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Chapter VIII

Contents

CHAPTER VIII

The Pacific

Part I. Cold Injury in the Tropics


    Although trenchfoot was recognized as one of the probable risks of combat in the Pacific in World War II, this condition, as it is ordinarily envisaged, did not occur among United States troops in these areas. The war ended before fighting was necessary under circumstances which would produce the classical type of wet-cold injury. However, in addition to the numerous skin diseases, including diseases of the feet, which developed in a tropical environment highly favorable for them, there was a brief experience in the Philippine Islands, chiefly on Leyte, with a disability of the feet caused by long exposure to wet terrain under combat conditions (fig.34) . This disability, for lack of a better term, was originally described as tropical immersion foot.1 It can more logically be described as a type of cold injury low on the gradient (p.20).

    Lack of complete information on all details of this experience makes it somewhat difficult to analyze it. Precise climatic records are not available for October, November, and December 1944, the period in which the disability appeared. Records for the preceding 2 years showed that during these months temperatures on Leyte had ranged from 74 to 88 F. (23.3 to 31.1 C.). It is not known whether they were lower than this in the fall of 1944, especially at night. Furthermore, it is still not known at what temperature level cold injury can occur when it is associated with long exposure, fatigue, insufficient food, and combat stress.
         
    Information about rainfall in the fall of 1944 is somewhat more adequate. During the preceding 3 years, it had ranged between 8.5 and 14.2 inches per month in three areas on Leyte (Tacloban, Palo, and Dulag) during the period in question. Weather records showed that, as a rule, rain fell on 20 days per month during the October-January period, against 10 days per month during the remainder of the year. Readings available for 1944 show a rainfall greatly in excess of what might have been expected in the light of these data. Engineers, who worked around the clock, recorded that 69 percent of the time lost on construction between 11 November and 18 November 1944 was caused by heavy rains, against only 11 percent lost because of air raids. Between 19 November and 2 December, the measured rainfall in three separate areas on
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1 (1) Letter, Maj. Frank Glenn, MC, Surgical Consultant, Office of the Surgeon, Headquarters, Sixth U. S. Army, to the Surgeon, Sixth U. S. Army, 27 Nov.1944, subject: Trench Foot. (2) Letter, Brig. Gen. 1. I. Martin, Chief Surgeon, United States Army Forces, Western Pacific, to Director, Army Institute of Pathology, 19 Oct. 1945, subject: Immersion Foot.


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FIGURE 34.- Tropical environment favorable to numerous skin diseases, including disability of the feet. A. Infantrymen from 7th Infantry Division wading across Maraby River, Leyte, October 1944. It was this sort of exposure in a tropical climate which produced so-called tropical immersion foot. B. Infantrymen of 43d Infantry Division moving along muddy road on Luzon, May 1945.


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Leyte (Tacloban, Palo, and Dulag) varied between 11.08 and 14.8 inches. Between 10 December and 14 December, 16.62 inches was recorded at Buwi Drome; 7.6 inches fell in a single day. There seems no doubt, therefore, in spite of the lack of complete information, that constant wetness played a decided role in the intensification of heat loss, especially through the feet, in this experience.

    From the time that fighting began in the jungles of New Guinea in the summer of 1942, large numbers of soldiers suffered from excoriations of the feet and from some degree of infection, which was often superimposed on a previous epidermophytosis. These lesions were, however, quite distinct from the variety of cold injury observed during the Leyte campaign (a total of 167 cases) , and observed later, in scattered cases (55 in all) , on the Visayan Islands during the first, 6 months of 1945. The second outbreak was much milder than the first.
           
    The incidence of this type of cold injury was comparatively low. Prompt recovery occurred in all but a few of the most severe cases when once the men were able to stay clean and dry. There was no similar experience on Luzon, because the dry season had commenced when combat operations were undertaken there (p.221).

CLINICAL ASPECTS

    On 23 November 1944, two evacuation hospitals on Leyte received some 120 soldiers with swollen, painful feet, all of which had been injured under the same circumstances. These men had been in combat on the frontline for periods ranging from 9 to 17 days. During this time, rains and typhoons had been almost continuous. Combat troops lived in foxholes or crawled through the jungles. Many were completely isolated. They had no dry socks or footwear, and there would have been no opportunities to change them if they had been provided with them.
           
    Maj. (later Lt. Col.) Frank Glenn, MC, Surgical Consultant, Office of the Surgeon, Headquarters, Sixth U. S. Army, observed and examined these patients within 12 hours after they had been hospitalized. Their stories were all substantially the same, and their physical findings differed only in degree. Most of them reported that, after 4 to 7 days of existence under the conditions described, they began to experience burning sensations in their feet, first on the dorsum, later on the soles and over the toes. Movement at first gave some relief. Later, walking was progressively more painful. When rescue finally came, the men had to be carried by litter through swamps and over difficult terrain, which they all agreed they could not possibly have traversed by themselves. In some units, as much as 50 percent of the personnel was affected.
           
    When they first removed their shoes, the men said, their feet appeared pale and swollen. Shortly afterward, the skin of the feet became flushed and warm. The burning sensations increased, and tingling and pain were soon experienced. Elevation of the feet gave some relief. Within 30 minutes after


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the shoes had been removed, it was impossible to replace them because the feet were so intensely swollen. Some soldiers volunteered the information that these symptoms and signs did not appear until after it became impractical to remove the shoes every night. When the tactical situation prevented this, the disability described quickly followed.
           
    At first, the feet were not ulcerated and there was no loss of skin. As time passed, however, pain and swelling increased, and ulcerations appeared, first on the dorsum, and then about the toes. Cracks on the soles were frequent, but ulceration in this area was uncommon.
           
    When the men were first observed in the evacuation hospitals, it was striking to note that, although all of them were obviously fatigued, only an occasional patient seemed to be resting. Some sat with their feet elevated. Some let them dangle over the edge of the cot. Some clasped their ankles and lower legs. Most of them changed position frequently. Those who attempted to stand seemed helpless and distressed and were obviously in pain. When they walked, they moved with "hesitant deliberation," putting the weight of the body on the feet only after the feet were put down, like "a cat walking on flypaper." The most frequent complaint was a burning sensation, associated with "deep" aching of the dorsum and sole of the foot. Neither socks nor dressings could be endured.
           
    Examination of the feet usually revealed a uniform erythema, which was frequently intense. The skin of the dorsum was tense and shining, and the soles were so swollen that they seemed to bulge. Blebs and ulcerations from which weeping serum exuded were often observed at the margins of, and between, the toes. In the most serious cases, there were scattered areas of ecchymosis, and the distal portions of the toes were blue, white, mottled and cold, in contrast to the swollen, erythematous aspect of the other portions of the feet. After the feet had been cleaned and dried, a line of demarcation was usually evident at, shoe-top level. Only occasionally did edema extend above this level.
           
