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HISTORY OF THE OFFICE OF MEDICAL HISTORY
WITH WINGATE'S CHINDITS
A Record of Heedless Valor
Major General W. J. Officer, C.B., C.B.E., Q.H.S., M.B.
In the blazing spring of 1943 the British fought the Japanese half a continent away from the headquarters hives on the dusty plain of Central India and many miles below the bulldozers cutting the Ledo Road to Shingbwiyang. In the Arakan, the eastern tail of India that flanks the Burma border, a disheartened army marked time ingloriously after futile efforts to sustain a limited offensive. But Brigadier Orde Wingate, prophet of unconventional warfare, had stealthily marched 3,000 infantrymen through the jungle, across the Chindwin River, and into enemy territory. His "Chindits" cut the railroad running north from Mandalay, blew up bridges, and harassed Japanese garrisons. In a last burst of daring they plunged eastward across the Irrawaddy. There the enemy nearly trapped them. Splitting into small parties, they struggled home, leaving nearly a thousand men behind.
The value of the Chindit expedition was difficult to estimate. The displays of courage and the capacity for jungle warfare were heartening at a time when morale was low in India. From a tactical standpoint, however, it did not much matter whether Japanese communications were temporarily disrupted, since no major campaign was in progress. Not until after the war did it become known that Wingate's sudden appearance in Burma led the Japanese to reassess their plans for defending their Southeast Asia conquests. They had believed that the Chindwin River protected their position in Burma. The Chindits demonstrated that this sense of security was ill-founded. The Japanese concluded that they could not be safe until they drove the British out of eastern India and captured the American airbases in Assam. In the summer of 1943, therefore, they began to assemble a force strong enough to assail the British Army on its own ground. One more jungle campaign, they hoped, and the possibility of Allied military action in the Far East would be forever ended.
Wingate's exploits soon attracted widespread attention. Disgusted with the sluggishness of the army in India, Churchill and others applauded the Chindits' aggressive spirit. The Prime Minister invited Wingate to visit him in London, and he took him on to the Quadrant Conference in Quebec in August 1943. There Wingate outlined his plans for a second, more ambitious campaign in 1944. To the dismay of GHQ in India, he returned triumphantly with the authority to
organize a Special Force of six brigades and to reinvade Burma as soon as possible in 1944.1
By late autumn 1943, all the Allied forces in the Far East were preparing for action--the new South East Asia Command of Lord Louis Mountbatten, Stilwell's Chinese Army in India, and the Generalissimo's American-supported "Y-Force" on Burma's eastern border. Lt. Gen. Sir William Slim, commanding SEAC's chief weapon, the Fourteenth Army, concentrated upon retraining his troops and restoring their confidence. Although suspecting the forthcoming Japanese attack, he himself planned a major offensive. Stilwell had the approval of Mountbatten and Chiang to attack the enemy in North Burma and reopen land communications with China. He had retrained and reequipped the Chinese 22d and 38th Divisions, veterans of the First Burma Campaign. They were the nucleus of the Chinese Army in India. Chiang had promised to add at least two more divisions to Stilwell's command, and, at Quebec, the Combined Chiefs of Staff issued orders to send him an American infantry regiment. Only Generalissimo Chiang was a doubtful starter. He was disappointed that more grandiose plans had not been adopted, and he was loath to risk his Y-Force in North Burma unless the enemy was heavily engaged in the south by a full-scale amphibious assault on Rangoon.
February 1944: The monsoon rains had abated, the roads and trails were drying, and the rivers had subsided. Stilwell's Chinese divisions and American infantry regiment began the descent of the Hukawng Valley below Shingbwiyang, straining to dislodge the crack Japanese 18th Division. Then suddenly, far to their south and west in the Arakan, the Japanese broke out of the jungle. Fast-moving columns drove in the forward units of the Fourteenth Army. But behind them, one of Wingate's brigades was marching down from Ledo, Assam. Four others were poised for flight into North Central Burma.
March 1944: The Chinese Army was at the base of the Hukawng Valley, ready to attack across the heights which separated it from the broader Mogaung Plain. The Fourteenth Army, having blocked the Japanese assault in the Arakan, was under massive attack on the Imphal Plain to the north and appeared to be in perilous straits. Yet it was doggedly holding on to key positions. As Slim maneuvered his reserves into position without utterly committing them, he became confident that he could repel the attack on India and shift to a counteroffensive in Burma by midsummer. The Chindits, soon to be bereft of their commander, were establishing strongholds in the jungle, from which their columns could emerge to molest either the Japanese who
1See Kirby, II, pp. 243-244, 309-329; III, pp. 5-6, 8-10, 37-38; Slim, pp. 162-163, 216-220; Sykes, pp. 371-374, 412-448; Mosley, pp. 187-213; Romanus and Sunderland, I, pp. 357-367, and passim. In U.S., Department of the Army, Burma Operations Record, 15th Army Operations, pp. 7-10, the Japanese assess the effects of Wingate's campaign in 1943. The works of Rolo and of Fergusson: Chindwin, are entirely devoted to the first Chindit expedition.
opposed Stilwell in the north or those who attacked Slim in the west. The Second Burma Campaign had commenced.2
To steal into enemy territory unencumbered by a long supply train, to skirmish without the burden of heavy weapons, to hit and run--these were the tactics on which the life of the Chindits depended in 1943. At first Wingate's superiors supposed that the new Special Force, although several times larger than the original Chindits, would be equally mobile. To their dismay, however, Wingate soon began to talk of establishing part of his Force in fixed "strongholds" deep in enemy territory. From these hornets' nests he proposed to send out his raiding or "floater" columns. If the enemy attacked the strongholds, he would swiftly draw in his columns to fall upon his assailants' rear. In his most prophetic moods he claimed that the strongholds could become great fortified bases to which the Fourteenth Army could be flown and from which it could issue to reconquer Southeast Asia.
Now seen in terms of strongholds and now in terms of guerilla-Iike columns, the image of Special Force became blurred. Whether its tactics would emphasize dispersal or concentration only Wingate himself could have said. Whether its strength would suffice to operate in both ways was very uncertain. His superiors finally warned him to avoid excessive commitment to the stronghold plan, anticipating that it might lead to unsupportable demands for reinforcement. But scorning their skepticism, Wingate determined to let success speak for itself. In 1943, his superiors had doubted the possibility of long range penetration. The result? In 1944 he had been rewarded by receiving a much stronger force with which to repeat his adventure. He was now confident that the campaign of 1944 would likewise confound his critics, and that his victories would win acclaim for the stronghold plan.
During the winter of 1943-44, Special Force organized under the cover designation of 3d Indian Division. Two brigades were formed especially for the Force, the 77th and the 111th. They contained some survivors of the first Chindit expedition. Three more brigades--the 14th, 16th, and 23rd--were produced by dismantling the 70th Division, veteran of the Middle East campaign. The 3d West African Brigade was brought in to complete the force. In all, the strength of Wingate's command approximated 20,000 troops. Some were destined to garrison the strongholds. The rest were assigned to mobile columns--two colums per brigade, four battalions per column. Except for one brigade, which was to enter Burma on foot, Special Force was to fly to its battle stations. Moreover, Wingate secured the assurance that aircraft would carry in his supplies and evacuate his casualties.
The principal mission of Special Force was to assist Stilwell's Northern Combat Area Command. This it was to do by interfering with the line of communications running north from Mandalay to the 18th
2Op. cit. Burma Operations Record presents the war on the Central Front from the Japanese standpoint. Also, South East Asia, op. cit., pp. 1-51; U.S. Department of the Army, Burma Operations Record, 33rd Army Operations, pp. 1-4.
Japanese Division, facing Stilwell's Chinese Army in India in North Burma. It was to begin its campaign in the vicinity of Indaw. There it could cut the railroad leading up to the Kamaing-Mogaung-Myitkyina triangle, the advanced base of the enemy troops in the north. Or it could demonstrate in a westerly direction, behind the Japanese forces attempting to invade India.
The 16th Brigade opened the campaign. Leaving Ledo, India, in early February, it marched down trail toward Indaw. Its purpose was to assure the security of Stilwell's right flank while his Chinese Army in India fought in the Hukawng Valley. Nearly 500 miles from its starting point, 16th Brigade formed a stronghold, Aberdeen. Wingate ordered it to attack Indaw immediately. Several days of arduous maneuvering and sustained fire fights proved futile. The l6th withdrew toward its stronghold, in which it tried vainly to rest portions of its columns, turn and turn about, while patrolling and skirmishing along the road leading north. Late in April it was obviously exhausted. The 16th assembled at Aberdeen and was flown back to India.
Meanwhile, Chindit columns and strongholds invested other sectors of the Railroad Corridor leading to Mogaung through Indaw. The 77th and 111th Brigades flew in early in March. After a bad first night, when wrecked gliders and scattered equipment obstructed the landing ground, the fly-in proceeded rapidly. Near Mawlu, shortly after the fly-in, the 77th Brigade attacked a Japanese garrison and established a stronghold, White City. For several weeks it menaced Japanese roads while under increasingly severe attack.
The 111th Brigade flew to two sites widely separated by jungle and hilly terrain. Part of the brigade, known as Morris Force, worked its way northward on the more easterly trails and roads of the area. The main body closed slowly on the strongholds established by the 16th and 77th Brigades. Its principal action in the campaign began early in May when it put down a roadblock below Mogaung. It fought tenaciously to maintain its stronghold, Blackpool, while waiting for the 77th Brigade to disengage itself from White City and march northward to ambush the Japanese attacking the 111th. But monsoon rains greatly hampered the air supply program. The enemy's strength increased rapidly. The "floater columns" of the 77th could not close in fast enough. Under very heavy attack near the end of May, the 111th finally abandoned Blackpool and struggled back into the jungle.
By this time, the 14th and 3d West African Brigades were also in Burma, having been flown in during April. Both were used partly to man the strongholds and partly to supplement the efforts which the 77th and 111th Brigades were making to isolate the Japanese defenders of Mogaung. Fourteenth Army retained the 23d Brigade with the 33d Corps. In April it went into the jungle to interrupt enemy lines of communication on the Central Front, but it never did serve as part of Special Force, itself,
In June the battle for North Burma reached a climax in the Kamaing-Mogaung-Myitkyina triangle. While the Chinese pressed toward their objectives from the north, Stilwell ordered the Chindits to pinch the enemy from the south. The eastern section of the 111th Brigade moved toward Myitkyina. The 77th Brigade attacked Mogaung. The western columns of the 111th marched north from the shattered stronghold of Blackpool and fought for positions which threatened Kamaing. The 14th Brigade was ordered to block the route which the Japanese would use if they tried to retreat.
Throughout June, Special Force maneuvered and attacked under unfavorable circumstances. The enemy possessed well-prepared positions and well-established ground communications, while the Chindits were deprived of the advantages of surprise and mobility. As the battle for the Kamaing-Mogaung-Myitkyina triangle became unexpectedly protracted, the strength of Special Force dwindled rapidly. It held to its task, however, despite criticism and complaints of its apparent inadequacy. Only when the vital area had been secured and the fresh troops of the British 36th Division arrived was it allowed to leave the battleground.3
The value attached to the exploits of Special Force varies with the viewpoint of the commentator.4 All have agreed that its mission
3Op. cit. Three of the brigade commanders
have written about the campaign. Bernard Fergusson's The Wild Green
Earth (1946) concerns the 16th Brigade. Michael Calvert, in
Prisoners of Hope (1952), accounts for the exploits of the 77th
Brigade. John Masters, who commanded the columns of the 111th Brigade which
fought at Blackpool and Kamaing, describes his part in the Second Burma
Campaign in his autobiographical The Road Past Mandalay (1961).
In the Stilwell Papers, Hoover Institution on War, Revolution, and Peace,
Folder 4 contains the Fourteenth Army Operation Instructions Nos. 60 and
61, 4 and 10 Apr. 1944, wherein the LRP mission is set forth. Its first
responsibility is to support Stilwell's advance on Mogaung and Myitkyina.
Second, it is to assist the Fourteenth Army by disrupting enemy communications
east of the Chindwin River. General Slim's letter of 12 April designates
Indaw as the most southerly point for LRP operations. The Chindits are
to concentrate upon the LOC leading toward the enemy positions which Stilwell
is approaching. The 3d Indian Division "Precis of Op. Instructions
No. 8 dated 28 April" (1944), also in Folder 4 of the Stilwell Papers,
sets forth the plan to place the brigades south of the Kamaing-Mogaung-Myitkyina
was extraordinarily hazardous and arduous. The Japanese testified, after the war, that it was a serious annoyance. The consternation caused by the sudden appearance of airborne troops in Burma led some commanders to propose a postponement of the invasion of India. Some troops in the strategic reserve were diverted to attack the Chindit landing grounds and strongholds. Other troops were delayed in their movement to administrative and transportation posts behind the Central Front.
Most particularly, the defense of North Burma became more difficult. With Special Force behind them, the Japanese facing Stilwell could not fall back indefinitely. Consequently, when they were forced to retreat from the Mogaung-Myitkyina line, they had to sacrifice the garrison at Myitkyina, disengage rapidly, and regroup along a line further to the south than they originally had chosen.
British and American evaluations are less generous and more qualified. Neither Slim nor Stilwell felt that Special Force interfered decisively with enemy communications, nor did they believe that its strongholds and "floater" columns were heavily enough armed to engage really significant numbers of the enemy. During the first 2 months, Special Force was too far south to help the Chinese directly and too far east to influence events on the Central Front significantly. In June and July, the discouragement of its officers and the debility of its troops brought it little--probably too little--credit for its contributions to the campaign.
Several explanations have been offered for the questionable features of Special Force. First, on 24 March, before the Force was well established, General Wingate, its originator, died in an airplane accident. Wingate's successor, Maj. Gen. W. D. A. Lentaigne, the former commander of the 111th Brigade, followed Wingate's plans for tactical operations as far as they had been divulged to him. But possibly, to be most successful, Special Force needed the special zeal and inspiration of its first prophet. Certainly, no one except Wingate might have proposed independent ideas for the deployment of Special Force, over against the plans of Slim and Stilwell.
A second factor in the situation was the prolonged period required to place Special Force in position. The time-consuming and exhausting march of the l6th Brigade almost certainly produced the failure of the attack on Indaw. During April, Fourteenth Army held back the 14th and 3d West African Brigades because all available cargo planes were being used on the Central Front. Consequently, when the 77th and 111th Brigades needed help in May, the 14th and 3d W.A. Brigades were just moving into position.
The third cause of the limited effectiveness of Special Force has been said to be its physical destruction by enemy action, fatigue, and disease during the campaign. Its own commanders repeatedly made this point when they sought to convince Stilwell, Slim, and Mountbatten that the Chindits should be relieved. Subsequently, those who feel that Special Force has been unfairly judged as a fighting unit speak of its physical incapacity for the tasks assigned to it in the battle for Mogaung.
The truth of the point appears obvious. Sixteenth Brigade was exhausted when it left Burma in April. When the 77th Brigade was evacuated in mid-July, most of its troops were headed for the hospital, and its few remaining effective men were, in fact, in very poor condition. An assessment of the strength of the 14th, 111th, and 3d West African Brigades late in July showed that only 3,400 officers and men remained from the fly-in and replacement strength of 11,200 troops. Thirteen hundred men of the three brigades had been killed, wounded, captured, or were missing. Nearly 7,500 were sick and either had been or were scheduled for evacuation. In these brigades, too, the men still listed as fit were disheartened, exhausted, and about as ill as those under medical surveillance.5
Despite the emphasis upon the physical deterioration of Special Force, published accounts of its operations have not given more than perfunctory attention to its medical history.6 How did the medical catastrophe come about? How adequate was its medical service? Did the troops sufficiently recognize the peril of a tropical environment? Is there a medical reason why the Force seemed to be more effective in its early hit-and-run maneuvers than when it fought in prepared or in relatively stationary positions later on? Finally, was the last and sorriest stage of Chindit operations the unavoidable medical consequence of military operations in the jungles and swamps of Burma?
5Statistics among the available documents rarely
check exactly with one another. The medical situation is discussed below,
but the summary here is drawn from the "Orders," 3d Indian Division
Headquarters, 19 July 1944, which appends a status report on the brigades,
Folder 4, Stilwell Papers.
Medical Report of the Work of Special Force 1943-44 sheds so much light on these matters that its specific contents require little more than prefatory assistance. Its opening section criticizes the initial plans for medical support of Special Force and the spirit in which those plans were conceived. The author's position--for reasons which become apparent in the Report--leads to brevity, if not circumspection, in the discussion of the original medical plan. A brief review of its background is appropriate here, therefore.
When General Slim took command of the Fourteenth Army in 1943, he recognized that its health and morale were unsatisfactory. He directed that steps be taken (1) to employ the latest results of medical research and practice in treating sick and wounded, and to obtain adequate supplies of recently-developed therapeutic drugs; (2) to move close to the troops the treatment facilities needed to care for malaria patients; (3) to provide air evacuation facilities for seriously ill or injured men; and (4) to take a variety of measures to improve morale and thereby reduce the malingering and insanitary practices which augmented the already high sick rates. Thus:
Air evacuation, in the long run, probably made the greatest difference of all to the wounded and sick * * * but it should be remembered that where the surgeon saved the individual life, the physician, less dramatically, saved hundreds by his preventive measures * * * Good doctors are no use without good discipline. More than half the battle against disease is fought, not by the doctors, but by the regimental officers.
To emphasize the importance of the daily intake of the malaria-suppressant, mepacrine (called Atabrine in the American army), Slim "had surprise checks of whole units, every man being examined. If the overall result (of the blood tests) was less than 95 percent positive I sacked the commanding officer. I had to sack only three; by then the rest had got my meaning."7
General Wingate's attitudes toward health and toward Army medical services were parts of his eccentric and militant personality. As for himself, he took pride in his hardihood. His passionate hatred for flies was as much a form of fastidiousness as it was a salutary contribution to camp sanitation. Although fully aware that all food and water in the tropics are presumed to be contaminated, he suffered a nearly fatal case of typhoid fever after impetuously downing the water in a vase of flowers in his hotel room in India.
Troops sent to him for his first long range penetration force were exactly the kind to arouse his prejudices. They were disgruntled, overage, and beset by various chronic disabilities. The weeding-out process began as soon as they assembled for their training--first, by their own pellmell flight to the medical stations. He wrote:
7Slim, pp. 173-180.
Hypochondria is the prevailing malady of the Englishman and of civilised nations. From earliest youth all are taught to be doctor-minded. National Health Insurance, necessary and beneficial in many ways, plays its part in inducing this disease complex. While a native of India or Africa will not, unless encouraged to do so by a European, even bother to mention a temperature of 103° F., an Englishman will throw himself out of work on account of the slightest deviation from normal. Even common colds are regarded as serious excuses for idleness. To this kind of self-indulgence there is no end * * * The first thing that had to be done when training the Long Range Penetration Groups was to root out the prevailing hypochondria. For this the co-operation of the medical profession was necessary. Although one would suppose my theory to be contrary to their interest, I must admit to having had the full, although sometimes misgiving, co-operation of medical officers.
Wingate's medical theories fitted his tactical practices. To guard the secrecy of his whereabouts on the march, he forbade the establishment of open lines of communication. Thus he had no means for evacuating sick and wounded men. The idea of devising an air evacuation system seems not to have been suggested. Instead, Wingate taught his troops that "sickness meant capture or death. He [the soldier] therefore did not only not go sick, he did not even fall sick." He also reported:
I am at last getting Platoon Commanders to be their Platoon Physicians for minor ailments and treatment. I never allowed this to interrupt our marches or operations. Gordon said, "A man is either his own physician or a fool at thirty." On this standard a great part of our nation must be classified as fools. I do not sit and take that as an unalterable fact, but set out to alter it, and I hope to succeed in doing so.
Wingate's first campaign did nothing to amend his principles, but it did convince him that his zeal for medical self-sufficiency had been excessive. The officers and men had found almost unbearable the necessity to abandon their sick and wounded. A sound evacuation plan, therefore, was considered an absolute prerequisite for the second campaign. Wingate, no less than others, saw that light planes or cargo aircraft would be Heaven-sent solutions to the problem of retaining mobility for the Force while adequately providing for the evacuation of severely sick and wounded men. Not only would marching columns periodically be relieved of the unfit, but the strongholds could serve as temporary evacuation points without becoming choked by casualties. The less seriously sick and injured, however, were to remain in the Force and recuperate on the march.8
8On Wingate's plans and attitudes, see Sykes, pp. 371-374, 415, 431, 469, 476-486; Rolo, pp. 156-160, 174-176, 188-189; Mosley, pp. 188-189, 201, 312; and Crew, V, pp. 133-136. Crew rejects the extreme position Wingate took, but he concludes that the campaign was so severe as to overwhelm any other medical policy that was likely to have been adopted.
Wingate's parsimony and prejudice on medical matters unquestionably affected his decisions about the organization and training of Special Force. After his death in March, however, the attitude of his subordinates became crucial. Such evidence as is available suggests that they were about at the average for line officers in their regard for medical services and in their cordiality to medical personnel: ready to accept available aids to the health and security of their men, but equally unwilling to allow their command to be coddled. Typically, their admiration of their own medical assistants was balanced by indifference to or resentment of medical advice from the rear. The three brigade commanders who have published their memoirs were realistic--although not especially optimistic--in accepting the traditional responsibility of a commander for the health of his men, second to, but not unrelated to, their fighting power.
Brigadier Bernard Fergusson has reported the regular administration of Atabrine (or mepacrine) to his troops in 16th Brigade. He claims that Atabrine was less effective than it was expected to be, even when faithfully taken. But he also confesses that:
In one respect we had the wrong attitude to malaria: we looked on it as inevitable; we believed that we were all bound to get it every so often. Good work and propaganda by commanders, doctors, officers and men elsewhere has shown that this is by no means true * * * But in one respect we had the right attitude, in that we never treated malaria as a disease meriting evacuation.
Exceptions to the rule were made for men with cerebral malaria or for those who had had numerous debilitating recurrences of the disease. Fergusson acknowledged the principle that: "Health in the jungle is not only the business of the doctor or the commander; it is the job of every officer and of every individual."9
Brigadier Michael Calvert, 77th Brigade Commander, has spoken especially to the point of Wingate's attitudes:
Those who accused him of not paying attention to the medical side, may be surprised to learn that we were the first brigade to have mepacrine in Burma, and that very many medical ideas which later were used throughout the Army were first tried out on Wingate's brigade and in some cases started by him. I do not suppose at that time any commander in Burma * * * took more trouble and interest in the medical health and hygiene of his troops.
He comments, from time to time, on the medical situation of his brigade in the second campaign. Like other commanders, his remarks give reason to suspect that disease and emaciation might be doing more than the enemy to destroy Special Force.10
9Fergusson, Chindwin, pp. 221, 239-240;
Earth, pp. 197-199.
Brig. Maj. John Masters, who commanded part of the 111th Brigade, has testified to the importance of air evacuation, and to the serious consequences arising from lax Atabrine discipline. He was aware that some malaria "breakthroughs" resulted from deliberate failure of men to take Atabrine regularly. However, he and his medical officers were convinced that these lapses in morale were rare. In their opinion, the rapid rise of sickness in the summer of 1944 resulted from the debility which had accumulated during an excessively long campaign.11
The attitude of junior officers and of the men can only be surmised on the basis of common observation. Typically, it involved acute apprehension about the effects of a tropical environment and (apparently by derivation) the medical measures taken to combat it. The myth that Atabrine produced sexual impotence or sterility was rampant among all Allied forces, for example. Yet conversely, the enormous labor required to reduce the hazards of contaminated water, insect bites, and fungus infections of the skin--indeed, the impossibility of preventing them entirely during a long campaign--produced laxity bordering upon hostility toward medical discipline.
The belief that Asiatics endured disease and physical distress more easily than Caucasians also was widespread, although the high mortality and morbidity of the native populations provided visible contrary evidence. Such leaders as Wingate and Slim insisted that Western troops could fit themselves for tropical campaigns, but the troops commonly felt that their enemies suffered less than they did from tropical perils. The sense of inevitability which accompanied such a prejudice produced, of course, a self-fulfilling proposition.
From this background, as well as from the objective realities of a severe campaign, the medical history of Special Force derived many of its peculiarities. The description of that history in Medical Report of the Work of Special Force is urgent and intelligent. It conveys the special anxiety of a participant who observes the intersection of a highly sophisticated science and art with a completely primitive situation and environment. When it was written, the author had every reason to suppose that the experience of 1944 would be used as a lesson for 1945 and 1946. That the turn of events proved otherwise does not
11Masters, pp. 133, 137, 237, 262-276. Crew, V, pp. 216-232, quotes at length the official medical report of Major Desmond Whyte, RAMC, the senior Medical Officer of 111th Brigade. It presents, of course, a responsible perspective on malaria control. Whyte's report may be profitably compared with that of General Officer; the two reinforce each other, although the latter is far more informative and judgmental. The quality and impact of Crew's history is much enhanced by his extensive use of quotations from participants.
reduce the importance of his report. For it shows how the technical resources and valor of Special Force were needlessly wasted by ignorance, indifference, and intransigent prehistoric attitudes toward hygiene, sanitation, and medical discipline.
