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Medical Service in the Atlantic Defense Areas
(from The Medical Department: Medical Service in the Mediterranean and Minor Theaters)
The war against Germany, which began for United States ground forces with the invasion of North Africa on 8 November 1942, could never have been won if the Atlantic approaches had not first been secured. Although less spectacular than combat operations, the establishment and defense of sea and air routes to Europe, Africa, and the Middle East were no less essential to the final victory. The few permanent installations in the Panama Canal Zone and Puerto Rico were supplemented in the early years of the war by new bases stretching from the Arctic Circle to the Equator and from central Canada to the Azores.1 The area involved is tremendous, and the diversity of climate and socioeconomic conditions great. Each base where Army troops served had its own special problems, but there was a common pattern. Together, the bases formed a screen of defensive outposts. They were also land links in three major transatlantic air routes, and some had additional strategic value as jumping-off points for future operations.2
The Atlantic Approaches to War
Establishment of Atlantic Bases
The German conquest of France in May 1940, with its immediate threat to Great Britain, stimulated the formulation in the United States of detailed plans for a dynamic defense of the Western Hemisphere that would include outposts far from the shores of the American
1 The account
excludes Alaska, Hawaii, and western Canada, which are treated in connection
with the war against Japan.
continents. The swiftly moving events of the summer culminated on 2 September in a U.S.-British agreement to exchange fifty overage U.S. destroyers for bases on British soil in the Caribbean and the Atlantic. The agreement covered Army, Navy, and Air Corps bases in the Bahamas, Jamaica, Antigua, St. Lucia, Trinidad, and British Guiana on 99-year lease. At the same time the right to establish U.S. bases in Newfoundland (then a crown colony) and in Bermuda was granted as a gift. Early in 1942 the British Government also authorized establishment of an American air base on Ascension Island, between Brazil and Africa. Studies of possible sites began in the fall of 1940 and early the next year American troops began moving into some of the new bases.
In mid-1941 American forces began relief of the British garrison in Iceland, after diplomatic arrangements with the Icelandic Government. A similar movement of U.S. forces into Greenland was authorized by the Danish minister in Washington, D.C., who functioned with his staff as a government in exile after the absorption of his country by the Nazis. Agreements with representatives of the Dutch Government led to American relief of British troops on Aruba and Curacao Islands, Netherlands West Indies, and to an American occupation of Surinam. The establishment of air routes across both the North and the South Atlantic led to stationing considerable numbers of Army Air Corps and other service personnel in central and eastern Canada, and in Brazil.
During the period before American entry into the war, U.S. Army strength was built up in Panama and Puerto Rico, and the number of troops in the newly acquired bases also increased rapidly. An Axis attack across the South Atlantic against Brazil was regarded by both the Army and the Navy as a distinct possibility, whereas a Japanese attack on Pearl Harbor was thought to be less likely because of the presence of the Pacific Fleet. When the less likely attack came on 7 December 1941, attention shifted abruptly to the Pacific, and estimates of Army strength necessary to maintain the security of the Atlantic were revised in the light of the new conditions. Expansion continued, but at a relatively slower pace. Nevertheless, by December 1942 there were 175,000 U.S. troops in the defensive bases along the eastern coasts of North and South America and on the islands linking the Western Hemisphere to Europe and Africa. This figure exceeded the American strength in the United Kingdom at that time, and was half of the U.S. Army strength in the Pacific, where actual combat had been in progress for a year. Troop strength in some areas began to decline while others were still building, so that the over-all figure never was much above that at the end of 1942. The peak month was May 1942, when 181,867 U.S. soldiers garrisoned the Atlantic bases.
These bases were set up as semitactical organizations, with enough ground combat troops in most instances to hold off a hostile landing force until help could be sent. Engineer troops were usually present in considerable numbers in the early stages of occupation, giving way to Air Forces units, mostly Air Transport Command (ATC) personnel, when the construction work was finished. Naval forces were also stationed at many of the bases. Administratively, the new
bases in the Caribbean were brought under the pre-existing military departments having jurisdiction over Puerto Rico and the Panama Canal Zone. In Brazil a theater-type organization was set up to supersede control by the Air Transport Command. In the North Atlantic, however, the various major bases were established as independent commands and were only brought together under the Eastern Defense Command in the middle of 1944. All of the North Atlantic bases ultimately passed to control of the Air Transport Command.
