CHAPTER IX
The Pacific Ocean Areas
Although Army troops in the Pacific were eventually organized withina single Pacific theater, from 1942 to August 1944 separate theater organizationalstructures prevailed in three main areas: the Central, South, and SouthwestPacific Areas (map 7). 1 In these three regions the land areas,small in proportion to the ocean surface, were strung out over great distances,with long stretches of water between. This feature had far-reaching effectsupon command structure, as well as military tactics. In the absence ofcontinuous land masses, the communications zones developed for the threeareas did not follow the orthodox pattern laid down for theaters of operations.The fact that land masses were small, with poor facilities for overlandtransport, and separated by long stretches of water, led to the burgeoningof many small commands with staff medical sections and to considerabledecentralization in the supervision of medical service. The Pacific islandsvaried greatly in climate, types of endemic disease, and sanitary conditions.They presented Army doctors with many problems of local scope.
The strategic Pacific areas that were to prevail throughout most ofthe war were established in March 1942. In the Southwest Pacific Area,Gen. Douglas MacArthur was in supreme command. In the other two major Pacificregions, the Central and South Pacific Areas, Army forces were subordinateto a higher Navy command headed by Adm. Chester W. Nimitz. In additionto his Navy assignment as Commander-in-Chief, U.S. Pacific Fleet, AdmiralNimitz was made Commander-in-Chief, Pacific Ocean Areas. The CommandingGeneral, Hawaiian Department (and his successor, the Commanding General,U.S. Army Forces, Central Pacific Area) was made directly subordinate toAdmiral Nimitz. Over the Commanding General, U.S. Army Forces, South PacificArea, Admiral Nimitz exercised command through a deputy naval commander.Through the extension of the principle of single control and responsibilitydownward, the Navy controlled various subordinate Army headquarters andunits in the Central and South Pacific Areas (Pacific Ocean Areas, as thesetwo were jointly termed), while the Army exercised highest jurisdictionover Navy headquarters and units in the Southwest Pacific Area. AlthoughArmy medical service was fully organized within the various Army commandsin the three areas, the fact of final naval authority in the Central andSouth Pacific Area indirectly affected medical planning for combat, aswell as the actual operations of field medical service in these areas.
1 The North Pacific Area is omitted from thisdiscussion. Except for air units in the Aleutians assigned to the Navy-controlledNorth Pacific Force, Army units in that area belonged to the Alaskan DefenseCommand, which in terms of its organization and administration resemblesa Zone of Interior rather than an oversea command.
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Map 7.- U.S. Army commands in the PacificOcean Areas, February 1943
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CENTRAL PACIFIC AREA
Hawaiian Department
When Pearl Harbor was attacked on 7 December 1941, the surgeon`s officeof the Hawaiian Department, located at Fort Shafter on the island of Oahu,was composed of 10 officers (including 4 of the Regular Army), 8 enlistedmen, and 15 civilians. In addition, certain medical, dental, and veterinaryofficers assigned to hospitals on Oahu were considered part of the departmentsurgeon`s staff. On the day of the attack, the office of the departmentsurgeon, Col. (later Brig. Gen.) Edgar King, MC (fig. 84), was divided,together with the other technical services, into forward and rear echelons.Colonel King was made directly responsible to the commanding general ofthe department (Lt. Gen. Delos C. Emmons, after 17 December), who maintainedhis forward echelon headquarters underground in Aliamanu Crater. Forwardechelon performed the functions of a theater of operations headquarters;rear echelon of those of a communications zone. The Hawaiian Departmentwas placed under martial law, and as the commanding general held the additionalresponsibility of military governor (with headquarters
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at Iolani Palace, Honolulu), Colonel King became responsible for thehealth of civilians, as well as for that of Army troops, in Hawaii.
During the early days of confusion after the Pearl Harbor attack, MedicalDepartment units of the 24th and 25th Infantry Divisions and Army and civiliandoctors and dentists pitched in to perform whatever service was most needed.As on the mainland of the United States, but under even greater compulsion,Army Medical Department officers and governmental and private agencieshandling medical work cooperated closely. The Japanese attack had madeclear this community of civilian and military interest. The uncertaintyas to the wisest allocation of medical personnel, supplies, and facilitiesas between military and civilian agencies and other questions of jurisdictionwhich repeatedly cropped up on the mainland in 1942 made little appearancein Hawaii. The stringencies of martial law, the longer working hours ofthe population, the threatened shortages of supplies, and the frequentmovements of the military and of civilian workers in and out of the outlyingislands as well as Oahu called for all medical assets that the Army couldmuster in Hawaii. The Army was given leading responsibility for civilianhealth.
Throughout 1941, Medical Department officers had made plans for immediatemedical care of civilians in the event of an assault on the islands. During1941, emergency aid stations had been set up in Honolulu, civilians trainedin first aid, and surgical teams of civilian doctors and ambulance corpsorganized. Schools had been selected for conversion to hospitals, militaryand civilian, should the need arise. As Japanese planes struck at Oahu,all these units- aid stations, surgical teams, and converted hospitals-went into action, some of them within minutes after the attack.
Medical Department officers had also made long-range plans, with thesupport of local agencies, for coping with preventive medicine problemsin the event of an attack. During the prewar period the health record ofArmy troops stationed in the islands, where few tropical diseases wereendemic, had been excellent. Plans centered around preparations to copewith the possible need for emergency hospitalization on a large scale,the increase of health hazards under wartime living conditions, and thethreat of introduction of diseases from other areas.
One of the most important measures taken had been the establishmentof a blood plasma bank for the protection of civilians. Originally setup at the instance of the department surgeon, it became the first to operateunder the jurisdiction of the United States under wartime conditions. TheHonolulu Chamber of Commerce, the American Red Cross, the University ofHawaii, certain commercial organizations, and a few local hospitals hadcontributed technical equipment, trained personnel, or moral support. Althoughthe supply of plasma, built up since June 1941, was exhausted within somehours after the Pearl Harbor attack, it was promptly replenished throughalready established channels.
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The Army`s prewar industrial medical program in Hawaii was derived fromstudies made by the Territorial Board of Health (counterpart of a Statehealth department on the mainland) with the aid of U.S. Public Health Servicefunds, to detect industrial poisons and determine conditions of heat, ventilation,and lighting in industrial plants. In September 1942, the Medical Departmentassumed joint responsibility with the Territorial Board of Health for industrialhygiene in the islands.
With the Pearl Harbor attack the destruction of insects on planes flowninto the islands became a responsibility of the Medical Department. During1941 the U.S. Public Health Service, then responsible for putting quarantineregulations into effect, had obtained the cooperation of the Army in enforcingthe regulations on Army planes. By October it had become clear that theincreasing number of flights and the exigencies of military secrecy might.interfere with notifying civil authorities of the arrival of military planes.The Hawaiian Sugar Planters` Association, concerned over the possible introductionof crop-destroying or disease-bearing insects, had contributed the servicesof its entomologists stationed on Canton and Midway Islands in identifyinginsects on planes landing there en route to Hawaii. After the Territorywas put under martial law, the Army assumed full responsibility for disinfestationof its incoming aircraft, and the Surgeon, Hickam Field, Was designatedAir Quarantine Officer to make inspections. In May 1942, the departmentsurgeon assigned a medical officer on his staff to supervise the program,and in June the senior medical officer of each airfield in the departmentwas made quarantine officer for the inspection of aircraft. 2
Plans had been made in the prewar period to cope with a contingencywhich never developed- the deliberate contamination of food or water suppliesby Japanese living in the islands. Fear had developed that the Japanesewould undertake some form of chemical or bacteriological warfare in theevent of an outbreak of hostilities. Nearly all dairies, food processingplants, and water supply systems employed people of Japanese descent. Onthe day of the Pearl Harbor attack the commanding general of the departmentmade the department surgeon his adviser on all problems connected withthe possible contamination, deliberate or accidental, of food and water.In his capacity as staff surgeon for the military governor, he issued aseries of general orders designed to control the sale of poisons, medicinalspirits, narcotics, and incendiary chemicals. An officer in his medicalsection obtained inventories of medical
2 (1) Office of the Surgeon, Headquarters,U.S. Army Forces in the Middle Pacific: History of Preventive Medicine.[Official record.] (2) Whitehill, Buell: Administrative History of MedicalActivities in the Middle Pacific. [Official record.] (3) Office of theSurgeon, Headquarters, U.S. Army Forces in the Middle Pacific: Historyof Surgery, Section III, Clinical Subjects. [Official record.] (4) Historyof U.S. Army Forces, Middle Pacific and Predecessor Commands, During WorldWar II, 7 December 1941-2 September 1945. [Official record, Office of theChief of Military History.] (5) Annual Report, Surgeon, Hawaiian Department,1942. (6) Annual Report, Surgeon, 24th Infantry Division, 1941. (7) AnnualReport, Surgeon, 25th Infantry Division, 1941. (8) Memorandum, Brig. Gen.Edgar King, for Col. Joseph H. McNinch, MC, 31. May 1950, subject: SupplementalData in Reply to Letter of 2 May 1950.
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stocks from dealers and passed upon the sale of all drugs under specialrestriction. The sanitary inspection of military installations, water systems,and local plants engaged in processing foods or bottling drinks was intensified.