MEDICAL REPORT OF THE WORK OF SPECIAL FORCE, 1943-44
The following is a Report covering the Medical Aspects of the Force from its inception to the conclusion of its operations in Burma in 1944 and it covers the whole field of Training, Organization, and Battle Experience.
Such a report must, of necessity, be frank and outspoken and opinions must be given frankly and fearlessly if it is to achieve the object for which it is written, namely to benefit future similar undertakings and to avoid the repetition of the mistakes and omissions which are bound to occur in new and original undertakings.
Many of the assertions may be considered unduly dogmatic and merely my personal opinion and for that reason many of the statements may not meet with universal approval. At the same time it must be realized that they are based upon a not inconsiderable experience of warfare in this theatre and on my own personal observation during the period of operations under review. For this reason it is considered that they should be given due consideration and weight and not discarded lightly on the grounds that they are so personal.
The report is divided into three phases, each covering a distinct period of the life of the Force and ending with the conclusions drawn and the recommendations made for the future.
The medical establishment of Special Force was underranked and undermanned. It consisted of (1) a Deputy Director of Medical Services and the Headquarters medical section of three officers and four other ranks; (2) the brigade medical units, each composed of two medical officers, a warrant officer, and 20 other ranks; and (3) the column medical units. Wingate intervened to prevent the senior medical officer from attaining a rank commensurate with his position as D.D.M.S. Wingate also reduced the size of the column medical detach-
ments below the level which the medical administration believed would be adequate.12
The D.D.M.S.13 put forward that each Column should have one Medical Officer and eleven other ranks R.A.M.C. (or I.A.M.C. for Indian columns).14 This was turned down by General Wingate, his reason being that it would increase the size of the columns too much, and make them unwieldy, and he suggested that one Medical Officer and two other ranks would be sufficient; as all ranks in the column should be capable of looking after themselves, and only require medical assistance in the more severe type of case.15
General Wingate suggested that use could be made of the Column Padre as a Medical Orderly but this was not agreed to by the D.D.M.S. However, after more discussion, it was finally decided by the General that the Column establishment would be one Medical Officer, one Sergeant and two other ranks R.A.M.C. on the columns with Padres, and one Medical Officer, one Sergeant and three other ranks R.A.M.C. on columns without Padres. On Indian columns the establishment was fixed at one Medical Officer, one Sergeant R.A.M.C. and three Indian other ranks, I.A.M.C.
Although this establishment was finally passed by G.H.Q. (I)16 it was never agreed to by the D.D.M.S., and as anticipated, it proved itself quite inadequate in that the Medical Officer was severely handicapped when a Medical Orderly was required for an isolated group, e.g., the Recce Platoon17 or Commando Platoon; and further if a group was isolated for any length of time from the Main Column, the responsibility for any casualties, etc., rested with the officer in charge. An attempt was therefore made to give instructions to the officers in First Aid with a view to making Columns self-sufficient and avoiding this; but with the limited time available and the lack of interest in anything Medical by combatants, only a sketchy course was covered.
During the Training period each brigade operated independently, concentrating on column exercises. The medical personnel were attached to the columns, and apart from their work with them no collective medical training was done in the Force.
12General Officer begins by describing the
composition of Special Force and its medical establishment. His comments
thereon are here summarized.
Brigade Medical Units lived in the Brigade Area but took no part in the general training. They proved, however, too small to deal with all the sick in the brigade, and became merely a collecting post to which the Column Medical Officers sent the sick. These were then evacuated to the hospitals in the Jhansi Area.18
Although on the establishment of the unit six ambulance cars were authorized, these could not be obtained and three-ton lorries fitted with Berridge equipment were issued in lieu, and these in their turn were later replaced by 15-cwt. trucks fitted to carry four patients. As brigades were widely separated from each other and as there was no central point at which casualties could be collected and evacuated to hospital, the Medical Units had to function independently. This meant that units had to evacuate in most cases over a distance of 100 miles, and with the limited transport available this was most difficult.
When the brigade moved out for an exercise away from its permanent area, the medical unit had to send a detachment with it, and from the limited numbers of officers and men available it was only possible in most cases to send one truck and a few R.A.M.C. orderlies.
It is considered that the evacuation should have been carried out by the areas and subareas concerned.19
Supplying Medical Stores to Columns
The O.C.20 Brigade Medical Unit indented in bulk from the Medical Store, Jhansi, and issued to the columns as required. For the collection and distribution of the stores the ambulance trucks were used as no other vehicles were available.21
18In northeastern India. The author here calls
attention in the text to a map enclosed with the report
On completion of training, the brigades moved to their Concentration Areas. 16 Brigade [went] to Ledo Area, 77 Brigade to Lalaghat, and 111 Brigade to Imphal Plain, leaving only the Brigade Depot Staffs in their Training Area. Brigade Medical Units followed their brigades and opened in the Rear Brigade Headquarters Area. Once the brigade moved into Burma, the main function of the brigade medical units was to supply their respective brigades with medical stores and equipment and take over medical charge of the personnel of Rear Brigade Headquarters.22
Meanwhile the D.D.M.S. recommended the following Administrative Lay--out of his staff on the move of the Force to the Operational Area: At Gwalior, D.A.D.M.S., D.A.D.H.; at Sylhot, A.D.M.S.23 The D.D.M.S. and the D.A.D.H., while being mainly at No. 1 Air Base, Sylhot, would be free to move into any area he considered necessary.
This, however, was not agreed to by Force Headquarters and instead it was laid down that as the brigades moved forward into the operational area the Medical Headquarters Staff would be: (a) At Gwalior, D.D.M.S., D.A.D.M.S., D.A.D.H., D.A.D.M.24 and the whole of the Clerical Staff, (b) at Sylhot, the headquarters of 3d Indian Division,25 A.D.M.S. How the D.D.M.S. was ever expected to direct the Medical Services of the Force or to advise his Commander on matters of medical importance so far in the rear of Main Headquarters, is beyond comprehension. Yet at the same time the D.D.M.S. Colonel [W. E.] Campbell has received all the blame for the nonworking and the maladministration of the Medical Services. When, as will be seen later, the D.D.M.S. was not even allowed to visit the Operational Area or to contact his new A.D.M.S. on the latter's arrival at Sylhot, it can be understood in what a difficult position the D.D.M.S. found himself.
Prior to the Brigades' moving to the Operational Area, the D.D.M.S. decided to visit the D.D.M.S. Fourteenth Army, put him into the picture as to the role of the Force, and prepare a plan with him for the hospitalization of the casualties on their evacuation.
Permission to do this was denied him on the ground that the A.D.M.S. had already visited D.D.M.S. Fourteenth Army and had made all necessary arrangements. It was only after the troops had moved to the forward area that the D.D.M.S. was allowed to pay them a visit. When in the area he suggested that his office should no longer be at Gwalior but should move up to No. 1 Air Base at Sylhot where Main Force Headquarters was now situated.
22In a brief passage here omitted, the author
reports the appointment of base depot medical officers. These arrangements
were made by higher administrative headquarters and did not involve Special
This suggestion was not approved and the D.D.M.S. had reluctantly to return to Gwalior.
Shortly after this Lt.-Col. [John L. Mewton], I.M.S.26 was appointed A.D.M.S. of the Operational Area with the title of A.D.M.S. 3d Indian Division and reported at Sylhot after visiting the D.D.M.S. Fourteenth Army. It was natural at this stage, and in effect essential, that the newly appointed A.D.M.S. should contact his D.D.M.S. and get some indication from him as to what his duties in a Force of this nature were likely to be and be put in the picture generally as regards the tactical situation. This, however, he was not allowed to do, nor was the D.D.M.S. allowed to come forward from Gwalior to contact him. The signal received at Gwalior in answer to the D.D.M.S. signal stating his intention of proceeding to No. 1 Air Base was "D.D.M.S. not required at No. 1 Air Base."
Thus with the exception of two brief visits to the forward area the D.D.M.S. remained at Gwalior until he left Special Force on repatriation to the United Kingdom.
From this it can be seen that the Medical Branch of the Force was not only not receiving every assistance to carry out what at the best of times could only be an extremely difficult administrative task but was meeting with active opposition. The D.D.M.S. had not been allowed to administer his command and the newly appointed A.D.M.S. had not the slightest idea of what his duties involved. Medical Units and the personnel were thus left without any leader, without any clear-cut Medical plan and they embarked on a hazardous undertaking with a feeling of insecurity and bewilderment.
After his interview with the D.D.M.S. Fourteenth Army the A.D.M.S. 3d Indian Division reported his arrival to his D.A. QMG27 (Brigadier [Neville] Marks) in Sylhot. He requested permission to proceed to Gwalior to meet the D.D.M.S. but was told that, while it might be desirable for him to see his D.D.M.S., there was first a more urgent task for him to do in the forward area. He was to visit the two brigades which were likely to go into Burma in the near future as General Wingate had reported that they were all suffering from a mild degree of Avitaminosis. He was directed to go to Imphal that afternoon and see 111 Brigade. When this inspection had been completed he was to return to Lalaghat and examine 77 Brigade. He would then report to Administrative Headquarters in Sylhot and after taking all necessary action he could report to Gwalior.
On his arrival at Imphal the A.D.M.S. reported to General Wingate and told him the purpose of his visit. General Wingate assured the A.D.M.S. that from his experience he personally had a much greater knowledge of Avitaminosis than any doctor but that he, the A.D.M.S., was to carry out his orders and report to him his findings.
The A.D.M.S. visited 111 Brigade in its camp 31 miles down the Tiddim road. All Medical Officers agreed that while the health of the men was of a very high order they had, some six weeks ago, "gone off their feed" as the
26In the typescript, the first and middle names
are omitted and the initial letter of the last name is illegible.
diet had then been of a very poor quality and very monotonous, but that since the visit of the D.D.M.S. a few days ago the diet was now above reproach and nothing more was needed or wanted. 77 Brigade was then visited in Lalaghat and all Medical Officers told a strikingly similar story. Brigadier Michael Calvert told the A.D.M.S. that in his opinion the diet was perfectly good and that the complaints were inversely proportional to the efficiency of the unit's internal administration. The Kings Regiment, whose internal administration was good, made no complaints while another regiment, which was not so well administered, was full of complaints. This the A.D.M.S. found to be so. While the Kings said that they had more food than they could eat the other regiment complained bitterly of the insufficiency and the poor quality of the ration. The ration in both cases was the same and it was pointed out to the latter where the trouble lay and by what means it could be remedied.28
On completion of these inspections the A.D.M.S. returned to Imphal where he made his report to General Wingate. He was then told that as no arrangement had yet been made for the reception of casualties on their evacuation from Burma, when operations began he was to return to Sylhot and make, in conjunction with the D.D.M.S. Fourteenth Army, whatever arrangements he considered necessary.
A few days later, during the course of a visit to 77 Brigade, the A.D.M.S. was horrified to note from the Senior Medical Officer29 that the "Fly-In" into Burma was due to begin the following evening. This was the first information he, the A.D.M.S., had received on the subject and up to this time no arrangements had been made for the hospitalization of the casualties occurring either during the landings or during the operations.30
A plan had, therefore, to be made immediately to deal with the situation.
It was at this time--10 April 1944--that I took over the appointment of D.D.M.S. Special Force and reported my arrival to the D.D.M.S. of Fourteenth Army and to Major General W. D. A. Lentaigne, the Force Commander31 who was then visiting Headquarters, Fourteenth Army.
28Brigadier Michael Calvert subsequently recalled
that rations were adequate, though monotonous. John Masters, then the Brigade
Major of the 111th Brigade, later stated that the diet during training
included shark liver oil. See Calvert, p. 193; Masters, p. 133. However,
a later report refers to severe avitaminosis among troops seen at Imphal
in September 1943. While the troops are not identified, the reference almost
certainly is to the incident described in General Officer's Report. In
four battalions, from 15 to 50 percent of the troops showed signs of vitamin
deficiency. See O'Dwyer, p. 115.
It soon became apparent from the information which I had received from Fourteenth Army and from my A.D.M.S. that the task before me was to be by no means an easy one. It was common knowledge that the Force in general and the late commander in particular were not Medically-minded to say the least of it, and from the story given by the A.D.M.S. it was quite evident that my predecessor had been given no active support and had instead apparently received only active opposition. With an officer of his seniority and experience, it is quite impossible to believe that the D.D.M.S. had not done everything in his power to put the Medical Services of the Force on as sound a basis as possible. I am confident that any faults or deficiencies which were to come to light were through no lack of effort on his part.
On my arrival at Force H.Q. at No. 1 Air Base D.A.Q.M.G. informed me that although it was probable that I had been told that the Force was antimedical, this was far from being the case and that the best Medical Service possible was their one desire. I was assured that it was through no fault of theirs that the existing Medical Setup was below normal standards, and that the fault lay entirely with my predecessor. I was assured that I would be given every possible support to this end, and I may say at this stage that this has proved to be the case.32
Taking over a "Going Concern" in the middle of an operation was of course a difficult problem, and without seriously interfering with, and interrupting the course of operations, the institution of any radical change was impossible. It was quite evident that any established Medical Organization was completely lacking; and while the policy had evidently been for the Force to be so "special" that it should be entirely self-contained and independent of all outside help, the Medical Organization presumably based on this policy was completely insufficient to cope with even the merest of operational necessities.
In order to get some clear picture of what the organization lacked and what, from the nature of its task, it required, an Appreciation was made, setting out all the factors and a suggested solution for the future.
After a rapid visit to the troops in "Aberdeen" and "White City"33 as well as to the Gwalior and to the Jhansi Area, in order to get a complete picture of the general layout, the work of attempting to direct a nonexistent Medical Service was commenced. At times it often appeared that all that was required was a Medical Officer of sufficient experience and seniority to act as a Medical Adviser to the G.O.C.;34 at others, that the task was so large and so fraught with difficulties which at times appeared insurmountable, as to need a D.M S.35 with the staff of an Army. When it is realized that at one time the Force was spread from Bangalore in the South to Dehra Dun in the North of India, and through the Headquarters situated at Gwalior,
32See pp. 208-211, for discussion and evaluation
of the attitudes attributed to Wingate and others in the Force.
Sylhot, Dinjan, and Shaduzup to the troops operating in Central and North Burma, it can be appreciated how true this was. Each in turn held their own importance and while medical representation was necessary at each this could not always be provided. As it was, this multiplicity of Headquarters involved such a subdivision of the Medical Staff that it seriously reduced the efficient running of this branch and made communications all the more difficult.
The general plan of operations was that brigades were to invade Burma by crossing the Chindwin River at selected points, at staggered intervals. The operations were to begin with 16 Brigade advancing via Ledo and the Hukawng Valley in early February, and 77 and 111 Brigades making their approach from the Imphal Plain. Shortly after 16 Brigade had started its march, the plan, so far as it affected the other brigades, was changed, as it was apparent from information received, that a crossing of the Chindwin River in force would be opposed. It was decided, therefore, that the remaining brigades would be flown in to preselected areas which were to be put into a state of defense and form bases from which columns would operate. The initial assault troops were to be flown in by gliders with the task of preparing and protecting a landing strip to receive the larger troop-carrying aircraft bringing in the remainder of the Force. Two sites were selected for this purpose and given the code names of Piccadilly and Broadway. As on the eve of the assault it was discovered that the Piccadilly site had been obstructed, presumably from enemy action,36 its contemplated use was abandoned and Broadway only was used. At a later stage three further sites, named Chowringhee, Aberdeen, and White City were made. The exact position of these sites was not known to any of the Medical Staff at this time, for none of its members were allowed to attend the 'S' Conferences,37 in spite of repeated representation being made as to the vital necessity of this.
Embarkation arrangements as regards Medical Detachments were poor, and while the principle of dispersal was appreciated and acted upon to a certain extent, it lacked organized plan. Officers, men, and equipment were dispersed to such good effect that there were no organized parties which could function on landing.
In any future operation this must be appreciated, and dispersal into parties, each capable of functioning independently, must be arranged; remembering always that casualties occurring from accident as well as from enemy action at the time of landing must be anticipated and provision made for their treatment.38
36Almost at the last hour before loading the
gliders, aerial photographs were obtained which showed that the clearing
called Piccadilly was crisscrossed with logs. The only safe assumption
could be that the enemy had discovered the plans of Special Force. After
a dramatic conference with Wingate, Slim ordered the fly-in to proceed
on schedule. Later it was learned that Burmese woodcutters had simply spread
out newly-cut teak trees to dry.
Embarkation for the fly-in took place from the airfields of Lalaghat and Imphal, but chiefly from Lalaghat.
With the construction of Dakota39 strips in the defended areas mentioned, it was now possible for casualties to be evacuated by air direct to base hospitals in Assam; and 91 I.G.H. in Sylhot was chosen as the base hospital for this Force.
It now became one of the functions of the Brigade Medical Units to receive the casualties on their arrival at the base air strips; and while arrangements had been made that all casualties were to be landed at Sylhot Air Strip, the possibility of their being landed elsewhere, namely Hailakundi, Lalaghat, and Agatala, had to be provided for, and Medical Detachments were consequently sited on each of these strips.40
The original idea that each Brigade Medical Unit would be responsible for the medical supply of its own brigade now became impossible, and 16 Brigade Medical Unit was given the task of doing this for the whole Force. [Since it had not been decided]41 in view of the uncertainty of the commencement of operations, as to how, if at all, evacuation of casualties was to take place, medical officers were instructed that everything was to be done with the means at their disposal to return individuals to column duty as quickly as possible. This meant carrying the sick and wounded wherever possible, either on stretchers carried by bearers or on ponies with which the columns were supplied; such nursing as was possible being undertaken at halts and in bivouacs as occasion arose. In the event of an action and the number of casualties increasing, or if, for any other reason, the carriage of patients became impossible, then arrangements would have to be made to leave them in the care of friendly villages. If this was not possible then they were to be hidden in some secure place near water, with sufficient food, ammunition, and money to enable them to subsist as long as possible until help arrived, or they became sufficiently restored to health to make their own way to safety. It was hoped that the abandoning of such casualties would never be necessary and medical officers were instructed to make every effort possible to get their men away by every means in their power.42
39The two-engine Dakota plane (designated C-47)
was the workhorse cargo and troop-carrier plane of the war.
As things turned out, evacuation to India did become possible, and was in fact so successful in the early stages, that in many cases men were back in the base hospitals within 12 to 24 hours of their being wounded. The jettisoning of casualties did, I regret to say, have to be resorted to in a few instances. The majority of these cases occurred in the course of an unsuccessful action when withdrawal had to take place under heavy enemy fire without the opportunity allowing of the collection of the more seriously wounded. At other times when the wounded were being carried and had, for reasons of speed or insufficiency of bearers, to be abandoned, these were in the majority of cases so seriously wounded that their chances of survival were of the slenderest. Such cases, in view of their serious condition, were put humanely out of their misery.43
The policy of economy in manpower, the treatment of the individual within the column and his rapid return to duty, remained the basic principle throughout the campaign even when a successful method of evacuation was devised and in regular operation; and it was always understood that only the most serious cases requiring skilled nursing would be evacuated out of Burma. Cases of malaria, diarrhoea, septic sores were all treated by column medical officers even when the malaria was sufficiently severe to necessitate the administration of quinine intravenously. Every means available to get the man back on his feet was adopted, and gradually it became the accepted practice to treat nearly all cases of malaria with an initial dose of quinine intravenously.
Toward the end of the campaign when both men and medical officers were feeling the strain both mentally and physically, there was a tendency for medical officers to forget their basic policy, and for them to send out men for whom during normal times, evacuation from Burma would never have been considered.
The serious mental strain to which all ranks were being subjected and the appalling conditions of weather and terrain in which they were compelled to operate were fully realized; at the same time, so long as an operational task remained and so long as those responsible remained deaf to the medical reports of the state of the men's health and their consequent noneffective
43Calvert led part of his brigade on a difficult
flanking raid outside White City, hoping to relieve some of the pressure
on it. As casualties accumulated, the force slowed down its pace to match
the litter bearers. At one point, however, efforts to recover several wounded
men under heavy fire produced new casualties. The troops were forced to
leave some of the wounded men behind (p. 134).
fighting state, this policy had to be adhered to as strictly as ever. Moreover, laxity with one brigade whose opportunities for evacuation were more favourable, produced its serious repercussions in others whose position was less fortunate. The gravest instance of this occurred on the Indawgyi Lake when, although the numbers awaiting evacuation from 111 Brigade were larger than any of the other brigades, they were in no way so serious as the [scrub] typhus cases in 14 Brigade, or the large number of battle casualties of 77 Brigade. As the means of evacuation became more uncertain and irregular, the attention of medical officers had again to be drawn to this basic policy, and the importance of a strict selection of the cases for evacuation, retaining within the column those with whom they could deal themselves, was again impressed on them.
Although this basic policy of treatment was accepted and carried out, it was only done under the greatest difficulties; for the number of medical personnel was quite insufficient to deal with even the small numbers occurring during the premonsoon period. Numbers of medical personnel must be sufficient to carry out not only the numerous duties involved in the efficient nursing of the sick but also the fatigues necessary for their accommodation, protection, cooking, and sanitary wellbeing. The allotting of combatant personnel for these duties when they are already fully employed in their own tasks of local defense and patrolling together with attending to their own personal needs, is not possible and cannot be expected.
For strongholds the ideal would have been the establishment in them of some form of field hospital and no doubt the original idea of the brigade medical unit was that they should be so employed. However, lack of aircraft space and the other duties to which they were already committed prevented this being done. Whenever possible, column medical personnel were combined with a view to carrying out this duty, but their resources were insufficient and their usefulness restricted.
The medical problems produced by warfare in the tropics were compounded by the difficulty in determining when and how to evacuate casualties. "To conserve fighting strength" required that genuinely incapacitated men should be withdrawn, both for their own sake and for that of their hard-driven comrades. In the strongholds or in the marching columns they were a burden. Yet the grave limitations in air transportation facilities for evacuees, and the absolute necessity of preventing losses in Force manpower precluded generosity in the evacuation plan.
For this dilemma, there were no happy resolutions. Painful compromises characterized the attitudes and practices of the medical establishment, from the Force Surgeon down to the Column medical
officer. Those who were conservative or who could not secure evacuation facilities on call were accused of cruelty. Those who were liberal were liable to be reprimanded for weakening the Force, and for encouraging malingering.
Medical Personnel for the Columns--Officers and Other Ranks
It can be truthfully said that without exception all commanders were high in their praise for the medical personnel with their columns. They were keen and had the welfare of their men at heart. They worked under the most extraordinary difficulties of climate, terrain, and insufficiency of equipment. They carried out their work with cheerfulness and an enthusiasm which was beyond all praise.44 The wonder is not that the Medical Services did so well but that they functioned at all. With lack of communications, the loss of and at times the absolute absence of Medical Supply Drops, the appalling weather conditions, and the lack of cover made the nursing of some of the more acute fevers almost an impossibility. With the small numbers of medical personnel available and the multiplicity of tasks necessary before cases could even be received, made the proper care of the sick and wounded even more astonishing.45
With it all a lack of training the arduous and important duties of the Regimental Medical Officer were in many cases painfully obvious.46 There was a disinclination by some, though these were in the minority, to realize the importance of the maintenance of a full frontline strength and economy in manpower. There was at times a misplaced sympathy with the hard lot of the men and an assurance to them that they were not receiving the attention they would like to give them. Such misplaced kindness had naturally a lowering effect on morale and it can truthfully be said it was in those columns where the Medical Officers were most popular that morale was of the lowest.
There is no one who has more influence on the morale of the men than the Regimental Medical Officer. The operational task and the war effort in general compatible with the well-being of his men must be his primary concern. Firmness must be combined with sympathy, and the infusion of a knowledge that his treatment is of the best and that the fitness of the man to resume his place in the frontline for the task allotted must be his prime considerations. Only by this means will the morale of the men be maintained at the highest.
44This estimate is confirmed by the comments
of Fergusson, Masters, and Calvert. Majors Desmond Whyte, RAMC, James Donaldson,
RAMC, and C. Roy Houghton, RAMC, were the Brigade Medical Officers of the
111th, 16th, and 77th Brigades, respectively. Fergusson also praised the
"outspoken and excellent" Force Surgeon, the author of this report:
Masters, pp. 272-273; Fergusson, Earth, p. 202; Calvert, p. 168.