Medical Service in the Atlantic Bases
In Puerto Rico and the Panama Canal Zone, medical facilities were part of the Army's peacetime establishment. Wartime needs were met primarily by expansion of units, just as they were in the zone of interior. In the new bases, however, all medical facilities had to be sent in. For the most part, buildings were constructed by the Corps of Engineers, whose troops generally preceded both ground and air personnel. Indeed, the engineers often supplied medical service as well as buildings for a time after the combat troops arrived. To care for thousands of civilian workers on its various airfield and other projects at the new bases, the engineers had been forced to establish a medical service of their own. Directing it for the eastern division was Col. (later Brig. Gen.) Leon A. Fox. Usually by the time ground troops arrived at a base, the engineers had in operation an infirmary or small hospital, which served until Medical Department units could be unpacked and housed.3
The Air Transport Command similarly had its own medical service, which at some bases co-existed with the Army medical service, and at others merged with it. Where command of the base itself passed to the ATC after the war, Army medical facilities and installations were transferred to the new jurisdiction.
Bed requirements for the new bases were computed on the same 5-percent ratio used for hospitals in the United States, but in practice the ratio was never more than a rough rule of thumb, more nearly true in the aggregate than in detail. Initially, hospital care at the bases was provided by medical detachments, the provisional hospitals established being activated in place later on as numbered station hospitals. It was not until the fall of 1941 that the first numbered hospital units activated in the United States were shipped out to Iceland. Before the war was over, the number of such units in the Atlantic defense areas increased to a peak of 5 general hospitals, 45 numbered station hospitals, a handful of unnumbered hospitals of varying sizes, and 10 or more dispensaries equipped to function as small hospitals. Excluding dispensaries and hospital expansion units, the Table of Organization (T/O) bed strength totaled a maximum of 10,145 in June 1943, at which time the bed ratio (percentage of the command for which beds were available) was 5.8.4
Medical Department activities at all of the Atlantic bases included dental and
3 For more
detailed treatment, see Blanche B. Armfield, "Medical Department, United
States Army," Organization and Administration, in World War II (Washington,
1963), ch. II.
veterinary work, but for the most part no special problems were encountered in carrying out these functions.
The North Atlantic Bases
Iceland Base Command
As a precaution against possible German occupation, the British in May 1940 sent troops to garrison Iceland. By the spring of 1941, however, the British were too hard pressed in Africa to waste manpower on a purely defensive situation, After some hesitation, but with the approval of the Icelandic Government (Icelanders felt there would be less risk in being occupied by a nonbelligerent) President Franklin D. Roosevelt decided early in June 1941 to relieve the British garrison with American troops. An initial force of 4,100 marines landed in Iceland on 7 July. The marines were followed on 6 August by the 33d Pursuit Squadron, whose P-40s were flown in from an aircraft carrier. The first increment of ground troops--some 6,000 officers and men of the 5th Division--arrived on 15 September. The Iceland Base Command (IBC) was established as the British garrison was relieved, and U.S. forces prepared to protect the transatlantic air transport and ferry routes and the vital sea lanes to the British Isles, less than 800 miles away.5
Command headquarters was established at Camp Pershing, about two miles east of Reykjavik. Several other camps lay north of headquarters, within a 10-20-mile strip close to the coast and centering around Alafoss. Eighty percent of the U.S. force was concentrated in these camps. The remainder was scattered at isolated airfields and radar stations around the rim of the island.
The IBC reached peak strength in May 1943 when, with 40,712 ground, air, and service troops, it was exceeded in size only by the Panama Canal Zone among Atlantic defense areas. Ground forces included engineer and service troops and the entire 5th Division. Air combat strength was augmented, as soon as suitable fields could be made available, by the 9th Bomber Squadron (H) and the 1st Observation Squadron. The bulk of the Air Forces units in Iceland, however, were elements of the Air Transport Command, whose home base, shared with the bombers, was Meeks Field near Keflavik on the southwest tip of the island.