In June 1942, Secretary Stimson became alarmed over the possible useof bacteriological warfare by the Japanese in the Hawaiian Islands whenhe received a letter of warning from a doctor in Honolulu. The writer declaredthat large numbers of Japanese. in the islands were loyal to the JapaneseEmpire. He advocated adoption of the following measures to prevent spreadof bacterial disease: The registration of bacteriological laboratoriesand bacteriologists and the internment of all laboratory workers of knownAxis sympathies, the eradication of mosquitoes and, more especially, ofrats because of the danger of plague; and the immunization of all inhabitantsagainst yellow fever and cholera.
At Secretary Stimson`s request for recommendations, Surgeon GeneralMagee advised the appointment of an officer to tackle the problem. He advocatedsupervision and inspection of civilian bacteriologists and laboratories,cooperation with health authorities in protecting the civilian populationof the islands against infectious disease through vaccination, and finally,cooperation with authorities engaged in the protection of agriculture andanimal husbandry. The officer in charge, in General Magee`s opinion, shouldhave an assistant trained in laboratory science and preventive medicine.He should be on the staff of the Chemical Warfare Officer, Hawaiian Department,and should report to the Secretary of War, through the commanding generalof the department, on any biological warfare undertaken by the enemy andon measures taken to counteract it. 3
The reaction of the Secretary of War and The Surgeon General to theHonolulu letter revealed the ignorance of current operations which sometimesprevailed at high levels as a result of the necessity for keeping certainprograms secret to all but a few people. It also reflects the fear, thenprevalent in all quarters, of subversive action by Hawaiian inhabitantsof Japanese descent. Although The Surgeon General seems to have been awareof a general prewar program for counteracting biological warf are in Hawaiiand the Secretary had taken the initiative in establishing this programon the homefront, neither seems to have been informed of the latest developmentin Hawaii. The Hawaiian Department Surgeon had been put in charge of antibiologicalwarfare activities at the outbreak of hostilities. Later an Army medicalofficer was designated antibiological warfare officer for each of the taskforces which invaded the westward islands, and officers of the Veterinaryand Sanitary Corps were given similar assignments on the various islands.All worked closely
3 (1) Memorandum, W. B. Herter, M.D., Honolulu,T.H., for the Secretary of War, 12 June 1942, subject: The Next AttackUpon Oahu- Bullets or Bacteria. (2) Memorandum, Harvey Bundy, Special Assistantto Secretary of War, for The Surgeon General, 26 June 1942; and reply byBrig.. Gen. Larry B. McAfee and Col. James S. Simmons, MC, same date. (3)See footnote 2(2), p. 378.
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with the medical inspector of the department surgeon`s office, withthe chemical warfare officer, and with the Territorial Health Department.4
With the expansion of military camps throughout the Territory of Hawaiiand of camps for civilian employees of the Army, the work of the medicalinspector of the department surgeon`s office increased. The large preventivemedicine program of the Territory, for which responsibilities were somewhatscattered in 1942, finally centered in his hands. Work which had formerlybeen limited to the inspection of fixed Army installations gradually grewinto a large program of many phases: Determination of the adequacy of foodand water supplies, waste disposal, mosquito and rat control, venerealdisease control, immunization of Army troops and of civilians in the Territoryagainst a variety of diseases, the three programs mentioned above (occupationalhealth, foreign quarantine measures, and the antibiological warfare program),and many general sanitary measures.
Before December 1941, the department surgeon had had no dental officerassigned directly to his office. In accordance with the prewar custom ofassign-ing responsibilities to the chief of dental service at the majorinstallation in a corps area or department, the chief of dental serviceat Tripler General Hospital had acted as dental adviser to the departmentsurgeon. In early 1942, he was formally assigned to the position in thedepartment surgeon`s office. The commanding officer of the veterinary generalhospital at Fort Armstrong, Oahu, served in a similar capacity in veterinarymatters. Besides supervising the usual inspection of meat and dairy foodand the quarantine and treatment of animals and work in antibiologicalwarfare, he gave technical aid to the military governor on the storageand handling of foods for civilian consumption. Not until March 1943 wasa staff nurse appointed to the department surgeon`s office.
The Pearl Harbor attack also led to the development of the standardlaboratory planned by the Surgeon General`s Office for corps areas anddepartments. Creation of a departmental laboratory in Hawaii had been longdelayed because of some uncertainty in the Surgeon General`s Office asto its necessity, possibly because the prewar health status of Army troopsin Hawaii had always been high. With the outbreak of war, the role it couldplay in the prevention of epidemic disease was acknowledged; the HawaiianDepartment Laboratory was established in January 1942. 5
In spite of the advent of war and the inclusion of the Hawaiian Islandsin one of the strategic Pacific areas- the Central Pacific Area- in March1942, the Army command in the islands was not organized after the fashionof a theater of operations; throughout 1942 it continued to be known asthe Hawaiian Department. Early in 1942 some nearby island groups- the so-calledLine Islands, Midway, Christmas, Baker, and Canton Islands- and a few others
4 [Whitehill, B. (?)]: Rough copy of Historyof Anti-Bacteriological Warfare, 7 December 1941-2 September 1945.
5 See footnote 2 (2), p. 378.
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occupied by American troops or jointly by British and American troopswere added to the territory included in the department; station hospitalsand branch medical depots were located on these islands. Additional veterinaryand sanitary service also became necessary when Christmas and Canton Islandswere stocked with chickens and cattle to supply food for troops.
When service commands were organized in March 1942 for the islands ofthe Hawaiian group- the Hawaii, Maui, Molokai-Lanai, and Kauai ServiceCommands- a surgeon was assigned to each. The surgeons` offices of theservice commands and the station hospitals on the islands served a varietyof components: the service command itself ; divisional and air force elements;elements of the Territorial Guard, the Women`s Air Raid Defense Service,and the Air Raid Warning Service; U.S. Engineering Department employees;and some Coast Guard personnel.
The introduction of a Services of Supply into the Hawaiian Departmentin October 1952 did not greatly change the situation. Although it was adistinct command, it was staffed by members of Headquarters, Hawaiian Department.Colonel King, who had held since the attack on Pearl Harbor a dual positionas surgeon of the Hawaiian Department and as the responsible medical officialfor the military government, was made additionally Surgeon, Services ofSupply. The Services of Supply (renamed Hawaiian Department Service Forcesin April 1943) was merely an intermediate command between the already establishedarea commands- here called "service commands" in Zone of Interiorterminology rather than base sections- and the departmental setup. Withinthe Services of Supply command, Colonel King`s office was made subordinateto a Supply Service Division headed by the Assistant Chief of Staff, G-4,Hawaiian Department. 6
Before 7 December 1941, the Hawaiian Air Force, which suffered severalhundred casualties when the Japanese attacked Oahu, had had several dispensariesfor the use of its troops, including one of 60 beds which was actuallythe station hospital for Hickam Field. Lt. Col. (later Col.) A. W. Smith,MC (fig 85), the senior flight surgeon, became surgeon of the Seventh AirForce, as the Hawaiian Air Force was renamed in March 1942. Flight surgeonswere needed to staff the nine airbases in the islands (including Midway,Christmas, and Canton) which the air force opened during the succeedingyear; the air force surgeon obtained permission from the Commanding General,Army Air Forces, to train locally medical officers obtained through thecooperation of the Surgeon, Hawaiian Department. The Seventh Air Forcesurgeon`s office also conducted the training of medical officers as aviationmedical examiners who would administer physical examinations for Hawaiianapplicants seeking aviation training on the mainland. 7
6 See footnote 2 (4), p. 378.
7 Consolidated Medical History of the Seventh Air Force fromits Activation to 1 June 1946. [Official record.]
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At the end of 1942, the Army Medical Department in Hawaii was engagedin caring for the health of Army troops on the Hawaiian Islands (Oahu,Hawaii, Maui, Molokai, Lanai, and Kauai) and on Christmas, Fanning, andCanton Islands. It was also carrying out policies which the Office of theMilitary Governor had established for the protection of civilian health-quarantine regulations and other measures for control of communicable diseases,regulatory measures for control of laboratories engaged in bacteriologicalwork, and regulations concerning the sale and use of civilian medical supplies.During the year of martial law, civilian hospitals had been under Armycontrol, and some Army doctors and nurses had been assigned to them. Thefixed hospitals of prewar days on Oahu- Tripler General near Fort Shafterin Honolulu and the station hospitals at Schofield Barracks and HickamField- had been augmented by several station hospitals. Many aid stationshad been built, some partially or completely underground. Dental clinicshad been set up in areas not served by other fixed medical installations,and dental trailers served troops in still more remote areas. A main supplydepot located at Fort Shafter and a number of branch depots furnished medicalsupplies for Army troops in the Central Pacific Area. 8
During 1943, as the fear of further enemy attack on Hawaii lessened,the responsibilities of the Office of the Military Governor for civilianhealth were
8 (1) See footnote 2 (4) and (5), p. 378. (2)Memorandum, Brig. Gen. Edgar King, for Editor, History of the Medical Department,22 Mar. 1950.
