and advance sections, and fillposts in the field of medical supply. The record also shows a dearth ofpersonnel for preventive medicine duties and of Veterinary Corps personnel.
The fact that the theater had as its chief raison d`être the trainingand support of troops of an Ally, the Nationalist Government of China,meant that the character of work to be done by the Medical Department-and the personnel and units needed- differed markedly from those in othertheaters. American troops for whom the Medical Department was responsiblewere largely air force and service troops. The dearth of U.S. Army groundtroops lessened the need for tactical Medical Department units-such asmedical battalions and other units employed in the chain of evacuationat the front. On the other hand, the usual resources of the Services ofSupply-hospitals, laboratories, supply depots, and so forth-were neededin numbers sufficient not only to give service to U.S. troops present butalso to serve Chinese patients of the X-Force. Moreover, Chinese medicalservice in the combat zones had to be supported wherever it was deficient.Poor liaison between the War Department and the theater command led toa misunderstanding in the War Department as to the number of Chinese forwhose hospitalization the U.S. Army was responsible and as to the actualnumbers being cared for in the U.S. Army hospitals.
The decline of disease rates, especially of malaria, and the diarrhealdiseases, in the India-Burma theater during the early months of its existenceas compared with the rates prevailing in the days of the China-Burma-Indiatheater testifies to the direct bearing of good and sufficient medicalsupplies, facilities, and trained personnel upon the quality of medicalservice. In the opinion of a chief of the Preventive Medicine Divisionin the office of the, Surgeon, India- Burma theater, and later surgeonof that theater, no adequate preventive medicine organization ever existedin the days of the China-Burma-India theater. Colonel Williams expressedwhat he considered to be the principal lesson to be derived from the MedicalDepartment`s experience in the China- Burma-India theater: "Good publichealth is, within limits, a purchasable commodity and the results obtainedwill be proportionate to the numbers and quality of the personnel employedand the amount of material that is expended."48
48 See footnote 4 (1), p. 511.