By the time peak strength was reached, the threat of German invasion of Iceland was negligible. In August 1943 the garrison was cut by more than 25 percent; the entire 5th Division was withdrawn. Thereafter, a steady decline in troop strength brought the total to less than 1,800 men by the end of 1945, more
5 Principal sources for this section include: (1) Conn, Engelman, and Fairchild, Guarding the United States and Its Outposts, chs. XVIII, XIX; (2) Narrative Hist, Iceland Base Comd, Always Alert, 16 Sep 41-1 Dec 45, MS, OCMH files; (3) Lt. Col. William L. Thorkelson, The Occupation of Iceland during World War II, MA Thesis, Syracuse University, September, 1949; (4) Annual Rpts, Surg, IBC, 1941-44; (5) Annual Rpts, Surg, 5th Div, 1942-43; (6) Annual Rpts, 208th Gen Hosp, 1942, 1943; (7) Annual Rpts, 11th, 167th, 168th Sta Hosps, 1941-43; (8) Annual Rpts, 14th, 15th, 49th, 72d, 192d Sta Hosps, 1942, 1943; (9) Annual Rpts, 92d Sta Hosp, 1942-45; (l0) Annual Rpts, 365th Sta Hosp, 1943, 1944; (11) Annual Rpts, 366th Sta Hosp, 1943-45; (12) Arctic Laboratory, Sep 41-Jun 44, AAF, N Atl Wing, ATC, app. F; (13) Med Hist Rcd, Oct 44-Dec 44, app. E, AAF, N Atl Wing, ATC; (14) Hist of Med Dept, ATC, May 41-Dec 44; (15) Ltr, Col Charles H. Beasley (Ret) to Col O. F. Goriup, 10 Aug 59, commenting on preliminary draft of this volume.
than a third of them Air Forces personnel. The Iceland Base Command, which was under the European Theater of Operations (ETO) from June 1942 on, passed to control of the Eastern Defense Command in the middle of 1944. The Air Transport Command, which retained an interest in Iceland after the war was over, assumed control of all remaining U.S. Army activities there on 1 January 1946.
Medical Organization- The strength of the Medical Department in Iceland rose from 749 at the end of 1941 to 2,959 a year later. By the end of 1943 the total number of officers, nurses, and enlisted men of the Medical Department had declined to 1,163 and was down to 429 by the end of 1944. T/O bed strength went through a corresponding expansion and decline, from an initial to a peak of 2,600 in October 1942, declining to 400 by the middle of 1944.
The base command surgeon during the most active period was Lt. Col. (later Col.) Charles H. Beasley, who had accompanied the initial Marine contingent in July in order to make a medical evaluation of the island. Colonel Beasley returned to Iceland with the Army ground troops, remaining until August 1943, when he was relieved by Col. John F. Lieberman. Lt. Col. John C. McSween became IBC surgeon in early 1944. In addition to its regular function as guardian of the health of the U.S. troops in the command, the base surgeons office did much to win over the Icelandic people. Army hospitals treated large numbers of Icelandic citizens who had been injured in the vicinity of American camps, and also cared for civilians who were struck by military vehicles. Members of the Medical Department co-operated freely with the local public health authorities, and Army veterinarians helped their Icelandic colleagues examine, test, and treat livestock, and aided them in other agricultural matters. Many of the most prominent doctors of Iceland inspected U.S. Army hospitals and attended Army medical meetings. In turn American medical officers visited Icelandic patients in consultation. On several occasions the Army supplied local hospitals with urgently needed drugs and biologicals, while the American Red Cross contributed hospital and medical supplies to its Icelandic counterpart.
The work of the surgeons office revolved around the system of hospitalization and evacuation and the related medical supply function, each of which will be discussed under a separate heading. Supplementing these activities at the base command level was the divisional medical service, which operated
camp dispensaries and treated 5th Division personnel wherever they were stationed. The organic 5th Medical Battalion furnished routine evacuation service from unit dispensaries to nearby station hospitals and from the hospitals back to the dispensaries. The medical battalion also operated a dispensary for the port of Reykjavik and ran a provisional hospital in the Keflavik area until a permanent station hospital was established there. Air Forces units maintained their own dispensaries and operated crash aid stations for emergency treatment at the various airfields. Engineer troops, which preceded the Army combat elements by about a month, had their own medical detachments, but anything of a serious or complicated nature went to Marine and later to Army installations.