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gradually returned to the public health authorities which had handledthem before the war. Beginning about March 1943, the control of communicablediseases and the regulation of sale of medical supplies and poisons werereturned to civil authorities. Army supervision of laboratories was relinquisheda few months later. Colonel King`s office continued to cooperate closelywith such civil authorities as the Territorial Board of Health and theOffice of Civilian Defense in efforts to maintain civilian health. A fewepidemics, including a poliomyelitis outbreak and an epidemic of denguefever in 1943, were brought under control through the combined effortsof military and civilian authorities. 9
Central Pacific Area Command: August 1943-Mid-1944
A major reorganization took place in August 1943 when the U.S. ArmyForces in the Central Pacific Area was established, with headquarters atFort Shafter, under the command of Lt. Gen. Robert C. Richardson, Jr. Thischange marked the revamping of Army organization for the offensive warfarein the Central Pacific Area which resulted in the taking of the Gilbert,Marshall, and Marianas Islands. The Army`s Hawaiian Department had beensubordinate to Admiral Nimitz` Pacific Ocean Areas command since the springof 1942, but the concept of the Central Pacific as an important area, ofcombat operations had applied primarily to Navy activities there. Althoughhe continued to hold the nominal post of Hawaiian Department Surgeon, GeneralKing became surgeon on the special staff of General Richardson. His medicalsection operated until mid-1944 as the chief medical office of U.S. ArmyForces in the Central Pacific- that is, in the role of a theater medicalsection. Headquarters, U.S. Army Forces in the Central Pacific Area, nowhad the chief .responsibility as a training agency for Army forces mountingfrom the Hawaiian Islands, as the logistic agency for supporting forwardoperations and as the administrative agency for all Army forces in theCentral Pacific Area. 10
The Hawaiian Department Service Forces (as the Hawaiian Services ofSupply had been renamed) was abolished at the time of this reorganization,but an Army Port and Service Command, set up on Sand Island, took overcertain of its functions applicable to the ports and subports of the HawaiianDepartment. The port of Honolulu underwent intensive development in preparationfor the capture of the westward bases. The Army Port and Service Commandenforced quarantine regulations applicable to personnel entering or leavingports and furnished medical service on transports and harbor craft operatedby the command. Up to the end of 1944, medical responsibilities increasedas the command received several important additional tasks: The trainingand use of port companies, operation of the Waimanalo Amphibious
9 (1) See footnote 2 (1), (2), (4), and (5),p. 378.
10 (1) See footnote 2(4), p. 378. (2) Memorandum, Brig. Gen.Edgar King, for Col. J. H. McNinch, MC, 9 Aug. 1950, subject: AdditionalData for History.
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Training Area and the Central Pacific Casual Depot, and the commandof the prisoner-of-war camps.
At the end of 1944- a date by which the war had moved far away fromHawaii- Medical Department personnel assigned to the Army Port and ServiceCommand included 38 medical officers, 14 dental officers, 4 Medical AdministrativeCorps officers, 1 Veterinary Corps officer, 243 enlisted men, and 1 civilian.Its Medical Division at headquarters contained, besides the surgeon, anassistant surgeon and medical inspector, a port surgeon, and a port veterinarianand administrative officer. Veterinary personnel of the division supervisedthe loading and discharge of the Army`s perishable foods aboard ships andinspected ship refrigeration. The division provided medical attention atdispensaries maintained at the various posts for Army and civilian personneland those at prisoner-of-war compounds. Individuals served by the dispensariestotaled about 37,000 by the end of 1944; about 7,000 were prisoners ofwar, largely Italians. The division also received and evacuated casualtiesby transports, provided quarantine information, made medical and sanitaryinspection of Army transports, supervised medical service on ships assignedto the port of Honolulu, and provided medical supplies to Army transportsstopping at the port. 11
Soon after Army reorganization under the Central Pacific Area command,Medical Department officers were given some responsibility in coordinatingmedical plans for support of Army combat units with those of Navy medicalofficers for support of their forces during the amphibious operations westward.Admiral Nimitz, who as Commander in Chief, Pacific Ocean Areas, had hada joint Army-Navy command (in addition to his naval command of the U.S.Pacific Fleet) since early 1942, was now to conduct joint combat operations.A staff of Navy and Army officers was established for him in his capacityas Commander in Chief , Pacific Ocean Areas, in September 1943; it drewup the plans for Army-Navy assaults on the Gilberts, Marshalls, and Marianas.Within its Logistics Division was created in October a medical section,initially composed of a Navy medical officer (the former Fleet MedicalOfficer) and an Army medical officer who had previously worked in GeneralKing`s office. A number of Navy medical officers were added, but the sectionnever contained more than two Army medical officers, a second one beingassigned in January 1944. When first established, the joint medical sectionwas mainly concerned with the campaign of November 1943 in the GilbertIslands (Tarawa and Makin atolls), making plans for evacuation, hospitalization,preventive measures, and the care of civilians. Later it drew up medicalplans for the campaign of January-March 1944 in the Marshall Islands (Kwajaleinand Eniwetok atolls) and that of June-August 1944 in the Marianas (Guam,Tinian, and Saipan). Continuing duties were the preparation of directiveson medical and sanitary problems and the allocation of Army and Navy facili-
11 Annual Report of Medical Activities, ArmyPort and Service Command, Hawaiian Department, 1944.
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ties for hospitalizing patients on the captured islands and for evacuatingpatients to fixed hospitals at the rear bases. Medical officers on thejoint staff also had duties with the Joint Intelligence Center, PacificOcean Areas; their work in medical intelligence was of a type normallyperformed by an Army medical officer assigned to G-2 of a general staff.12
The Office of the Surgeon, Central Pacific Area, worked in close liaisonwith the two Army medical officers participating in the high-level planningon Admiral Nimitz` staff; it prepared in its turn the more detailed medicalphases of plans for the Army combat units participating in the westwardoffensive. The Operations and Training Section of General King`s officetook on increased importance; it conducted several training programs aimedat support of the island campaigns. Basic medical training was given tomen of the divisions staging on Oahu; technical training was given to medicaltechnicians in the hospitals on Oahu; medical officers and nurses wereinstructed in work under field conditions. At a Medical Department trainingcamp established in January 1944 at Koko Head, intensive training was givento Medical Department units and special instruction to tactical units inthe best methods of survival in tropical jungle. Some of the surgeon`sstaff observed rehearsals and maneuvers in amphibious and jungle warfare.The movement of troops from the salubrious Hawaiian Islands into areasof endemic tropical disease called for additional immunizations of troopsand special equipment and trained personnel to combat insect vectors ofdisease.
General King`s medical section had to provide medical support for thesix divisions (the 6th, 7th, 24th, 40th, 77th, and 96th) which were sentto other islands during 1943 and 1944 after staging in the Central PacificArea; all but the 24th received medical units and equipment especiallydesigned to support amphibious operations. The office worked out plansfor the Medical Department units which came to be standard support forthe reinforced division (about 20,000 men) typically used in the islandassaults in the Central Pacific Area: a field hospital, two portable surgicalhospitals, and a malaria control and a malaria survey unit. Another standarddevelopment which emerged from its planning was the addition of equipmentto the divisional clearing company which enabled it to operate as a 250-400-bedhospital on small islands where mobility was not so imperative as on largeland masses.
Staff medical sections and fixed hospital units (station and general)were furnished to the Army garrison forces which accompanied task forcesand became the Army administrative organizations on the westward islandsafter combat had ceased. Supply officers in General King`s medical sectionworked out special procedures for providing medical supplies to the remoterislands
12 See footnote 2,(2), p. 378. Since this medicalsection was under control of the Navy and naval medical officers assignedto it greatly outnumbered Army Medical Department personnel, an appraisalof its work is not in order here. However, an opinion expressed in thedocument cited, to the effect that the medical section on Admiral Nimitz`joint staff could have been more efficient "had Naval Medical Officersbeen trained or experienced in staff and logistics principles and proceduresto the extent that those of the Army had been" is of some significancein this connection.
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directly from the mainland; the ordinary lines of communications didnot prevail in this area and the bypassing of islands produced more rapiddelivery. 13
In addition to General King and his deputy, Col. Kermit H. Gates, MC(fig. 86), former surgeon of the 24th Infantry Division, the theater medicalsection at the end of 1943 included 27 Medical Department officers, 3 warrantofficers, and 121 enlisted men. Before mid-1944 specialists in medicine,surgery, orthopedic surgery, and laboratory work in several general hospitalshad been given the additional assignment of consultants in those fieldsin General King`s office. At that date, General King`s medical sectionserved as the highest medical office in the Central Pacific Area, supervisingdirectly (without the interposition of a Services of Supply) the work ofthe surgeons` offices of the following commands: XXIV Corps and variousdivisions, the service commands on the outlying Hawaiian Islands, the armygarrison forces on the westward islands, the Army Port and Service Commandin Hawaii, and the Seventh Air Force. In June 1944, the total Army strengthin the Central Pacific Area was approximately 296,000 men. 14
Late in 1943, when the westward offensive began, units of the SeventhAir Force, which until that time had been chiefly occupied with defenseand training, were scattered over a number of islands; total air forcestrength in November 1943 was about 25,000. The Seventh Air Force maintaineddispensaries at airfields, but as a result of close cooperation betweenthe Surgeon, U.S. Army Forces in the Central Pacific Area, and medicalofficers of the air force, these dispensaries did not tend to develop intohospitals as did those operated by the air forces in. some other areas.The Seventh Air Force surgeon, Colonel Smith, although favorably disposedin theory to the operation of separate hospitals by the air forces overseas,pointed out several f actors which argued against it so far as the CentralPacific Area was concerned: the small proportion of air force patientsin the total number of hospitalized troops, the convenient location ofthe fixed hospitals maintained by the Hawaiian Department Service Forces,and the sympathetic consideration given by the Pacific Area surgeon toair force medical problems.