Pari passu with this and closely intermingled with it is the infusion of a knowledge of a healthy way of living. In other words constant education in the maintenance of health and the prevention of disease--a high standard of Sanitation and Hygiene--amongst all ranks especially the leaders to whom the men look for example and guidance. Slackness in the former naturally leads to slackness in the latter, and it is here where the Regimental Medical Officer can exert an enormous influence. Constant reminding during periods of off duty of antimalaria precautions in which officers were notoriously slack, the digging of latrines, and the reporting of indiscipline in sanitary habits, while all tending to risk the loss of popularity, if done with tact and friendliness lead to an enormous improvement in health and efficiency. In fact it can be said that the influence that can be exerted by a good Regimental Medical Officer with a sound knowledge of human nature and a set standard in discipline and morale is beyond measure, and it is only by training that the young Medical Officer can be made to realize it.47
There was a tendency in the early days of the Force for Medical Officers to be sent to the Force as a punishment. The type of man who got into trouble at a guest night or at a dance night at the club for smashing the furniture or laying out the most senior officer present, was considered, by virtue of his toughness, as the most suitable type for the hazardous operations envisaged for this Force; and in actual fact many of this type were posted and had to be changed. From what has been said above it can be seen how very mistaken was this policy and it cannot be overemphasized that the standard of Medical Officer for this type of formation must be of the best available and imbued with the best traditions of the Profession and the Service, and trained to the realization of the importance of the duties of the Regimental Medical Officer.
It can truthfully be said that intercommunication48 between Column Medical Officers and Senior Medical Officers on the one hand and the D.D.M.S. on the other did not exist. Medical messages were invariably incorporated within the body of normal column signal messages for Rear Brigade, and as the result these were seldom extracted and passed for the information of the Medical Branch. On one occasion at least action was initiated by the "G" staff on a purely medical signal without any reference to the Medical Branch, and it was only by virtue of a repeat signal being received
47The reader of these homiletic passages may
profitably recall that such afteraction reports aimed immediately at affecting
current plans, training programs, and administrative policies. The lecturettes
which sometimes intrude into General Officer's otherwise factual or historical
exposition are anything but gratuitous displays of sanctimonious military
doctrine. In a rather severe self-criticism, based on the wartime experiences
with disease in India and Burma, another officer concluded: "We [in
the RAMC] failed prior to 1943-44 to appreciate the problems set us by
warfare in the tropics because of a lack in our basic medical training
and because of our lack of use of the hygiene measures at our disposal
* * * we failed to convince the combatant that hygiene was to him of vital
importance": O'Dwyer, p. 122.
a month later, that any knowledge of the previous communication on the subject was brought to light.
Much of the fault lay in the ignorance and lack of training of the Medical Officers, and from the fact that they were imbued with the realization that they were brigaded and dependent on their brigade for everything rather than that they were part of a medical organization directed by a D.D.M.S.
No arrangements had ever been made for keeping the Medical Directorate informed at regular intervals of the state of health and of the number of casualties in the columns. The result was that the Directorate was never in a position to know at any particular time the medical condition of the Force or any part of it. An attempt was made to remedy this and Medical Officers were instructed to send in a Weekly Medical Situation Report giving the necessary minimum details; and orders were given that a record of all men reporting sick must be maintained.
The result was very disappointing. Medical Officers in many cases never realized the importance of doing this and that the help which they themselves expected and which was only too willing to be given [sic] was dependent on its prompt submission. Many, however, did make a real attempt to comply, and the Senior Medical Officer of the 14 Brigade sent in a daily sitrep49 --at one stage by a signal--none of which reached either the D.D.M.S. or his staff. In other cases reports when they were received were irregular and out of date so that a picture of the Medical situation at any one time was never really known.
The whole system of Medical Intercommunication must be given very careful thought for any future operations. Medical officers must be in a position to contact and receive the help of their Service Chief and every assistance must be given to them to this end.
Medical signals should be entirely separate and addressed to the D.D.M.S. and the Weekly Situation Reports must be rendered promptly and accurately in the form of some simple code by signal. Only in this way can the D.D.M.S. direct his services and be in a position to render the necessary technical advice to the G.O.C.
Fighting behind the enemy lines necessarily produces problems not met with in other types of warfare.
This is putting it mildly. On occasions the problem seemed insoluble and it says much for the ingenuity and resourcefulness of those responsible that evacuation at times was ever made possible. No praise is too high for the American pilots of the light planes who worked ceaselessly and unremittingly, often in appalling weather, and always with the risk of being shot down, day in and day out; to the RAF and USAAF pilots of Troop Carrier Command who were never unwilling to undertake every reasonable risk compatible with the safety of their crews and aircraft, and who did magnificent work in the most appalling monsoon conditions of weather and terrain; and to
the pilots, doctors, nurses, and medical technicians of the No. [sic] Air Evacuation Squadron50 whose services were always willingly given and because of whose untiring efforts and loyal cooperation the evacuation was at first made possible in the Ledo area; not least and not last, to the "G" Staff and especially to Brigadier [H. T.] Alexander to whom most of the credit must be given for initiating many of the methods of evacuation used and devised.
It was not known at the commencement how evacuation was to be achieved. It was hoped that light planes would be available for use in conveying casualties from the vicinity of columns to already existing airbases. Failing this, the only method possible was for casualties to be carried with the columns when they would of necessity have to be left to the care of friendly villagers, or with sufficient food and water until they became well enough to proceed on their way alone and able to look after themselves.
With the change in plan of operations, it was soon seen that evacuation by air would be possible, and in actual fact it became so and remained the sole method of evacuation throughout the whole premonsoon period. Wherever possible, columns constructed light plane strips in the vicinity in which they were operating and casualties were evacuated by light plane to the nearest Dakota Strip. These light planes were of two types, L-1 and L-5. The former could carry four casualties (two lying and two sitting or one lying and three sitting). The L-5 on the other hand could evacuate only one sitting patient. Moreover, as the length of strip required by the L-5 was greater than that required by the L-1, the former was rarely used. Dakota strips were for the most part situated in the strongholds and were being used nightly by incoming supply planes of Troop Carrier Command bringing supplies and equipment into the strongholds. These were available for the evacuation of casualties on the return trip.51
This, then, was the method used, and proved highly successful right up to the onset of the monsoon. No fighter opposition was ever experienced and evacuation was carried out continuously and without interruption.
The conveying of casualties from columns to light plane strips was usually carried out with the help of the local inhabitants or by personnel of the columns acting as stretcher bearers. They were invariably escorted by an armed guard.
With the onset of monsoon conditions and the consequent increase in the risks involved in flying from the previous air base, the axis of evacuation had to be changed. Many of the strips previously in use were now soft and unserviceable, so that other arrangements had to be made. As long as the weather held, the construction of light plane strips could still be continued for while the ground was too soft to allow of the landing of heavy planes,
50The 803d Medical Air Evacuation Squadron
of the U.S. Air Force was the only such unit in North Burma until July
1944. Two flights supported the Stilwell front. The 443d Troop Carrier
Group, Tenth Air Force, provided some assistance, also. The light planes,
so vital to the evacuation system, were flown by the 5th and 7th Liaison
Squadrons, Tenth Air Force.
there were places still dry enough to carry the weight of light planes, which worked from the all-weather strips of Tinkok [Tingkawk] Sakan and Warazup. This presented no difficulty except that it meant that our casualties would have to be evacuated through the American Operational Area and back along their L. of C.52
During the transitional period casualties were being evacuated to our old bases at Sylhot, Agatala, Lalaghat, and Hailakundi as well as our new ones at Tinkok Sakan and Warazup. This meant that our medical resources were going to be hard put to it to be able to staff all the airfields now being used by the Force. It was quite evident therefore that reliance would have to be put on the American Army Medical Organization which was briefly as follows. The 20th General Hospital at Ledo, together with the American Hospital at Shingbwiyang were the two main base hospitals to which all American and Chinese troops were evacuated.53 Forward of these were the usual Field Medical Units through which American casualties were evacuated from the frontline to the two main Dakota Strips of Warazup and Tinkok Sakan. At each of these localities there was a field hospital with a medical detachment situated on the air strip for loading purposes.54
Casualties were evacuated back to Ledo and Shingbwiyang by planes of the 803d Air Evacuation Unit based on Chabua, and it was with the help of this unit that the casualties of the Force were evacuated from Dinjan for admission to the hospitals in that area in accordance with the plan of A.D.M.S 202 Area, and which had been prepared to meet the large number of sick that were expected from the Force on its eventual evacuation from Burma through this route.
52By May 1944, the 151st Medical Battalion
was so widely dispersed that administration became very difficult. It was
reorganized into a Headquarters and Headquarters Detachment, 151st Medical
Battalion; and four separate companies: the 385th Medical Collecting Company,
the 685th and 686th Medical Clearing Companies, and the 889th Medical Ambulance
Company (Mtr). These units established air clearing stations as well as
other evacuation stations on the North Burma front. Dr. Floyd T. Romberger,
Jr., the original editor of North Tirap Log, was the chief officer
in charge of the medical aspects of air evacuation
The air ambulance planes functioned backwards and forwards between Warazup and Tinkok Sakan on the one hand, and later Myitkyina, and Shingbwiyang and Ledo where they [the patients] were staged by the detachment of a brigade medical unit, until they were picked up in the evening by the returning empty ambulance planes and carried to Dinjan en route to their base at Chabua. At Dinjan another detachment of the same medical unit was sited to load the ambulance cars which conveyed them to the Combined Military Hospital, Panitola. The Combined Military Hospital, Panitola, thus became in effect a casualty clearing station. All casualties were admitted there in the first place and later distributed to the hospitals at Digboi and Dibrugarh. Any serious case which required immediate admission to hospital on arrival at Ledo was admitted to No. 44 Indian General Hospital at Ledo, the principal function of which was the hospitalization of the personnel of the Indian Labour Units working on the Ledo Road.
The hospitals at Digboi, Panitola, and Dibrugarh were augmented by D.D.M.S. Fourteenth Army bringing to the vicinity of each a Malaria Forward Treatment Unit.
At this stage of operations brigades had moved north from the two defended localities of White City and Blackpool, in the areas of Renu and Hopin respectively, and had concentrated in the general area of Indawgyi Lake; with the exception of 77 Brigade which had begun its move on Mogaung. All brigades had with them a considerable number of sick and wounded and it was decided to attempt the evacuation of these in the Indawgyi Lake area by seaplane. For this purpose a Sunderland Flying Boat was based on the Brahmaputra near Dibrugarh; and to this was later added a second one. Because of the limited flying ability of these machines it was arranged to evacuate only the more serious cases by this means. The highest tribute must here be paid to the R.A.F. pilots who, in spite of the risks attendant on flying over mountainous country through the worst possible monsoon conditions of low clouds, rain, and thunderstorms, and over a route which at first was quite unknown to them, never failed to fly whenever the slightest chance of success presented itself.
As envisaged, this method of evacuation came to a sudden end, partly because of the damage sustained by each of the planes while moored on the Brahmaputra River, partly to the monsoon conditions of weather which made the opportunities for flying few, and to the height and swiftness of the Brahmaputra which made mooring difficult if not impossible, and through the floating down of large logs, a danger to the aircraft. All this, combined with the fact that they were urgently required for their normal tactical role, decided those who were responsible to discontinue their employment.
As there was still a considerable number of casualties awaiting evacuation and as the old method of evacuation by land-based aircraft could now no longer be reinstituted owing to the constantly low lying cloud formations, as well as to the constantly wet ground, it was decided to make an attempt to evacuate them by river up the Indaw Chaung to Kamaing. As this, too, offered a means of supply to the forward troops and was a means of relieving the already overstrained aircraft space, arrangements to implement this were
instituted. Lt.-Colonel Howell [?]55 was ordered to raise a force composed of Royal Engineer personnel to act as boat operators and to assemble as large a number of craft, assault boats, and country craft, as could be secured, with all necessary outboard motors for their propulsion. These were to be flown to Warazup which would be the Headquarters of the Force as well as the riverhead. Colonel Howell then made a recce of the route from the air and made his appreciation. At this point, and on the information so received, the Medical Branch was asked to arrange for what they considered to be the minimum necessary medical support.
On the information received that the journey from the lake to Warazup would take only 12 hours, it was suggested that two whole Brigade Medical Units would be necessary. One [was] to undertake the reception and dispatch of the casualties at Warazup and the other to divide into two parts and establish staging posts en route, sited at approximately 4-hour intervals. As an Advance Party, one officer and eight RAMC other ranks with 400 pounds of equipment were flown into Warazup from Sylhot. The remainder were sent up to Dinjan by rail for onward dispatch by the more abundant air transport which was available in that area.
With the acute shortage of rail transport in the first place, the similar shortage of air transport in the second, there was a long and most unfortunate delay in the implementation of this plan. To fill this hiatus, skeleton staging posts had to be established by available column medical officers at the lake end of the route and a much reduced Brigade Medical Unit flown in by the American Air Evacuation Unit to Warazup. While this gave the barest possible aid to the sick and wounded and was much below what had been hoped for, it sufficed until the prearranged units and equipment could be sent in.
Arrangements were made for those casualties who were still awaiting evacuation from Indawgyi Lake to be moved up the Indaw Chaung to Kamaing, staging at Chaungwa and Manwe en route, at which places a medical officer and medical staff had been located. At Kamaing all serious cases were admitted into the American Field Hospital until they were fit enough to stand the second stage of the journey to Warazup.56
Evacuation from Kamaing was carried out by means of a shuttle service of American Assault Craft to Warazup. This part of the journey, being against the current, took about 12 hours, and was an extremely trying experience for these unfortunate men, as the construction of head cover which was attempted in the early days made the boats topheavy and dangerous in the fast flowing current. They were thus exposed to the elements of the hot burning sun or the drenching from a heavy monsoon rain. No medical attention was available during the course of this long journey as sufficient medical personnel to man each boat with a medical attendant were not to be had. In spite of the dangers and hazards of this long and arduous route,
55The dittoed typescript is not clear: "Nowell"
may be correct. The full name of the officer has not been identified.
the numbers of casualties evacuated ran into many hundreds and with the exception of one fatal accident, all were evacuated safely.
At Warazup a brigade medical unit was eventually established for their reception and they were from there conveyed by planes of Troop Carrier Command and of the Air Evacuation Unit to Dinjan. Prior to the Brigade Medical Unit's getting into position, the casualties were admitted to and treated in the American Hospital which had been sited there for the use of C.A.I. troops. Owing to the severe monsoon conditions there were occasions during which the Warazup Strip, which was not an all-weather strip, became unserviceable, and the casualties had then to be transported by road to Shaduzup and were admitted to the American Evacuation Hospital situated there. From this hospital they were conveyed by light plane to the all-weather Dakota Strip at Tinkok Sakan, as the intervening road was unserviceable owing to the rains, and thence by Dakota to Dinjan. As the monsoon progressed, the road between Warazup and Shaduzup was interrupted by the two main bridges being swept away by floods. A ferry service, with shuttle system of ambulance cars between, had thus to be organized.57
It can be seen, therefore, how very dependent we were on the cooperation of our American Allies; and without their assistance, which was always very willingly given, evacuation would never have been possible. To them and especially to the American Army Medical Services we owe an undying debt of gratitude.
By this time all brigades except 77 Brigade had reached the vicinity of Lakhren. Here a light plane strip was constructed and as long as this remained serviceable casualties were evacuated by light plane to Tinkok Sakan. When this in its turn went out of action evacuation was carried out through Manwe by river to Kamaing and Warazup. To the already trying river journey was thus added a long and tedious march, along mud-infested mountain paths over the hills to Lakhren, from the area in which columns were now operating.
77 Brigade had now reached the high ground south of Mogaung investing this township. They had had no opportunity since their withdrawal from White City of evacuating any of their sick and wounded. As the result of the many engagements in which they had taken part, the numbers of those awaiting evacuation at this time was in the region of 250. The area around Mogaung was almost completely under water and with the railway linking it with Myitkyina still in enemy hands, it was completely isolated from all contact with the outer world. A recce was made with a view to seeing if an L-1 converted by the addition of floats could be landed on the water or nearby river. Arrangements were put in hand, meanwhile, for this conversion to be carried out. Unfortunately this proposition was found to be unworkable. The float plane was however used for evacuating from the
57American medical reports describe the same prodigious effort. At Warazup, troops of the 686th Clearing Company operated Air Clearing Station No. 7. At Shaduzup, elements of the 25th Field Hospital received patients. If Shadazup airfield were also closed, casualties went on to the temporary hospital of the 686th Clearing Company or to a branch of the 25th Field Hospital at Tingkawk Sakan.
Indawgyi Lake to Tinkok Sakan. It being amphibious, it proved itself a most excellent means of getting away some of the most serious cases from that area.
The situation then at this time was critical. The number of casualties was increasing and with the need for every available man in the front line, the protection of the sick and wounded became a problem. Something had to be done and efforts were made with the help of tree branches and coconut matting on a base of sandbags to produce a light plane strip. This proved successful and evacuation by light plane to Myitkyina commenced.58 From Myitkyina they were carried by returning supply plane to Dinjan.
With the move of 111, 14, and the West African Brigades towards the line of Japanese withdrawal from Mogaung, evacuation to Lakhren became more difficult. It was decided therefore to use the Taungni-Pahok road and the Kamaing-Pahok road. A detachment of No. 80 Parachute Field Ambulance of the 51st (Parachute) Brigade operating in the Imphal Plain was requested and, through the D.D.M.S. of Fourteenth Army and 4 Corps, permission to transfer this was granted. This detachment was eventually dropped at the Pahok crossroads where it established a staging post. Evacuation was now through Pahok by road to Kamaing thence by river to Warazup. As soon as the remaining pockets of Japanese resistance in this area were mopped up, a light plane strip was constructed at the Pahok crossroads and serious cases were evacuated by this means direct to Myitkyina. Eventually Myitkyina fell; the Myitkyina-Mogaung Railway was freed from all enemy and this became the main route of evacuation.
The problem now was to decide how best to make use of this; for though rolling stock was plentiful, motive power was nonexistent. To fill this deficiency Jeeps were converted by a change of wheels for use on rails. Each Jeep was capable of drawing one 20-ton flat and three such trains were made and used to excellent effect. Later, two, then six Luda petrol motor-driven trucks were flown in, each doing more reliably and more powerfully the work which the Jeeps had been doing up to now.
As by this time the greater part of the sick had been evacuated and as the scene of operations had shifted southwards to Taungni, a medical unit forward of Pahok was necessary. The medical unit from Warazup was therefore brought forward to Milestone 15 on the Pahok-Taungni Road and arrangements made for a light plane strip to be prepared on the road itself. At this stage the remaining brigades of the Force were relieved by 36 Division and operations as far as this Force was concerned came to an end.59
58Stilwell had taken the airfield at Myitkyina,
but his Chinese and American troops did not capture the town until August.
Air Clearing Station No. 8 opened on 18 May, as soon as the attack on Myitkyina
It can be seen from the above account some of the difficulties which were encountered, and at times these were so great that they appeared almost without solution. It was not until one was again on an almost normal L. of C. that one began to realize how extraordinarily easy is the task of solving the numerous problems of normal evacuation. In no theatre of war were the diversity of methods used probably so numerous and improvisation stretched to such lengths, as they were in this operation. With the means available and the absence of any proper medical organization, the wonder is that evacuation to the extent achieved was ever possible.
The development of a medical supply system dependent upon aircraft proved as necessary and difficult as the institution of air evacuation. The columns carried a few days' supply with them. They called by radio for replenishment. The calls were decoded at the airbase and passed to a detachment of the Force medical service. It assembled the needed items and turned them over to the Force Quartermasters for packing and delivery to the Air Supply Company. To regularize the issue of medical supplies, 5-day standard units were designed. They could be preassembled and packed, and the brigades could order them singly or in multiples, as required by the tactical situation.
The lack of sufficient medical supply troops and depot facilities produced confusion and inefficiency. The irregular movements of the Force and the vagaries of jungle warfare made rational planning almost impossible. An important part of General Officer's responsibility,
therefore, was the constant reevaluation of the medical supply and equipment system.60
With so many links in a chain of supply, it was never possible to pin down the responsibility for any loss which might occur at any one link. It was quite evident that the only satisfactory method would have been for the medical unit concerned to be responsible for the packing and for the medical responsibility not to have ceased until the stores were loaded on the aircraft. With the small size of the packages so common with medical supplies it was realised of course that this was impossible and uneconomical. At the same time the problem of a satisfactory method of medical supply must be solved, as during these past operations it was far from satisfactory, and although all demands, exorbitant as some appeared, were always supplied, many column Medical Officers were frequently complaining that their QQs61 were not being met.
Complaints, too, were now beginning to come in from the columns that deficiencies other than those acknowledged on the packing notes were existing when the stores were received by them. It can only be assumed that the missing items were either being mislaid or stolen after leaving the Medical Store. This belief was furthered when occasional odd articles of medical stores were handed back from the Packing Section undelivered with no indication as to which column they were originally intended [for]. It may be added, however, that this trouble did not arise when dealing with the all-British 61 Coy R.A.S.C.62 Packing Section.
With the responsibility of supplying additional brigades, difficulties began to increase. Firstly the "5-day" system in use by 16 Brigade was not being observed by 77 and 111 Brigades, and demands were being received from them at very short notice for immediate collection. As many as eight demands from one brigade would be received in one day, whereas under the "five day" system no more than three separate demands were ever received in 24 hours. To ensure the supply of stores without delay it was necessary to supplement the staff by two Privates (1 storeman and 1 clerk). A further addition to the staff, although desirable, could not be made through lack of personnel.
Although column medical officers realised that only items included in the Code List were available at the airbase, it was at this time that other items started to appear in clear on the QQ signals. Every effort was made to supply these articles from the unit dispensary or from the local hospital, but soon it was found necessary to indent on 16 Indian Depot Medical Stores to meet these demands. Unfortunately, the delay in obtaining these items prevented
60These editorial notes summarize General Officer's
opening passages on supply. Stilwell's arrangements for the Chinese Army
in India may be cited, in comparison. One section of a medical supply company
at Ledo specialized in air supply. Field requisitions were relayed to it
and it controlled the entire operation until packed supplies were turned
over to the air crews for loading. This is not to say that Stilwell's supply
system was without fault. On the contrary, the sources of medical supply
nearly dried up early in the Second Burma Campaign: See Tamraz Diary.
the immediate supply to the demanding column, and for the first time items had to be marked "N.A."63 on the demands.
As operations continued, repeat demands became more evident. That is to say, a demand would be received in respect of one column one day, and the next an identical demand would be had for the same column. When this was queried it was invariably found that it was in fact a repetition of the original demand due to nonreceipt of the stores which had been put on the wrong plane or dropped on the wrong column. Regardless of who was responsible for such errors, these duplicate issues were a drain on the already diminishing stocks, apart from being additional work for the staff.64
An "Air Base Set" of medical supplies was designed as a standard 3-month reserve for each brigade. Field experience revealed that the set was severely understocked in the drugs used to treat diarrhea and dysentery, foot diseases, and helminthic worm infestations. The special medical panniers and haversacks which the columns carried soon needed replacement. None were available and improvised substitutes had to be hurriedly produced. On the other hand, assemblages of supplies known as the "Ten-Day" and "Before and After Engagement" units proved to be wasteful. Brigades often ordered them to obtain a few scarce items. General Officer recommends that such units be abandoned or carefully revised. His review of particular supply problems continues:
Suppressive Mepacrine.--Tabs Mepacrine Hydrochlor were always available in sufficient quantities from 16 Indian Depot Medical Stores but the issue to columns was perhaps the most difficult problem encountered by the Brigade Medical Unit. Some brigades endeavored to include tablets in ration drops whereas others left it to column medical officers to indent for their requirements, but both of these methods led to a great deal of duplication in issues and still reports were received that suppressive mepacrine was not being received by the columns. It is felt that the best solution to this problem is for suppressive mepacrine to be included in the individual ration pack, e.g. in the "K" ration pack or in the Delhi Light Scale65 pack or its equivalent. This would ensure a constant supply to each man. The next best solution is for every man to start out with 1 month's supply in an individual container and for the column medical officer to demand a month's bulk supply a week or two before the current issue is expended. Curative mepacrine was available on demand at any time.66
Tablets water sterilising individual.--Next to mepacrine, tablets Water Sterilising Individual were a great problem. At the outset of operations, air base sets were found to contain an initial issue of this item, some of which were of English manufacture but the majority of which were of Indian make. In most cases the latter were of very poor quality and had deliquesced to a great extent. The English brands were therefore issued in the first instance and indents were placed on 16 Indian Depot Medical Stores for a further supply to meet anticipated demands. These demands were never fully met however, and even when issues were made the tablets were of Indian make. This resulted in Water Sterilising Powder being issued in lieu, much to the annoyance of column medical officers who found that the water bottle method of sterilising water in bulk quantity with W.S.P. was not convenient in Long Range Penetration, besides which it was too heavy to carry.