    Ulcerating lesions were most numerous on the toes and over the dorsum of the foot. These lesions were blotchy, and their appearance suggested that they had been produced by pressure and abrasions. They varied in degree from patient to patient. Some were only superficial. In others, the destructive process extended down to, or through, the true skin. Some lesions were well demarcated, with a zone of necrotic tissue along the margin, as in decubitus ulcers or a gangrenous process. The skin between the lesions, especially over the dorsum of the foot, was pale, cold and inert. Secondary infection was strikingly infrequent.
           
    Lymphangitis was present in a few cases, in all of which there was a previous history of troublesome epidermophytoses. When the men were directly questioned, about 15 percent admitted to some discomfort in the groin; all of this group were found to have enlarged and sensitive regional lymph nodes. There was no correlation, however, between the presence of lymphadenopathy and the degree of pain and swelling in the feet.


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    Pressure over the affected areas caused pain. Erythematous areas blanched slowly, and the return flush was delayed. In no instance were pulsations absent, nor in any instance were variations in the pulsations beyond the range of normal. Sensory changes were not clear cut. Areas of numbness and tingling could be demonstrated by light touch and pinprick. Areas of diminished sensation seemed to be increased when the feet were elevated. Attempts to outline areas of paresthesia and anesthesia were not satisfactory, perhaps because the patients were all uncomfortable and fatigued.
           
    Temperature and pulse were invariably within normal range. Fatigue and inability to sleep were the only systemic reactions.
           
    Treatment was based on keeping the patients off their feet as much as was possible in a crowded forward hospital. If the shoes had not already been discarded, they were cut off. Most of the patients had long since discarded them, and no pictorial or other record, unfortunately, was made of the condition of the few pairs available for examination. The feet were washed with cool water and mild soap, which brought, only temporary relief; the discomfort returned as soon as the feet were dry. At the most, only light, dry dressings could be endured, and the patients were more comfortable with no dressings at all. Applications of mineral oil were not well tolerated. Lanolin was not tested. General supportive measures were instituted, such as would be employed for men who were extremely tired physically and who had been without food and sleep for long periods of time. Sedatives were given as necessary to insure sleep and rest.
           
    Contrary to the usual course in trenchfoot or immersion foot, recovery in these cases was fairly rapid. Most of the casualties were evacuated by ship to hospitals in Hollandia within 36 hours of their admission to evacuation hospitals on Leyte. When they arrived in Hollandia, most of them were almost entirely free from symptoms and signs of the injury. Pain, swelling, excoriations and vasomotor manifestations had, for the most part, disappeared during the voyage, apparently as the result of rest, and healing was usually complete by the time the men were admitted to general hospitals in New Guinea.
           
    Gangrene did not occur in any of these cases, and no recurrences of sequelae were recorded. The uniform absence of thrombosis and gangrene was believed due to the relatively high temperatures in which the injuries occurred.
           
    The additional cases of cold injury which occurred on Leyte in December 1944 and which brought the total number on that island up to 167 were similar in all respects to those already described. The 55 cases which occurred in the Visayan Islands, most of them in January and February 1945, were considerably milder but were otherwise similar to those which occurred on Leyte.
           
    It should be noted how closely the symptoms and signs of the variety of cold injury observed in the Philippine Islands resembled those of cold injury as it was observed in both the Mediterranean and the European Theaters of Operations, where the classical type of trenchfoot occurred. On Leyte, the degree of injury appeared, at least superficially, to be mild, but all of the men affected required hospitalization. They could not walk, let alone put on their


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shoes, and they could not sleep because of discomfort. The most important difference between the cold injuries in the Pacific and those in other areas was that in the Pacific, in contrast to the course of events in both the Mediterranean and the European theaters, virtually all of the men affected could be returned to duty after being hospitalized, and there were no recorded recurrences. In other theaters, a large proportion of the trenchfoot casualties were lost permanently to combat duty, and there was a high percentage of recurrence in the soldiers returned to full and limited duty (p. 327).
           
    The Surgical Consultants Division, Office of the Surgeon General, in commenting on 8 February 1945 on the report, of this experience in Essential Technical Medical Data, United States Army Forces, Far East, dated 23 December 1944, took occasion to point out the gravity of the United States experience with trenchfoot in Europe in the winter of 1944-45 and recommended that any additional information on this extremely important medicomilitary subject be compiled.

Part II. The Wet-Cold Program

    The actual experience with cold injury in the Pacific was limited to the type just described. There was general realization, however, that the invasion of the Japanese islands, which was planned for the fall of 1945, would again require combat operations in a cold-wet environment, and at temperatures which had produced the classical type of trenchfoot in the Aleutian Islands and in the Mediterranean and European theaters. By the time that planning for the invasion of Japan was undertaken, the lessons inherent in the serious losses from cold injury which had occurred in other theaters had already been well learned. Moreover, the successful prevention and control programs which had eventually been formulated and implemented in Italy and in Europe had shown that such losses were in large part neither necessary nor inevitable.
           
    It was therefore taken into consideration early in the planning for the invasion of Japan that if similar misfortunes were to be avoided the fullest advantage must be taken of the knowledge which had been gained in the Mediterranean and European theaters. A considerable part of the losses from cold injury in the Mediterranean theater could be explained by the fact that the experience gained in the Aleutians had not been transferred to it. A considerable part of the losses from this cause in the European theater could be explained by the fact that the experience gained in Italy had not been transferred to it. Those errors were not repeated in the Pacific theaters. The wet-cold program there was planned against the background of what had been learned in other theaters. The program of prevention and control was worked out with the joint cooperation of the Office of the Surgeon General, the Office of the Quartermaster General, and the various levels of command in the Pacific. The war, fortunately, ended before it was necessary to test the program in combat, and the story of wet-cold injury is therefore a story of planning and


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prevention and not, as in other theaters, a story of the actual occurrence of trenchfoot. The planning was thorough and precise, and there is every reason to believe that the program would have been highly effective, and that losses from cold injury would have been reduced to an irreducible minimum, had it been necessary to put it into operation.
           
    As a matter of convenience, and to simplify the account, the programs of planning for the prevention and control of cold injuries are described under a number of separate headings, without any attempt at the integration which was in progress when the war ended.

OFFICE OF THE SURGEON GENERAL

    The first formal recognition by the Office of the Surgeon General of the possibility of cold injury in the Pacific appeared in an article prepared in that office and published in the February 1945 issue of Health.2 In it a number of facts about future fighting in the Pacific were emphasized:
           
    1. Warfare in this area would extend northward during the fall and winter months, and a range of temperature particularly favorable to the occurrence of cold injury would therefore be encountered.
           
    2. The terrain of the lowlands, where most of the fighting in Japan would probably take place, was also favorable to the development of cold injury, since drainage was poor and the numerous rice paddies made much of the ground little more than swampland.
           
    3. The same general conditions would also be encountered if fighting should be necessary in the northern provinces of China.
           
    4. Trenchfoot would not occur in the mountainous regions of Japan and the north Asian mainland, where dry cold rather than wet cold would be encountered, but frostbite was a possibility seriously to be considered in these areas.
           