The general and station hospitals run by the Hawaiian Department ServiceForces on the islands of Oahu and Hawaii took care of air force, as wellas ground force, patients, although the station hospital at Hickam Fieldwas operated by the air force with Medical Department personnel assignedby the theater surgeon. As in other air forces, a few veterinarians inspectedfoods when they were received at airbases from the theater command andwhen they were issued to air force units. One medical supply platoon (aviation)drew
13 (1) See footnotes 2(2) and 2(8), p. 378.(2) Interview, Col. Kermit H. Gates, MC, 17 July 1945. (3) History of theMedical Service, Central Pacific Base Command, vol. VIII. [Official record,Office of the Chief of Military History.] (4) Annual Report, Medical Section,Headquarters, U.S. Army Forces, Pacific Ocean Areas, 1944. (5) QuarterlyReports, Medical Department Activities, XXIV Corps, 2d, 3d, 4th Quarters,1944.
14 See footnotes 2 (2) and 2 (4), p. 378.
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medical supplies from the Fifth Medical Supply Depot and furnished themto the units of the Seventh Air Force by truck or to outlying bases byair. For its laboratory service the Seventh Air Force depended upon theregular theater laboratory service. 15
Until the summer of 1943 only two or three divisions were stationedin the Central Pacific Area at any one time; as divisions arrived fromthe United States, others moved westward to participate in the island campaignsdirected by the Navy. In April 1944, XXIV Corps was activated, and a corpssurgeon`s office coordinated the medical work of the divisions assignedto it. During the summer several additional Medical Department officersand enlisted men were temporarily assigned to the office to aid with intensiveplanning for Medical Department personnel and supplies to support the invasionof Yap Island in the Palaus by XXIV Corps, then scheduled for the fall.16
The Pacific Wing of the Air Transport Command bad its headquarters inthe Central Pacific Area- at Hickam Field, Honolulu- and for many months,in advance of the organization of all Army forces in the Pacific into a
15 (1) See footnote 7, p. 381. (2) MedicalReport, Seventh Air Force, 26 Nov. 1943. (3) Interview, Maj. Everett B.Miller, VC, 27 June 1951. (4) Letter, Col. A. W. Smith, to Acting Air Surgeon,5 Apr. 1944.
16 Annual Report, Medical Department Activities, XXIV Corps,1944.
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single theater of operations, it conducted Pacific-wide air evacuation.The wing surgeon and nine other medical officers arrived in Honolulu soonafter the wing was established early in 1943. By April, they had establisheddispensaries at several locations along the Pacific routes of the Air TransportCommand: Hickam Field, Amberley Field near Brisbane, Christmas Island inthe Line Islands, Canton Island in the Phoenix Islands, Nandi Airport onViti Levu in the Fijis, and Plaines des Gaiacs in New Caledonia. Theseinstallations served, as did other Air Transport Command dispensaries,personnel en route by air. During 1943 the Pacific Wing evacuated thousandsof patients from forward areas to fixed hospitals in rearward Pacific bases,especially Hawaii, and to the United States. Because of the great distances,a relatively large proportion of evacuees in the Pacific were transportedby plane. 17
SOUTH PACIFIC AREA
The creation of the Army command which administered medical servicefor Army troops throughout the South Pacific Area (map 7) took place inmid-1942. During the early months of the year, Army troops, as well asMarine and Navy units, had moved into the islands of the southern Pacific;the chief Army elements were the Americal Division in New Caledonia andthe 37th Division in the Fijis, smaller troop elements being scatteredover a number of other islands and atolls. Until the end of the year, withthe exception of the work of a few station and general hospitals, medicalservice was largely furnished by the units that had come in with troops.At times during the early island campaigns a single unit, such as an evacuationhospital, had rendered the medical care commonly afforded by hospital unitsof both the combat and the communications zones, performing the standardfunctions of a collecting company, clearing company, general hospital,and so forth, since it was the only Medical Department unit within hundredsof miles. 18
Areawide Direction of Medical Service
The U.S. Army Forces in the South Pacific Area was established in July1942, with headquarters in Auckland, New Zealand, until November when theywere moved to Nouméa, New Caledonia. Commanded by Maj. Gen. (laterLt. Gen.) Millard F. Harmon, it was directly subordinate to the Commanderof the South Pacific Area (Vice Adm. Robert L. Ghormley, later Vice Adm.William F. Halsey), who was in turn responsible to the Commander in Chief,Pacific Ocean Areas, Admiral Nimitz. Col. (later Brig. Gen.) Earl Maxwell,MC (fig. 87), became staff surgeon of the U.S. Army Forces in the SouthPacific Area, and when the Services of Supply, South Pacific Area, wascreated
17 (1) History of the Medical Department, AirTransport Command, May 1941-December 1944. [Official record.] (2) See footnote2 (2), p. 378.
18 Letter, Col. Earl Maxwell, MC, Surgeon, U.S. Army Forcesin South Pacific Area, to The Surgeon General, 7 Dec. 1942.
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late in the year he was additionally made surgeon of that command. Inhis staff position with General Harmon, an air force officer, at Headquarters,U.S. Army Forces in the South Pacific Area, Colonel Maxwell was termedAir Surgeon, as he was the senior flight surgeon in the area. At the sametime he served as assistant surgeon on Admiral Halsey`s staff, second onlyto the Navy staff surgeon.
Colonel Maxwell`s office prepared plans for medical units and suppliesto support Army combat troops invading the South Pacific islands. Althoughthe Navy surgeon on Admiral Halsey`s staff had the higher responsibilityfor making medical plans for forward movements and the Navy the final authorityin the South Pacific campaigns, in some cases- plans for medical supportof the Bougainville operation, for example- Colonel Maxwell was given themajor responsibility, for he had a larger staff than the Navy surgeon.As in the Central Pacific Area, many changes were made in the compositionof units and equipment to fit the needs of medical service in jungle andamphibious warfare on small islands.
When Colonel Maxwell became surgeon of the newly formed Services ofSupply in November 1942, his office personnel were transferred to the head-
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quarters of that organization, but after late March 1943 some were assignedto theater and some to Services of Supply headquarters. Officers who workedin the fields of operations and planning were assigned to the U.S. ArmyForces in the South Pacific Area, while those handling medical supply,personnel, hospitalization, food inspection, and statistics were Servicesof Supply personnel. Assignments were essentially nominal, however, forthe two groups occupied the same quarters in Nouméa. Often an officerperformed the same work after a theoretical transfer to the other headquarters.The medical section remained under this dual arrangement throughout thelife of the South Pacific Area command- that is, until August 1944; itnever moved with General Harmon`s headquarters to forward areas. The useof one surgeon and of complementary rather than duplicate assignments fortwo static headquarters effected a substantial savings in medical personnel.Colonel Maxwell favored a small, simple organization at this top level,believing that too large all organization would be unwieldy. He recognizedthe need for a good deal of decentralization in a region in which the landareas were so widely dispersed as in the South Pacific.
Not until the closing days of the New Georgia campaign were vacanciesfor a surgical consultant and a medical consultant allotted to the medicalsection of U.S. Army Forces in the South Pacific Area. In mid-1943, ColonelMaxwell obtained the release of a medical officer from the 39th GeneralHospital, an affiliated unit from Yale University stationed in New Zealand,and of another from the 19th General Hospital [sic - 18th General Hospital], an affiliated unit fromThe Johns Hopkins University stationed in the Fijis, for duty with hisoffice as surgical consultant and medical consultant, respectively. Laterin the year a neuro-psychiatric consultant and an orthopedic consultantwere added to his staff. 19
Since it became standard policy to decentralize responsibility to localcommands, each island tended to become medically independent. Because ofthe absence of sizable metropolitan areas on some islands and the inaccessibilityof the larger towns to troops on others, venereal disease was a minor problemon many islands. Wherever preventive measures were necessary, the medicalofficers of the Army area command handled the problem in conjunction withlocal authorities. The work of the theater surgeon`s office was thus greatlyrestricted.
Problems of general sanitation were also tackled on a, local basis.In New Caledonia, when several thousand American troops crowded the island,sanitary problems increased; the dumping of additional garbage and theopening of new bistros and restaurants called for additional sanitary inspections.
19 (1) See footnotes 2(2), p. 378, and 18,p. 388. (2) Memorandum, Brig. Gen. Fred W. Rankin, for The Surgeon General,2 Nov. 1943, subject: Remarks on Recent Trip Accompanying Senatorial Party.(3) Report of Observations of Medical Service in SWPA and SPA, 12 July1943, by Brig. Gen. C. C. Hillman. (4) Annual Report, Medical DepartmentActivities, South Pacific Area, 1943. (5) Interviews, Brig. Gen. Earl Maxwell,11 and 12 May 1950. (6) Memorandum, Lt. Gen. M. F. Harmon, for AssistantChief of Staff, Operations Division, War Department, 6 June 1944, subject:The Army in the South Pacific. (7) Letter, Brig. Gen. Earl Maxwell, toCol. J. H. McNinch, MC, 8 Mar. 1950.