Outfits water sterilising individual.--Every man was in possession of an individual water sterilising outfit at the commencement of operations, but as the majority of these were of Indian make the tablets therein had deliquesced. Demands were soon received on the majority of QQs for replacements. 16 Indian Depot Medical Stores however could not supply anything like the number of replacements required, and those they did supply were of exceedingly poor quality and really unserviceable.67
Medical comforts.--When Medical comforts were appended to the Medical Code List they were intended for patients only and it was visualised demands for them would therefore be small. From many of the demands received it would appear that they were being used to supplement rations.
Although it is agreed that this was an excellent idea, neither the storage space nor personnel were available to enable the medical store to function as a F.S.D. as well.68 * * *
67Here also the supply situation was vital.
Water contamination was inevitable. Supplies of water purified in bulk
under careful supervision could not be expected. Individual and small-unit
water purification discipline was absolutely necessary to prevent widespread
incapacity from diarrhea and from bacillary or amebic dysentery. Such discipline
was difficult enough to maintain without the handicap of insufficient or
obviously ineffective drugs and equipment.
Equipment and Stores69
Personal equipment.--The weight carried by the men was far too high and considerable thought must be given as to how this can be reduced.
It is one of the elements of Military Hygiene that the weight carried by the man should never be more than one-third of his body weight. Anything over that reduces the man's efficiency and capacity to physical effort. That, in the case of a soldier in battle, means the reduction in his power to move, to seek out the enemy, and to successfully engage him in combat.
The average weight of the men in one column was 145 pounds and yet the weight carried by the Bren gun carrier amounted to 95 pounds--in other words, he was carrying about two thirds of his body weight or twice what he should carry. The lightest weight carried was 67 pounds--the weight carried by a rifleman armed with a carbine--which is nearly half of the man's body weight.70 There is only one answer to this problem and that is that anything over the optimum "man-load" must be carried by someone or something else. It means increasing the tail but it also means increasing the fighting efficiency of the fighting soldier.
In the Chinese Army every third man is a porter.71 In the British Army the introduction of a porter element of Britishers would not be feasible; the alternative then is a foreign porter element--say Dhotial porters--the whole or a proportion of whom could be armed, or alternatively an increase in the number of mules. In 4 Corps, Dhotial porters--a proportion of whom were armed--proved most successful and crossed the most difficult country with incredible loads at amazing speed.
Whether this is practicable for L.R.P. is not for me to say.72
The type of equipment is always open to criticism and all sorts of suggestions are made to improve it. Suffice it to say that the '38 pattern of web equipment73 is the best available and has been devised after considerable thought and experiment by the Army Hygiene Directorate at the War Office.
69Although conveniently connected to the subject
of supply, this section on Equipment appears somewhat later in the original
Other types such as the Bergen Rucksack have all been tried and discarded. In spite of this, recommendations for its reissue are constantly being received. The latest experiment in this connection was carried out by 17 Division last summer, their conclusions coincided with all other investigations, and its use was discarded.
It is submitted that the present type of water bottle is most unsatisfactory and should be changed. It has the following disadvantages: (a) the cork rapidly deteriorates and becomes dirty. (b) the string breaks and the cork is lost. (c) the cloth cover easily tears. It is recommended that a screw stopper secured by a chain similar to that in use by the American Army be adopted.74
Water sterilization tablets.--The Indian-made tablets are quite useless and their issue should be discontinued, and only those of British make issued. The Detasting tablets were never used and their issue is not considered necessary.
Mosquito repellent.--As the troops have developed a strong partiality to Dimethyl Phthallate, and because they have in it a complete faith, it is suggested that this drug be issued in future rather than the antimosquito cream in which they have no faith. It is hoped that by this means a more cooperative attitude will be adopted to the great problem of malaria prevention.75
Containers, individual, for mepacrine.--These proved to be of great value during the present campaigning seasons and should be made available next year for, even though the normal daily dose of this drug is to be packed in the rations, there will be times when rations are short and no mepacrine available. On such occasions the troops will have then the opportunity of something to fall back upon and they will thus be deprived of any excuse for failing to take their daily dose.
Jungle hammocks.--During the monsoon, jungle hammocks were sent in to columns chiefly for the benefit of the sick. They proved such a success that eventually as many personnel as possible were issued with them. Everyone speaks very highly of them and although the weight is in the region of 7 pounds, they proved such a boon that everyone is prepared to carry them. When men were tired and soaking wet, the haven afforded by a jungle
74Obviously, individual water sterilization
discipline could be thwarted by a faulty canteen. Thus, bad equipment would
not only lead to thirst during the hot marches, but it also would prevent
effective use of water sterilization tablets. The water problem was difficult
enough in any case. Charlton Ogburn, Jr., who fought with the Merrill's
Marauders--the American counterpart to Special Force--recalls "the
utter despondency, if we have been marching down a dry ridge all afternoon,
of having to endure an evening, a night, and at least part of a morning
without water or coffee and consequently without food either, for a dry
throat will pass no part of a "K" ration": Marauders,
p. 151. Among the associations that he still remembers is "the sweet,
chlorinated taste of the treated water you seldom could get enough of;
you were thirsty again almost the moment you had drained your canteen"
hammock was beyond description. It afforded a good shelter from the rain as well as a protection from flies, mosquitoes, and other jungle pests, all of which, particularly in the region of Moxo Sakan, were unbelievable.
It is questionable whether hammocks would be necessary during the premonsoon period as at that time mosquitoes are neither so numerous nor so dangerous, and a hammock enclosed by a mosquito net is a difficult thing to get out of in an emergency. Throughout the year, however, the mere fact of their being raised off the ground is a protection against the bites of typhus-carrying ticks and mites.
The introduction of a jungle hammock as part of the personal equipment of all ranks is strongly recommended and will, no doubt have a very definite effect on the reduction of malaria and typhus.76
In brief notes on certain items of medical equipment, General Officer comments on the design or quality of stretchers, casualty saddles, and equipment and supply chests (panniers); leaky metal containers of liquids and ointments; and badly constructed syringes, scissors, and forceps. He notes, for future reference, such drugs and chemicals which were either too limited or were excessive in amount. "Bandages," he writes, "must be coloured green or khaki. On more than one occasion a white bandage has been made the target of a sniper's bullet and has been the direct cause of more than one man's death." The section on technical medical equipment concludes:
Ambulance cars.--Having ridden in an Austin box Ambulance Car as a patient across the Western Desert and in a 4 x 4 Indian pattern Ambulance Car along the tarmac roads of Burma and Assam, I can find little difference between them, and can truthfully say I know of no more uncomfortable method of travel for a healthy, much less than for a seriously sick or wounded man suffering pain. The discomfort experienced in the Austin box Ambulance Car in the desert was equivalent to that experienced in the Indian pattern Ambulance Car running on a tarmac surface. On the other hand, a journey in an American Dodge 4 x 4 Ambulance Car is one of real comfort. Even over a rough surface across country the amount of jolting experienced by a patient with a careful driver is minimal.
With vehicle production in America as it is now, there would appear to be no reason why this ambulance car should not be adopted as the standard pattern by the British and Indian Services in the same way as the Jeep and the weapon carrier have been introduced.
It is strongly recommended that the American Dodge 4 x 4 Ambulance Car be supplied to the medical units of this Force in future.
76Once more, the problem of weight and mobility was involved. The tendency of the marching columns was to dispose of as much equipment as possible. If the enemy pursuit was vigorous, the Force sacrificed convenience and comfort to speed. At the time to which General Officer refers, however, the Force was relatively stationary in the Kamaing-Mogaung-Myitkyina triangle. The severe rains and flooded grounds made shelter a necessity for prolonged operations. Calvert has high praise for the jungle hammock (p. 192).
Although the importance of rations77 has occupied the minds of all army commanders since the beginning of modern history, there still remains much to be done to bring those of present day issue up to a standard commensurate with modern life and warfare. That an effort to this end has been made during the present war no one will deny but it has come too late and is far from complete. The result is that in this sixth year of war rations suitable for our particular type of warfare are not yet available and will not become so before the beginning of the next campaigning season.
If it had not been for the "K" type ration--an American product--the modern ration would have differed in no way from that of the last war. While there is no doubt that the importance of a good ration for the fighting soldier has been appreciated for more than a century--commencing with the world famous Napoleonic dictum--little effort has been made by those responsible to implement this. It has been left to the Medical Services to introduce nutritional experts on to the staffs of Armies in an attempt to stimulate interest and research in this important subject.
For this type of warfare certain principles in the provision of a diet are indisputable and absolutely essential. First, it must be light in weight and of reasonable size and shape. It must be packed in one-man one-meal units. It must be calorifically sufficient, well balanced, and must contain a full complement of vitamins. Lastly, it must be made in a sufficient number of variants to avoid monotony.
The importance of a sufficient diet with the necessary variability to stimulate interest in its consumption cannot be overemphasised and there is no doubt whatsoever that diet in itself has an enormous effect on morale.
During the various phases of this past campaign, many varieties of ration have been used in this Force with varying degrees of success. The experiences with each are set out briefly below.
Rehabilitation ration.--Rehabilitation ration was used during the final training period in India in an attempt to maintain the men's strength at its peak level and to prevent their using up their reserve or "Hump," at this most strenuous time.
This ration, with certain modifications, was approximately one and a half the normal scale rations. While in the main it achieved the object for which it was designed, it produced two adverse results. The first of these was a mild degree of Avitaminosis, and secondly, it made the men dissatisfied with their normal ration when the time came for them to return to it. Some of the units which had this ration considered that it was excessive in amount and that its issue was unnecessary. The Avitaminosis was due to the fact that it was composed largely of tinned meat and biscuits and was a poorly balanced diet. If the use of this ration is contemplated in the future, care must be taken to ensure the issue of one Compound Vitamin tablet to each man each day.78
77This section, also, has been relocated from
its original position in the Report, in order to relate it more obviously
to other passages describing the provisions made for health and medical
safety of the Force.
Delhi light scale.--Although its components appeal more to the British troops' taste than many of the other types of ration do, it was an almost uniform failure. The BOR far prefers Bully Beef to any of the meat equivalents found in other rations. They prefer, too, the biscuits and cheese of this ration, but all of these components reached the men so often in such an advanced state of decomposition that they were quite inedible. For this reason the use of the Delhi Light Scale ration was discontinued as soon as the American "K" ration became available.
Though it is not possible to make any very definite assertion, I am convinced that the inedibility of this ration so reduced the "Hump" of the men of 16 Brigade in the early days of their march into Burma that it can be held partly responsible for their premature fatigue at the time they reached the Indaw area.79
In future, every possible effort should be made to avoid the use of this or any other diet produced in India under present conditions.
American "K" type ration.--American "K" type ration is without doubt the best that has been produced yet, and though monotonous, is less so than any of the other types, for it does make some attempt at variety, which none of the others do, and after living on it for 5 months the men can still speak well of it. For this I can conceive no greater compliment.
In the early days the biscuits were over-sweet for the British palate, but, with that efficiency of which at times the Americans are capable, these were immediately changed when the defect was made known to them. In place of the original type of biscuit three new varieties were produced and supplied in substitution. Now instead of having a single type of biscuit, which was unpopular, for all meals, there are three types, a different one for each meal, and all three are excellent and well liked by the troops. This change has made all the difference, for it has made the troops feel that not only were their complaints reasonable but also, and more important, that there was someone who was sufficiently interested in their welfare to take action upon it. Now there are few who have any complaints at all.
There is, however, still room for improvement, and by the combination of what is best in the jungle ration together with what already exists in the "K" ration an excellent ration with more modifications could be substituted so that at each 5-day interval a variation in diet could be supplied. Examples of how this could be achieved without any increase in size or weight are as follows:
Tinned sausage or bacon could be substituted for the eternal chopped ham and egg yolk in the breakfast unit.
In the dinner unit the cheese could be halved and an equal quantity of one of the many varieties of jam substituted.
79The march itself was very long and the route was unimproved and hilly. The point General Officer makes can be put more certainly in another fashion: on such a strenuous march into battle any consistent failure in rations was a dangerous misfortune. As noted in the prefatory summary, the brigade felt that Wingate did not let it rest sufficiently after it reached the operational area before he ordered it to attack Indaw. The attack failed and no really effective work was carried out afterward by the brigade. It was the first to be evacuated.
For supper, compressed roast beef, tongue, mutton, pork and even bully beef could with advantage be substituted for the all too frequently occurring corned pork loaf.
Certain additions should be made. In the dinner unit, some, if not all, of the sugar could be cut out and in its place, compressed salt tablets and one tablet of mepacrine given. A tube of condensed milk such as is found in the jungle ration might well be included, and so forth.
The packing of this ration seems excellent and is waterproof enough to withstand dampness and most rain. It will not, of course, stand up to immersion in water such as may occur in the crossing of deep rivers. To achieve this would be desirable, but only provided that it does not involve increasing the weight. The separation of the day's ration into three meal units is excellent and should be continued, for on those not infrequent occasions when rations are short and the men have to restrict themselves to 2/3 or even 1/3 it can be done easily and without the wastage which occurs when a whole day's ration is put up in bulk.80
Jungle ration-Mark 1.--Jungle Ration--Mark 1 has proved to be a great disappointment. When it was known that the Delhi Light Scale was out forever and that a new British made ration, which was packed in England, was being produced, much was expected of it, and when it was found lacking, as indeed it was, great was the disappointment. Men who have been on "K" ration for 3 months, and, one would have imagined, would have looked upon any change with favor, liked the jungle ration so little that they threw much of it away. The faults found are:
1. It is too heavy. Five days' rations weigh 18 pounds as against 16 pounds in the "K" if left packaged, or 12½ pounds if unpacked, as is the custom of most men.
2. Too many packages of different shapes and sizes for one ration. It does seem extraordinary that, as this ration was something entirely new and specially designed, it had to be made up in bits and pieces instead of being put up in one compact element which could be easily stowed and easily carried. As it is, from their different shapes and sizes, each component has to be put in a part of the equipment and in consequence one or other can easily be lost.
3. It was often impossible to open the large tin without having to resort to the use of a tin-opener, jackknife, bayonet, and so forth. The cause of this lay in the fact that the tongue of metal upon which the key operates was so firmly bound down at the rim that it refused to strip. The key, if subjected
80Hunger was a profound factor in the campaign, whether the troops were British or American. Ogburn's recollection of the "K" ration (which American troops, too, agreed was the best of the packaged field rations) occupies three eloquent pages. Hunger was "our other enemy." "We had two conditions--one in which we felt unfed, the other in which we were unfed." One of his companions wrote an elaborate "treatise" on the "K" ration, which the soldiers "learned to know * * * as intimately as a monk his rosary * * *." The arts of division and subdivision, combination and separation of the several components of the three meals became Byzantine in their refinement. The effect of careful management was not satisfaction, however, but the mere reduction of "gnawing in [the] belly" to predictable periods of the day and nighttime (pp. 153-155). The brief remarks of Masters are to the same point (p. 191). Calvert recalled "perpetual" K rations as "a hardship" but not a "great hardship." Whenever possible, extra tea and sugar, meat, stewed fruit, white bread, and rum were added. Occasionally captured food was eaten, and rice, buffalo, and pigs were sometimes purchased: Calvert, p. 193.
to any force in consequence of the already mentioned fault, broke. In the "K" ration such a state never arose. All tins opened easily and cleanly. The metal strip which was torn off by the key in opening was so preweakened that it never failed. Further, if by chance the key was lost, this preweakening made it possible for the man to open the tin with his teeth, a thing quite impossible in the jungle ration.
4. The cheese, though good and popular, is unattainable, for there is no means of getting into the container unless the top is smashed off by the use of a bayonet or jackknife. When this method is used the resulting messing up of the contents causes considerable wastage.
5. What has been said of the cheese applies equally to the jam container. In a majority of the containers which have come to personal notice a considerable degree of fermentation had taken place in the tin, due to the fact that it had not been completely filled, with the result that when opened with the spike of a jackknife or tin opener, much of the jam spurted up by being blown out by the raised internal pressure and very often soiled one's clothes.
6. The amount of sugar supplied is far too small. The men had a great craving for sugar and the amount supplied was barely sufficient for one cup of tea. On their evacuation from Burma it is not uncommon for one man to eat a one-pound pot of jam and a whole tin of tinned fruit without a second thought and he would continue to do so two or three times a day if given the opportunity. For men of this sort the jungle ration gives in a whole day only as much sugar as is found in each meal of "K" ration, i.e., four lumps.81
7. The compressed salt tablets are excellent, but are supplied in excessively large numbers. There are approximately 32 tablets in each day pack. If this number was reduced to 6-7 and mepacrine and water sterilising tablets, as well as sugar, packed instead, it would be an advantage.
8. The "oatmeal" (sic) cakes were unfortunately named. They are quite good if munched in their natural state, and if powdered down, make the basis for an edible and satisfying dish, but THEY ARE NOT OATMEAL, and when cooked they do not make porridge. The fact that the men were expecting porridge and did not get it was a great disappointment and turned them against this item completely. When it was suggested that it made a good pudding they agreed. Real oatmeal in the same amount would however be appreciated.
9. The chewing gum should be omitted, for with regard to that packed in the American rations opinion is divided, but about that packed in the jungle ration there is no diversity--it is universally disliked.
10. With modern methods of canning and packaging there would appear to be no reason why meats such as those already enumerated in the report of the "K" ration and in daily use by the American Army, should not be supplied to the British.
81" 'Pack of Cavaliers for two lumps of sugar, anyone?' 'Coffee for a fruit bar,' " (Ogburn p. 150, remembering the subdued voices at a rest-stop or in bivouac. The compressed chocolate bar--D-ration--was especially popular with those suffering from diarrhea or dysentery. They would trade it for an entire "K" ration meal).
Road/rail rations.--Railroad rations are composed of a various assortment of tins of bully beef, tins of sardines, tins of milk, bags of sugar, bags of tea, loaves of bread, and cases of Delhi biscuits jumbled together in a gunny bag.
The tins of milk and of jam are all of such a size (11 pounds or 21 pounds) that when they cannot be used at one time they must either be thrown away or have the holes plugged with any dirty bit of paper that can be found. This is but one of the disadvantages of this ration, as it is now, and it is suggested that its use be discontinued and that the American 10 in 1, or 5 in 1 rations be substituted. One has only to see these American rations to be convinced of the need for this change.
Special Force rehabilitation ration.--Special Force rehabilitation ration has proved to be entirely satisfactory and should be retained for its special purpose in the future.
There are besides these, two points that might be well worth remembering for future operations. (1) A man who has been living on "K" type or equivalent rations for long periods cannot tolerate and should not be given full normal rations immediately after he gets out of Burma. He should have for the first 2 days at least, sweet and easily digestible food, working gradually up to a normal diet. A large number of men, thinking they could take normal food, took it, and suffered from an acute diarrhoea in consequence. (2) Every opportunity for giving a change should be seized, and whenever a column gets into a stronghold a ration other than the one upon which it has been living should be sent in at once. Amongst the articles of this, pickles, sauces, etc., must be prominent.
Statistically considered, Special Force met a more dangerous enemy in disease than in the Japanese Army. Clinically analyzed, it was more severely injured by malaria and dysentery than by bullets and grenades. Tactically appraised, its battle worthiness was determined by its medical discipline more than by its courage.
During the first 45 days of the campaign, little evidence appeared that health factors would affect combat maneuvers. Then the plight of the l6th Brigade offered an ominous but little heeded warning. The major cause of its inability to capture Indaw probably was its exhaustion after the long and difficult march from India. But the inconsequence of its subsequent actions and its wholesale evacuation back to India were due to rapidly rising rates of disease and disability.
The loss of the l6th Brigade apparently produced some regrets but no surprise or change in plans for Special Force. It had always been assumed that long range penetration groups would be "used up." However, the brigade had not been severely engaged by the enemy. It had not encountered special health hazards, such as a region from which scrub typhus infection could be acquired. It had not survived
into the monsoon season, when admittedly bad environmental conditions became infinitely worse. Therefore, it might have been asked whether its high sick rates could be sufficiently explained by exhaustion. This factor, it might have been thought, would lower the resistance of the brigade to all kinds of diseases. But as a matter of fact, malaria and dysentery were so prevalent that all other conditions (including battle casualties) could have been ignored in determining whether or not to evacuate the brigade. Both diseases were controllable, if not preventable, by medical measures and by military discipline.82
The fate of the 16th Brigade notwithstanding, plans made at the end of April assumed the existence of a still-vigorous force. The strongholds were to be evacuated. The Chindits were to move rapidly northward to assist Stilwell. The 111th was to put down a strong roadblock south of Mogaung. The 77th and 14th Brigades, moving swiftly by different routes, were to reinforce the 111th if necessary, and to attack Mogaung. The 3d West African Brigade was to be deployed as needed in conjunction with the other brigades. Although these brigades were depleted by about one-fourth, the planning documents and conference notes did not suggest any alarm or doubt. Tentatively, it seemed likely that the 77th Brigade--up to then the most strenuously active unit of the Force--would be due for relief after the capture of Mogaung. The other brigades, however, were positively listed for continued service under Stilwell during the summer.83
Two weeks later, these movements were in train, with no notice of any particular health problems.84 But in another 10 days the picture was rapidly changing. The 111th Brigade was in difficulty at its stronghold and the reinforcing columns of the 77th and l4th Brigades were still not in touch with it. In messages and then in conference, the Force Commander sought Stilwell's permission to give Masters, the 111th Brigade Commander, discretionary power to abandon Blackpool, if to do so would mean the difference between destruction and survival.
Stilwell was suspicious. Was the 111th really so hard pressed? Would its situation be any better, really, if it left Blackpool and attempted to scramble through the jungle, in an area where enemy strength was great? Were the 77th and 14th Brigades making all possible efforts to move into striking position? Stilwell had already complained that the 77th failed to move northward immediately upon being ordered to do so, and was unduly slow in completing the march. In a climactic confer-
82See General Officer's analyses below.
ence on 25 May,85 Lentaigne and Stilwell debated the issues. Stilwell reluctantly conceded discretionary power to the 111th Brigade Commander. Then Stilwell learned that on that very day, at an hour he could not discover, the 111th had left the roadblock. He was convinced that Lentaigne had deceived him to cover up the flight of the 111th in advance of Stilwell's permission to leave its post.
No reasons exist to doubt the integrity of the 111th Brigade or the Force Commander. Although the brigade was reported to have had nearly 2,000 effective troops when it left Blackpool, it had incurred 325 casualties in the preceding 24 hours, and it carried 200 men on litters when it went into the jungle. It knew that the Japanese were bent on eliminating the roadblock and had brought up enough troops and artillery to do so. Bad weather and enemy action had severely reduced the air supply effort, and it was obvious that no relief could immediately be expected from the other brigades.
Equally, Stilwell's position was well justified. The roadblock seemed vital. All his success up to that time involved attacks on the enemy rear by a mobile striking force while the main body of the Chinese infantry drove hard against the enemy's prepared positions. He believed the Mogaung area to be vulnerable, and it was imperative to prevent the Japanese from reinforcing it. If Special Force had not been created for just such a purpose, he thought, what, then, was its use?
On these terms, two determined men, Lentaigne and Stilwell, argued inconclusively. But into the debate Lentaigne inserted a new point, the health of the troops. In addition to the perilous shortage of supplies and ammunition which had developed as the Japanese (and bad weather) took command of the airstrip, the 111th faced the inability to evacuate its rapidly accumulating sick and wounded. Although this difficulty seemed to be less urgent than immediate tactical problems, Stilwell later mentioned it as one of the reasons for assenting to Lentaigne's arguments.