    5. Attention was directed to the recorded experiences with cold injury among Japanese troops during the Russo-Japanese War.
           
    For the next several months, the Preventive Medicine Division and the Surgical Consultants Division, Office of the Surgeon General, continued, in various ways, to emphasize the potential dangers of cold injury in the Pacific theaters and the necessity for the prompt institution of preventive measures. Among the specific actions taken were the following:
           
    On 12 February 1945, Brig. Gen. Stanhope Bayne-Jones, acting chief of the Preventive Medicine Service, initiated the preparation of a communication for the signature of The Surgeon General, to be sent to the commanding general of the Army Service Forces. This communication was sent to General Somervell, in the form of a memorandum, through the Quartermaster General on 24 March 1945.
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2 Monthly Progress Report, Army Service Forces, War Department. 28 Feb. 1945, Section 7: Health.


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    This memorandum, to which was attached a copy of the article on cold injury which had appeared in the February 1945 issue of Health, contained meteorologic data to support the strong probability that cold injury would be encountered in Japan. It recommended the use of the shoepac (12-inch height), with two pair of wool ski socks, as well as the use of other modern cold weather protective garments and equipment developed by the Quartermaster General. The memorandum also recommended that all troops taking part in operations in cold climates receive training in foot hygiene, in accordance with Section IV, War Department Circular No. 312, and War Department Technical Bulletin (TB MED) 81.
           
    On April 7, a memorandum prepared by Maj. Gen. (later Lt. Gen.) LeRoy Lutes, Acting Chief of Staff, Army Service Forces, was sent to the director of Plans and Operations, Army Service Forces, directing that the Planning Division initiate a study on trenchfoot immediately. This study was to include all available data on incidence, causes, preventive measures, and similar matters. As soon as the study was completed, it was to be sent to the commanding general of the United States Army Forces in the Pacific, with a covering letter to be prepared for the signature of the Chief of Staff. The memorandum concluded: "It is General Somervell's belief that the language of this letter should be so couched that General MacArthur would understand that there should be no excuse for trench foot developing in the Far East due to the ample warning given to him on this subject."
           
    On April 11, a memorandum containing the material to be included in the proposed letter to General MacArthur was sent by General Kirk to General Somervell, for the attention of the director of Plans and Operations, Army Service Forces. In this memorandum, the unfortunate experience of the United States Army in the Mediterranean and European theaters was recounted, and it was emphasized that it was urgently necessary to institute a prompt and energetic program of prevention for the United States Army troops in the Pacific. It was also pointed out that the far better record of the British Army in respect to cold injury in both the Mediterranean and the European Theaters of Operations seemed to be the result of the far more effective measures of prevention employed in this army.
           
    On 27 April, a communication from the War Department on the subject of trenchfoot was addressed to General MacArthur.3 It contained the following information:
           
    1. Large numbers of troops had been incapacitated by trenchfoot during the winter campaigns in the Mediterranean and European theaters.
           
    2. The majority of these losses could have been avoided if troops had been properly indoctrinated concerning the cause and effect of cold injuries and the measures necessary to prevent them.
           
    3. The Pacific fighting was about to advance into areas in which conditions conducive to trenchfoot would exist during certain seasons of the year.
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3 Letter, The Adjutant General, War Department, to Commander in Chief, United States Army Forces in the Pacific, 27 Apr. 1945, subject: Trench Foot.


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    4. The disastrous losses suffered in other theaters need not be duplicated in the Pacific if the risks of the situation were recognized and the necessary preventive measures taken.
           
    Since the role of the Medical Department in the prevention of cold injury is entirely advisory, it was specifically stated in this communication that the control of trenchfoot "is primarily a command problem that can only be solved by proper indoctrination of troops prior to entering the combat zone and continuous follow-up supervision backed up by a strict disciplinary policy during the period in which the troops are exposed to the condition. Troops must be made trenchfoot conscious."
           
    Enclosed with this letter was a resume of all available information on trenchfoot secured in the study made in the Office of the Surgeon General on General Lutes' instructions (p.218). A graphic training aid (8-16) was also enclosed. The letter noted that Film Bulletin No. 180, a training film on trench-foot (p.223), had already been sent to the commanders of the Pacific Ocean Areas and Southwest Pacific Area.4
           
    This letter was received at General Headquarters, SWPA (Southwest Pacific Area), on 8 May 1945 and was forwarded for necessary action to the Commanding General, USASOS, SWPA (United States Army, Services of Supply, Southwest Pacific Area), on 12 May 1945. It was received on 15 May 1945.
           
    On 30 June 1945, a memorandum addressed by General Rankin to The Surgeon General again stressed the seriousness of cold injury and the importance of its prevention. It was suggested that the programs conceived and in process of execution for the prevention of cold injuries in the Pacific should be critically reviewed by all divisions in the Surgeon General's Office, so that past experiences could be utilized to the fullest advantage in future planning.
           
    A conference for the purposes suggested in this memorandum was held on 9 July 1945 under the chairmanship of General Bayne-Jones. The clothing and equipment then in production and planning for troops in the Pacific were fully discussed, and it was noted that representatives from the Office of the Quartermaster General were already in the Pacific theaters giving instruction in the wearing and use of the winter outfit, including shoepacs (p.226). The training of troops in foot discipline was discussed, and plans were made for the full utilization of such aids as films, film strips, graphic portfolios, posters, manuals, and pamphlets which would call the attention of the soldiers to their individual responsibility for the care of their own feet.

    Efforts had been begun on 14 June 1945, by the Preventive Medicine Division, Office of the Surgeon General, to obtain the release from the European theater of certain medical officers who were thoroughly experienced in cold injury, so that they could be assigned to the Southwest Pacific for supervision
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4 The consolidation of the United States Army Forces in the Pacific under General MacArthur was occurring just as the planning for the prevention of cold injury in that area was getting under way. His appointment, in fact, was made after a team from the Office of the Quartermaster General had already begun to operate in the Pacific Ocean Area. A second team from this office was latter assigned to General MacArthur's headquarters (p.228).


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of the program of prevention to be instituted in that area. The first request, which was sent formally on 19 June, was refused by the theater on 23 June. In retrospect, it was thought that the reason for the refusal was that the radiogram requesting the release was weakly worded and provided no explanation of the urgency of the need for these officers for this assignment. A second, more strongly worded radiogram to the European theater was drafted on 24 June and sent on 9 July. When no reply to it had been received by 19 July, a tracer radiogram was sent. The consent to the transfer of these officers was finally received on 23 July.
           
    The original request had been for the release of Lt. Col. (later Col.) Richard P. Mason, MC, and Maj. William L. Hawley, MC, both of whom had had considerable experience in the European theater. Later, Colonel Gordon's release was requested. On their arrival in the Zone of Interior, these officers were temporarily assigned to the Office of the Surgeon General and participated in the conference on medical matters in the Pacific held 30 July-1 August 1945.
           