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These tasks could be handled only through liaison with the local FrenchGovernment. Army and Navy medical officers and French medical officialstherefore established a Joint Sanitation Board. This organization- a coordinatingrather than an operating one- served to prevent duplication of effort anddisagreement on Army, Navy, and French policies with respect to maintaininga satisfactory water supply, standards of sanitation in barbershops, restaurants,and other establishments frequented by troops, as well as on preventionof venereal disease. 20
The isolation of units and installations on the scattered islands hamperedthe pooling of their resources. The central dental clinic, effectivelyused in some areas to pool the specialized training of dental officersand special dental supplies and equipment that separate installations hadin insufficient quantity, could not be effectively established in the SouthPacific Area. Here the distances between camps on separate islands weretoo great. The hospitals had to furnish prosthetic equipment, which wasnot provided to tactical units; and small units without dental personnelwere attached to specific hospitals for dental care. By the spring of 1944,when enough trained enlisted personnel became available, prosthetic teamswere formed; they were attached to the various hospital and division dentalclinics to furnish dentures to troops receiving rehabilitation after periodsof combat. 21
One of the most difficult problems encountered by Colonel Maxwell`soffice was the establishment and supervision of a, satisfactory systemof inspecting foods for Army troops. The usual system prevailed among localcommands on the various islands, where foods were inspected when they werereceived at island ports and at various stages of distribution and preparationfor troop consumption. At these stages the task was complicated chieflyby the necessity for many transshipments from island to island (makingfurther inspections necessary) to adjust to changing troop strength. Amore serious problem arose in connection with inspection of foods at thepoint of origin, mainly New Zealand. From mid-1942 to the close of 1945,millions of pounds of dairy products and fresh vegetables and fruits, aswell as canned foods, were bought monthly in New Zealand by the Joint PurchasingBoard in Wellington (established June 1942 and immediately responsibleto the Commander, Service Squadron, South Pacific Force) for consumptionby Army, Navy, and Marine Corps troops on the scattered islands. In theearly period, the Board maintained a policy not in accord with the thinkingof U.S. Army veterinarians assigned to Colonel Maxwell`s office in NewCaledonia. Partly out of reliance upon the sound reputation of New Zealandfood exports in prewar years and the country`s strong protective legislation,the Purchasing Board in Wellington was inclined to rely upon the New ZealandGovernment`s
20 (1) Annual Report, Headquarters, ServiceCommand, New Caledonia, 1943. (2) King, Arthur G.: Medical History of NewCaledonia Service Command. [Official record.] (3) Letter, Col. Arthur G.King, to Director, Historical Unit, Office of The Surgeon General, 21 Aug.1955.
21 (1) See footnote 2(2), p. 378. (2) Dental History, SouthPacific Area.[Official record.]
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standards and its system of inspection. Army veterinarians of the U.S.Army Forces in the South Pacific, on the other hand, noted the lack ofenforcement under wartime conditions, of New Zealand legislation relatingto food products, partly as a result of the shortage of qualified New Zealandinspectors; they warned of the danger that persons interested in the saleof food products would bring pressure to lower standards. They insistedupon the need for a sound system of food inspection by Army veterinariansat slaughterhouses and processing and packing plants.
Some struggle between the two points of view continued throughout thewar. In July 1943, an Army veterinarian was assigned to the Joint PurchasingBoard. This agency created a Food Inspection Division to supervise theinspection of food and food processing plants to insure that products boughtwere processed from suitable raw materials and packed under sanitary conditions.By dint of continued pressure, bolstered by an inspection of the situationin New Zealand by General Maxwell`s veterinarian, the Army succeeded earlyin 1944 in assigning 13 veterinarians to the Board. They were placed incharge of food inspection in. the various areas of New Zealand and supervisedthe inspection of foods processed at plants and items in storage; theychecked also on the sanitary conditions of ships loading foods for shipmentat the New Zealand ports. Two laboratories maintained in New Zealand bythe Food Inspection Division made examinations of canned, frozen, and dehydratedproducts and tested dairy and water supplies from processing plants andships.
As in the case of other protective measures involving relations withlocal governments- as well as with the Navy command- large-scale inspectionof local food products by Army veterinarians was difficult to achieve tothe satisfaction of all concerned. Nevertheless, in spite of some dissatisfactionwith the amount of support afforded to the program by the Navy commandin control of the Joint Purchasing Board, as well as with the number ofArmy veterinarians assigned to the Board, the special system had been founded.During the last year of the war the scope of its work and the results wereconsidered generally satisfactory by the Army veterinarians of the SouthPacific Area command, as well as by those assigned to the work with theJoint Purchasing Board. 22
Control of Malaria and Other Insectborne Diseases
The prevention of tropical, diseases, chiefly malaria, was the challengethat demanded, and received, centralized control in the South Pacific Area.The most serious diseases in the islands were insectborne- mainly malaria,dengue fever, filariasis, and scrub typhus. In 1942 malaria rates roseto epidemic proportions on Efate in the New Hebrides Islands and on Guadalcanalin the
22 (1) Annual Report, Veterinary Service, Headquarters,U.S. Joint Purchasing Board, 1945, and inclosures. (2) History of the SouthPacific Base Command. [Official record, Office of the Chief of MilitaryHistory.] (3) See footnote 2(2), p. 378. (4) Annual Report, VeterinaryService, Headquarters, U.S. Army Forces, Mid-Pacific, 1945.
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Solomons, where American troops with insufficient antimalaria supplies(chiefly the Americal Division and the 1st and 2d Marine Divisions) werein close proximity to infected enemy troops, as well as malarious natives.Colonel Maxwell noted in November 1942 that malaria was "the mostserious disease present." The exigencies of the military situationand the typical belief of commanding officers that malaria control wasof secondary importance, or that it was not possible to cope with the diseaseduring the combat period, made a purely local system of control unsatisfactory.The statement of one officer that "we are out here to fight Japs andto hell with mosquitoes" succinctly expressed the attitude of manyline officers. 23
An organization at a high level appeared to be the solution for controlof a disease prevalent in most of the islands and responsible for the lossof many hours of work and combat. The South Pacific Malaria and InsectControl Organization24 was set up in November 1942, almost concurrentlywith the establishment of the Headquarters, U.S. Army Forces in the SouthPacific Area. Its primary task was the control of malaria among Army troops(including the Thirteenth Air Force), the Navy (including Marine Corpspersonnel), and the New Zealand forces. The organization developed by theSurgeon General`s Office for control of malaria overseas was somewhat modifiedto fit the complex command structure, but most of its features prevailed,although the resources of the Army and Navy were pooled and the Navy hadfinal authority. A Navy medical officer, attached to the staff of the Commander,South Pacific Area, headed the organization; Lt. Col. Paul A. Harper, MC,acted as Army liaison officer and held the highest Army position in it.Army Medical Department officers and Army malaria control and survey unitswere added from January 1943 on; since the Army had more personnel availablethan the Navy, it performed the greater portion of the work.
By the end of 1943, 49 Army Medical Department officers, including malariologists,sanitary engineers, entomologists, and parasitologists, and 264 enlistedmen were working on malaria control. The headquarters of the organizationwas first located at Efate, then at Espiritu Santo after April 1943, andfinally moved to the headquarters of the Commander, South Pacific Area,on New Caledonia in February 1944. With the addition of about a dozen malariousislands to the command, the South Pacific Malaria and Insect Control Organizationeventually directed a large network of Navy, Army, Marine, and Allied personnelin antimalaria work among a troop population of more than 200,000. Later,it had responsibilities for control of other epidemic diseases as well,including two other mosquitoborne diseases-
23 (1) Memorandum, Surgeon, U.S. Forces Inthe South Pacific Area, for The Surgeon General, 4 Nov. 1942, subject:Preliminary Sanitary Survey of CACTUS (Guadalcanal). (2), Harper, Lt. Col.Paul A., Butler, Comdr. Fred A., Lisausky, Capt. Ephraim T., and Speck,Maj. Carlos D.: Malaria and Epidemic Control in the South Pacific Area,1942-44. [Official record.]
24 This title appears to have been used loosely to apply sometimesto the total network of personnel engaged in control and sometimes to thetop directing personnel only. Other titles used were "South PacificMalaria and Epidemic Control Organization" and "Malaria ControlBoard."
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filariasis, which appeared in epidemic form on several of the easternbases in 1943, and dengue fever which reached epidemic proportions on NewCaledonia early in 1943- as well as the miteborne scrub typhus. The mosquitowas unquestionably the outstanding disease vector in the South Pacificislands; by about the middle of 1944, more than 750 personnel trained inentomology, engineering, and malariology and about 4,000 laborers wereengaged in mosquito control.
Army malariologists went to the South Pacific Area as casual officers,were originally assigned to the Services of Supply and then reassignedto the various bases and to divisions. Six malariologists became seniorbase malariologists at headquarters; six more became division malariologists.A malariologist was also appointed for General Maxwell`s office. As inother malarious areas, Army survey units and control units performed thefieldwork. As of 1 June 1944, 17 malaria survey units and 20 malaria controlunits were in the South Pacific Area.