The point was more strongly advanced immediately after the conference of 25 May. Lentaigne suggested that Special Force had better wind up its affairs at once to avoid annihilation. It was no longer possible, he thought, for his troops to join the Chinese in a concerted attack on Kamaing and Mogaung. The distance was too far for the weary Chindits to march into battle, and the Chinese were not advancing fast enough to close the gap. Further independent action by Special Force was prohibited by the numbers and concentration of the enemy. The only recourse was for the brigades to evade the Japanese and go as quickly as they could to Stilwell's lines of communication at Myitkyina airfield or north to Mogaung. Unless they did so before the monsoon
85"Summary of Conference held on 25 May 44," signed by H. T. Alexander, Stilwell Papers, Folder 7; FE Hq NCAC, "Notes on 111th Brigade," 25 July 1944, Stilwell Papers, Folder 4; untitled memorandum, Hq Fwd Ech NCAC, 25 July 1944, Stilwell Papers, Folders 4 and 160; Stilwell Diary, 25 May 1944.
rains came down in earnest, they would be isolated and unable to evacuate their sick and wounded.86
From this time onward the controversies regarding the fate of Special Force referred significantly to the increasing numbers of sick men and to the difficulty of evacuating them. When the 111th left Blackpool, Stilwell ordered it to remain in the vicinity to harass the enemy. It shifted to Indawgyi Lake, north of its roadblock position. Whatever Stilwell expected of it, its first concern was to send out its invalids. The 77th Brigade, criticized for alleged procrastination or disobedience late in May, not only claimed ambiguity in the order Stilwell had given it, but also reported that its troops were incapable of sustained and rapid movement. As the monsoon closed down and the brigade took up positions below Mogaung, references to its sickness rates were invariably included in discussions of its plans and operations.87
In the first week of June, Stilwell ordered the brigades to deploy for the final assault on the Kamaing-Mogaung line. The losses in Special Force were reckoned up before the movement began. The 14th Brigade had lost 151 men to sickness; 71 had been killed, 95 wounded, and 27 missing. In 77th Brigade, 269 men had been evacuated because of sickness. Its battle casualties numbered 172 killed, 415 wounded, 84 missing, and 11 captured. The 111th had had 58 killed, 157 wounded, and 49 missing; nearly as many--218--had been lost to disease. The section of the 111th which operated separately in the east--"Morris Force"--reported that its sick evacuees totaled 100, in addition to 24 killed and 49 wounded. The 3d West African Brigade, least heavily involved, reported 19 killed, 30 wounded, 33 missing, and 77 evacuated because of illness. The total came to 2,000 officers and men, 40 percent of whom had been felled by disease--and the monsoon and the hardest fighting had just commenced.88
On 11 June, the 77th Brigade reported that its action in the Mogaung area had become extremely costly. Five days later, it warned Stilwell that it had little left to go on. Unless the Chinese soon arrived, it would be forced to escape into the hills, perhaps with no more than 500 effective troops remaining.
Stilwell's headquarters was skeptical. It noted that the 77th Brigade casualty figures of 3 June came nowhere near the losses being claimed by mid-June, and that the brigade strength report of 24 June listed 137 officers and 3,334 other ranks. The disparity, it appeared, could be explained by taking account of the actual physical condition of the men in the field. Most of those still called fit were succumbing to the effects of
86Memorandum by Lentaigne dated 2 [sic] May
1944, Stilwell Papers, Folder 7. The contents indicate it was written on
or within 2 days after 25 May.
incessant rain and mud, were bone-weary, and were acutely or subclinically sick.89
Similar reports were coming in from the 111th Brigade, the 14th Brigade, and Morris Force, but these reports notwithstanding, Stilwell was increasingly dissatisfied with Special Force. Consultations between Mountbatten, Slim, and Stilwell from June 6 onward led to support for Stilwell in his arguments with Lentaigne, but there was an increasing effort to persuade Stilwell to let most of Special Force leave Burma.90 These interchanges led to another conference on 30 June. Special Force, Lentaigne insisted, was overdue for relief. The 77th and 111th Brigades were in a "very exhausted state and their stamina so lowered that they were unable to resist disease and sickness * * * Only about 350 men of these two brigades are really effective."91 Mogaung had fallen on 26 June. Mop-up operations should be left to the Chinese. Special Force had done its duty.
To this representation Stilwell replied repeatedly that he had no intention of keeping sick men on the line. But the Mogaung area still contained enough enemy troops to reinforce the stubborn garrison at Myitkyina, and it was possible that the enemy might attempt to send in other forces to recapture Mogaung. Until the entire area was secure, the whole campaign was jeopardized. He demanded that Special Force remain in the field, and pointed out that its currently-reported strength still warranted expectations of effective, if limited, action.
The debate finally centered upon the question of the health of the troops. With Mountbatten presiding, Stilwell and Lentaigne agreed to conduct a medical survey of Special Force. The sick and "unduly weak" should be promptly removed. The remainder should help isolate Myitkyina by patrol and roadblock operations below Mogaung.92
While waiting to hear the results of the medical survey, Lentaigne irritated Stilwell by once more asking for immediate evacuation of the 77th Brigade because of its ill health and fatigue. Rebuffed, he next asked Stilwell to authorize the 77th Brigade Commander to cease operating and to send out all who appeared unfit. Stilwell replied by a terse message that Lentaigne was to carry out orders. Calvert's reaction, on behalf of his 77th Brigade, was the statement (as reported to Stilwell): "Can not anyone realise that we are finished and fought frantically to the end before we defeated the Japs and that when we beat the Japs they remain beaten."93
89FE Hq NCAC, 25 July 1944, "Notes on
77th Brigade"; untitled memorandum, 25 July 1944, Stilwell Papers,
Folders 4 and 160; Stilwell Diary, 15 June 1944. Also, see pertinent sections
At this juncture, the Force Medical Officer, Colonel Officer, summarized the medical situation. He had not, he wrote, been able to keep fully in touch with the brigades because bad weather had often prevented flights to the combat area and because field officers failed to send weekly reports despite urgent reminders to do so. However, on the basis of such visits as he had recently made to some brigades, to field hospitals, and to air clearing centers, he reported:94
[The] state of health in all Bdes is very much the same and is, taken all around, extremely poor. All have lost anything from two to three stones in weight. Morale, while high, is highest in 77 Bde which is accounted for by their recent successes in action. The incidence of fever is steadily rising and there are few men who have had less than three attacks of malaria. The majority have had as many as seven attacks, and all have been treated within their columns.
With the onset of the rains men are constantly wet, both day and night, and have little or no chance of getting dry. Paths are in many cases waist deep; and foot rot and prickly heat, which very quickly turns septic, have become rampant. Deaths from cerebral malaria and typhus fever are common and on the upgrade, and the S.M.O. of the 14th Bde in a report says: --"in a week or two's time the number of deaths due to sickness will absolutely stagger the authorities. But we have sounded the warning, don't blame us. Soon the sickness will be quite beyond our control. Eleven deaths from fever at Plymouth last week." While one of his M.O.'s in a report of the same day says:--"General health is undoubtedly deteriorating at a rapidly increasing rate due to (1) the frequent occurrence of short rations and (2) the continued wet weather."
Officer went on to say that since the l4th Brigade had left the area where scrub typhus was a threat, some improvement had occurred. He reported that the Morris Force near Myitkyina was severely debilitated. Weight loss, anemia due to malaria, and fatigue had reduced its marching capacity to about 5 miles per day, with half-hour rest stops after every hour of exertion.
He concluded that the Force should be withdrawn as soon as possible. It was especially necessary to do so if the troops were ever to be redeployed. At best, he thought, they would need to recuperate for 3 months before they could return to duty.
The medical surveys were carried out between 11 and 23 July. Meanwhile, the controversies over the effectiveness of Special Force continued. Lentaigne took Calvert to meet Stilwell, hoping to obtain a better hearing for the case of the 77th Brigade. Calvert explained that he had used his last 70 effective troops to enter Mogaung; and that "after this my men were completely exhausted and flat on their backs." The
94"Medical Report--3rd Ind Div," 10 July 1944, Stilwell Papers, Folder 4.
disposition of the brigade afterward, which had not accorded strictly with Stilwell's orders, resulted from the absolute inability of the brigade to maneuver any longer. Calvert felt that he and Stilwell had come to an understanding. "All very polite," was Stilwell's dry comment.95
On 14 July, Lentaigne asked Stilwell to relieve "Morris Force." It was wasting away. Its principal officers were sick and on the verge of hospitalization, whereupon the Gurkha troops would be left without sufficient British leaders. He regretted that the unit would not be able to stand by until Myitkyina fell, but it was merely using up air-supply potential without results.96
The Supreme Allied Commander, Mountbatten, sent Stilwell some pointed advice next day. At Stilwell's "very earnest request," he wrote, he had "broken his promise to L.R.P. Brigades." He was "forcing them to stay in long after Wingate, or his successor Lentaigne, considered was either right or feasible." On the original schedule devised by Wingate, the 77th and 111th Brigades should have been relieved by 1 June and the 14th and 3d West African Brigades would have been out of Burma by the end of that month. Mountbatten did not renege on the 30 June agreement to leave Special Force in Burma. However, he reminded Stilwell that the fall of Myitkyina should be the signal for removing whatever remained of the 77th and 111th Brigades, and that the other two units should be released soon afterward.97
Four days later, on 19 July, Stilwell summoned Lentaigne for a conference about apparent disobedience of the 111th and 14th Brigades. He opened the meeting by reading an order Lentaigne had issued the day before, directing the 111th Brigade to break off an attack and move to Kamaing, in order to evacuate its sick and wounded, and instructing the 14th Brigade to change its position in order to relieve the 111th. Lentaigne acknowledged that he issued the order on his own initiative.
Stilwell: I have never objected to getting out of the sick and wounded. I do object to a change in missions.
Lentaigne: I had to do it * * * I had to take action to safeguard my men.
95Typescript, "Comments of Brigadier Calvert,"
11 July 1944, Stilwell Papers, Folder 4. The account is unsigned, but it
is evidently out of Stilwell's office: a penned note on it says Lentaigne
and Calvert were uneasy and anxious to leave before Stilwell raised certain
questions about obedience to orders. Also, Calvert, pp. 250-251. The hostility
in the air was partly due, the British believed, to the ignorance and malice
of one of Stilwell's staff officers. He persistently misrepresented the
work and attitudes of Special Force, they believed. References scattered
among the entries of June in Stilwell's Diary confirm this possibility.
Calvert pp. 226, 230, 241-242, 247; Masters, pp. 244, 261-262, 282-283;
Stilwell Diary, 11 July 1944.
Stilwell: Certainly. We must all look out after our own men. I intend to make a case out of this. You are not obeying orders. You have not made an effort to keep me informed.
Lentaigne: You have been away a good deal of the time.
Stilwell: Yes, but I do not recall any efforts to contact me. * * *
Lentaigne: I felt that I had to do it because it was desperate. * * *
Stilwell: We have tried to get to Taungni. [Your] new orders have been issued to relieve one unit making an attack and to move in another unit that, I thought, was on another mission. I do not see why we should give up the ghost when there are 5300 effective men [remaining in the two brigades].
Lentaigne: The 111th Brigade is absolutely finished.
Stilwell: It is agreed that the sick and wounded should be evacuated. I cannot see why you issued these orders.
Lentaigne offered to rescind the order, since the two brigades had not completed the change in position. Stilwell, in turn, acknowledged this effort to relax the tension by asking his chief of staff whether there were any Kachin auxiliaries available who could help move sick and wounded men. There were none, apparently, and all Chinese transport troops were in use elsewhere. * * *
Stilwell: I understand how you feel about the sick and wounded. We all feel the same way.
Lentaigne: The big question at the moment is taking care of the wounded. The remaining effectives are in very bad condition themselves. The feet are absolutely raw on some of the men. They have been wringing wet for a month or more. There is no sunshine in those jungles. Another thing we have just found is that almost every man is full of worms. This is probably because they have been on "K" rations ever since they have been in. Malaria is a constant source of trouble, the men are taking from three to four atabrine tablets every day. There are many deaths due to sickness.
Stilwell then asked about the reliability of the troop strength reports he was receiving. Lentaigne answered that the reports were accurate as to numbers, but "they are all sick. On a recent visit to the [111th] Brigade they were actually rude to me concerning their condition of sickness. Those men are carrying 20 lbs on their back. They are nothing but skin and bones, plus all the other forms of sickness."
Stilwell said again that the unit must hold its position until ordered to do otherwise, but that the sick and wounded "will be withdrawn."
Lentaigne: The doctors would now say that the unit is 100% unfit.
Referring again to a recent strength report, Stilwell remarked, apropos of the picture Lentaigne had just drawn of the 111th Brigade,
that it was the 14th rather than the 111th which seemed to have more unfit troops. Why was that? he asked.
Lentaigne's chief of staff, Brigadier H. T. Alexander, answered:
That is because the doctors are not so strict in their inspection in the 111th.
Lentaigne: The main trouble is the lack of officers. I will do my best.98
Immediately after the conference, Stilwell issued orders to Lentaigne to proceed on the missions assigned "to the best of your ability * * * Ineffective, sick and wounded, will, as before, be evacuated. All effectives * * * will continue on the mission assigned."99
Still later on 19 July, Lentaigne sent Stilwell a new strength report, incorporating the results of the medical surveys.100 According to the column medical officers, the figure of 5,300 effectives used earlier that day was erroneous. No more than 3,700 officers and men were fit for action. Three-fourths of the 77th Brigade was permanently or temporarily incapacitated; the latter, too, should be hospitalized as soon as they reached India.101 The 111th Brigade had only 722 officers and men listed as fit for duty; over 1,100 were seriously or temporarily unfit because of sickness. The 14th Brigade was down to a strength of 60 officers and 1,100 men, not counting those ready for evacuation. The 3d West African Brigade, much better off than the others, still had a sick list equal to one-third of its strength. Comments by medical officers on the statistical picture included such remarks as: "near mental and physical breakdown", 50 percent of the fit have foot rot; the fit men are at 40-60 percent efficiency; "Coln comd states men will not attack further. Only outstanding officers can lead them", 70 percent of the fit are weak from previous diseases; sick rates "rising alarmingly."102
In view of these circumstances, Lentaigne again gave priority to the problem of evacuating the sick. He notified Stilwell he was, in effect, reinstating the cancelled order to relieve the 111th and replace it by the 14th Brigade. Once more, Stilwell reacted angrily. But Mountbatten immediately sent him a radio message in which he confirmed the need to evacuate the 77th Brigade and Morris Force in their entirety, as well as all who were unfit in the other brigades. He did not consider the 111th Brigade should remain any longer, either, and he instructed Stilwell to remove the 14th and 3d West African Brigades as soon as the British 36th Division--already under movement orders--appeared.
98"Record of Meeting between General Stilwell
and General Lentaigne," 19 July 1944, Stilwell Papers, Folder 4. Lentaigne's
disputed order of 18 July 1944 is also in Folder 4. Stilwell's diary entry
for 19 July 1944 is terse and unfriendly.
Finally, he called for another conference to clear up "misunderstandings." Under the eye of Gen. Albert C. Wedemeyer, who represented Mountbatten, Stilwell and Lentaigne compromised their differences reluctantly. No one of the 77th Brigade remained except the "muleskinners"; they were to be sent out forthwith. The 14th Brigade would cover the 111th while it evacuated its casualties, but the attack on Taungni would continue. The 14th and 3d W.A. Brigades were to remain with Stilwell until after the fall of Myitkyina, but Lentaigne was to keep Stilwell fully informed regarding their physical condition.103
So ended the history of Special Force. It was overwhelmed by disease. The few not actually sick enough for hospitalization were despondent and, in fact, had all the conditions for acute sickness--malnourishment, skin disorders, vitamin deficiency, utter fatigue. The statistics used on 25 July 1944 to reach the final decisions, are printed in the notes.104 They vary in detail, but not materially, from those presented in the concluding section of General Officer's Report, and from those elsewhere published. The number of troops admitted to hospital for sickness was one-third of the troop strength; the number of sick who were hospitalized was three times the number who were admitted for wounds (and, of the latter, a large number were also ill); and of the troops still classified as "fit," the majority were ill and would be hospitalized after leaving Burma.
103Stilwell Diary, 20, 21, and 25 July 1944;
radio message, Mountbatten to Stilwell, 22 July 1944, Stilwell Papers,
Folder 4. The untitled memorandum of 25 July 1944, with its "Notes"
on the 14th, 77th, and 111th Brigades, apparently was designed to indicate
the salient actions of the several parties to the various controversies.
A memorandum of the conference, dated 25 July 1944, is signed by Stilwell,
Lentaigne, and Wedemeyer, Stilwell Papers, Folder 4.
The summary figures in Mountbatten's final report were as follows: 1,035 killed; 2,531 wounded; 473 missing; 7,217 hospital admissions, 75 percent of which were due to disease. Of those examined in the medical survey, 50 percent were declared unfit for active service: South-East Asia, p. 75. Crew, V, p. 195, gives 944 killed, 2,434 wounded, and 452 missing.
The health of the command diminished precipitously after the middle of May, even before the monsoon rains aggravated the dangers of the environment. Tactically, the key to the situation seems to have been the deployment of the brigades in relatively stationary positions. After the engagements around White City, the 77th Brigade showed signs of deterioration. At Mogaung, it collapsed rapidly, although the victorious end to the battle kept up morale.105 The 111th Brigade never recovered from the punishment it took at Blackpool.106 Its morale was low. After it evacuated its casualties and went into action around Kamaing it won little but criticism. The 14th Brigade lost men to disease at a rising, but relatively even rate, while it was patrolling and marching south and west of the Kamaing-Mogaung area, as was also the case for Morris Force, southwest of Myitkyina. But when these units were called upon in June and July to settle down to relatively immobile tactics, their effectiveness dropped markedly.
105According to Calvert, p. 170, "Our hospital had been filling with sick and a few wounded," during the interval between leaving White City and attacking Mogaung. In this period, the Brigade was maneuvering northward in an effort to contact the 111th Brigade at Blackpool. When the 77th left White City, its strength was calculated to be 2,277; the White City operation had cost it 748 killed, wounded, and missing. In addition to these casualties, there were 279 sick men who were evacuated (Calvert, p. 144). Calvert also furnishes the figures for the operations between White City and Mogaung, and at Mogaung (p. 282):
The figures show that the 77th lost 572 killed and wounded in its march and patrol actions between the engagements at White City and Mogaung. The severity of its combat efforts at Mogaung is shown by the casualty figure of 849 killed and wounded. Its sickness rates were high, compared to those of the White City operations. To get to the Mogaung area cost the 77th 369 men who died or were evacuated with disease. In the Mogaung area, prior to the complete withdrawal of the 77th, almost 44 percent of that number--161--was added to the sick-evacuated list. But in addition, as Calvert and others testified, over 50 percent of those remaining were subject to medical evacuation when they were finally surveyed en masse. And of the men still listed as "fit," another 50 percent (25 percent of those who were surveyed) were hospitalized after returning to India.
106Masters reported that at Blackpool the situation was complicated by a rapid increase in malaria and dysentery cases, and that afterwards, while evacuating patients at Indawgyi Lake and in the maneuvers for position around Kamaing, the 111th failed rapidly. Immediately upon leaving Blackpool, Masters reported he had 150 men for evacuation. Actually, at Indawgyi Lake, some 600 men were sent out, evidently because of sickness in two-thirds
Three reasons may be offered to explain this phenomenon. First, the morale of the Force was derived from its conception of itself as a hit-run striking team. Associated with the Chinese and American forces in more conventional and sustained warfare, late in the cam-
of the cases. At this point, there occurred "a fearful falling off in general health," although the unit was inactive. Malaria cases, while still relatively low, doubled in number compared to earlier weeks. The medical officers began to speak of near-fatal depths of "exhaustion, undernourishment, exposure, and strain." Ordered again into action, Masters began asking for medical relief. Probably not knowing that Lentaigne was making similar demands for the entire Force, he believed that it was his reiterated messages which finally resulted in action (Masters, pp. 260-262, 272-273, 276). A strength report of Special Force (quoted below) covering the period from March through May indicated that the 111th had lost 264 killed, wounded, and missing, and 218 sick evacuees. Between the fall of Blackpool, then, and the medical survey of mid-July, all but 118 officers and men among 2,200 troops succumbed to medical disabilities.
Finally, the effects of the campaign after the White City and Blackpool engagements may be suggested by comparing the following table of casualties up to June with the final table of 25 July. The figures are given in "Strength and casualty reports 3d Ind Div," Stilwell Papers, Folder 4:
Such a comparison suggests that units which fought most lost fewer men because of disease. One reason might have been that battle casualties received priority in evacuation; another that treatment of minor diseases in the field was more common than treatment of minor wounds. But while these factors would affect the ratio of evacuation due to wounds versus disease for short periods, in the long run it would seem sound to suggest that the operational health of the troops remained highest when they were in combat. The 77th Brigade is the example. Similarly, the whole Force was more nearly a mobile striking unit prior to 3 June than afterward. Up to that time, as the figures just cited show, the ratio of battle casualties to sick evacuees was 1,294 to 815. In the more nearly static operations in the Kamaing-Magaung area, and in the same monsoon conditions which beset all units, 77th Brigade, the most heavily and successfully engaged, maintained the primacy of battle casualties over sick evacuees (although by a much smaller margin than before). But in the rest of the Force, the ratio was rapidly reversed until it was overwhelmingly weighted toward disability due to sickness.
paign, the officers and men felt misused. In turn, medical as well as other forms of discipline were relinquished. The will to stay well diminished more rapidly than did the will to fight well.
Second, the monsoon rains produced severe tests of Force morale and medical discipline. Insect carriers of disease, contamination of water supplies, difficulties in disposing of fecal wastes, and conditions producing skin disorders rapidly multiplied. These increased odds against health appeared at the time when, for other reasons, the Force was least prepared to resist them.
Finally, the accumulated strains of the campaign, appearing in the generalized form of weight loss, listless appetite, avitaminosis, and fatigue were, of course, concentrated in the late weeks of action. With mental and physical powers depleted, environmental hazards sharply increased in terms of discomfort as well as disease, and the sense of mission and self-respect diminished by conventional deployment, Special Force broke down. Its losses to malaria and dysentery especially revealed the relationships among environment, battle-weariness, and morale. With respect to dysentery and allied conditions, low standards of sanitation had already cost the troops dearly by the end of May. As they entered the relatively static phases of action, opportunities for self-contamination greatly increased, as compared to the situation when the troops were on the march most of the time. With discipline declining, sanitation suffered. Only the most rigorous care, backed by training and desire, could have held down the rates of enteric disorders to acceptable levels.
The situation is even clearer in the case of malaria. Here, infection was difficult to prevent under the field conditions which were imposed on the Chindits. But even accepting the troops' belief that total suppression of the clinical manifestations of the disease could not be produced even by perfect Atabrine discipline, still, according to overwhelming medical evidence, wholesale breakthroughs could be explained only by the failure of morale. The malaria rate became appreciably high in April. In May and June, limitations on the facilities for evacuation, plus treatment "in the line," kept down the reports on the disease, although its incidence was actually rising. In July, however, the rate ran twice as high as in the May-June period. In August, the rates were from six to nine times higher than they had been in April. There is no possible conclusion except that Special Force broke medical discipline and deliberately, or as a consequence of despondency and indifference, gave up the suppressive benefits of Atabrine.
Like their predecessors of 1943, the Chindits of 1944 deserved all the praise they ever received for a bold venture in jungle warfare. But what more might they not have achieved had as much care been taken with their health as with their honor?
Hygiene and Sanitation
The mention of this subject [hygiene and sanitation]107 to officers and men more often than not produces in them a sense of tolerant amusement intermingled with boredom. It is not sufficiently realised, even by the more senior officers, that hygiene is not only a matter of discipline, but is in fact one of the basic factors upon which discipline is built. It is personal discipline as opposed to collective discipline, and its absence in the individual merely produces an absence of it in the aggregate, which is the unit.
Further, it is a matter of man management, and in the same way as the proper grooming and care of a horse or the regular care and maintenance of a vehicle is essential to its efficient running so with the man. Unless his welfare receives constant attention sickness and ill-health are bound to ensue. It can be said without any chance of contradiction that in those units where hygiene and sanitation is poor or lacking, the officer commanding has neglected the interest and welfare of his men and is unfit to command.
Finally, the standard of hygiene and sanitation is not only an indication of the discipline within the unit but also the standard of upbringing and habits to which the individual is accustomed, and is consequently a direct personal reflection on the commanding officer and his officers.
General Sir Archibald Wavell when Commander-in-Chief stated--"Disease and especially malaria is a more dangerous factor than enemy resistance. We must be prepared to meet malaria by training as strict and earnest as that against enemy troops. We must be as practiced in our weapons against it as we are with a rifle." The truth of this statement with regard to malaria applies equally to all diseases.
It has been proved that the defeat of the German Armies in North Africa was in a large measure due to their appalling sickness rate as a result of their complete lack of sanitation and sanitary conscience. Their incidence of enteric and dysentery was over 50 percent of their strength whereas that of the victorious Eighth Army as a result of the constant attention given to this important aspect of warfare was infinitesmal, and one of the deciding factors of the whole campaign.
The truth of this is amply borne out in this Force from a study of the detailed analysis of the casualties during the campaign under review.
As will be seen, the incidence of preventable disease far exceeded the number of casualties inflicted upon us by the enemy. Training therefore in the prevention of disease must be given top priority and be treated as any other battle drill, the object of which is the attainment of the objective with the least number of casualties, and training must be sufficiently intensive to ensure that all personnel can be relied upon to maintain it unsupervised during the period of active operations.108
107Rearrangements by the editor have brought
together these sections of the Report on hygiene, battle casualties, and
sickness. The editor has supplied the chapter title.