    On 4 July 1945, General Kirk wrote personally to Brig. Gen. (later Maj. Gen.) Guy B. Denit, the Surgeon, AFPAC (United States Army Forces, Pacific), to inform him of the expectation that the officers whose release from the European theater had been requested would be sent to the Pacific to aid in the setting up of the cold injury prevention program. It was hoped, General Kirk wrote, that General MacArthur would see these officers himself, to secure firsthand information of the seriousness of the experience in the European theater. The activities of the teams from the Office of the Quartermaster General, which were already in the Pacific, were discussed, and all the material then available on trenchfoot was enclosed. The letter ended with another reminder of the seriousness of the problem in the European theater and with the statement that it would be equally serious in the Pacific if preventive measures were not taken. Trenchfoot, it was pointed out again, is an essentially preventable military hazard.
           
    A similar letter to General MacArthur was prepared in the Office of the Surgeon General, for the signature of the Chief of Staff, but does not seem to have been dispatched.

MEDICAL PLANNING IN THE PACIFIC

    The first published mention of cold injury in the Pacific theaters took the form of a memorandum (Technical Memorandum No. 10) issued from the Office of the Surgeon, USASOS, SWPA, on 9 July 1943. This memorandum, which was entitled "Immersion Foot," was obviously prepared with shipwrecked persons in mind. The causes of the injury, the clinical picture, and the management were discussed. Preventive measures were listed as removal of constricting footgear, which would be of no use for warmth if the feet were in water; exercise of the feet and legs, to maintain vascular and muscular tone;


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and the application, when possible, of a thick coating of grease. The affected parts were not to be rubbed, and heat was not to be applied to them.
           
    The problem of wet-cold injury did not arise in the hot jungles of New Guinea, New Britain, the Admiralty Islands, and the Schouten Islands, where all the fighting occurred in this area before the invasion of Leyte in September 1944. The outbreak of a form of cold injury which occurred in Leyte has already been described (p.211). Col. I. Ridgeway Trimble, MC, Consultant in Surgery, Office of the Surgeon, USASOS, SWPA, who was familiar with the losses from trenchfoot in the Aleutians and in the Mediterranean theater, reacted to this outbreak in two ways:
           
    1.  He wrote Major Glenn on 8 December 1944, suggesting that the men with these injuries be considered for sympathetic block. When this suggestion reached Major Glenn, the patients had already recovered.
           
    2.  Colonel Trimble also prepared a technical memorandum on the subject of trenchfoot, based on War Department Circular No. 312, to be issued by Headquarters, USASOS. This memorandum, which was not issued, recognized that the disability sustained by a number of troops on Leyte, although it had occurred in the Tropics, was actually a form of cold injury or trenchfoot. With proper preventive measures, the number of men disabled from this type of trauma could be held to a minimum. It might not be possible, the memorandum continued, to carry out, during the exigencies of jungle warfare, all the preventive measures recommended, but every effort should be made to follow the directions outlined. Particular emphasis was placed on the provision of extra dry socks for each man.
           
    With the concurrence of General Denit, Colonel Trimble also discussed with the Surgeon, Sixth U. S. Army, Brig. Gen. William A. Hagins, the indoctrination of troops in the prevention of wet-cold injuries, in view of the impending fighting on Luzon.5 In General Hagins' opinion, which events proved to be correct, this was an unnecessary precaution at this time, since conditions on Luzon during the rainy season would not be comparable to those encountered on Leyte.
           
    Between 30 April and 16 July 1945, Colonel Trimble, on General Denit's instructions, prepared a number of memoranda and drafts and revisions of circular letters n the subject of cold injury. They were chiefly exploratory and preparatory and were designed to keep the Office of the Theater Surgeon informed on this matter, and to have all the necessary material in readiness when the time came to issue circular letters and technical memoranda. In these various drafts the following points were made:
           
    1. Trenchfoot could be expected to become a problem of great seriousness as fighting developed in colder climates.
           
    2. In spite of the experience in the Aleutians in 1943 and in Italy in 1943-44, some American units went into combat in Europe without proper footgear. As a consequence, they suffered seriously from cold injury.
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5 Check Sheet, Surgical Consultant, Headquarters, 1, nited States Army Forces, Western Pacific, to the Chief Surgeon, 16 July 1945, subject: Trench Foot, Sunimary of Program to Date.


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    3. The rate of cold injury under similar circumstances varied from unit to unit, depending upon the efficiency of commanding officers in enforcing preventive measures.
           
    4. British and Russian troops, who had better winter footgear than United States troops and who had been better schooled in foot hygiene, had almost no trenchfoot.
           
    5. Strenuous measures must be taken in the Pacific to avoid a repetition of the previous United States Army experience, most of which was preventable.
           
    6. Appropriate memoranda should be published at once, through technical and command channels, concerning these preventive measures, which were a command and not a medical responsibility.
           
    7. It was urgent that requisitions be placed at once with the Office of the theater chief quartermaster for sufficient supplies of shoepacs, wool socks, and other winter equipment. In the memorandum dated 8 May 1.945, it was noted that these supplies were already on order and that teams trained to give instruction in the proper use of the new winter clothing would arrive in the Southwest Pacific Area in August.
           
    Colonel Trimble, with General Denit's concurrence, also held conferences with a representative of the theater chief quartermaster concerning the protection of ground troops in cold, wet weather. Originally, the use of white clothing for camouflage had not been contemplated, but, after Colonel Trimble had raised the question, his suggestion was approved and 10,000 suits, enough for two regimental combat teams, were put on order.
           
    The new items of clothing and footgear were demonstrated for Colonel Trimble who wrote in a memorandum to General Denit on 16 July 1945: "The temperature then in Manila was 105 F. in the shade. It was rather painful to observe the demonstrating soldier put on in layers a pair of `long johns,' a wool shirt, two pairs of wet resistant pants, two pairs of wool ski socks, an Eisenhower jacket, an M-1943 jacket, a cap with ear muffs, and a high shoepac."
           
    On 27 June, Colonel Trimble submitted a recommendation to General Denit that all United States Army officers and enlisted men of ground combat elements be given a special foot examination by their unit medical officers, to determine the status of the two main arteries of the foot.6 Men in whom the pulsations in these arteries were absent would have further examinations, including roentgenologic studies, to detect or exclude insufficient circulation due to arteriosclerosis and other causes. The rationale of this recommendation was the peculiar susceptibility of this (small) group of soldiers to cold, and the possibility that they would contract trenchfoot under conditions in which those with normal circulation would suffer no disability whatsoever. This recommendation was approved by General Denit.
           
    On 12 July 1945, General Denit received from General MVlacArthur's headquarters a letter incorporating the information about cold injury which had been
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6 Check Sheet, Surgical Consultant, United States Army, Western Pacific, to the Chief Surgeon, 27 June 1945, subject: Comments on Indoctrination Program Cold-Wet.