An organization was set up at each island base; the area entomologist,engineer, and others of the staff at headquarters kept in touch with thework on each island through frequent visits. A senior base malariologist(either an Army or a Navy officer) was responsible on each island, originallythrough a commanding officer of the island service command, to the islandcommander, and later directly to the island commander, for developing aprogram applicable to all forces (Army, Navy, Marine, and Allied) on theisland. The senior base (or island) malariologist estimated the assistantmalariologists and survey and control units needed and requisitioned themfrom the area malariologist. Theoretically, the island malariologist, onesurvey unit, and one control unit formed the organization for malaria controlat a base, but a larger island, such as Guadalcanal, had an assistant islandmalariologist and one or more survey and control units for each of severaldistricts. On most islands a mixed Army and Navy organization was used.
The responsibilities of the island malariologist were of broad scope:The initiation of malaria surveys, the preparation of directives for protectivemeasures to be enforced by unit commanders among troops, and measures takenin collaboration with colonial authorities or native chiefs to reduce thethreats of transmission of malaria from natives to troops. In order toprevent transmission from infected natives, camps were located at somedistance from native villages, or if necessary, the villages were moved.Another task of the island malariologist was the inspection of departingships and planes for the presence of mosquitoes; some areas- New Zealand,New Caledonia, Fiji, and Samoa- were nonmalarious, and disinfestation ofships and planes was undertaken to prevent transmission of malaria vectorsto uninfested islands. The island malariologist- as well as the islandentomologist, the parasitologist, and the engineer- also had the job oftraining troop personnel assigned to malaria control work.
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The malaria survey unit made geographic surveys of areas within thebase for actual and potential breeding grounds of mosquitoes, maintainedrecords on the mosquito population, and surveyed malaria parasites amongtroops, natives, white civilians, and Japanese prisoners. The control uniteliminated mosquitoes by draining and applying larvicides and insecticidesto areas designated by the survey unit. Army Engineer troop units and Navyconstruction battalions provided additional skilled or semiskilled labor.To perform the unskilled, and some semiskilled, work, troop antimalariadetails and Army medical sanitary companies (consisting of two platoons,each made up of two drainage teams, two oiling teams, and two sprayingteams), as well as natives, were used.
The malaria control carried out in Army tactical units was done exclusivelyby personnel of the Army Medical Department; that is, the programs of theArmy and Navy were separate at this level. Unit commanders had direct responsibilityfor initiating and enforcing the antimalaria measures in Army units. Anantimalaria detail, consisting of a noncommissioned officer and enlistedmen in numbers proportionate to the, size of the unit (company, battery,squadron, or other unit), maintained mosquito control by oiling, spraying,and draining on campsites and in the surrounding area for a distance of1 mile. Battalion and regimental surgeons were designated malaria controlofficers for their respective units and given responsibility for trainingthe antimalaria details. For the Army division the control group consistedof a malariologist, responsible to the division Surgeon, and one malariasurvey and one malaria control unit. Whenever the division went into anew combat area, its antimalaria group carried out control work until thebase organization was in working order; thereafter the antimalaria workof the division was closely integrated with that of the base. Antimalariapersonnel assigned to a base usually had the more stable duties, of course,while the division malariologist sometimes had to create temporary teamsfor spraying and to shift them about as the tactical situation changed.25
Obviously no set Pattern prevailed either for the various bases or forArmy units. The number of units and their assignments varied with the terrainand climate of the island bases and were modified within the base or theArmy unit in accordance with change of season, shifts in the tactical situation,and so forth. During periods of combat or movements of units, emphasisshifted from environmental control of malaria to the mass taking of Atabrine(quinacrine hydrochloride), then the drug of choice for suppression ofmalaria. But the establishment of broad uniform policies, standard assignmentsof per-
25 (1) See footnotes 2(2), p. 378; 19(3), 19(4),and 19(5), p. 390; 20(2), p. 391; and 23(2), p. 393. (2) Report No. 35,Air Evaluation Board, Southwest Pacific Area: Medical Support of Air Warfarein the South and Southwest Pacific, 7 December 1941-15 August 1945. (3)Memorandum, Chief, Professional Services, to Chief Surgeon, USAFIA, 6 Oct.1943, subject: Malaria Control. (4) Annual Report, Malaria and EpidemicControl, Guadalcanal Island Command, 1944. (5) Annual Report, Medical DepartmentActivities, South Pacific Base Command, 1944. (6) See also Medical Department,United States Army. Preventive Medicine in World War II. Volume VI, CommunicableDiseases: Malaria. [In press.]
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sonnel, and routine procedures helped to prevent interruptions in controlwhenever troops moved from one island to another.
A steady decline in malaria rates took place in the South Pacific Area,beginning in mid-1943 and continuing in 1944 and 1945, interrupted onlyby sporadic rises whenever troops went on maneuvers or entered uncontrolledareas. The low rates on Bougainville, potentially an area of high malariaincidence, and on other islands occupied in 1943 and 1944, proved the valueof control work begun on the day of occupation. The draining, leveling,or, filling in of extensive mosquito breeding areas, clearing of underbrush,spraying water surfaces and buildings with DDT, better identification ofmalaria- carrying mosquitoes through improved laboratory work, more thoroughtraining of troops and wider publicity of the need for control- all theseundertakings of the organization for malaria control contributed to thedecline of malaria. The regular dosage of troops with Atabrine in orderto build up immunity in advance was relied on to prevent the incidenceof the disease in mosquito- infested areas during the early days of combatbefore the mosquito population could be destroyed. Commanding officers,impressed by the loss of man-days resulting from the incidence of malariaon Efate and Guadalcanal, enforced more strictly the Atabrine regimen onthe eve of later campaigns.26
One noteworthy feature of the South Pacific Malaria and Insect ControlOrganization was that from its inception its head, a Navy doctor, was placedat the highest level of command in the South Pacific Area; a similar positionfor the island or base malariologist was early established. The principleof centralized control over malariologists and control and survey unitswas steadfastly maintained. Most observers found that the organizationin the South Pacific worked more smoothly than that in the Southwest PacificArea, where the question of the proper structure and placement of the malariacontrol organization was bandied about for some time and where controlover the effective employment of units was lost through their assignment.to various commands. While some problems arose in the South Pacific Areawherever local command relationships were not well defined, Army and Navyforces attained a high degree of cooperation in their joint program inthe South Pacific. Ready exchange of supplies, facilities, and technicalknowledge seems to have taken place. Administrators made the followingappraisal: "The efficiency and economy of this joint use of personneland equipment is a stimulating chapter in combined service organization."Colonel Harper stated: "It is worthy of emphasis that the South PacificMalaria. and Insect Control Organization was based on a combination ofcentralized control over assignment of personnel and over matters of policywhich could reasonably be areawide in application and of decentralizedresponsibility for day to day operations at each base." 27
26 See footnotes 19 (4), p. 390 ; and 22 (2),p. 392.
27 (1) See footnote 23(2), p. 393. (2) Letter, Paul Harper,M.D., to Col. John Boyd Coates, Jr., MC, USA, Director, The HistoricalUnit, U.S. Army Medical Service, 25 July 1955.
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The Ground Combat Forces and the South Pacific Islands U.S. Army tacticaltroops sent to the South Pacific Area from early 1942 to the spring of1944 (when plans were made for redeployment of troops in the South Pacificto the Southwest Pacific) consisted of six divisions (the 25th, 37th, 40th,43d, 93d, and Americal Divisions) and the Thirteenth Air Force. Duringcombat, the divisions usually functioned under XIV Corps. The latter`sheadquarters on Guadalcanal included a medical section which by March 1943was acting as the medical section for a provisional island command forGuadalcanal as well as the medical section of the corps. From July to aboutNovember 1943, it functioned in the same dual capacity on New Georgia.In the winter of 1943-44, the, office of XIV Corps surgeon, then consistingof three Medical Department officers, was on Bougainville. In June 1944,when XIV Corps took over control of New Georgia, Treasury, and Green Islandsin the northern Solomons, as well as Bougainville, and of Emirau in theBismarck Archipelago, four more officers were added to the medical section.As in most corps medical sections, officers were of the Medical or MedicalAdministrative Corps, the task of the corps medical section being largelythat of coordinating the medical work of the divisions operating underthe corps. On 15 June 1944, XIV Corps was transferred to the SouthwestPacific Area. command, having entered islands within the latter`s boundarylines. 28
With the progress of combat, "island commands" were establishedon islands of strategic importance on which troops were concentrated inconsiderable strength; each was composed of all tactical troops on theisland- Army, Army Air Forces, Navy, and Marines. Island commands werefinally established on the seven following South Pacific islands or islandgroups: New Caledonia, Fiji, Efate, and Espiritu Santo in the New Hebrides;Guadalcanal and New Georgia in the Solomons; and the Russell Islands. Inaddition, the Army maintained for varying periods of time garrison forcesat the following locations: Auckland, New Zealand; Upola, and Wallis Islandin the Samoan Islands; Tongatabu in the Tonga Islands; Bora, Bora in theSociety Islands; Aitutaki and Tongareva in the Cook Islands; Treasury Islands,Bougainville, and Green Islands in the Solomons; and Emirau Island in theBismarck Archipelago. While troop strength varied greatly, most of theseforces, except on Bougainville, were small. In January 1944 nearly 36,000Army troops were on Bougainville, approximately the same number as wereon Guadalcanal and on New Caledonia. By early August 1944 (when the SouthPacific Area command was abolished), only four island commands still existed-New Caledonia,
28 (1) Annual Report, Medical Department Activities,Headquarters, XIV Corps, 1943. (2) Quarterly Reports, Medical DepartmentActivities, Headquarters, XIV Corps, 1st, 2d, and 3d quarters, 1944. (3)Letter, Col. Maurice C. Pincoffs, MC, to Brig. Gen. Guy B. Denit, 10 July1944. (4) Annual Report, Surgeon, Service Command, Guadalcanal, 1943. (5)History of U.S. Army Forces in the South Pacific Area During World WarII, 30 March 1942-1 August 1944. [Official record, Office of the Chiefof Military History.]