Hygiene and sanitation.--During the training period the standard of sanitation in the Force was exceedingly poor. The necessity for the rapid training of personnel in Long Range Penetration tactics absorbed the attention of commanders to the exclusion of almost all other considerations, and sanitation was one of those which had to occupy a subordinate role. The trained sanitary personnel of a unit, if fit, were removed from their ordinary duties to increase the fighting strength of the columns. Unfortunately no adequate provision was made for their replacement, and the cleanliness of camps became the responsibility of fatigue parties, which were constantly being changed. This resulted in a lack of interest which, combined with their ignorance of even the elementary principles of sanitation, led to a disgraceful state of affairs. Every excuse was seized upon to provide an explanation--the nonavailability of wood and nails, the shortage of manpower to attend to sanitary duties, and the difficulties experienced in constructing latrines and soakage pits owing to the rocky nature of the subsoil stratum. That these explanations were indefensible was shown by the higher standard of sanitation existing in adjacent campsites, where improvisation and ingenuity had been used to overcome these obstacles. Moreover, the filthy state of cookhouses, and the gross negligence displayed in the disposal of kitchen refuse and mule litter, heightened this impression. It was not realised by Commanding Officers that if sufficient time and consideration had been directed in the first few days of occupation to the erection of proper sanitary structures their maintenance would have entailed much less labour than the constant repair of already defective installations.
This lack of consideration for the fundamental rules of sanitation was also apparent in regard to antimalaria precautions. At one time during the training phase 70 percent of the personnel of one brigade were admitted to hospital from malaria in a period of 6 weeks.
It is regrettable to state that the medical officers meeting with a difficult situation which appeared to them insurmountable gave up the unequal struggle of trying to improve things and allowed themselves to fall to the low standard set by the men.
After perusal of the January report of the D.A.D.H.109 on the hygiene and sanitation of the Force, the D.M.S.110 in India expressed his strong disapproval of the appalling state of sanitation within Special Force. Some attempt was made to rectify the existing position, but only a few weeks elapsed before the brigades had to move to the operational area, and little change could be effected in the attitude of officers and men.
Hygiene and sanitation during operations.--During operations, as was to be expected, the observance of the principles of hygiene was even less than in the training area if such were possible. The example set by officers was extremely low and this is not surprising in view of the policy laid down in re-
109Deputy Assistant Director, Hygiene.
gard to this important subject by the late Force Commander111 in his training pamphlet, which reads:
"(m) Comfort in Bivouac.
Except when the bivouac is occupied and evacuated within the same night, strict orders must be issued regarding use of latrines. The object of this will be to prevent flies and other annoyances. It will, however, be a waste of labour to dig latrines unless the bivouac is to be occupied for more than one week. Men should carry out their functions at distances not less than 100 yards from the perimeter."
This lack of attention to hygiene was no less marked in regard to antimalaria measures and the resultant sickness rate reached a high level, even greater than an estimation of the statistical data outlined below relating to hospital admissions, would appear to indicate. Many of the patients who contracted any of the principal preventable diseases, were treated in the columns and were not evacuated to hospital, [and] therefore do not appear in the statistics outlined below.
The following observations were made by Majors Kelly, I.M.S. and Evans, R.A.M.C., the surgical specialists at the C.M.H.112 Panitola at which hospital the majority of battle casualties were received.
General conditions.--This on the whole was surprisingly good although almost all the patients were very thin and many were infected with malaria. The general condition of the wounded was often better than those men who were admitted to hospital with conditions not due to enemy action, i.e., medical cases and jungle sores. The most outstanding feature however was the contrast between the British and the Gurkha casualties.
The British wounded had obviously been through an ordeal. They were generally underweight and haggard in appearance. Jungle sores and tinea infections were complications in a high percentage of the wounded seen.113
111General Wingate. In this matter, Wingate
was as up-to-date as Moses (Deuteronomy 23: 10-12). The spirit of the patriarch's
command regarding camp sanitation seems more positive than Wingate's.
The Gurkha on the other hand appeared little affected by the hazards of the campaign. Skin complications and jungle sores were seldom seen and their general constitution appeared not to have suffered.
West African troops fell midway between the two categories. Their general condition was good, but boils, ulcers, and skin infections were frequently seen.
Dehydration in lesser or greater degree was evident in most of the wounded in all three races.
Between 6 June and 15 August 1944, 706 battle casualties from 3 Indian Division were admitted to the C.M.H. Panitola. The evacuation of casualties had been carried out by air entirely. This rapid and efficient method of evacuation from the battlefield enabled many casualties to arrive in hospital the same day as they were wounded. This was not the general rule, as most of the cases had been wounded 2 or 3 days before admission and even on occasions as long as a week previously.114
Type of wound.--As would be expected in jungle fighting, shell wounds were extremely uncommon and grenade wounds of different varieties outnumbered the gunshot wounds by about two to one. The great majority of surgical casualties comprised wounds of the extremities, including compound fractures.
Wounds involving the thorax were next in order of frequency, followed closely by wounds of the head and neck. Penetrating or perforating wounds of the abdomen as usual constituted a very small proportion of the whole, the reason probably being that the high mortality in these cases occurred before they could reach the base.115
One case of tetanus occurred with a fatal termination.
114The fighting at this time occurred in the
Kamaing-Mogaung-Myitkyina area, in which air evacuation occurred only on
an irregular basis: see pp. 228-232.
Treatment in the forward areas.--This in the main was extremely good considering the general lack of facilities and was rightly confined to first aid treatment.116
In the early stages an occasional ambitious attempt at primary excision and suture had been made. The results were deplorable and in the majority disastrous. Excision was always inadequate and in some cases the skin and superficial fascia had been carefully excised but nothing had been done to the deeper tissues. Skin at all times is precious and in war wounds is relatively resistant to infection, and excessive removal is to be deprecated. Only badly damaged skin should be excised. On the other hand devitalized muscle which offers little resistance to infection was often left in situ and was doubtless the cause, with primary suture, of gas gangrene.
The value of incision of the skin and deep fascia above and below the wound, particularly in leg wounds, to allow of thorough inspection and removal of devitalized muscle, did not appear always to be fully appreciated.
As was always being impressed on column medical officers, the only surgery that should be attempted in the forward area is major surgery in the form of a lifesaving emergency, such as perforation of the peritoneum.117 Other surgery should be reduced to an absolute minimum and confined to first aid treatment, the arrest of haemorrhage, sprinkling with sulphanilamide powder and a Vaseline gauze covering and where necessary immobilisation. In this connection plaster slabs which are an excellent method of immobilisation, were in many cases too thin to be efficient. The suturing of war wounds in forward areas is only to be mentioned to be condemned.
The simple treatment mentioned above had in the majority of cases been carried out and proved on the whole satisfactory.
Records.--These in general were bad. If there were any notes, these were recorded on any available piece of paper. The importance of notes did not seem to be fully appreciated and their absence caused a great deal of inconvenience to the surgeons. In almost all cases it was impossible to find out if A.T.S.118 had been given and in consequence it had to be repeated in almost every case. Excision or nonexcision of the wound, the dosage of A.T.S., Antigas Gangrene Serum, and prophylactic sulphonamide should be clearly stated. In this connection the amounts actually given as opposed to the amounts ordered are of interest to the M.O.s who subsequently have to treat the case.
116When casualties from 77th Brigade at White
City became numerous, they were sent to the stronghold Aberdeen for air
transportation. Fergusson, the 16th Brigade Commander, requested and obtained
the services of a surgical team at the brigade aid station. A supply of
whole blood also was flown in (Earth, p. 92). In the 111th, Masters
recalls the case of an officer with a serious head wound who had to be
carried with the column for 5 days before air evacuation was possible.
The medical officer improvised a bamboo travois pulled by a mule. The wounded
man was unconscious all of the time. He was fed by a tube and catheterized.
"They did it with dirt-stained hands, in dusty jungle, among the blowing
mules and the sweating men, for we came across little water at this time"
It is not understood why Field Medical Cards were not used as the supply was adequate and they were available on demand. It can only be thought that the constant rain prevented them from being written up.
Treatment in the base hospital.--This followed the usually accepted principles of traumatic surgery, viz:--
1. Shaving and thorough cleansing of the surrounding skin.
2. Adequate wound excision, extraction of foreign bodies, manipulation and immobilisation of fractures.
3. Impregnation of the wound with sulphonamide powder and insertion of Vaseline gauze drains.
4. Immobilisation in plaster of paris.
Anesthesia.--Intravenous sodium pentothal proceeding to open ether if necessary was almost routine, and from the point of view of both surgeon and patient was eminently satisfactory and no theatre deaths occurred.
Resuscitation.--The majority of patients on arrival in hospital exhibited signs of dehydration and in many cases this delayed operation. While there was no lack of plasma the absence of an adequate supply of whole blood was markedly felt. Some form of blood bank service would have been of great assistance. With local units and personnel constantly changing, whole blood is not readily available.119 * * *
Statistics of the Operations
General considerations.--It must be emphasized at the commencement that the statistical data included in this report are based on admissions to base hospitals, and not on the actual number of sick and wounded which occurred in the operational area. Cases, which under normal circumstances would have been evacuated to Field Ambulances of C.C.S.120 were treated by the medical officer and retained with the columns. This applies especially to such diseases as malaria, dysentery, and minor maladies, for example, I.A.T.,121 tonsillitis, and so forth, which normally constitute a high proportion of the admissions to field medical units. In spite of numerous requests, information regarding these casualties was, with few exceptions, not forwarded by medical officers or was lost in transit.
Moreover, owing to the interference with the channels of evacuation by enemy action, several patients died before admission to hospital or when evacuation became possible had sufficiently recovered to rejoin their unit.
Consequently in any comparison with the sickness rate of other active formations, due consideration must be given to the above factors and allow-
119These remarks on hospital care of the wounded
are excessively condensed, but it may be recalled that the subject lay
beyond the immediate purview of the Force Surgeon, and that even Crew,
the official historian, goes no further into the matter. It is unfortunate,
however, that no details were collected from the column and brigade medical
officers regarding their handling of casualties, except, apparently, those
reported by Whyte of the 111th (Crew, V, pp. 216-232). General Officer
concludes this section of his Report with a few notes on certain items
of hospital supply and equipment which had not been satisfactory.
ances made for a much higher incidence of sickness and battle casualties than the following statistics represent. It is conservatively estimated that the actual number of men who suffered from malaria alone was at least 60-70 percent greater than the admission rate to hospital would indicate.
The second factor mentioned above, namely the interruption on the long lines of evacuation through enemy action, and the impossibility of removing casualties by air on account of inclement weather, must be taken into account when correlating these statistics with the various actions, localities, and general incidents of the campaign. For on occasions a delay of 2-3 weeks occurred between the onset of disease or the infliction of casualties and the subsequent admission of these patients to hospital.
Incidence of casualties from all causes.--The total number of casualties from disease and enemy action admitted to hospital during operations was 7,217. This represents an admission rate of 40.1 percent of the personnel engaged.
Of the total casualties, sickness accounted for 5,422 or 75.1 percent of the hospital admissions; battle casualties amounted to 1,795 or 24.9 percent of cases requiring hospitalisation. Sickness was therefore responsible for 30 percent of the whole Force requiring to be evacuated, and war injuries for 9.9 percent.
Incidence of casualties by ranks and nationalities.--The composition of the Force with regard to personnel was very cosmopolitan, and at various times contained the following nationalities: British, West African, Gurkha, Indian, Burmese, and Kachins. The last three nationalities, however, were represented by so small a minority that their numbers were insignificant, and their casualties have been included among those of the Gurkhas for the purpose of these statistics. The officers, almost without exception, were European. As will be observed from table 1, there was considerable variation among the casualties sustained by the various nationalities.
TABLE 1.-Incidence of casualties from all causes among officers and other ranks
The total admission rate of battle casualties for the Gurkhas is markedly higher than for other personnel. This is in no way surprising when it is remembered that only four battalions were engaged in the campaign, and
all took part, at some time or other, in more than one of the major operations; the garrisoning of Broadway, the protection and defence of Blackpool and White City, and the successful capture of Mogaung. Whereas with the exception of the British Columns of 77 Indian Infantry Brigade, few other battalions participated in more than one major engagement.
The sickness rate was lowest among officers and West African other ranks. While in the case of officers this calls for little comment, the manner in which the West African personnel underwent the rigorous physical and mental strain of 6 months' campaigning behind the enemy lines, was one of the outstanding features of the operation from the medical point of view. This fact became even more apparent on examination of the troops after their evacuation from Burma. The gaunt, sallow, emaciated condition of the B.O.R.s and the G.O.R.s was nowhere apparent among the West Africans.
Distribution of Principal Diseases by Ranks and Nationalities
British.--The incidence of every principal disease was highest amongst B.O.R.s (see table 2). The greater prevalence of malaria and dysentery in B.O.R.s in comparison with the incidence of these diseases among officers can only be attributed to the much lower standard of antimalaria and sanitary discipline amongst the former. This would appear to be substantiated by the more equal prevalence of infective hepatitis, typhus, and I.A.T., diseases against which little if any preventive measures can be undertaken.
TABLE 2 .--Comparisons by ranks and nationalities of the principal diseases which required admission to hospital
1The original typescript erroneously shows 2,760.-Ed.
The absolute necessity for the strictest observance of antimalaria precautions is amply demonstrated by the fact that one out of every five B.O.R.s engaged in the campaign required to be evacuated with malaria.
Gurkhas.--The incidence of malaria was appreciably lower among the G.O.R.s in comparison with the B.O.R.s. This could hardly be the result of a more efficient antimalaria discipline, as the standards observed by all ranks and nationality were poor in the extreme. A nonspecific immunity from numerous attacks in their lifetime together with acquired ability to tolerate the incapacity arising from attacks of this disease and thereby avoiding the necessity for evacuation, offers a more acceptable explanation. The occurrence of dysentery among the Gurkhas in comparison with the B.O.R.s was even less frequent than the incidence of malaria. The previous remarks probably apply with greater force to dysentery as the immunity conferred would probably be of a more specific nature. It is of interest to note that no case of [scrub] typhus fever was diagnosed among the G.O.R.s. From the available evidence, this may be accounted for by the fact that the brigades most affected with this disease did not include Gurkha regiments and presumably did not pass through typhus infected areas.
The incidence of skin lesions among the Gurkhas showed the same prevalence as in other nationalities. However, there was a very high proportion of tinea corporis which proved much less incapacitating than such varieties as jungle sores and other widespread septic ulcerations and lesions. In consequence, the number of personnel requiring evacuation was smaller than among other troops.
West Africans.--Attention has been drawn previously to the relatively low sick rate among the W.A.O.R.s and from a perusal of table 2 it will be observed that this was principally due to the much lower incidence of malaria as compared with other nationalities. This again cannot be attributed to excellent antimalaria discipline, but rather to a nonspecific immunity, in conjunction with an acquired ability to carry on while undergoing an attack of the disease. In this, they were probably helped, to a great extent, by the magnificent physique which most of the troops possessed. The dysentery and diarrhoea incidence was comparatively high, but this was to be expected from the poor standards of sanitation displayed in the training area. Although the general health of the West Africans remained good throughout the operations, after the monsoon commenced, I.A.T. became a problem of some magnitude, and at one time was responsible for more evacuations from this brigade than any other disease.
Incidence of Total Casualties by Brigades
The total number of casualties from disease and enemy action were distributed among the various Brigades as shown in table 3. As the strength of these formations and the period during which they were actually in the operation varied to a considerable extent, the figures are given in ratios per thousand per month for the purpose of comparison.
TABLE 3.--Total admissions to hospital due to sickness and battle casualties from the brigades comprising Special Force
1The figures should probably be 4,100 and 17,000. A change would require recalculation of the ratios: 1,759÷5.25 (months in action) ÷ 4.1 (thousands of troops) = 81.71; and so forth, throughout.-Ed.
111 Brigade.--Of the brigades which were required to undergo 5 months' campaigning, 111 Brigade had the highest admissions to hospital, principally due to their very high rate of sickness. The evacuation of casualties from both enemy action and disease mounted rapidly after the retreat from Blackpool, especially with regard to sickness. The latter can in part however be ascribed to forced marching through quagmires along swampy paths, and partly through a lowering of morale and discipline with a subsequent increase in malaria, dysentery and other preventable diseases.122 It is of interest to note that 68 percent of the casualties from malaria and 60 percent of those from dysentery in this brigade were evacuated after the fall of Blackpool.
16 Brigade.--The monthly evacuation rate from 16 Brigade was the second highest in the formation principally due to the high incidence of sickness (82.2 per 1,000). As this Brigade was engaged in the operational area for little more than 3 months in comparison with the 5- and 6-monthly periods during which the other brigades were operating, and was evacuated before the onset of the monsoon, this high figure of sickness is all the more surprising. Some consideration, however, must be given to the fact that this was the only brigade to march to their objective over steep jungle-clad mountains and along tortuous tracks, the surface of which greatly impeded movement and made marching an extremely arduous task. Consequently when these troops eventually contacted the other brigades, which had been flown to their objective, they were in the majority suffering from extreme exhaustion with its concomitant--a lowered resistance to disease. As a result, the sickness to the battle casualty ratio was the second highest in the Force.
14 Brigade.--From table 3, the ratio of sick to battle casualties was greatest in 14 Brigade. This was in a large measure due to the role allotted to this brigade during the campaign; continual arduous marching along tracks knee
122See pp. 252-255 the editor's view is a stronger one.
deep in mud, with only occasional skirmishes with the enemy, a pitched battle occurring as a rare exception. This is shown statistically by this formation's having the lowest evacuation rate of battle casualties. Moreover, this brigade suffered greatly from several minor epidemics of typhus in comparison with other brigades where the incidence was negligible.123
77 Brigade.--With regard to 77 Brigade, this ratio was highly creditable, almost as many battle casualties being evacuated as casualties from sickness, owing to the fact that this brigade adhered more strictly to the policy laid down that only those personnel who were unlikely to be of any further use for some considerable time, were to be flown out. While this policy was followed by the other brigades, it was much more stringently enforced by this brigade, to such an extent that some cases had suffered 12 attacks of malaria before they were evacuated, and a substantial number had 5 to 7 attacks. In consequence the hospitalisation of sick from 77 Brigade was the lowest recorded. In contradistinction, the battle casualty rate was the highest, owing to this formation's being engaged in more operations against the enemy than the others.
3 W.A. Brigade.--3 W.A. Brigade had the lowest admission rate to hospital of any brigade in the operation owing to the very small incidence of disease. In addition, the occurrence of battle casualties in any large number was rare as these troops were never engaged in any full scale operation apart from the defense of White City.
Distribution of Principal Diseases by Brigades
Table 4 shows the monthly distribution of the principal diseases among the various brigades.
14 Brigade.--Although of minor significance as far as the number of casualties which were evacuated was concerned, the disease which caused the greatest uneasiness in 14 Brigade was [scrub] typhus. The disease first
TABLE 4.--Average monthly incidence of principal diseases, by brigades, requiring hospital admission
123Arriving in the combat area several weeks later than the 16th, 77th, and 111th Brigades, the 14th Brigade lost much of its time and energy trying to catch up with the other columns, rather than engaging the enemy.
made its appearance towards the beginning of May, with a few sporadic cases which gradually increased in number during the month until approximately 40 cases had been evacuated, while another 12 died or recovered before evacuation was possible. Cases continued to occur in small numbers intermittently until the middle of August when a fresh outbreak occurred mainly confined to one battalion. From the evidence at present available it would appear that of the 60 cases which occurred from this period to the time when the brigade was withdrawn from operations, the mortality was over 30 percent. The serious nature of this disease with its prolonged fever, severe prostration, and general debility, together with its high death rate, was quickly recognized by the troops and caused a considerable degree of anxiety and loss of morale. Fortunately at no time did it assume epidemic proportions, although the possibility remained a constant threat throughout the campaign. Malaria accounted for 68 percent of the casualties from sickness evacuated from this brigade and I.A.T. was becoming a serious problem towards the end of operations, almost 250 cases being flown out during the last few weeks.124
16 Brigade.--Attention has already been directed towards the very high sickness rate in 16 Brigade although it participated in the campaign for only 3 months. Analysis of this sickness rate shows that over 75 percent of cases admitted to hospital from this formation was evacuated for malaria and intestinal disorders, two of the main preventable diseases.125 In spite of the allowances that must be made for the exhausted condition of the troops after their strenuous approach march, and the consequent lowering of the bodily resistance to disease, the statistical data would appear to indicate that the standard of sanitary discipline and antimalaria precautions leave room for considerable improvement in future campaigns. There were no cases of infective hepatitis or typhus, and I.A.T. was of little import as a cause of evacuation, as this brigade was withdrawn before the commencement of the monsoon.
77 Brigade.--In spite of the policy adopted by 77 Brigade to evacuate casualties from disease only as a last resort and when it was evident that the patient would be of no further use to the brigade, malaria was still responsible for over 50 percent of the cases requiring hospitalisation. Most of these patients had innumerable attacks of the disease and were in an extremely debilitated state. Dysentery was the lowest recorded in any brigade, but it is felt that this could be accredited more to the above policy regarding
124On scrub typhus, see Chinese Liaison
Detail, n. 153, p. 123. The first cases encountered by M. H. P. Sayers
and I. G. W. Hill were doubtless from the 14th Brigade; of 50 cases evacuated
in May, 15 died in the hospital. Between May and September, 132 cases were
reported from British troops in Burma; a number of these were from the
36th Division, which relieved Special Force in the late summer. A report
by J. R. Audy is a thorough review of all aspects of the disease as it
was encountered in Burma. The brief account of the disease in United Kingdom
Medical Series, Medicine and Pathology, pp. 18-20 and chapter VII,
relates to the entire British Army in Southeast Asia, as does that in Raina,
Official History, Medicine * * *, p. 548.
evacuation than to a higher standard of sanitation. Moreover, this brigade was continually on the move in comparison with other brigades, and their itinerary generally passed through areas where fouling of the ground had not yet occurred from the previous passage of other troops. The incidence of I.A.T. was also lower than that of any other brigade which remained in Burma during the monsoon.
111 Brigade.--The highest sickness rate was recorded in 111 Brigade. Of these casualties, 61 percent were due to malaria. Dysentery and I.A.T. were also more prevalent in comparison with other brigades. The greater incidence of disease in this brigade can hardly be attributed to any special circumstance which other brigades did not experience. It is generally appreciated that the amount of sickness in any unit or formation has a direct relationship to its morale and discipline, and there was abundant evidence that the morale of this brigade was extremely low on its withdrawal from Burma. After their expulsion from Blackpool, and subsequent long marching through quagmires in drenching rain, their fighting spirit was at a low ebb, and evacuation of the sick increased in inverse proportion. In sharp contrast was the casualty rate recorded in 77 Brigade, whose morale after their successful defence of the Renu block [White City] and the capture of Mogaung was at a very high pitch. A minor epidemic of 145 cases of infective hepatitis occurred in 111 Brigade, the cases appearing in a sporadic fashion at the commencement, and gradually increasing in frequency until approximately 90 cases required to be evacuated during the last month of operations.
3 W.A. Brigade.--The incidence of malaria was only 30 percent of the sickness casualties in the West African Brigade, and this was the only brigade in which a figure below 50 percent occurred. The European officers and NCOs of this formation were responsible for the majority of these cases. This surprisingly low malaria rate among West African other ranks cannot be attributed to any greater strictness or observance of antimalaria precautions and can only be explained by a nonspecific immunity of this disease already postulated elsewhere in this report. Dysentery and I.A.T. were comparatively high but 33 percent of the sickness casualties came under the heading of nonpreventable disease.
It should be here noted that in comparing the sickness rate from malaria in the European personnel of the West African Brigade with that of the British personnel in the Force, the incidence of this disease was 30 percent lower. This is attributed to the far better mepacrine discipline which through long usage had become a habit and there is no doubt that if this had been combined with the other necessary precautions the incidence of malaria would have been even lower.
Discussion of Principal Diseases During Campaign
Before entering upon a discussion of these diseases separately, the time at which they occurred during the campaign as shown in table 5 deserves consideration. Their incidence is shown in table 1.
TABLE 5.--Fortnightly incidence of principal diseases throughout the Second Burma Campaign, 1944
[Ratios per 1,000]
When the columns entered Burma and the evacuation of sick and wounded to base hospitals in India became feasible, the policy adopted was to retain personnel until disease lowered their efficiency to such an extent that they were of no further use to their unit. In this manner, manpower was maintained at its maximum level, and owing to the very high standard of health and endurance required in order to remain with the columns during its long and arduous marches, patients were evacuated before their general constitution was seriously affected. However, in spite of the gruelling nature of their task, the excellent training and physique of the men allowed brigades to carry on with a high proportion of men who, in other formations would have been immediately sent to a field medical unit.
This policy proved admirable for the first 10 weeks of the campaign. Then the strenuous nature of the operations carried on under extremely adverse conditions in conjunction with a diet which was becoming increasingly monotonous, began to exact its toll on the physical condition of the troops. Disease now became more rampant and the evacuation rate rose from 5 per 1,000 during the first fortnight of March to 43 per 1,000 in the first fortnight of May.