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sent to the latter by the War Department on 27 April 1945 (p.218). On General Denit's instructions, Colonel Trimble prepared a circular letter on the subject, to be issued as a command directive from General MacArthur's headquarters.7

    Various changes were made in this letter as it passed through various hands. One change was the deletion of the recommendation that all soldiers should have an investigation of the pulsations in the pedal arteries as part of their physical examination. Another was the deletion of a paragraph in which it was stated (1) that the great majority of cold injuries in other theaters could have been avoided if troops had been properly indoctrinated concerning the cause, effect, and prevention of cold injury and (2) that the disability rate in armies subjected to the same climatic conditions varied enormously with the efficiency of their commanding officers.
           
    Had the war continued and had it been necessary to issue technical memoranda and circular letters on the subject of cold injury, their preparation would have been a simple matter, since the material had been thoroughly workedover and was readily available for use. Instruction on the prevention of trench-foot and the training of troops in foot hygiene was included in the medical planning for the impending OLYMPIC and CORONET operations against Japan, and provision had also been made for shoepacs and other winter footgear.8
           
    On 17 July 1945, Col. Charles W. Mayo, MC, who had been placed on temporary duty in the Office of the Chief Surgeon, AFWESPAC (United States Army Forces, Western Pacific), as a special consultant in cold injury, prepared memorandum for General Denit, in which he made the following suggestions:
           
    1. That a wet-cold indoctrination program, similar to the program already instituted in other parts of the Pacific, should be carried out in the Philippines. The Quartermaster Corps would provide the program on instruction in the use of winter clothing, and there would be a related medical program on the care of the feet.
           
    2. That training film 180 should be made compulsory viewing for all personnel and officers, on the ground that it would probably be the greatest single aid available in persuading troops to carry out the preventive measures advised. It was recommended that it should not be combined with films shown for entertainment, and that there be no comment upon it afterward unless an exceptionally able medical speaker was present, since it was sufficiently informative and impressive in itself.
           
    The war in the Pacific ended before these plans could be put into effect.
           
    Colonel Gordon and Major Hawley, who had been released from theEuropean theater for service in the Pacific (p.219), arrived in Headquarters, MIDPAC (United States Army Forces, Middle Pacific), on 11 August 1945.9 They held conferences with the surgeon and members of his staff, representa-
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7 Circular Letter (draft), Office of the Commanding General, AFPAC, 12 July 1945, subject: Trench Foot.
8 Check Sheet. Surgical Consultant, Office of the Chief Surgeon, Headquarters, United States Army, Western Pacific, to the Chief Surgeon, 24 June 1945, subject: Outline of Studies Being Conducted on Medical Support for Next Operation.
9 Memorandum, Col. John E. Gordon, MC, Headquarters, MIDPAC, to General Willis, 17 Aug. 1945, subject: Trenchfoot Control.


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tives of the quartermaster, a representative of the surgeon of the Central Pacific Base Command, and others, to review the entire wet-cold program and related subjects. One day was spent at Headquarters, 98th Infantry Division. Extended conferences were held with medical officers of the marine forces, the Pacific naval force, and the United States Navy, Pacific. Two general conferences were held with medical units alerted for service in Japan.
           
    At all of these conferences, the principal topic of discussion was the medical aspects of cold injury and the epidemiologic features of its control. It was the opinion of Colonel Gordon and Major Hawley that adequate attention had been given by Headquarters, MIDPAC, to the probability of cold injury in forthcoming military operations, and that sound measures had been taken for its prevention. The excellent training of the 98th Infantry Division furnished proof of these statements.
           
    When Colonel Gordon and Major Hawley reached Manila, they were informed by General Denit that he desired the trenchfoot program to be carried out as planned, but with such modifications as would make it suitable for an army of occupation. The scope of the mission was extended to include considerations of acclimatization. Later, it was decided to defer indoctrination until all troops in the Philippines had been moved to Japan, since the confusion attending their deployment made the institution of a formal program impractical at this time. For various reasons, the medical phase of the program was never instituted, although the instruction of the troops in the use of winter clothing went forward as planned (p.228).

ACTION BY COMMANDERS IN PACIFIC

   The training directive issued on 20 January 1945 from Headquarters. Army Ground Forces (p.76 and appendix B), was received by General Mac-Arthur's headquarters and was transmitted for informational purposes to the commanding general of USASOS, on 21 March 1945.
           
    On 27 April 1945, a communication from the War Department to General MacArthur (p.218) pointed out that the prevention of trenchfoot is primarily a command problem and directed that adequate indoctrination of troops be undertaken before they entered combat zones. This communication was transmitted by General MacArthur's headquarters to the commanding general of USASOS, SWPA, on 12 May 1945, for necessary action.
           
    On 18 July 1945, a letter directive from General Headquarters, AFPAC. (appendix H, p.533), to the various headquarters in the Pacific announced the wet-cold indoctrination program and placed the responsibility for its technical and administrative control on the commanders logistically responsible for the troops in the Western and Middle Pacific areas. The commanding generals of the Sixth and Eighth U. S. Armies and of the Far East Air Force in turn were charged with responsibility for the indoctrination of personnel in their commands. Direct contact between the various commands was authorized


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for the purposes of the program. Appropriate directives containing pertinent information were issued to all subordinate echelons.
           
    A second communication on the subject of cold injury was in preparation in General MacArthur's headquarters on 12 August 1945, the day of the Japanese surrender, for distribution to the various commands in the Pacific. In it the following points were discussed:
           
    1. Attention was called to the earlier letter on the subject, in which the responsibility for the training program was placed specifically upon command, with unit commanders responsible for the dissemination of information and for enforcement of preventive measures.
        
    2. The European experience with cold injury was briefly reviewed, and it was emphasized that only the strict application of correct preventive measures could forestall a repetition of that experience in Japan.
           
    3. The importance of rotation of troops was stressed.
           
    4. It was again directed that the wet-cold indoctrination program be included in all training programs.
           
    This letter was accompanied by an outline intended for the guidance of officers responsible for the training of troops. Details of the required preventive measures were described.
           
    The rationale of these measures was stated as follows:
           
    1. Men who have lived in the Tropics for approximately 2 years are physiologically attuned to weather varying from warm to extremely hot and have probably all but forgotten modes of living imposed by cold weather. They must therefore be prepared for sustained out-of-doors life in circumstances of extreme cold.
           
    2. The mere provision of suitable winter clothing is not sufficient. The experience in Europe clearly demonstrated that troops must also be taught how to wear such clothing and how to maintain it. Knowledge of the proper fit and sizing of garments is also essential.
           
    3. Protection of the soldier in winter combat is the responsibility of all echelons of command, from senior commander to squad leader. The experiences of United States Army troops on Attu, in Italy, and in Europe clearly showed the importance of this attitude and achievement, as did the British experience. Because their officers and leaders were aware of their responsibility, the incidence of trenchfoot in British troops was negligible.
           
    4. Trenchfoot is chiefly a disease of infantrymen. It causes actual losses among men who carry the fight to the enemy; also, soldiers who become chilled beyond the point of comfort are neither mentally nor physically fit for efficient combat.
           
