Medical Department Activities
WILLIAM J. SHAW
Lt. Colonel, M.C.
41st Division, 6th Army.
Interview with Lt. Col. William J. Shaw, M.C.
2 September 1944
(Lt. Col. William J. Shaw served with the 41st Division, 6th Army, since March 1942. He commanded the Medical battalion for eighteen months and is now Division Surgeon).
1. GEOGRAPHY AND CLIMATE.
At present the 41st Division is on Biak Island, a sandy coral reef off the Northwest coast of New Guinea. A mountain range, reaching about 6000 feet is barely visible through the top of the dense jungle and the surrounding terrain is unusually rugged. Our location being less than a degree off of the equator has a constant temperature of 110° during the day but at night drops to 80°. The humidity wears a person down and causes much discomfort during the dry season.
The T/O of our Medical Department had no deficiencies. We had an Evacuation Hospital, three portable surgical hospitals, an extra clearing company and two additional Collecting Companies. it is my belief that a third platoon should be added to the Clearing Company, so that each Collecting Company, working with a regiment, would have a clearing element.
We arrived in Victoria, Australia, March 1942 and after nine months additional training went into action near the swamps of Dobadura; fighting through New Guinea to the position now held. The Medical Department personnel did splendid work. Each of the three portable surgical hospitals (T/O 4-0, 33 EM), one for each regiment, usually handled emergency cases near the Battalion Aid Stations. At times we found it
difficult to locate the wounded and often the terrain was such that it required 20 natives to carry a patient four miles. At the Clearing Company, which served as a base hospital, taking care of all emergency and non-transportable surgery, I saw eight operating tables used continuously for 48 hours.
There are no white people on Biak Island unless they are on plantations in the interior. The natives have been a great help through-out the campaign and if it had not been for their assistance at Salamaua and Tamboo Bay, we never would have evacuated our casualties. I have a
feeling they were just as nice to the Japs because they cooperate with whoever feeds them. All of them have malaria and bookworm.
Thousands of natives did pick and shovel work for us and were no trouble except for disease. In British New Guinea their affairs are regulated by the ANGOW, and Australian-New Guinea Civil Association, but where we are now the NICA, Netherlands Indies Civilian Administration, has control.
4. MEDICAL SITUATION.
At the beginning of any action it is mostly surgical, then there is a gradual increase in disease and a gradual decrease in battle casualties, so that eventually, everything is practically medical. Extremities had the highest incidence and it would be difficult for me to differentiate between upper and lower. Casualties presenting combined wounds were numerous. Portable surgery hospitals had some deaths, about2%, because that`s where usually some pretty heavy surgery is done. Anything not emergency is carried back to the Clearing Company.
(1) Infection-- Although every man had sulfanilamide on the first dressing, many wound infections developed for we were in a country which is prone to infections when there is delay in reaching a hospital.
Gas gangrene is very low probably due to the fact that wounds were incised widely and never sewed up, but at first we lost one or two cases. When amputations from gas gangrene developed, the operation had to be done right on the spot. I saw no tetanus.
(2) Fractures-- Many compound fractures, mostly leg, came in, and I cannot give you an exact percentage, but I can say there were not as many fractures as other wounds. We had difficulty with hip fractures, since the nearest x-ray was at the evacuation hospital, always a four or five mile haul by boat or jeep. Therefore much guess work was often necessary when putting on casts and splints.
(3) Plasma-- Plasma seemed adequate and reactions were not unfavorable. Whole blood was not used forward but always at the clearing station or evacuation hospital. It was obtained from donors right on the spot and we always cross matched their blood with the dog tag. Tubing held up well, since our sterilizers were in good condition. Two men from Washington visited us about six weeks ago and were interested in extending the use of whole blood. I think a blood bank would be excellent and it could be kept at an evacuation hospital in an ice-box on a truck.
(4) Chemotherapy-- Treatment with sulfanilamide began on the front lines by the soldier who carried his sulfa drugs with him.
When wounded, he usually had plenty of sulfa in him by the time he got back to a fixed hospital. Penicillin was difficult to obtain and was not used in the forward area.
(5) Anesthesia-- Sodium pentothal and spinals produced excellent results but ether was too volatile for use in the tropics. Sodium pentothal is best and nitrous oxide is fine for large operations, abdomen or something similar.
Malaria, diarrheas, dysenteries, typhus, and skin diseases are prominent. Our malaria smears show falciparum, then later the same patient shows vivax, and at the base camp it`s all vivax. The therapy used at the present time is suppressive. The only constructive work that has been done on malaria, as far as I know, in the Southwest Pacific was done by Colonel Duncan, who has definitely shown, at least to our satisfaction, that malaria can be suppressed by 10 tablets (one grain) of atabrine a week. He worked out a system whereby each man is given his atabrine twice a week under supervision of a commissioned officer.