Hospitalization -The disposition of U.S. Army hospitals in Iceland was dictated by the combination of mountains, lava beds, and glaciers that circumscribed roads and airfields, and by the rugged coast line, turbulent seas, and icebergs that made water evacuation hazardous much of the year. Although the bulk of the beds were in the Reykjavik-Alafoss area to serve the largest concentration of troops, it was still necessary to supply hospital facilities wherever American soldiers were stationed. Three numbered station hospitals arrived with the main body of troops in mid-September 1941, and two of these were in operation before the close of the year. The 168th Station Hospital was established in Reykjavik in a permanent building formerly used by a British hospital. The main frame structure held 100 beds, and Nissen huts were used to bring the hospital up to its 250-bed T/O capacity. The first patient was admitted on 24 September. The following week the 11th and 167th Station Hospitals, both 250-bed units, which had arrived in Iceland at the same time as the 168th, were attached to the latter until suitable sites could be prepared. The 11th Station Hospital opened on 22 December in a section of a British hospital at Camp Helgafell, some ten miles north of Reykjavik. The 167th remained attached to the 168th until April 1942, when it moved into newly erected Nissen huts at nearby Alafoss. (Map 1.)
During 1942 six more station hospitals and one general hospital arrived on the island to serve an increasing number of Army troops coming in from the United States. The 1,000-bed 208th General Hospital came in March and began operating before the end of the month at Camp Helgafell, where it shared quarters with a British general hospital and the U.S. 11th Station Hospital. The 11th moved in June to Kaldadharnes, some twenty-five miles southeast of Reykjavik, where it served personnel of an airfield. The British hospital was withdrawn to the United Kingdom in August, leaving the 208th General in sole possession of the hospital plant.
The 72d and 92d Station Hospitals both arrived in August 1942. The 92d, with 75 beds, began operating in September at Reykjaskoli near the head of Hrutafjodhur on the north coast of Iceland. The 72d--a 50-bed unit--was scheduled for Borgarnes about thirty miles north of Reykjavik but, because of a variety of construction difficulties, did not get into operation until the beginning of January 1943. By then changes in troop dispositions had made a hospital
at Borgarnes unnecessary, and the unit was moved later in January to Kaldadharnes, where air activity was increasing. The 75-bed 14th Station Hospital and the 500-bed 49th both reached Iceland in September 1942 and went into operation the same month. The 14th was at Seydhisfjördhur on the eastern coast; the 49th enlarged a 200-bed hospital plant taken over from the British near Akureyri on the north coast, the second largest city in Iceland and the site of a large seaplane base. The 15th Station, another 75-bed unit that also arrived in September, began operating at Budhareyri, about forty miles south of the 14th, in November. The 75-bed 192d Station Hospital arrived in October and was
attached to the 168th Station at Reykjavik until its own hospital plant at Höfn on the southeastern coast was ready in January 1943.
With the exception of the 168th Station at Reykjavik, all U.S. hospital plants, including those taken over from the British, were Nissen, Quonset, or similar types of corrugated steel huts. Even with prefabricated buildings, however, construction was difficult. Materials for drains, plumbing, and electrical fixtures were not always available. Little could be accomplished during the winter months, when the nights were twenty hours long, and even the brief periods of daylight were often marred by cold, dampness, and winds up to 130 miles an hour. A civilian labor shortage forced reliance on troop labor, including that of Medical Department personnel. In the vicinity of Alafoss natural hot springs were used for heating hospital buildings.
The officers, nurses, and enlisted men of Iceland Base Commands hospitals, in addition to caring for all U.S. Army personnel in the command, provided hospitalization for members of the American Red Cross and for U.S. civil service employees. They also treated and hospitalized on occasion U.S. Navy and Marine Corps personnel, certain British Army, Air Force, and Navy men, some members of the Norwegian Army and Navy, and
American and Allied merchant marine casualties and survivors from sea mishaps. However, the bulk of patients were, of course, from the various camps of the command.