    To implement the program planned for the prevention of cold injury, it was directed-
           
    1. That the wet-cold indoctrination program be given top priority in all echelons and be incorporated into the requirements of all training programs for operations contemplated in temperate climates.


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    2. That the implementation of training doctrines be made the responsibility of command in all echelons.
           
    3. That individual organizations be held responsible for further indoctrination of troops in various echelons, the basic program being designed only to orient, as fully as possible, all command and staff officers and key enlisted men in these echelons.
           
    4. That the program be limited to ground combat and service elements of the Army and to Military Government personnel. Other provision would be made for the instruction of Marine Corps and Air Forces personnel.
           
    5. That the program occupy approximately 8 weeks, with an additional 2 weeks allowed for the dissemination of the doctrines of the preliminary courses to organizational personnel by individual commands. The officers detailed to the area by the Office of the Quartermaster General, who were already in the area, would be available for consultation. Courses of instruction were outlined for higher headquarters and for ground combat and ground combat service support echelons.
           
    6. That indoctrination be provided at the latest date practical before staging, the program being phased to meet this objective. A refresher course in living and fighting in wet-cold areas should be included in shipboard orientation programs, but, as far as practical, should be delayed until convoys had passed out of the tropical zone, so that normal cold weather conditions would help to emphasize the doctrines to be employed at the target area.

THE QUARTERMASTER CORPS
 
    The Quartermaster General employed in the Pacific areas the same policy which lie had employed in other theaters of operations. Observers were sent into the area to introduce new equipment and to lay the basis for future requisitions.10 The action taken in the Pacific was greatly influenced by the serious consequences of the failure in the European theater to accept the advice of his office concerning the best type of clothing and equipment. Long-range planning was essential in the Pacific because the long distances would make procurement and transportation difficulties more serious than in either the Mediterranean theater or the European theater.

    The observers sent to the Pacific from the Quartermaster General's Office also had the responsibility of indoctrinating the troops in the correct wearing and care of the new winter clothing. The same general routine was followed that had been followed in other areas, but the observers in the Pacific area had two advantages: They had seen the results of training in the Mediterranean
__________
10 (1) Report, Capt. William F. Pounder and Capt. Clarence J. MacManus, Military Planning Division, Research and Development Branch, Office of the Quartermaster General. (2) Report, Col. Charles P. Bellican, QMC, Senior Member Quartermaster General Liaison Group in Pacific Areas, 1 Nov. 1945, subject: Quartermaster General Liaison Indoctrination Program in Wet-Cold Clothing Concepts, also Cold Weather.


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theater in the winter of 1944-45, and they had also seen the serious situation which developed in the European theater because requisitions for the proper kind of clothing and footgear had been placed too late for the material to be delivered when it was needed for the winter campaign.
           
    When the first observer from the Office of the Quartermaster General, Capt. (later Lt. Col.) William F. Pounder, QMC, arrived in the Hawaiian Islands (then MIDPAC) on 5 April 1945, the logistic responsibility for the assault operations on Japan had not yet been firmly established. Almost as soon as the requisitions for winter clothing and equipment had been completed and approved by the supply staff of MIDPAC, these responsibilities were assigned to AFPAC. The requisitions prepared in MIDPAC, which were thus left without authorization, were forwarded to the Office of the Quartermaster General, to serve as a guide for the specific amounts of individual wet-cold winter items considered necessary for the invasion.
           
    The team headed by Captain Pounder eventually consisted of seven other officers from the Office of the Quartermaster General and two Quartermaster Corps officers who were attached to it locally. Its mission was threefold, to plan the quantities of supplies needed for the forthcoming winter operations, to train the troops in the use and care of their personal winter equipment, and to observe the functional adequacy of individual items of wet-cold clothing and equipment. All previous operations in the Pacific had required only tropical clothing and equipment, and the change from supplies of that type of clothing to supplies of clothing and equipment suitable for winter combat would represent, in itself, a major logistic operation. The advice of the representatives of the Quartermaster General, contrary to the experience in Europe, was accepted at once. When the war ended, large amounts of winter clothing and equipment were already on hand in the various commands in the Pacific, and more were en route. It is certain that, if the war had continued into the winter, all the troops would have been properly protected for combat in a cold environment. The first demonstration of the new clothing was given on Oahu on 12 April 1945.
           
    Training Memorandum No.11 for the United States Army Forces, Pacific Ocean Areas, was issued on 16 May 1945. In it, the date for the completion of all unit training in MIDPAC was set for 1 September 1945. Training was practically completed in the Hawaiian Islands by 20 June, when the team left Oahu for the training of other units elsewhere.
           
    Work carried out elsewhere by this team was as follows:
           
    1. Establishment of the program of indoctrination at Fleet Marine Headquarters for all Marine units in the Pacific areas.
           
    2. Indoctrination of troops on Johnson Island, Kwajalein, Saipan, Tinian, Guam, Iwo Jima, and Okinawa.
           
    3. Assistance to the second team working on Mindanao and Luzon by two members detached from the first team.


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    4. Indoctrination of troops in Korea and Japan and in Kyushu (Sasebo), Honshu (Yokohama), and Shanghai, after V-J Day. Indoctrination was expedited in Korea, where it grows steadily colder after the first part of October. Each major unit was helped in the planning of requisitions and the distribution of clothing, and the actual distribution was supervised by two officers from the team attached to the XXIV Corps.

    The final phases of the work of Captain Pounder's team were carried out. under the direction of the liaison group from the Office of the Quartermaster General, which had arrived in the Pacific on 21 May 1945. The initial activities of this team, on Oahu, consisted of conferences with the first team and additional planning for wet-cold clothing and equipment, for Operation OLYMPIC.
           
    The second team, which was headed by Col. Charles P. Bellican, QMC, operated in four sections; namely, a planning section assigned to the Commander in Chief, AFPAC, for coordination purposes, an operating section in MIDPAC, and two operating sections in AFWESPAC. The planning section was later assigned to the administrative control of the Commanding General, AFWESPAC, who then had general logistic control of Operations OLYMPIC and CORONET. After command responsibility had been approved by the Commander in Chief, AFPAC, and a general directive had been prepared dealing with the capabilities and limitations of wet-cold clothing, supply problems connected with its issue, and similar matters, the entire program was placed in the hands of the liaison group.

    Training directives were first prepared for the, various separate commands. Teams were then dispatched from the operating sections of the group to the lowest tactical elements of the various commands, to insure that all soldiers received proper individual instruction. This phase of the work lasted from June until the middle of August.
           
    When the Japanese surrendered, the indoctrination program was at once modified to fit the needs of an army of occupation, and plans of instruction were modified to meet the needs of the changes of tactical units within the several commands and assignments in the areas of occupation. The program was hampered by delays in the delivery of winter clothing, due to the shortage of ships; by the shortage of port facilities, due to the destruction caused by bombing during the war; by the necessity for using harbors which were still mined; and by the very bad weather. As late as 28 September, only small amounts of winter clothing had been received in the Tokyo area.
           