(1) Typhus-- Typhus causes almost as much sickness as diarrheas. There`s an order now, I learned today, that no one is allowed in a new area, unless his clothes are impregnated with dimethylphthalate, which is a preventive of typhus. When an area is entered, it is cleared so that the mites are destroyed; but when you first go in, it is similar to going into an area where it has been difficult to control the mosquitoes. This impregnation of clothing with dimethyl phthalate is similar to atabrine suppression of malaria.
(2) Fungus-- When we first went into New Guinea, practically 90% of our personnel had big open sores all over their legs but cleanliness has remedied this. One must keep clean clothes on the men and make them wash. We had troops who did not have their shoes off for three weeks during this last operation, so you can imagine the type of skin condition that developed. These men were wet half the time, then dry and then wet again with the same shoes and socks on, which could not be washed, water being scarce. We were not troubled with immersion foot, but mostly fungus infections and a little ulcer. Foot powder- is a great help, but troops do not carry it. When a man marches for eight hours steady on 3/4 canteen of water, he wants a light pack. I have seen them cut a towel in half to lighten the pack.
(3) Dengue-- We had much dengue but it was not serious. For after four or five days in the hospital, then a week or two in quarters, the patient was ready for duty. Often it was difficult to
distinguish between dengue and typhus, since they were similar at the beginning, and both had a rash and fever. But the dengue patient began to clear up when the typhus patient really became ill.
(4) Jaundice-- Recently a few cases of jaundice came in, but we did not know the etiology. In Victoria we knew that our jaundice was due to yellow fever vaccine before it was ever announced in this country, because individuals would get it in one company and the company alongside didn`t have it. By checking our records, we found that the only thing that one company had, which the other did not have, was twelve shots of yellow fever vaccine.
During the first five weeks on Biak, 402 psychopathic cases were recorded and approximately 40% of them were caused by exhaustion and shock. The troops were out physically before we invaded the island, so they folded up easily. We sent NP cases to the hospital, giving them food and rest. If normal in five days, they returned to duty; if not, they were evacuated. About 270 of these patients had to be taken to the rear. Both officers arid men break quickly when fatigue overcomes them.
To my knowledge there was no reconditioning in the area.
I had the dentists under my control and incidentally we could use a few more, as there will be a tremendous amount of decayed teeth and broken plates needing repair. There was some Vincents, but it has not been a factor in health. Replacements are needed for six dentists who were transferred because of disabilities.
We have a veterinary officer who is Sanitary and Food Inspector for the Division. He also checks the health of our six war dogs, which are valuable for jungle fighting. There are two types of dogs, the Scout and Baggage Carrier. The scout dog goes on a leash with a patrol and locates Japs. When the dog signifies to his trainer that he smells a Jap, the patrol disperses. I can smell a Jap a mile away so the dog should be twice as good. The baggage dog carries important supplies, but I haven`t seen them in action.
We did not have nurses with us until about two weeks before I left, when 32 arrived from Brisbane to help in the typhus epidemic. They had been left behind by the 92nd Evacuation Hospital.
It has been the policy, when ahospital moves forward, to leave nurses in the rear echelon until positions are secure. Their clothing and equipment, as far as I know, are perfectly good. They dress and live like the men, eating out of mess kits and having the same laundry and housing facilities. The girls do a fine job. I think that their morale is higher than that of any group connected with the hospitals. Since there were 32 nurses to approximately 25000 men in the area, a ratio of 1 to 800, 1 think that our nurses had a better time in the combat zone than in other installations. Age, looks, or figure was immaterial, for each nurse had a string of dates lined up for two weeks in advance. You cant have bad morale under those conditions. The nurses have their recreation hut where they gather to listen to the radio or play cards.
The facilities of the evacuation hospital were adequate, until the present typhus epidemic gave us 750 patients. This bogged us down, because they required more nursing attention than our personnel could give, our daily patient census in the Division numbered about 1200.
A year ago we used the "C" ration; this year we used the "K" ration almost exclusively. The "K" ration, I believe, is less liked by the troops. Its dry, unpalatable, and monotonous. After eating two or three mouthfuls of it, the men drink water and quit for the day. "C" ration was just as bad. As soon as possible, fresh food and meat should be sent to those men. Sometimes they go five months without seeing an egg. We had men go out and trade Japanese souvenirs to native boys for pork or beef. Although nutritional disease did not appear, loss of weight per man averaged 30 pounds. The Air Corps was getting everything in the world. Since the Air Corps and the Navy have plenty of fresh food why cant these boys who are taking the brunt of that jungle fighting have a little of it. As far as the infantry is concerned somebody is "falling down." We did manage, however, to give patients soup and fruit juices.
The division should have a medical laboratory equipped to do malaria smears, stool examinations, typhus agglutinations, etc. The 41st Division went into Dobadura with no laboratory facilities except those with our hospitals. The technicians were not sufficiently trained and called everything they looked at, malaria. in the present typhus epidemic at Biak, we have no way of differentiating, until a man has been sick ten days, whether or not he has typhus.
The laboratories attached to station and general hospitals never reach us, and at times are four or five hundred miles away.