I am convinced that if the Force had been removed from operations at this period, before the onset of the monsoon, the appalling deleterious effects on the general constitution of the majority of the troops would have been avoided.
During the second fortnight of May the evacuation rate dropped to its lowest, apart from that of the initial fortnight. This was entirely due to the loss of the only available airstrip suitable for Dakotas, which were necessary for evacuation in any large numbers. Thereafter, casualties could only be removed from the columns by light planes, the activities of which were themselves seriously curtailed by the monsoon, so that reliance could no longer
be placed upon their regularity. Consequently, the monsoon adversely affected the health of the formation, in two ways:
1. Directly, by increasing the difficult conditions under which the troops were living and fighting--constant marching in drenching rain and sleeping on sodden ground with no opportunity for drying clothes and boots. Not only did these conditions further undermine the general health but caused an alarming incidence of infected skin lesions.126
2. Indirectly, by preventing the evacuation of personnel who required hospitalisation and who by having to remain with their units underwent a still further deterioration in health.
When more effective methods of evacuation were ultimately established in the middle of June, the operational commitments of the Force had greatly increased and made it essential that every available man should remain in order to maintain sufficient firepower in an attempt to carry out the tasks allotted to them, the most important of which was the capture of Mogaung.
By the time these tasks had been accomplished, almost another month had elapsed, and in spite of the very low standard of health to which these personnel had to be reduced before they were sent out, the evacuation rate increased to 115 per 1,000 per fortnight by the middle of July.
Medical recommendations for the withdrawal of the Force met with little success and it was not until the end of August that this was ultimately carried out. In consequence, troops arrived at the reception camp in India in a very emaciated condition, covered with sores and many on the point of collapse. It is my opinion that at least 30 percent of these men have been so undermined constitutionally, that they will be unfit for front line operations for at least a year.
One definite lesson learnt from this campaign is that 3 months is the very maximum period during which personnel can undertake this type of operation, and even this period must be reduced if carried out under monsoon conditions.
Malaria.--Of the 5,422 patients evacuated from sickness, 3,108 (57.3 percent) belonged to the group "NYD Fever" and Malaria, that is to say more than half of the patients considered sufficiently ill to require hospitalisation suffered from these diseases. This number represents 17.3 percent of the total engaged.127
126Calvert, commanding the 77th Brigade, asked
Force Headquarters to send in 1,000 pairs of "gum boots"--because
his men were up to their knees in water. "I received a reply saying,
'It is the medical opinion that the wearing of gumboots injures the feet,
and that the best insurance against trench feet is to keep the feet dry'!"
p. 211. Although medically correct, the advice obviously risked a deterioration
in morale on the calculation that boots and wet feet would produce more
medical casualties than shoes and wet feet! Calvert notes several times
that his evacuation policy was stringent with regard to malaria cases,
and that officers periodically visited the base to see that the sick and
wounded returned to duty as soon as possible. "In actual fact persuasion
was rarely necessary; the spirit of the men, with their resolve to defeat
the Jap at all costs, was so amazing that they would return without, or
even against, the doctor's orders, still with their wounds unhealed"
(pp. 212-213). The Report, be it noted, independently confirms Calvert's
claims regarding morale and casualty evacuation policy.
At first sight it would appear that the incidence of malaria in this Force compares very favorably with that occurring in other formations. When, however, the difference in policy regarding evacuation is taken into account then it can be appreciated that the true incidence of malaria in this Force would be very much higher than would at first sight appear, and would very likely be higher than in other formations fighting under similar conditions.
As the period of operations lengthened, other, less obvious deleterious effects of malaria became apparent, in addition to the more evident loss of manpower from evacuation. Firstly, the fighting efficiency and morale of personnel who had suffered from three or four attacks of malaria, diminished considerably. Secondly, a further diminution in health occurred insidiously and indirectly from these repeated attacks of malaria. The general resistance of the troops to infection was lowered, and other diseases such as dysentery, diarrhoea, respiratory infections, and skin diseases had a much more crippling effect than they would have had otherwise. This in combination with the chronic malaria made evacuation sometimes an urgent necessity whereas, if this constitutional weakness had not been present, these patients could have remained with their columns. Thirdly, an even more serious sequel to the above combination of malaria and another concomitant disease than the mere loss of manpower was debility, anaemia, cachoxia, and other indications of a very grave undermining of the efficiency and health of these men. This became even more pronounced during the course of these secondary diseases. In many cases, similar constitutional defects were produced by repeated attacks varying in individuals from four to twelve.
It is perhaps convenient at this point to discuss the policy which should be adopted in future operations, regarding the evacuation of patients suffering from malaria. From experience gained in this campaign, it has been found that even a B.O.R. is capable of continuing to march and of retaining his place in the column provided the initial temperature is treated at once with intravenous quinine and the response satisfactory, as it was in the great majority of cases. Routine administration of quinine by mouth, mepacrine, and pamaquin can then be carried out along the lines of march without any deleterious effects to the patient. The only adjuvent treatment required was the liberal intake of fluids and the carriage of the man's equipment by mule during his feverish stages.
Column medical officers are of the opinion that while the necessity for evacuation of the patients must be decided individually, personnel can generally withstand at least two attacks, either fresh or relapse, but after the third attack debility and anaemia make their appearance and efficiency and general health suffer as a result. Consequently, it is suggested that the optimum policy would be to evacuate all cases suffering from their third attack. Such a policy would on the one hand avoid the serious depletion in the ranks such as occurs when the normal method of immediate evacuation to a field medical unit is adopted, and on the other hand avoid the destruction of a healthy constitution from frequent intermittent attacks which would occur
if these men were retained beyond this period. Naturally this policy will require certain modifications according to the tactical situation at the time, for example, lack of opportunity for evacuation, from clinical considerations such as the ability of certain individuals with a more robust physique to withstand at least three attacks, during which the constitution is allowed some degree of recovery to combat the next infection. Moreover, these men if evacuated are available to fly in again as reinforcements after a short period of hospitalisation and convalescence.
Although the above treatment of malaria, while in actual contact with the enemy, may seem somewhat harsh and peremptory, the present campaign has proved its efficiency empirically. To such an extent is this so that it is felt that it should be given serious consideration as to whether or not it should be adopted under certain circumstances in normal warfare by battalion medical officers where the usual medical L of C128 is in existence. Personnel, especially officers and key men, could then be retained with their units at times when the maintenance of that unit at its maximum strength is a matter of urgent necessity. This advantage would easily counteract any wastage of antimalaria drugs through faulty diagnosis. Moreover, the dangers attached to the procedure are negligible, no fatalities occurring among the patients who were treated in this manner during the campaign.
Prevention.--Each man was eventually supplied with the following equipment for the prevention of malaria: green battle-dress, a tin of mosquito cream, a head veil, a pair of cotton gauntlets, and a container to hold 30 tablets of mepacrine. If these articles had been put to effective use, the incidence of malaria would have been greatly reduced. Unfortunately, as has been repeatedly stressed throughout this report, antimalaria discipline was of a very low standard.
Owing to the manner in which movement of the knees was restricted, especially when climbing hills, by slacks tucked into puttees or anklets, and the greater discomfort experienced in comparison with the wearing of shorts, some men cut off the greater part of the trouser legs from their battle-dress. Little attention was paid to the rolling down of sleeves. Veils and gauntlets were rightly soon discarded owing to the discomfort they produced. The veil was completely ineffective as it offered little protection during sleep and so restricted vision at night as to offer a serious handicap.
At the commencement of operations, oil of citronella in a greasy base was issued to the Force as an antimosquito cream. The discomfort produced by this obsolete repellent, and the manner in which it failed to repel culicines, resulted in its falling into disrepute. Consequently little faith was placed in its nongreasy counterpart when its supply became possible, and no organised parades were held to ensure its proper and regular use. Greater trust was placed in Dimethyl phthallate and this liquid was generally used in a more conscientious fashion. Unfortunately, supplies of this chemical were limited and could not be supplied in the necessary quantities.
128Line of Communication. The position here taken is that the existing policy of advancing malaria treatment units as far as possible could be even more sharply developed by reducing or eliminating malaria patient evacuation from the combat line.
Suppressive treatment could not be carried out with a 100 percent efficiency for various reasons. In spite of the fact that large quantities of mepacrine were issued to rear brigades for distribution to the columns, their arrival was a matter of extreme uncertainty and some columns were forced to suspend its issue to conserve supplies for curative treatment. No regular parades were held to ensure that the drug was being taken when it was available, and one medical officer had the experience of discovering that the mepacrine containers of two of his patients who had just died of cerebral malaria still contained their original quota of tablets at a time when they should have been almost empty.
In order that the loss of manpower from malaria should be reduced to a minimum, and the chronic ill-health and disablement resulting from numerous attacks avoided, the strictest antimalaria discipline must be enforced during the training period and any breach of this discipline severely punished. Methods of personnel protection must be practiced repeatedly until their observance becomes a conditioned reflex set in motion at the first indication of sundown. The application of mosquito cream and the administration of mepacrine must be ensured at an evening parade.
Owing to the inefficiency of the mosquito veil, a portable mosquito net is considered essential. The jungle hammock provides excellent protection but suffers from the disadvantage that it is heavy and bulky. An effective solution to the problem can probably be reached by some modification of the existing hammock to reduce its weight and bulkiness. Moreover, there would be a compensatory decrease in the weight of the total equipment as the groundsheet and blanket could probably be dispensed with.
Dimethyl phthallate would appear to be the best repellent at the moment, and ample stocks should be guaranteed for future expeditions. If antimalaria cream is supplied in lieu, it must be of the nongreasy variety.
Suggestions have already been made in this report for the issue of mepacrine to ensure its regular supply. From the manner in which malaria continued to appear during the operations, the dosage of the drug when administered for suppression would appear to require further investigation.129
From experiments recently undertaken in Australia130 on a large scale, it would appear to have been conclusively proved that if mepacrine is taken regularly and without interruption at the dosage of one tablet per day, malaria will be completely suppressed during the exposure to infection.
In this Force, suppressive mepacrine was taken, and during the first few weeks of the campaign supplies were regular. It is not known, however, with what regularity and conscientiousness the tablets were taken. It was nevertheless an outstanding observation not confined to any one column that at the end of 6 weeks this dosage of suppressive mepacrine appeared to lose its efficiency and the malaria commenced to rise. This would appear to be due to
129Subsequent investigations supported Fairley's
original conclusions. True clinical "break-through," although
never entirely ruled out of possibility, was deemed entirely negligible,
compared to the factors of discipline, supply, and tactical situations:
See U.S. Army Medical Service, Malaria.
some change in the metabolic process of the drug in the body leading to an increased excretion rate. If this is so, then some information in regard to the concentration of the drug at this period would be of value in assessing the efficacy of the standard dosage of mepacrine over a long period.
Although the experiments in Australia appear to have been carried out in a most exhaustive and thorough manner, they are open to the criticism that the men were subject to a limited series of bites, and it is a matter for argument whether or not the effect would have been the same if this had not been so; for it is reasonable to suppose that suppression depends on the ratio: concentration of mepacrine to the number of malarial parasites in the blood; suppression only being successful when the concentration is sufficient to overcome the degree of infection. As the latter is an unknown quantity, varying presumably from day to day, it is open to doubt whether the Australian experiments have proved whether the concentration resulting from one tablet of mepacrine per day is sufficient to overcome all degrees of infection.
During this campaign, the periodic rises in the incidence of malaria occurring at intervals of 6 weeks were very successfully overcome by increasing the dosage to three tablets per diem for 5 days before they were expected. Other columns on discovering the inadequacy of the standard dosage increased the consumption to two tablets per day with similar beneficial results.
In spite of this large intake of mepacrine over a prolonged period, no toxic effects were recorded, although some individuals exhibited an idiosyncrasy to it at the commencement and required quinine for suppression.
Unfortunately, there was a somewhat widespread belief that mepacrine produced impotence, and in one battalion the administration of the drug was suspended before troops went into action as it was considered by the combatant officers to reduce the fighting efficiency of the unit. As such fallacies have a tendency to spread rapidly and become exaggerated and gain greater credence during circulation, every opportunity must be seized to discredit them.
Clinical consideration.--Most B.O.R.s on admission to hospital gave a history of intermittent attacks of fever during a period of 2 to 3 months. The number of attacks varied up to sixteen, the average being four or five. Although this information is based on the statements of the patient, corroboration of the medical officer was received on numerous occasions verifying the fact that many had undergone at least twelve attacks.
As was to be expected, the general health condition was poor. In spite of the large quantities of mepacrine administered for suppression and quinine at the commencement of treatment, a large percentage still had positive blood slides on admission. Five percent remained positive after a full course of treatment, although only one patient was recorded as remaining positive after two courses.
It is estimated that approximately 40 percent of the cases admitted for malaria were evacuated ex-Assam as being unfit for active service within a minimum of 3 months, owing to the debility and anaemia resulting from recurrent attacks and in many cases aggravated by the presence of some other concomitant disease. Reference has already been made to the weakening
of the constitution and general physique. In addition it must be stressed that many of these cases will require to be recategorised B or C,131 as they are almost certain to have further relapses.
Owing to the absence of any information regarding the deaths from malaria inside Burma, it is impossible to give an accurate estimate of the mortality from this disease. It is considered unlikely however to have been more than 3 percent.
Treatment.--Attention has been directed to the modifications of the standard treatment which were found necessary during operations, especially the more frequent administration of intravenous quinine, and the absence of any untoward effects from its use. The difficulty of clearing the blood of parasites and the necessity for repeated courses has also been mentioned. Another fact of considerable importance regarding treatment also emerged a month or two after the commencement of operations. Although cases responded to treatment during the first 2 months, much greater difficulty was experienced in controlling the temperature as the campaign proceeded, probably due to the parasites beginning to acquire a resistance to mepacrine. In these cases, large doses of quinine, prolonged for a week, were required to bring the fever under control.
Dysentery and diarrhoea.--This group of diseases was responsible for the evacuation of 483 patients, or 9 percent of the total casualties from sickness.
Causes.--The main reasons for the above incidence were mainly poor water and sanitary discipline. The attention given to water sterilisation was indifferent and various factors contributed to this. Not the least important of these was the lack of faith resulting from the use of the Indian manufactured water sterilising tablets, which on analysis proved to have little or no free chlorine. Again troops arriving at a water point with empty water bottles after a long and strenuous march were not prepared to wait half an hour for the water sterilising tablets to take effect, nor would the operational situation always allow of this.
Moreover, the proper siting of water-points in regard to bathing was not always observed.
A plentiful supply of English water sterilising tablets was not always available, and rather than send in nothing at all, resort was made to the use of water sterilising powder. As this was packed in 7-pound tins, it proved itself worse than useless, first because of the difficulty in carriage and secondly because constant opening and contact with the air reduced the available free chlorine content.
Another factor of importance in the causation of this disease was the lack of attention paid to conservancy. It was not sufficiently realised that the site occupied by one column might, and actually was in some instances, soon to be occupied by another. As a result, strict sanitary discipline was not imposed and succeeding columns were forced to live in the acutest discomfort under the most insanitary conditions possible through no fault of their own. This
131Degrees of limited duty status.
selfish attitude is another aspect of the subject which must be impressed on all ranks.
Moreover, this lack of discipline was in effect lack of security, as litter from K rations and latrine paper gave ample evidence of the route taken by columns. For this reason in the case of one brigade, orders were issued that latrine paper would not be used--an astonishing order when, if any thought had been given to the matter, strict sanitary discipline with the burial of faeces or at worst, the covering over of excreta with a layer of earth, was all that was required.
In strong points, trench latrines were frequently used but conformed to no known plan, for they were too shallow for deep trenches and too deep for shallow trenches. Further, seldom if any attempt had been made to cover them with any sort of superstructure. The excuse given for this was that there was no wood available. Training in the construction of a simple superstructure which can always be easily done from locally available materials must be one of the high priority items in all future training programmes.
Another cause of diarrhoeas, although of more mild type, was prolonged use of the K ration. After consuming this ration for a week or two, stools became loose, watery and light yellow in colour. Fortunately, only on very few occasions did it prove incapacitating and generally cleared up with adequate doses of chalk and opium.
Prevention.--Any future decrease in the incidence of dysentery will depend on the success with which a proper respect for the elementary principles of sanitation is instilled into the minds of all ranks. They must learn to appreciate the fact that a low standard of sanitary discipline will not only result in a loss of manpower in their own columns but that it may have similar effects on the strength of other units. This particularly applies to officers, to whom other personnel turn for example and guidance.
The necessary knowledge for maintaining a satisfactory standard is possessed by all medical officers, but it is only on rare occasions that his advice is sought, and his recommendations and suggestions carried out. A very common excuse is the inability of the combatant officer to supply the necessary materials and personnel. On active operations little material is required which cannot be acquired from the neighbouring jungle. It is essential that at least two men in each column are trained in the basic elements of field hygiene so that they can advise on the proper construction of sanitary fieldworks and act as Sanitary police for the officer commanding and medical officer of the column.
When elements of the Force become static, as occurred in the last expedition at strong points and roadblocks, the necessity for the strictest sanitary discipline in these confined areas becomes even more pronounced. Borehole latrines into which a charge of gelignite was dropped to increase their capacity were found eminently satisfactory but only on the too-rare occasions when the lid was kept closed.
The importance of perfect water discipline was generally realized to a greater extent than sanitary discipline, but extreme thirst on many occasions forced men to drink before the water sterilising tablets had ensured com-
plete effective sterilisation. Owing to the time factor which must elapse before chemical sterilisation is effective, resort must be made to mechanical methods to shorten this period. The common methods, filtration, sedimentation or boiling, are impracticable on account of a variety of reasons, most of which are self-evident. There is one method, however, which has been used with satisfactory results in the provision of a safe water supply in Assam labour camps, and the necessary apparatus is extremely portable, consisting of two silver plates and an ordinary torch132 battery. The only other equipment required for its introduction in future campaigns would be 1- or 2-gallon canvas tanks. The efficiency of this method is meantime under investigation.
Clinical considerations.--Bacteriological investigations of the cases of dysentery admitted to hospital revealed the fact that the bacillary type was much more prevalent than amoebic. Both types responded satisfactorily to specific treatment and evacuation was not necessary unless the general health of the patient had been weakened by malaria or some other debilitating disease.
Sulphaguanidine was not always available in the quantities required, and there should be an adequate stock of this drug held at air base. Emetine produced no untoward effects, but injections were omitted if the patient was likely to be engaged in action within a few days. This bears out a contention that I have always put forward that, although emetine is a potentially dangerous drug, it is not so dangerous as has been held heretofore, provided always that it is administered with proper care and supervision. The presence of an idiosyncrasy can easily be discovered after the administration of an initial minimal test dose.
Infective hepatitis.--Two hundred twenty cases, or 4 percent of the total evacuation from sickness, were admitted to hospital from this disease. The incidence was mainly confined to 111 Brigade from which 145 cases were recorded.
The source of infection was easily traced, as two cases had to be evacuated from one battalion in this brigade 2 days after their arrival in Burma. Moreover, several officers were flown in during their convalescent period at their own request. One medical officer developed the disease 2 days before the operation commenced and refused to be evacuated when a replacement was eventually found.
Although the mode of transmission is still a matter for conjecture, from the evidence available from the minor epidemic which occurred in this brigade, the disease would appear to be conveyed by droplet infection. The manner in which each soldier was supplied with individual rations, the absence of communal use of mess tins, and the impossibility of preparing meals collectively probably excludes the possibility of transmission by foodstuffs and cooks, the mode of infection which [was] previously postulated. The outbreak commenced with a few isolated cases, the incidence gradually increasing until the average weekly number of evacuations was approximately 50 during the last month of the campaign. This mode of occurrence is strongly indicative of a respiratory infection.
No conclusive evidence was furnished regarding the incubation period, but it is considered that it is lengthy, at least 3 weeks, and in the majority of cases 4 weeks.
Clinical manifestations.--The severity of the symptoms increased as the campaign progressed, and together with the very acute onset gave medical officers the impression that they were dealing with an outbreak of spirochaetal jaundice. One West African medical officer who had had some experience with yellow fever was struck by the resemblance and requested that this possibility should be investigated in hospital. The clinical manifestations soon allayed this fear. One case proved bacteriologically to be of the spirochaetal variety, the organism being found microscopically in the urine. Unfortunately, agglutination tests in this [case] could not be undertaken from lack of facilities.
In view of the many factors which together tended to tax the liver in an already debilitated individual, it is not surprising that the clinical manifestations of this disease were of such a severe nature.
Consequently, it was found that these cases had to be evacuated at the first opportunity. With even healthy personnel becoming nauseated at the sight of their never varying rations, little could be done to overcome this symptom and the anorexia which accompanied it. This equally applies to other symptoms such as the marked pyrexia, and intense malaise and headache, which occurred in these patients.
I.A.T.--This did not prove troublesome until the onset of the monsoon when it became a problem of increasing magnitude. Five hundred thirty-one cases, or almost 10 percent of the total casualties from sickness required to be evacuated from this cause, 350 of these being flown out in the last month of the campaign.
These skin infections were not confined to any particular nationality and even the West African troops who had managed to withstand to a greater extent the rigorous conditions under which the Force was required to operate, were compelled to send out a substantial number of men in the later stages. Attention has already been directed to the high percentage of ringworm among the Gurkhas; as this variety of skin disease proved less incapacitating than the other forms, their evacuation rate from this cause was smaller.
The following were the commonest varieties of skin affections occurring during this operation: Jungle sores, septic prickly heat, widespread tinea of the feet and groins, which proved very disabling owing to the manner in which it restricted marching, and bullous impetiginous lesions generally around the flexures. These bullae collapsed leaving raw skin, which rapidly ulcerated with further chafing. Boils and carbuncles were also common, and the surrounding cellulitis was often a marked feature of these lesions.
It is considered that one of the major causes of these skin infections was the constant marching through swamps in pouring rain or in a warm clammy atmosphere, together with the absence or nonavailability of clean, dry clothing and socks. Nevertheless, there was in most columns an absence of
organised arrangements for bathing and washing of clothes to ensure that the more lax members of the column maintained the necessary basic standard of cleanliness. It is realised of course, that such arrangements can be implemented from time to time in accordance with the local tactical situation. Regular medical inspections to ensure the medical officer is up-to-date in his knowledge of the state of health of his men, is one more method of maintaining the effective manpower of their columns. Minor lesions can then receive immediate treatment to prevent them from increasing in severity until the patient requires hospitalisation.
It is not known to what extent foot inspections were carried out by subordinate commanders, but there is no doubt that a lot can be accomplished in the prevention of casualties from bad feet if frequent inspections of the feet, socks, and boots together with sound foot hygiene is carried out conscientiously. In this way, many of the more severe cases of foot-rot, which occurred during the monsoon period could have been prevented by early recognition and treatment. The number of cases of lice infestation was surprisingly few. The reasons for this can only be attributed to a strict medical inspection prior to entering Burma and the absence of lice in the villages. This is in marked contrast to the experience of General Wingate on his original expedition.
Typhus.--One hundred sixteen cases or 2.1 percent of the total evacuation from sickness were admitted to hospital from this cause. Interrogation of medical officers after their return from Burma would indicate that a further 49 cases were diagnosed but were not flown out owing to recovery or death occurring before evacuation of the patient could be undertaken.
The majority of the cases (77 percent) belonged to 14 Brigade, in which sporadic outbreaks occurred from the beginning of May to the second week in August. In the other brigades, cases commenced to appear intermittently during the last 2 months of the campaign but mainly in July.
The type of terrain in which these cases were infected varied considerably. The area in which infection must have occurred in the first outbreak, estimating the incubation period as 12 days, was mainly scrub jungle interspersed with open paddy-fields. The second minor epidemic broke out during the occupation of a village (Nammum) in which the troops were static for almost a month. However, the greater part of it was overrun with elephant grass and this location more closely resembled a jungle clearing than an inhabited locality. The third and most explosive outbreak could be traced to infection occurring during the occupation of a chaung in which the banks of the river were covered with thick elephant grass. In general from the evidence available, the type of terrain in which the majority of cases became infected was open country abounding in elephant grass and in the neighbourhood of water. No cases occurred in dense bamboo jungle, only in the scrub variety.
No conclusive proof regarding the vector could be discovered from investigation of these cases. Typical tick eschars were present in only 10 percent of the cases, and there were no medical officers willing to admit that they
had detected mites or their bites on any of the patients. From enquiries regarding the fauna in the areas where infection occurred, the most probable reservoir was the field mouse. Even in the village, few rats were to be seen.