    In spite of these difficulties and delays, Colonel Bellican was able to report to General MacArthur on 3 November 1945 that as of 1 November, the original target date for the completion of the program, approximately 96 percent of the army of occupation had been indoctrinated and that the program had been completed 100 percent in the XXIV Corps and the Eighth U. S. Army. Arrangements had been made for the training of the elements of the Sixth U. S. Army not yet indoctrinated.


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PRACTICAL CONSIDERATIONS OF THE WET-COLD INDOCTRINATION PROGRAM

    It was originally estimated that the program of wet-cold indoctrination for troops in the Pacific would cover a total of 1,500,000 men. The necessity for a program of such magnitude is readily explained: The training program instituted in the Zone of Interior (p.74) had been in operation too short a time to affect most of the troops in the Pacific. Many of the troops deployed to the Pacific from the European theater had arrived late in that area, had had little combat experience, and had also had little training in the prevention of cold injury. Finally, troops which had fought, only in the Pacific had had no indoctrination at all, and without it they would have been completely unprepared for combat in wet-cold weather. Training en masse was far more efficient than an endeavor to isolate the groups and individuals making up the small minority which had already been trained.
           
    There were a number of factors which complicated the indoctrination program:
           
    1. All the military bases in the Pacific were islands, and there were therefore enormous distances between the groups of men to be indoctrinated.
           
    2. No specific organization was in existence for meeting the special problems posed by the prevention and control of cold injury. Command, staff, technical personinel, and enlisted components alike had to undergo comprehensive indoctrination on all phases of this type of trauma at the same time that administrative facilities for organization and implementation of the program were being developed.
           
    3. The varying character of the troops in each command required the setting up of a number of special programs. Combat troops, service troops, and the various organizations of the Army Air Forces all had to be instructed differently.
           
    4. Facilities for instruction ranged from indoor theaters and classrooms on Oahu to demonstrations in makeshift areas deep in mud. Extreme heat and frequent drenching rains added to these difficulties.
           
    5. The size of the class was often determined by the availability or lack of availability of a public address system.
           
    6. Language difficulties also arose. Instruction had to be given to soldiers of several nationalities, including Chinese and Filipinos. When Film Bulletin No. 180 was shown, the sound track was translated as the showing progressed.
           
    7. The program was timed to permit completion just before the invasion, so that the troops would not forget what they had learned about cold weather during the additional period they had to spend in tropic temperatures.
           
    8. Written records required from commanders concerning the progress of indoctrination within their units proved essential but were sometimes produced unwillingly.
           
    9. Training aids had to be of convenient size to be carried no matter how


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the instructor might be traveling. Large, heavy, bulky materials, no matter how valuable, were not practicable.
           
    Training directives.- Although class schedules had to be widely varied according to the extent of the area of each base, the complexity of commands, the type of personnel to be instructed, and other considerations, training directives could be practically uniform. The training directive for the Pacific Ocean Areas (Training Memorandum No.11) was issued on 16 May 1945 (p. 227) . It was reproduced with only minor changes as Training Memorandum No. 1. AFWESPAC, 2 August 1945. This latter directive furnished the authority for the indoctrination of all troops in the Philippine Islands and all adjacent areas under the administrative control of AFWESPAC. A separate directive was issued on 4 August for service troops.
           
    These directives covered the following points:
           
    1. The indoctrination of all individuals liable for service under wet-cold conditions; the training of supply personnel in supply, storage, care, maintenance, proper fitting, and issue of clothing and equipment; effective instruction in the use of these items; command responsibility for the training; specified dates for the completion of the program.
           
    2. Description of the new wet-cold clothing and equipment.
           
    3. Details of the training courses, which were 2 hours for officers and enlisted personnel; 4 hours for instructors; 1 hour for supply personnel; and a refresher course when the winter clothing was to be issued.
           
    4. The function of the indoctrination teams from the Office of the Quartermaster General.
           
    5. Training aids and references (p.231).
           
    6. Provision for unit status-of-training reports to be submitted to headquarters before operational commitment of troops or before transfer of units between major echelons, the date to include the hours of training accomplished per individual and the commander's estimate of the unit's proficiency.
           
    Three courses of instruction were provided in the wet-cold program, one for officers and enlisted men for indoctrination purposes, one for instructors who would conduct future courses, and one for supply officers and enlisted supply personnel. The best results were obtained if the instructor took for granted that his audience had never seen the new winter clothing and equipment, as indeed most of them had not.
           
    The material was usually presented as follows:
           
    1. Explanation of the purpose of the course.
           
    2. Necessity for the course, because of past experiences in wet-cold climates.
           
    3. Statement of cold injury casualties in the Aleutians and in the Mediterranean and European theaters, with a discussion of the responsible climatic factors.
           
    4. Brief descriptions of trenchfoot, frostbite, and the respiratory diseases, with special references to their relationship to the incorrect use of uniforms and equipment.


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    5. Showing of Film Bulletin No. 180 on trenchfoot.
           
    6. Explanation of the difference between wet-cold and extreme cold.
           
    7. Climatologic data on Japan and the coast of China. Information was also included on Russia, to provide for all contingencies.
           
    8. Principles of living in cold and wet-cold.
           
    9. Demonstration of the winter combat unit, with special reference to the layering principle.
           
    10. Explanation of the importance of the correct fit of garments, methods of ventilation, washing of woolens and cottons, provision of dry socks and insoles, and similar matters.
           
    11. Display of posters on the proper use of clothing.
           
    12. Demonstration of the correct use of special equipment, including the sleeping bag with water-repellent case, the poncho, the pack, and the mountain cook set.
           
    Each course of instruction was concluded with a summary, a question period, and inspection of the items of clothing and equipment by the audience.
           
    Training aids and references.- The chief training aid was the combat uniform itself, which troops in the Tropics had never seen before. There was some delay in the receipt of the first sets to be used for teaching purposes, but eventually sufficient numbers were available to be shipped ahead to all the islands on which instruction was to be given.
           
    In addition to material of interest only to supply personnel, the following training aids were employed:
           
    TM 10-275, Principles of Cold Weather Clothing and Equipment. FM 70-10, Mountain Operations.
           
    FM 70-15, Operations in Snow and Extreme Cold. This manual was not of very great value, since extreme cold was only relatively important in the Pacific.
           
    Trenchfoot, Cause and Prevention (Sect. IV, WD Circular No. 312, 1944).
           
    Prevention of Trenchfoot and Frostbite (Letter, Headquarters, Army Ground Forces, 20 Jan. 1945) .
           
    FB-180, Trenchfoot. As noted elsewhere, it was the general opinion that this film bulletin was the greatest single aid in the prevention of cold injury because it showed so vividly the possible consequences of cold injury; namely, gangrene and amputation. When the technicolor Navy film on trenchfoot became available, it was shown to medical officers and other personnel who might be interested. Film strips on cold weather operations were of little value and were seldom used.
           