As the threat of German invasion of Iceland faded during 1943, the withdrawal of troops and relocation of remaining forces brought a number of changes in hospital dispositions. In April the 192d Station left Höfn for the Reykjavik area, where most of its personnel were already on detached service with the 168th Station, but the hospital did not resume independent operation. Further shifts came in June when the 15th Station, no longer needed at Budhareyri, was attached to the 49th at Akureyri, and the 92d Station, including patients, was transferred from Reykjaskoli to Alafoss.
On 24 June the 192d Station Hospital was disbanded and its personnel and equipment were transferred to the 92d, which was reorganized as a 150-bed unit. On the same date the 208th General Hospital at Camp Helgafell was reduced from 1,000 to 750 beds, and the 168th Station in Reykjavik was expanded from 250 to 500 beds, in preparation for a mission elsewhere.
A few days later, on 2 July 1943, the 208th General was redesignated the 327th Station Hospital, without change of site or mission. On the same day the 500-bed 49th Station closed at Akureyri, leaving the smaller 15th Station to care for remaining patients in that area, and a week later sailed for the United Kingdom. It was followed by the 168th Station on 3 August.
The 11th Station, meanwhile, had shifted from Kaldadharnes to Reykjavik to replace the 168th. It was joined there by the 72d Station on 19 August. Two days later the 92d Station Hospital opened near Keflavik, adjacent to the Meeks Field headquarters of the Air Transport Command.
By this time the bulk of the ground force troops had left, as had many of the air and service forces. When the 15th Station from Akureyri and the 14th from Seydhisfjördhur both moved to the Alafoss-Helgafell area late in September, all U.S. hospitals were concentrated in the Reykjavik area. It remained only to consolidate the units for more efficient operation.
The first step in this direction was taken on 30 October when the 327th Station sailed for England. A consolidation of the remaining hospitals was effected on 6 December 1943. The 11th and 72d Station Hospitals were combined at Reykjavik to form the 150-bed 366th Station, while the 14th, 15th, and 167th Stations were combined at Camp Helgafell to form the 365th Station Hospital, with a T/O of 500 beds. At the end of 1943 only the 92d, 365th, and 366th Station Hospitals remained in Iceland, with a combined bed strength of 800. Seven months earlier there had been one general and nine station hospitals, with an aggregate of 2,600 T/O beds.
Except for Iceland's strategic function as a stop on the air route to Europe, the war there was over. Hospitalization was on a garrison basis, with the garrison steadily decreasing in size. The 365th Station transferred to the United Kingdom on 26 June 1944. On the first of that month the 92d Station had increased its bed strength from 150 to 250, but the number of beds on the island was still halved. The 366th was inactivated early in 1945, leaving the 92d Station the only
U.S. Army hospital in Iceland. It was transferred to the jurisdiction of the Air Transport Command on 1 January 1946, along with the remains of the Iceland Base Command.
Evacuation- From most of the army camps in Iceland patients were evacuated by ambulance from the unit dispensary to the nearest station hospital. Those who required general hospital care were moved on to the 208th General Hospital at Camp Helgafell, by ambulance from station hospitals in the western part of Iceland, by sea or air from those in more isolated areas. Evacuation by boat through coastal waters proved to be a very efficient method of handling patients from the eastern and northern parts of the command except during the long winter season, and was more frequently used than air evacuation.
The 120-day evacuation policy set up by the War Department for evacuation from Iceland to the United States proved to be entirely satisfactory. Both air and water transportation were used. In either case, patients to be evacuated to the zone of interior were cleared through the 208th General Hospital or, after its departure, through a station hospital acting as a general. Although the number of evacuees was not unduly large--327 in 1942, 1,180 in 1943, and 248 in 1944-- there was generally a backlog because of unavailability of transportation or lack of proper facilities, especially for neuropsychiatric and other cases requiring medical attendance. Psychiatric cases amounted to 33 percent of those evacuated in 1942, 32 percent in 1943, and 56 percent in 1944.