Methods of getting patients to rear depend almost entirely
on terrain. In areas where jeeps and trucks could not travel, natives were employed as litter bearers. Often a nearby stream was the answer; there were places where all evacuation was done by boat. Whenever an air strip or landing field was secured, planes evacuated the wounded. When evacuating by air, it is necessary to select surgical cases since many patients cannot stand this method. The Air Surgeon checks each case.
1. General Conditions.
(1) Malaria Control-- In malaria you have the two types of control: the group control is a question of cleaning up the swamps and oiling them. Individual type of control means sleeping under bars, keeping clothes on at all times, using spray, etc. We had one survey unit and two control units, assigned to the Division, that went in as early as D+2. When the beachhead was established, wed have the malaria control unit determine the type mosquito larvae present and then start cleaning the area. The men consider lectures on malaria monotonous.
(2) Water Supply-- The Engineers did a good job on water by chlorinating it at the source. However, we checked often to be certain. At our present location the water was very poor, since it came through coral on its way to the sea. Many of the shallow wells were brackish and salty due to the seepage from the sea. Men, who have gone all day on less than a canteen of water, when arriving at a creek, will not wait for chlorination even if there is an officer standing over them with a club.
m. Waste Disposal.
Waste disposal varied with the situation. We couldn`t bury it because of the coral terrain. Incinerators did the job until fuel became scarce, then we loaded all waste on a barge and hauled it out to sea.
(1) Intelligence-- G 2 of the Division agreed that captured enemy medical supplies were not to be sent home until they had been approved by our office. If it could not be used by us, we would give the finder a free bill to send it home. Much equipment was never turned in and I, personally, know that six of the eight good microscopes found at Hollandia, disappeared. Jap equipment seems very cheap to me, but microscopes were an exception.
4. SUPPLY AND EQUIPMENT.
Medical supplies were sent to us in MMUs which is the medical maintenance units necessary to supply 10,000 men for one month. We never learned what an MMU was based on. There was always a definite amount of each item and never an extra amount of the things we used most. For
instance, with all the dysentery, we needed 10 times the amount of sulfaguanadine and paragoric that was in the MMU.
There should be a supply point close by so that equipment could be replaced faster. There are many items in the medical chests that we did not use.
Rust was a problem but cosmolin kept instruments from falling apart after a few months. I could safely say that equipment should be replaced every six months when action is heavy.
We had some trouble with lamps in the surgical units. When a lamp, generator, or sterilizer goes out, it is almost impossible to get replacements, especially when we were in combat.
The rotation policy has failed as far as our Division is concerned. A definite statement, that a certain number of men would go home each month was published and the men pepped up at once. However, very few men have returned to the States. We had men killed in the latter part of July who were on the June quota to go home. They would not believe that transportation caused the delay, be cause they watched ships bring in supplies, unload them, and head back for the States.
The favorite broadcast heard by our troops comes from Tokyo. The Division had more publicity from Tokyo than from the United States. The Japs called us the "4lst Division Butchers" and we were proud of that name. I heard our boys, when on "C" ration for weeks, laugh at the Tokyo broadcast, especially the one in which the speaker asked, "How would you like to put your feet under mothers table tonight and have a nice dish of hotcakes."
The average man in the front lines knows nothing about the labor situation, but the usual amount of griping about strikes always makes conversation. Men are disturbed by distressing letters from home. They pick up a letter and know what`s in it before opening it, for after two years and a half mail follows a set form. The enlisted men sit and talk for hours about home and good food.
The Australians are not well liked. In combat, we got along fine but back in rest camps, the friction was obvious. It irked the Australians because we had a few more cigarettes and better food.
The normal soldier breaks quickly if he becomes exhausted. AWOL is out of the question; there`s no-place to go. Court martials are practically non-existent in the front lines. Very few self-inflicted wounds have been determined. I saw one man who had shot himself but I did not hear of any suicides. They don`t have to kill themselves. There was very little malingering, and the only men falling back were
those who unconsciously believed something wrong with them. To the average GI, the Jap is no more than a yellow rat. They have no use for them and just shoot them like anyone would kill a rattlesnake. They hunted the Japs like one would a deer, and shot them without mercy.
I recently heard someone talk to a group here about the medical soldier being a man without a gun. That s not the 41st Division medical service. Every man in the medical department had his cartridges on his back. We have no idea how the Japs would re-act toward the arm band because to my knowledge they never saw one, and as long as I have any control, they never will. I made it known in the landing at Biak that I would shoot the first man I saw with an armband. When Japs deliberately fire at litter bearers carrying wounded patients, I don`t know what good the red cross would have done. That has been our actual experience. A road that the Japs held for ten days was opened recently and at one end we found three American bodies. On inquiring who they were, I learned one was an infantryman, and the other two were medics who had gone to his aid.
1. Special training in tropical medicine for all medical officers going to the tropics.
2. A third platoon for the Clearing Company.
3. A laboratory with the Division