    Posters, radio announcements, and publicity in Yank, Stars and Stripes, and other Army publications were utilized to keep the indoctrination program in the minds of men who had received instruction but who were still in tropical areas and who would be inclined to think of clothing and personal hygiene accordingly.


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Instruction After V-J Day

    Inquiry at theater headquarters after the surrender of Japans revealed that combat maneuvers and patrols would be discontinued at once and that the chief task of the troops would be policing. It was expected that forces in both Japan and Korea would be billeted in heated quarters and would not be subjected to extraordinary exposure to cold-wet conditions.
           
    At the desire of the theater commander, the program was continued after V-J Day, with modifications in the emphasis and the content of the courses. The film bulletin on trenchfoot was no longer shown, but the correct fitting and use of the winter combat uniform were still emphasized. To maintain the interest of the troops. which naturally decreased as the acute need for protection against wet and cold was lessened, the usefulness of this special clothing for hunting and fishing in civilian life was stressed. The 2-flour period formerly allotted for the course was now reduced to 1 hour.

Acclimatization Program

    The Chief Surgeon, AFWESPAC, 30 June 1945, concurred in the proposal made earlier by the theater quartermaster to G-4 of the theater concerning the institution of an acclimatization program for all troops who were to move from tropical to cold climates in the forthcoming operations against Japan.11 In his concurrence, General Denit stated that a medical officer would be delegated to collaborate with the theater quartermaster in setting up the technical aspects of the program and to assist in the correlation of its technical and administrative control. It was suggested that the program be so phased that instruction would be given at the latest feasible time, which would not be before 15 July 1945.

    Shortly after this proposal was accepted, Maj. (later Lt. Col.) Paul Siple, QMC, an experienced climatologist who had been in the Antarctic with Admiral Byrd and who had made au extensive study of the clothing used in the European theater during the trenchfoot outbreaks the preceding winter (p.431). was temporarily assigned to the Office of the Chief Surgeon, AFPAC, as a representative of the Quartermaster General. His special mission was to devise plans for the proper, gradual acclimatization of troops who would suddenly be transferred from tropical to colder climates.12
           
    It was estimated that under these circumstances men would be considerably below peak efficiency for about 2 weeks, at least that period of time being required for the establishment of compensatory vasomotor controls. It was believed that the time could be shortened if training were instituted during the journey on the transports from southern bases to the target areas farther north. It was therefore recommended that during this journey, particularly
____________
11 Check Sheet, Chief Surgeon, AFWESPAC, to G-4, 30 June 1945, subject: Indoctrination Program, Wet-Cold.
12 Letter, Col. Charles P. Bellican, QMC, Quartermaster General Liaison Group, Headquarters, AFWESPAC, to Brig. Gen. Georges F. Doriot, Military Planing Division, Office of the Quartermaster General, 9 Aug. 1945.


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during the last 2 weeks, troops should be encouraged, as they entered cold waters, to expose themselves to the cold as much as possible, by remaining on deck for long periods with minimum clothing. It was expected that they would object to being uncomfortable, but it was considered more desirable to impress upon them the value of acclimatization while they could still get warmed up occasionally than to let them suffer the rigors of getting used to cold weather in the midst of combat.
           
  The acclimatization program came to an end with the end of the war, before the theories on which it was founded could be put to the test. One of the indirect results expected from it was the saving of tons of shipping space; it was estimated that men who had been acclimatized would require for efficient comfort at least one layer of clothing less than men who had not been trained to withstand cold weather.

INDOCTRINATION OF OTHER SERVICES

    In June 1945 representatives of the Office of the Surgeon General made contact with the Bureau of Medicine and Surgery, United States Navy, to inform the appropriate officers of the Army experience with trenchfoot in the European theater and of the plans for its prevention and control in the Pacific.13 Transmission of this information was considered essential, since the Navy had had little experience with the ground type of cold injury which would be encountered in the Pacific, where large numbers of Marines would be involved in forthcoming operations. Medical officers of the Navy were informed on all phases of the Army program, and the Army officers, in turn, were given a print of the Navy film in technicolor on cold injury. This film later proved useful in the indoctrination program in the Pacific.
           
    When demonstration classes were held on Oahu for Army officers, at the beginning of the indoctrination program, they were also attended by Marilee officers, who were much impressed with the potential dangers of winter warfare to Marines whose entire previous combat experience had been in tropical areas.14 These officers were also greatly concerned about the possible efficiency of their winter uniform, which was still an unknown quantity under wet-cold combat conditions. Marine equipment did not include such items as shoepacs, overshoes, trigger-finger mittens, water-repellent jackets with hoods, and sleeping bags. When the Army uniform and equipment were demonstrated to the Marine Corps Command on 22 May 1945, the comparison was so greatly in favor of the Army items that the Marine Corps immediately submitted requests for many of them. After a conference with the representatives of The Quarter-
____________
13 Memorandum for Record, Lt. Col. A. L. Ahnfeldt, MC, Director, Sanitation and hygiene Division, Preventive Medicine Service, Office of the Surgeon General, 30 June 1945, subject: Conference on Trenchfoot at Bureau of Medicine and Surgery, Navy.
14 See footnote 10 (1), p. 226.


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master General on 11 June,15 Navy officers also decided that Army clothing would be better for their land-based personnel than their own uniforms for their seagoing personnel.
           
    As soon as it was realized that wet-cold indoctrination was essential for all Marine personnel who would participate in future winter operations, the necessary directives were issued. On Okinawa, which was a combat area, direct instruction was given to Marine contingents by members of the army quartermaster team.16  Elsewhere, the general plan was to train Marine officers as instructors who would serve as instructors for other officers, who were then responsible for the indoctrination of their own units.

SUMMARY

    The most important conclusion to be derived from the story of the wet-cold program in the Pacific is that for the first time in World War II the problem of cold injury was attacked in advance of its occurrence, and was attacked by all the elements whose responsibility it was to be. Command, staff, Quartermaster Corps, and Medical Corps all participated in the endeavor to prevent it. It is true that coordination of the separate efforts had not yet been fully accomplished when the war ended, but the originally divergent lines of action were clearly beginning to converge. There seems no doubt that, had the fighting continued, the program as set up and implemented would have proved an effective means of preventing the cold injuries which had been responsible for such heavy losses in theaters of operations earlier in the war.
____________
15 Letter, Capt. William F. Pounder, QMC, to Brig. Gen. Georges F. Doriot, Military Planning Division, Office of the Quartermaster General, 11 June 1945.
16 (1) Letter, Capt. William F. Pounder, QMC, G-3 Section, Headquarters, Army Garrison Forces, Okinawa, to Brig. Gen. Georges F. Dorlot, Military Planning Division, Office of the Quartermaster General, 27 July 1945. (2) Letter, Captain Pounder, G-3 Section, Headquarters, Army Service Command I, to General Doriot, 12 Aug. 1945.