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Fiji, Espiritu Santo, and Guadalcanal Island Commands- the remainingthree having been made subbases.29
On 10 islands or island groups a service command (corresponding to abase section in other theaters of operations) was set up to serve all Armytroops on the island. (A naval advanced base filled this role for Navytroops.) Between November 1942 and April 1944, the following 10 servicecommands were established in the order named: New Caledonia, New Zealand,Fiji, Guadalcanal, Espiritu Santo, Efate, Russell Islands, Green Islands,Emirau, and Bougainville. Whereas the island commander- who might be eitheran Army, a Navy, or a Marine Corps officer- was responsible to the CommandingGeneral, U.S. Army Forces, South Pacific Area (General Harmon), the servicecommander was responsible (through the Commander, Services of Supply, ForwardArea30) to the Commanding General, Services of Supply, SouthPacific Area. Oil some islands there existed, for a limited time aftertactical troops moved into an island, both an island command surgeon anda service command surgeon, who operated within the channels of their respectivecommands. Their respective functions roughly resembled those of the surgeonof an army and those of a service command surgeon in the United States,or of an army surgeon and the usual base section surgeon in an oversea,theater. Later the position of island command surgeon was discontinued,and the service command surgeon was then the Army medical officer of chiefresponsibility on the island. Although he served within the service commandsetup, he was usually assigned additional duty as island command surgeonor given unofficial recognition in that capacity. A provisional servicecommand which arrived on Guadalcanal early in 1943, for example, had amedical section by May 1943. This section took over the responsibilityfor the Army`s medical program on Guadalcanal from the medical sectionof the provisional island command (XIV Corps) mentioned above, when thelatter left Guadalcanal in mid-1943.
Channels of command were somewhat involved for the service command surgeon.He was responsible to the service commander of the island, who, althoughon the next echelon below the Commanding General, Services of Supply, SouthPacific Area, was responsible to the island commander for local operations.However, both channels for the service command surgeon led back to theindividual with single responsibility for the health of Army troops, ColonelMaxwell, for he was not only Surgeon, Services of Supply, South PacificArea, and surgeon at the next higher, or theater, level, but also assistantsurgeon on the staff of the Commander, South Pacific. Thus, Army medicalresponsibilities were clearly centralized at the top level. Certain complicationsthat arose in medical administration on the South Pacific islands werenot due to lack of centralized responsibility within the command structurebut to
29 (1) Annual Report, Medical Department Activities,South Pacific Area, 1942. (2) See footnote 22(2), p. 392. (3) General OrderNo. 1175, Headquarters, South Pacific Base Command, 3 Aug. 1944. (4) GeneralOrder No. 1184, Headquarters, South Pacific Base Command, 19 Aug. 1944.
30 Under the Navy organization of the South Pacific Area theisland commands lay within the forward area, intermediate between combatand rear areas.
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the great distance between islands which prevented effective controlfrom the top level and thrust responsibility downward to the island levelwhere several channels of command, including Navy commands, prevailed.31
The medical administration on the largest of the New Hebrides islands,Espiritu Santo, governed under French-British condominium, illustratesthe situation that prevailed on the island bases and the problems thatarose. Espiritu Santo was used as a base by air units for attacks on Guadalcanal;by early 1943 the Thirteenth Air Force was based there, as well as someArmy ground force, Navy, and Marine Corps elements- the medley of troopscharacteristic of the South Pacific bases. During 1942 Army medical officerson Espiritu Santo were those assigned to tactical units. A Navy hospitalreceived Army sick, and a French colonial hospital cared for sick or injurednatives employed by the U.S. Army. The organization of Army medical servicewas not of islandwide scope until March 1943, when Lt. Col. Arthur G. King,who had pioneered as surgeon for the service command of the very largebase of New Caledonia, organized the medical section for the newly formedEspiritu Santo, Service Command. An evacuation, a station, and a generalhospital opened on the island in 1943, and Colonel King`s office establisheda fairly elaborate system of dispensaries for the 17,000 widely scatteredArmy troops there.
The IV Island Command had tactical control of all Army troops on EspirituSanto and was responsible to the Commanding General, South Pacific Area.The Espiritu Santo Service Command, though locally responsible to IV IslandCommand, took orders from the Commanding General, Services of Supply, SouthPacific Area, in turn responsible to the Commanding General, South PacificArea. As no rival surgeon existed at IV Island Command headquarters, ColonelKing appears to have been recognized as island command surgeon, as wellas service command surgeon. On the other hand, he encountered difficultyin coordinating his work with that of surgeons of various commands on EspirituSanto. The Surgeon, Thirteenth Air Force, reported directly to the theatersurgeon at Headquarters, U.S. Army Forces, South Pacific Area, in spiteof the fact that Colonel King, as service command surgeon, had responsibilityfor hospitalizing Thirteenth Air Force personnel in hospitals on EspirituSanto and, as island command surgeon, was responsible for issuing sanitationorders to which the Thirteenth Air Force units, along with other militaryunits, were subject. Until the fall of 1943, when a naval advanced basesurgeon was appointed, with duties comparable to his own as service commandsurgeon, Colonel King was obliged to handle problems of sanitation on anindividual basis with the various Navy medical officers concerned. ColonelKing still had to deal separately with Marine Corps units, and with thetwo large naval hospitals, as only the service elements of the
31 (1) See footnotes 2(2), p. 378; 19(5), p.390; 20(2), p. 391; and 28(3) and (4), p. 397. (2) Scattered quarterlyreports of Medical Department activities from various South Pacific islands,including Aitutaki, Tongareva, Upolu, Green Islands, and Viti Levu.
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Navy were under the Naval Advanced Base, while the Marine Corps elementswere semi-independent of the Navy.
As might be expected, he experienced his major difficulties in preventivemeasures which called for consistent policies among troops throughout EspirituSanto, such as garbage disposal and other general sanitary measures, quarantineregulations, and malaria control. The island commander instructed him toemphasize sanitary measures, which, before the establishment of a servicecommand, had failed signally because of the plurality of tactical unitsand chains of command. An order of the commander in March 1943 that eachunit clean up its own accumulation of garbage, tin cans, and cocoanut wastehad led to the threat of armed clashes when units tried to dump garbageon each other`s territory. A system of fixed sanitary sectors had alsoproved ineffective. Colonel King established a central sanitary detail,composed of personnel from Army, Air Force, Navy, and Marine Corps elementson the island, to clean up the entire occupied portion of the island, aswell as a central garbage and trash dump. Centralized control by the MedicalDepartment with the backing of the island commander proved to be the answer.
Problems arose with respect to the jurisdiction and responsibility ofthe port surgeon in Colonel King`s office over quarantine and disinfestationmeasures for incoming ships and planes. Apparently considering ColonelKing only an Army service command surgeon, the naval advanced base commandwas averse to recognizing his port surgeon`s authority to inspect Navy-controlled ships and to issue the necessary certificate of health for disembarkingpersonnel, as well as his authority to disinfest Navy-controlled shipsand planes. An epidemic of hog cholera among swine on a plantation on anisland near Espiritu Santo, supposedly caused by garbage dumped overboardby Navy ships, gave further trouble. In this case not even the naval advancedbase command could control the situation effectively, as ships of the Fleetwere not responsible to it but directly to the Commander, South Pacific.Not only did the epidemic endanger the supply of meat for troops, but hisproblem, like some others encountered on Espiritu Santo, could have affectedrelations of the U.S. Army with the French plantation owners, since thelatter paid their native Melanesian workers in hogs. These conflicts withthe Navy were eventually solved by various compromises after considerableeffort by the service command surgeon to establish specific responsibilitiesand reconcile conflicting claims.
Although the organization for malaria control seemed a satisfactoryone to the malariologists, Colonel King found some defects in the workingsof an unorthodox system that singled out a single phase of medical service,albeit an important one, for control through special channels. An earlyrequirement that the malaria control officer (Navy) approve the locationof any troop unit was ignored by many Army units. Various directives formalaria control measures, issued by the South Pacific Area command, itsServices of Supply, and The Surgeon General sometimes conflicted with thepolicies of the local
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command. In the spring of 1943, the responsibility for directing theprogram on Espiritu Santo rested with the Navy malaria control officer.Colonel King considered himself responsible, in his capacity as islandcommand surgeon, for carrying out the program, while the Services of Supply;South Pacific Area, provided the necessary supplies. In late May 1943,however, a Navy order put all malaria control work under the authorityof the island malaria control officer, who was responsible to the Commander,South Pacific. This order short circuited the Army chain of command, thatis, the Espiritu Santo island command, the U.S. Army Forces in the SouthPacific Area, and the Services of Supply, South Pacific Area. Thus theisland commander received only information copies of monthly reports, sometimesstrongly critical, of work in malaria control among his own troops afterthe original report had gone to higher headquarters. A directive requiringsubmission of malaria control reports to the commanding general of theisland through the commanding general of the service command straightenedout the matter temporarily. However, in August a directive issued by theNavy Bureau of Medicine and Surgery placed the control of all epidemicdisease under the malaria control officer; hence re-ports on control ofnot only malaria but all epidemic diseases were once more sent throughNavy channels, the island commanding general and his surgeon receivingonly information copies at a later date. The appearance of a War Departmentcircular placing all insect control of any island under the commandinggeneral of the island led to further confusion, but the Army command apparentlyavoided duplication of Navy work in malaria control. In October 1943, adirective requiring all communications of the malaria control officer tobe routed through service command channels brought an end to the controversy.