It is a point for consideration and investigation whether mules may not carry ticks or mites from infected areas, thus prolonging an epidemic, and in addition furnishing an explanation for cases who develop typhus after having left the affected locality for some days in excess of the recognised incubation period. The evidence from the above outbreaks suggested such a possibility, although the incidence of the disease was no greater among muleteers than among other personnel of the columns. Moreover as the typhus virus is transmitted from one generation of the mite to the next, infected areas may be considerably extended in this manner, and cases commence to appear in formations occupying areas previously understood to be free from the disease.133
Clinical considerations.--The first cases to appear were generally diagnosed as glandular fever, being mild with little more than complaints of headache, feeling out of sorts, and some glandular enlargement. Several of these cases, especially during this early period and at a time when the possibility of typhus had not yet been fully appreciated, remained ambulatory throughout the whole of their attack, and recovered; this even occurred later when the disease had been fully recognised and diagnosed.
It was not until the onset became more abrupt with a high temperature, which failed to respond to quinine, that typhus was fully suspected. Thereafter the severe constitutional upset, the red bloated face with intensely congested conjunctives; the prolonged fever without the intermittency of malaria, pyrexia, and the appearance of a macula-papular rash on the trunk 3 or 4 days later, left no doubt regarding the diagnosis in the minds of the medical officers.
The progress of these cases caused generally grave anxiety. Pulmonary complications were generally severe, mental depression so profound that the patients appeared to have no desire to recover. This apathy was counteracted in the Black Watch to a very considerable extent when someone conceived the idea that the sound of the pipes might do much to dispel this apathy. Moreover, in the absence of specific treatment little could be done for these patients under the existing circumstances. Proper and efficient nursing was quite out of the question. Protection from the monsoon had to be improvised with indifferent success; fever became unbearable in the warm moist climate, and some patients lapsed into delirium; water was warm and brackish and great difficulty was experienced in forcing these patients to maintain their water and salt balance and avoid dehydration, diet was restricted to articles upon which the patients had existed for many months and which now produced intense nausea; the number of nursing orderlies was limited and they could not cope adequately with the number of cases.
133See citations in n. 124, p. 267. General Officer's observations conform generally to more thorough investigations, although his "hunch" that mules might carry the mite vectors was not confirmed.
Under these circumstances, and in men already debilitated with prolonged marching and recurrent attacks of malaria, it is not surprising that mortality from this disease reached the high figures of 29.7 percent. This high death rate was quickly appreciated by all ranks, and the subsequent fear of contracting the disease resulted in a substantial decrease in morale.
The Weil-Felix reactions in all cases admitted to hospital showed agglutination with OXK strains, although high titres were not reached until the eighth day after the onset of the disease. Agglutination with OX 19 and OX 2 strains was insignificant.
Prevention.--It has now been definitely established from several epidemics of scrub typhus that certain types of terrain are closely associated with epidemics of the disease. Experience gained from this campaign indicates that the following areas should be skirted and other routes selected whenever possible. Only in exceptional circumstances when the tactical situation permits no alternative, should camps be situated or troops allowed to bivouac in these localities.
(1) Scrub jungle, in contradistinction to thick wooded jungle with dense overhead cover.
(2) Jungle clearings, especially deserted villages which have become overgrown with elephant grass and small trees. This applies equally to the periphery of dense jungle.
(3) Rivers or streams bordered by tall grass. If camps must be situated in the vicinity they must be at least 1 mile from water.
If a suspicious area must be traversed or in which a camp requires to be sited [sic], strict personal precautions must be enforced. As it is not possible in this type of operation to fire the grass and undergrowth of such areas, every possible individual precaution must be taken. All exposed areas of skin should be protected by clothing while passing through such localities and if the night has to be spent in them, then improvised charpoys134 to raise the sleeper off the ground are essential. No padding with brushwood or grass must be allowed, the charpoy being covered only with the groundsheet whose edges have been smeared with dibutylphthallate.
It is strongly recommended that adequate stocks of dibutylphthallate should be available for any future operations, and all ranks trained in its proper application to the edges of the clothing and exposed parts of the skin.
Malnutrition.--Approximately 1 month after their withdrawal from Burma, 34 cases of deficiency in the vitamin B complex had been admitted to hospital, seven cases from 14 Brigade, the remaining 27 being distributed between 77 and 111 Brigades. All cases occurred among B.O.R.s.
Of the seven patients admitted from 14 Brigade, all suffered from multiple neuritis. A previous history of malaria was volunteered in six cases, and three had suffered from jungle sores.
It is of interest to note that the neuritis did not develop until almost 1 month after the substitution of "Compo"135 and later the Rehabilitation, scales of rations. It is difficult to assess whether the above indications of
malnutrition in these personnel of 14 Brigade were due to complications appearing after malaria, or were the sequelae of postdiphtheritic ulcerations. It is considered more likely, however, that the manifestations were occasioned by the bodily reserves of vitamin B becoming depleted during the lengthy period of existence on K rations, and the failure of the later diets to replace it in sufficient quantity.
In the other brigades the symptomatology showed greater variety as will be seen from an analysis of the symptoms of the 27 patients belonging to these brigades:
One of the most striking manifestations was the extreme degree of mental depreciation in these patients. Lassitude and, in some cases, even inability to move was marked. Depression was severe, and orientation and concentration were also affected.
No significant abnormality was found in the pulse rate but in 21 cases the blood pressure was below 120 m Hg. In the C.N.S.136 the deep reflexes were altered in 18 cases, and there was some impairment of sensation in seven.
Five cases gave a history of malaria, and another six had suffered from dysentery.
These cases appeared more rapidly after evacuation from Burma than those of 14 Brigade. This is probably due to the fact that 77 and 111 Brigades had lived almost entirely on K rations until their arrival in the Rehabilitation Area, and the rations issued during their travelling period had little time to replace the body reserves of vitamin B Complex, so thoroughly depleted in Burma. The same discoveries [sic: difficulties?] of postulating the aetiological factors involved, postmalarial complications, postdiphtheritic paralysis, or failure of intestinal absorption after dysentery or gastroenteritis was experienced. It is considered however, that these were probably precipitating factors in patients suffering from avitaminosis in a subclinical form.
No frank cases of scurvy were found on examination of these brigades after their evacuation, but again the disease may have been present in its subclinical form.
Although the discovery of these cases of avitaminosis would seem to indicate that the vitamin content of the K ration is deficient, this is in fact not so,
136Central Nervous System.
and those cases of avitaminosis which did occur, can only be attributed to the well-known fact that the men threw away or failed to eat some vitamin-containing part of the ration. While this cannot be condoned it can never be avoided, and it does indicate the absolute necessity of the inclusion in the ration of a separate multi-vite tablet.
Condition of Personnel on Termination of Operations
All brigades on their withdrawal from Burma, with the exception of 16 and 23 Brigades, concentrated in the reception camp at Tinsukia. Here they were placed on a special convalescent scale of rations--received their first hot bath for months, and were given a complete new issue of clothing and necessaries.
At this camp the psychiatrist137 attached to the Force was located, and as the various brigades passed through, he was in a position to take a cross section of each brigade and assess their general condition and morale, and at the same time was available to see any special cases considered by the medical officers to require psychiatric advice and treatment.
The reports on his observations are attached and are of considerable interest and show clearly that morale was highest in those units and formations which finished on a high note, with a recent success in battle--and the lowest in those where a reverse had led to acute disappointment.
Morale on the whole--considering the length of time the men had been in and the hardships to which they had been subjected--was surprisingly good.
Psychiatric Report on 77 Ind Inf Bde, Special Force138
Examined at--69 Ind. Rest Camp, 6 A.B.P.O. July '44.139
Procedure. In conducting this investigation two aims were formulated:
(1) To assess the morale of the Brigade as a whole, and
To accomplish the latter the co-operation of the Camp Medical Officer and the local hospitals was enlisted to supplement personal interviews.
In assessing morale an essay was made to garner data under two sub-headings:
(1) Factors favourably influencing morale
In the two to three days available, as many as possible of the British personnel of the Brigade were interviewed immediately on arrival at camp from the local air-strip.
In all 189 men were examined. The number more or less equally divided between the South Staffs and Lancashire Fusiliers.
Psychiatric Casualties. Not one case of mental illness was seen on personal contact. Neither was any case referred by the Camp Medical Officer or to the hospitals in the neighbourhood.
Relative the present evacuees the mental health is 100 percent sound.
137J. S. Dawson, Captain, RAMC, who signed
each of the reports quoted below.
Factors influencing Morale Unfavourably.
(a) Promises. Officially promised out before the Monsoon and again after "White City" in May. Undivided opinion of the men here gave it that these promises dashed their hopes considerably when not implemented and they would much rather they had not been given.
(b) Monsoon Equipment. Non-existent. The gas-capes issued were useless after a fortnight's rain. Loss of sleep and consequent exhaustion were attributed to lack of this equipment. American hammocks would have been appreciated.
(c) Clothing. Replacements inadequate and for most unobtainable.
(d) Rations. Monotonous and depressing. Three months on "K" rations is enough for any man.
(e) Repatriation. A sore point with those concerned. Men with five years service overseas and more before entering Burma, resent having been detailed to go in. An ominous bond of sympathy exists between these and many of the remaining men, strengthened by the assertions that many of those who were due repatriation have been killed.
(f) Medical Attention. Uncivil and inadequate. By far the greater majority of men expressed this view and said they were ultimately afraid to go sick for fear of being accused of "scrounging." Men with fevers and dysenteries had to continue fighting. The absence of detailed stretcher bearers in the columns was also bemoaned. These complaints were largely mitigated however, by the almost unanimous opinion that the conditions obtaining were due to lack of medical personnel. (N.B. Surgical cases interviewed could not speak too highly of the attention received from M.O.s and orderlies alike.)
(g) Length of Campaign. Much too long. None would have minded being in twelve weeks.
(h) Chinese. Very unpopular. Described as an undisciplined collection of looters and thieves. Very difficult to distinguish from Japanese troops owing to the variety of clothing they wore. W.O.s and N.C.O.s shared the same opinion as the men. All would have preferred to have continued to fight as an independent Chindits Force.140
Factors Favourably Influencing Morale.
(a) Officers. Apart from a few isolated instances, the officers had the unbounded confidence of the men. Brigadier [Michael] Calvert was extremely popular and the admiration of the men without exception, stopped a little short of hero-worship. One wit expressed the opinion that "we would follow the Brig. through Burma into Hell."
(b) Evacuation of sick. Air-personnel's work in evacuating the sick much appreciated. All felt confident of getting out if wounded.
(c) Self-appreciation. Stated un-reservedly that they had had their fair share of fighting in this campaign and hadn't done so badly either.
(d) Japanese. Not the invincible myth he was conjured up to be. All feel they have got his measure in jungle warfare, both in attack and defence.
Summary. The general tone is one of satisfaction, with one thorn, that of repatriation, in the flesh of an otherwise healthy body. Even considering the "unfavourable influences" listed above, there was the encouraging observation that these were given in the nature of constructive criticisms in a co-operative effort to improve things to come.
The morale of this Brigade is excellent.
Sd/-J. S. Dawson, Capt., R.A.M.C.
140The allusion here is to the last stage of the campaign when the 77th Brigade and the Chinese were attacking Mogaung, and when the former (like the latter) were parts of the total force commanded by General Stilwell.
Psychiatric Report on 111 Ind Inf Bde, Special Force
Examined at--69 Ind Rest Camp, 6 A.B.P.O., July-Aug. '44.
Procedure--This investigation was conducted with two formulated aims:
(1) To assess the morale of the Brigade as a whole
In assessing morale an attempt was made to gather relative information under the sub-headings:
(1) Factors favourably influencing morale
British personnel only were concerned in this review, and, in all, 273 men were examined, 97 of these from the Cameronians and the remainder, including 17 Royal Artillery other ranks, from the King's Own Regt.
Psychiatric Casualties. None of the men personally contacted showed any signs of mental illness. No cases were referred to the Camp Medical Officer or the local hospitals.
Factors influencing Morale Unfavourably.
(a) Promises. Before the campaign promised "out" before the monsoon. Four to five days after the evacuation of "Blackpool" (3rd-4th June) officially told they had no further commitments and were then going out, but two days later ordered to advance and assist in the attack on Mogaung. Morale fell considerably, and the King's Own gave it that they had 17 desertions as a result.
M.O.s and Chaplains confirmed the men's assertions that the promise after "Blackpool" had a very deleterious effect on the morale of the Brigade.
(b) "Blackpool." Complaints were numerous and bitter regarding this block and were shared by almost every man. Why was it called a "block" at all? It was too far from the road and railway to act as such. Many regarded it merely as a "decoy" and little better than a death-trap. Why wasn't the railway put out of action, and why were Jap troop-trains allowed to come beyond the block unmolested? Where were the floating 14 and 77 Brigades promised?
W.Os, N.C.Os, and men all believed the air-strip on which they depended entirely for supplies and ammunition to be inadequately defended. Part of the strip was actually outside the block and had no defence at all.
The continual shelling, to which they had no reply, ultimately got most of the men down, and they had had about all they could take when the block came to be abandoned.
(c) Officers. The rationale of this observation is obscure, but it is an undisguised fact that before "Blackpool" the officers as a whole had the confidence of the men, but after the block that confidence almost completely vanished. After the block administration was described as chaotic, recces were said not to have been carried out, no-one knew what was going on and leadership was considered poor.141
(d) Nature of campaign. Not one man but complained of having been ordered to participate in "Static warfare" for which he was not equipped. Wingate had intended the Chindits to function as L.R.P. troops and as such they had done everything asked of them. Had Wingate lived they felt sure they would have continued to fight in their intended capacity.
Until "Blackpool" morale was 100 percent throughout the Brigade. There were insufficient, if any, rest periods during the campaign, marching was excessive and the campaign as a whole was much too long.
141Masters describes the affair at Blackpool in great detail, pp. 240-262, 282-283. He was not entirely happy about the idea of establishing the block, nor with the site; he too was impatient when neither the 14th nor 77th Brigades reached the perimeter to reinforce him. The punishment the Japanese gave with artillery as well as reinforced infantry became intolerable. Repeated declarations that the position had become untenable brought no command to retreat. Using, finally, the initiative of the local commander to estimate the situation, Masters ordered the stronghold to be abandoned in the face of obviously imminent destruction of the Brigade. See also the introductory section of part IV.
(e) Medical Attention. Inadequate, with the depressing prospect of having to continue marching when suffering from a fever. Not many held any great hopes of speedy evacuation when sick. All the Medical Officers were extremely popular, however, with one exception, who depressed the column with his uncivil barrackroom attitude.
(f) Repatriation. A considerable number of N.C.O.s and men were due repatriation before they entered Burma, and resent having been detailed to go in. Many due repatriation lost their lives during the campaign.
(g) Public Flogging of B.O.R.s. Greatly resented. Nothing but an exhibition of slavery. All agreed that the guilty men deserved their punishment, but the punishment should not have been implemented publicly in front of natives and coloured troops.142
Factors favourably influencing morale.
After "Blackpool" the men could instance nothing which raised their morale in any way.
Medical Administration. Certain criticisms, of sufficient magnitude to occasion concern, were served on the D.D.M.S. and A.D.M.S. by medical officers of the Brigade. A statement by the D.D.M.S. to the effect that too many fit men were being evacuated engendered great indignation amongst the M.O.s concerned and in their opinion, showed a lack of appreciation of the true conditions obtaining in the columns and reflected seriously on their judgment. As neither the D.D.M.S. nor the A.D.M.S. contacted them in the columns they consider the above statement unjustified.143
Medical supplies were considered so inadequate during "Blackpool" as to seriously influence the morale of the men. One Medical Officer of No. 3 W.A. Fd Amb144 gave it as his opinion that the medical arrangements lacked organization, which would have been materially improved if the A.D.M.S. had "lived in" with the Brigades.145
The S.M.O.146 was dissatisfied with the support received from the D.D.M.S. and harboured criticisms which he intended to make personally.
Summary. Of the 273 men examined not one expressed his willingness to participate in another Burma campaign, and of this total, 184 declared they would do detention rather than face a second campaign under similar conditions. The 184 figure comprised 69 Cameronians, 17 Gunners and 98 King's Own personnel. Despite the histrionic quality, in several cases, of the avowal to do detention, the incubus of discontent pervading this Brigade is none the less obvious and alarming.
Morale is low.
142The only reference to corporal punishment
anywhere in any sources available to the editor.
Psychiatric Report on 14 Inf Bde, Special Force
Examined at--69 Ind Rest Camp, 6 A.B.P.O. Aug-Sep '44.
Procedures--As adopted with 77 and 111 Ind Inf Bdes 372 men were examined comprising 126 Black Watch, 88 Leicesters, 84 Bedfs Herts and 74 Y & L.147
Psychiatric Casualties--No case of psychiatric illness was seen on personal contact or referred by Camp. M.O., Bn. M.O.s or local hospitals.
Factors influencing Morale Unfavourably
(a) Promises. Black Watch and Y & L personnel complained bitterly of official promises of their "going out," which never materialized. Every job after May was their last job and morale dropped considerably with each promise.
In marked contrast the other two bns stated they never had one official promise throughout the campaign and suffered no loss of morale in consequence.
(b) Reinforcements. All stated they were never up to full strength and an increased burden was thus thrown on remaining personnel of unit. Many of the reinforcements received were untrained in jungle warfare and had never seen a heavy pack.
(c) Length of Campaign. Much too long. If the campaign had terminated before the monsoon many deaths from illness would have been avoided and all felt they would have been in a better mood to face a second campaign than they are now.
(d) Rations. "K" rations monotonous and almost unbearable after three months.
(e) Officers. "Class-distinction" too much in evidence, particularly regarding monsoon equipment and medical evacuation.
(f) Medical Inspections. Not one individual but complained of having had no proper medical "over-haul" before he went in. Some had none at all. Others were actually checked for fitness by a Sgt-Major consulting pay-books.
They have had no medical inspection, not even an F.F.I.148 since leaving Burma.
The general feeling, resultant on this, is that they are of the opinion that no one cares how they feel and that they have been neglected.
(g) Medical Treatment. Despite the admirable efforts of the M.O.s (with two exceptions) treatment was described variously as inadequate to ridiculous to call it treatment at all. It was common for sick to be turned away by the M.O. with the apology that he had nothing to give them. On occasion it was impossible to get even a bandage, parachute cloth having ultimately to be torn up to serve the purpose.
Coln. 16 of Bedfs Herts complained of having no M.O. at all for 6 weeks. A L/Cpl.149 (from the Bn) carried on in his absence and it was rather alarming to learn from the Cpl himself that he was giving intravenous quinines, pentothals150 and performing minor operations on his own.
(h) Unknown Fever (Scrub Typhus). Without exception this affected the morale of the men considerably. They saw friends "dying like flies" with the fever and in cases they were even afraid to visit those stricken with the fever for fear of contracting it themselves.
(i) Medical Evacuation. None had any great confidence of getting evacuated if sick. Indeed the one concern in the mind of each individual was the fear of falling sick with the disturbing prospect of having to endure hardships in the coln were he unfit.
Age and Weight. A considerable bond of sympathy existed between the men and those they considered overage and underweight. Men of 38 and 39 they believe should never have been sent in, and it was ridiculous to have included men of little more than 8 stone in weight. Giving the weight of the heavy pack as 69 to 81 lbs. this meant those men were carrying over half to three quarters of their own weight. They blame this on the lackadaisical medical inspection prior to entering the campaign.
147Abbreviations: Leicesters--7th Battalion,
Leicestershire Regiment; Bedfs Herts--lst Battalion, Bedfordshire and Hertfordshire
Regiment; Y & L--2d Battalion, York and Lancaster Regiment.
Defective Vision. Those wearing glasses definitely did not possess the confidence of the men whose visual acuity was good. They went in constant fear of either losing or breaking their glasses, and even with them on the glasses were often little better than useless owing to rain and perspiration dimming the lenses. (An M.O. from personal experience gave it as his opinion that this latter observation was a very real one.)
Syphilitics. A disgruntled few were interviewed but of such a mental make-up to spread dissension through any unit. They complained of being neglected and of having no treatment for their condition while in Burma.
Factors Favourably Influencing Morale.
Self-appreciation. All bns could point with some pride to the part they had played in the campaign. They feel they have achieved what they set out to accomplish and are solid in their assertions that the Jap is anything but invincible and "has it coming to him."
Addendum. Prior to the campaign a considerable number of men were put up by S.M.O. and Bn. M.O.s for regrading, but many of these were turned down by Medical Boards. S.M.O. maintains that Specialists in hospitals are not fully conversant with the true conditions obtaining in the field and that less stress should be put on their findings and more on those of Bn. M.O.s. Those originally put up for regrading by him and his staff were ultimately evacuated as unfit during the campaign.
Summary. It was obvious from the outset that medical problems occasioned the chief concern in each Bn., yet criticisms were, on the whole, positive and constructive, particularly regarding treatments and evacuations.
That the "conditions and diseases" have not undermined the morale of the Brigade to any serious degree is evidenced by the unanimous opinion of the men that they think they would be able for another "go" in six months time.
Morale is good.
Certain very definite points arise from the experience of this last campaign and require earnest attention before embarking on further similar operations. These can be numerated as follows:
(1) A Medical Organization capable of dealing with the casualties likely to be encountered. Such an organization has been requested.
(2) Medical Personnel who are in their technical training above the average and so able, in any Medical Emergency, to act on their initiative. As well as this they must be fit enough to withstand the rigours of Long Range Penetration Warfare.
(3) Combatant leaders who realise that preventable disease is, unless countered, liable to take a heavier toll in casualties than the Japanese and who, in consequence, must be prepared, by ensuring strict discipline, to do everything in their power to train their men in preventive measures and, by personal example, ensure that sickness from this unnecessary and avoidable cause is kept to an absolute minimum.
(4) A diet that is not only sufficient but which is interesting enough to stimulate a desire and enthusiasm for eating it and thereby maintain morale at its highest. For probably no single factor plays a bigger part in the maintenance of morale than good food. While this is a truism in all conditions of life it is even more so under conditions in which this Force must operate and when everything else is looking blackest and bleakest it is amazing what
good food can do to counteract acute depression. If the answer to all other problems was as easy as it is to this one, then all difficulties would disappear. Knowing what is wanted, as everyone does, it should be easy at this stage of the war to produce it.
(5) The preliminary to the regular taking of Suppressive Mepacrine is the regular supply of it to the columns. If this is not Fool-Proof then no amount of discipline nor desire on the part of the men to take it can overcome its deficiency. The only safe way of ensuring this regular supply is the inclusion of the requisite dose in the men's individual ration. No other method can be Fool-Proof.
In conclusion, I would repeat what I have had to say so often before, and that is that without a very close co-operation between the Medical Branch and the Planning Branch, whether this be before or during operations, it is impossible to run a good Medical Service with that efficiency which, unlike that of any other service, is so open to adverse criticism.
The habit of looking upon the doctor as a Fifth Columnist likely to blab the merest piece of confidential information which is vouchsafed him, is still all too prevalent. Apart from the fact that we are all of the same nationality, holding the same Commission in the same Army and fighting the same enemy for the same reasons, a doctor, by the very virtue of his profession and his training, probably holds more secrets and information of a personal and confidential nature than any other individual. This being so, and it is agreed, as it must be, that the inclusion of a Medical Service in the planning of a campaign or operation is essential then the most Top Secret information can safely be disclosed to the head doctor without any fear of it being repeated. So often one finds that information of this sort is known to a junior "G" officer but is not told to the Medical Service until it is too late to be of use in the making of an efficient Medical Plan.
With the increased speed and tempo of modern warfare the time has passed when the D.D.M.S. of a Corps or the A.D.M.S. of a Division received his information through the head of the "A" [Administration] Branch. Every means by which Red Tape and unnecessary effort and time are dissipated should be cut ruthlessly. When it is realised that the head of the Medical Service of such a formation is, as the representative of the D.M.S. of the Army, the Commander of all Medical Units and Personnel in it, then surely it is right to assume that he should be treated in the same way as the C.R.E. [Chief, Royal Engineers] and the C.R.A. [Chief, Royal Artillery] and that he should, by his attendance at all conferences, receive his information first hand direct from his Commander.
The best units and formations are always those which are most Medically minded and where the doctors are in the closest confidence with their respective commanders, and it is in these units where discipline is of the highest. The reason for this very definite statement needs no further elaboration except to say that such close cooperation leads to a mutual trust and confidence with a realisation of the other's difficulties. The all too ready attempts to criticise adversely treatment and procedure which are a feature
of a certain type of officer are eliminated and the realisation that success at all times and in every undertaking is no more possible by a doctor than by a commander is more fully appreciated.
It is with no attempt to make out that this Force is more culpable of more breaches in this respect than any other that this truism is included. It is repeated only in an effort to eliminate it altogether and to remind senior Staff Officers of the need of continuing to imbue their less experienced officers with this fact.