A proposal to prevent contact of troops with the malaria-ridden Tonkineselaborers working for French planters on Espiritu Santo was also bandiedabout in various commands. After failure to move the Tonkinese or to getFrench doctors to treat them early in 1943, the malaria control officerproposed in August their forcible removal to a central village from whichthey could be transported daily to the plantations. The island commanderapproved this move without consulting the surgeon, but when the commandinggeneral of the service command protested, the scheme was dropped. In Octoberthe Commander, South Pacific, ordered the removal of all Tonkinese andother natives from. the military area on Espiritu Santo without any consultationwith a newly appointed island commander. The following day the order wasrescinded. A few days later the island commander directed the surgeon totreat the Tonkinese on the plantations, and treatment was given with thecooperation of the French planters. Colonel King noted that this satisfactorysolution was brought about only through centralizing authority in the newisland commander who was able to deal realistically and tactfully withthe sensitive French.
Colonel King found his lack of control over the assignments of medicalpersonnel another stumbling block to efficient medical service. Like many
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another island command surgeon (and many base section and theater surgeons),he noted his need of a pool of medically trained personnel to replace officersto be sent home for rest and recuperation and to fill certain medical jobswhich had developed in the areas outside official allotments and tablesof organization. When he tried to use the personnel of hospital ship platoons,stranded for lengthy periods in the theater, for this purpose, he foundthat command channels interfered with transfer of medical personnel fromone command to another. He developed a plan to effect more efficient useof medical personnel on the island by transferring them to the positionsfor which they were best fitted after classifying them according to specializedtraining, experience, and proficiency. This undertaking bogged down becauseof the unwillingness of commands to surrender personnel and the many papertransactions necessary to effect reassignments. His efforts to transfera pathologist, then surgeon of an antiaircraft battalion, and a highlyqualified orthopedic surgeon, who was a ship`s hospital platoon officer,to hospitals where their specialized skills were urgently needed, weredefeated in spite of complicated paper transactions.
In summing up his experiences, Colonel King made a plea for a medicalservice with more direct control by medical officers and less hamperedby chains of command. In his opinion "the complex and cumbersome"command relationships on Espiritu Santo and throughout the South PacificArea had put difficulties in the way of administering medical service there.His insistence in his report that "optimal cooperation between theArmy, Navy, and Air Force, even to the point of loss of identity, was sorelyneeded" is significant in view of the trend towards unification ofthe three military arms that took place in the postwar period.32
Thirteenth Air Force
The Thirteenth Air Force built up in the South Pacific from and afterearly 1942. Its nucleus was air units dispatched to South Pacific islandsfrom Hawaii, which were temporarily supplied by their remote parent organization,the Seventh Air Force. An island air command, with a flight surgeon onits special staff, was created on each of several islands, and in Decemberadministrative control of all air units oil the South Pacific islands becamethe responsibility of Headquarters, U.S. Army Forces in the South PacificArea. In January 1943 Headquarters, Thirteenth Air Force, was called intobeing, with Lt. Col. (later Col.) Frederick J. Frese, MC (fig. 88), asits surgeon, based on Espiritu Santo; Colonel Frese had previously beenassistant to Colonel Maxwell, who was serving in the dual capacity of Surgeonand Air Surgeon, U.S. Army Forces in the South Pacific Area. Like ColonelMaxwell himself, Colonel Frese had been trained as a flight surgeon.
32 (1) King, Arthur G.: Medical History ofEspiritu Santo (New Hebrides) Service Command, 12 March 1943-15 May 1944.[Official record.] (2) Annual Report of Medical Activities on EspirituSanto, 1944.(3) Diary, Lt. Col. Arthur G. King, MC, 12 Mar. 1943-21 Nov.1944.
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As units of the Thirteenth Air Force were scattered over the South Pacificislands and were operating against the Solomons in close conjunction withair elements of the Navy, Marines, and the New Zealand forces, centralizeddirection of medical service throughout the air force from headquarterswas out of the question. Late in 1943, duties of staff surgeons were unorthodox.One officer of the headquarters medical section was on detached servicewith the combined Army-Navy-Marine, headquarters for all aircraft on theSolomon Islands, and another was acting as flight surgeon in the rest areaat Auckland. The Surgeon of XIII Air Service Command was also serving atAuckland, while his assistant was handling the neuropsychiatric dutiesfor the whole air force. At that date the bomber command was the only oneof the air commands which had a well-developed medical section functioningas planned.
The geographic and tactical situation weakened arguments for controlof separate hospitals by the air force, as well as efforts at centralizedsupervision of medical service for air force troops. The Thirteenth AirForce surgeon agreed with the Air Surgeon`s Office in Washington that overseaair forces should operate separate hospitals for their personnel, but ColonelMaxwell noted that the short stay of the air force units on small islandsmade control of hospitals by the Thirteenth Air Force in that area impracticable.Hospitals assigned to the air force would have been subject to frequentmoves to conform to the rapid changes of station of air force units; theywould have had to be
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put under tentage and would have lacked various facilities. Sendingin one hospital, under the Services of Supply, for both ground and airtroops to a relatively permanent location had resulted in better construction,running water, screening, and other advantages. In the Thirteenth Air Forcethe majority of tactical as well as service groups established small infirmaries,many as well equipped as small station hospitals except for such specializeditems as operating equipment. These treated many cases of malaria and dengue.After the transfer of Thirteenth Air Force to the Southwest Pacific Areacommand, a few 25-bed portable surgical hospitals were attached to it;the group infirmaries were then abandoned. An informal agreement by ColonelFrese and Colonel King on Espiritu Santo to ignore the rules for distributionof patients on an area basis and concentrate all Thirteenth Air Force patientsin only one of the three hospitals on the island, with free participationby flight surgeons in their treatment, solved the problem in that areato the satisfaction of the Thirteenth Air Force surgeon.33
The organization which directed air evacuation within the South PacificArea- the area where large-scale evacuation by air occurred earliest inWorld War II-was an interservice, command, which reflected both the advantagesand the problems inherent in joint Army-Navy direction of a medical activity.From the fall of 1942 to the spring of 1943, no special organization existedto evacuate casualties by air from the overcrowded facilities on Guadalcanalto base hospitals on New Caledonia. During the late months of 1942, unarmedand unescorted planes of the Marines and troop carrier planes of the ThirteenthAir Force which carried supplies to troops on Guadalcanal evacuated patientson their return flights to their bases, with Marine Corps hospital corpsmenassigned to each plane to care for patients en route. Late in November,the South Pacific Combat Air Transport Command was formally organized,under direction of the Marine Corps, to carry supplies; its returning planestook care of intratheater air evacuation. Planes and medical personnelof the Thirteenth Air Force were used, along with those of the Navy andMarine Corps, by the combined command. After the 801st Medical Air EvacuationTransport Squadron arrived early in 1943 and was assigned for duty withthe medical section of the combined command at Tontouta on New Caledonia,Army Air Forces medical personnel constituted three-fourths of the personnelavailable to accompany patients in flight.
Personnel of the squadron (later based on Espiritu Santo) were individuallyassigned and reassigned by the South Pacific Combat Air Transport Command(directly by the Navy flight surgeon who headed its medical section) ratherthan by an Army Air Forces command as in other areas. In a, report on theeffectiveness of medical support given air force elements in the Pacifictheater, the Air Evacuation Board criticized the tendency of the Navy andMarine Corps to establish policies on air evacuation without consultationwith
33 Letter, Col. Arthur G. King, MC, USA (Ret.),to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit,U.S. Army Medical Service, 21 Aug. 1955.
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the Thirteenth Air Force and a tendency to assign patients to the careof Navy corpsmen during flight in preference to putting them in the handsof the more highly trained flight nurses of the Army Air Forces. Neverthelessthe operations of the Army evacuation unit under this system were highlysuccessful. By the close of 1943, 62 members had flown more than 18,700hours, nearly all in combat zones, evacuating thousands of Army, Air Force,and Navy patients over the lengthy routes from the Solomons.34
34 (1) Medical Report, Thirteenth Air Force,11 December 1943. (2) See footnotes 19(5), p. 390; 25(5), p. 395; and 28(5),p. 397. (3) War Critique Study, XIII Air Force Service Command. (4) SpecialOrder No. 1, Headquarters, Island Air Command, 17 Oct. 1942. (5) GeneralOrder No. 407, Headquarters, U.S. Army Forces in the South Pacific Area,19 March 1944. (6) Annual Report, 801st Medical Air Evacuation TransportSquadron, 1943. (7) Link, Mae Mills, and Coleman, Hubert A.: Medical Supportof the Army Air Forces in World War II. Washington: U.S. Government PrintingOffice, 1955, pp. 773-774.