The medical facilities of the Iceland Base Command were also available, to the extent needed, to care for 19,589 transient patients who were flown from the ETO to the zone of interior by way of Iceland between 1 January 1944 and 1 July 1945. To accommodate these, an unnumbered holding hospital was set up at Meeks Field, including mess facilities for walking patients. Litter cases were served hot meals aboard the planes. If a plane were held because of poor flying conditions, the 92d Station took care of the patients until they could continue their journey. The hospital also took care of any patients whose condition made it unsafe to continue. Medical attention was similarly available to 5,930 able-bodied men from the ETO who passed through Iceland between June and September 1945 on their way to the States.
Medical Supplies and Equipment- Medical supplies for the Iceland Base Command were handled through a main depot in Reykjavik and a subdepot and a package storage depot in the Alafoss area. The main depot--two fish-drying houses leased for the purpose--had more than 11,000 square feet of floor space for storage; the subdepot, in three prefabricated huts, had 2,880 square feet of storage space; and the package warehouse about a mile distant had 4,000 square feet. Individual hospital and other medical units maintained supply levels of from 90 to 80 days, the larger stocks being held by installations on the northern and eastern coasts, which were not readily accessible in bud weather. The depots held a 120-day supply by the end of 1942.
Six officers and 75 enlisted men were authorized for operation of the medical supply system in Iceland, but this number was never reached. Five officers and
50 enlisted men were sent, but even these figures were reduced by attrition to 4 and 45 respectively before the end of 1942. The supply system was reorganized early in August 1943 and again in mid-December. In August a Base Depot Section, 20th Medical Depot Company, was organized to carry on the medical supply function, but was supplanted in December by the 300th Medical Composite Platoon. Under the latter form of organization the depots were operated by two supply teams, one with an officer and 11 enlisted men, the other with 2 officers and 27 enlisted men.
While some medical units encountered a number of delays in getting their normal equipment, medical supplies as a whole were plentiful. Some items, such as quinine, mosquito bars, and various combat items, were never required in Iceland, and other items became surplus as the strength of the command declined. During 1943 excess British medical supplies to a total of 130,000 pounds, and 2,325,000 pounds of excess U.S. medical supplies were shipped to the United Kingdom. The years end still found the depots bulging with supplies for 60 days of operation, 90 days maintenance, and a further 90-day final reserve of certain necessary items, held in dispersed locations. These levels were sharply reduced during 1944 to a 30-day operating and 30-day maintenance level.
Professional Services- In spite of unfamiliar and unfavorable climatic conditions, the incidence of disease among U.S. troops in Iceland was exceptionally low. There were no diseases peculiar to the country, no mosquitoes, few insects of any kind. Common respiratory diseases constituted overwhelmingly the largest single cause for hospitalization. Half of all hospital admissions in 1942 were for respiratory diseases. In 1943 the respiratory disease rate was 190 per 1,000 per annum, including mild cases treated in quarters as well as those hospitalized. The 1944 rate, similarly computed, was down to 95. The command experienced a sharp rise in rates for such diseases after the arrival of each new troop contingent, but the situation would return to normal in about a month.
An outbreak of jaundice in May 1942 claimed 478 in that month. In June the number of cases climbed to 661, dropping to 170 in July and only 11 in August. The total number of cases for the 4-month period was 1,320. There were no deaths from jaundice. The cause was not determined. Large numbers of the rats that abounded in Iceland were examined, but none were found to be diseased. There appeared, however, to be some connection with yellow fever inoculations. All but 7 of the 1,320 men who came down with jaundice had been inoculated for yellow fever from the same lot of vaccine before leaving the United States.
An epidemic of mumps in the civilian population in 1942 was kept from spreading to the troops by prompt preventive measures. Only 128 sporadic cases were reported. Venereal disease, scourge of the Mediterranean and European theaters, was notable in Iceland chiefly for its almost total absence. Venereal rates for the base command were 4.4 per 1,000 per annum in 1942; 5.3 in 1943; and 6.2 in 1944. Only mental disorders showed a significant rise as time went on. Isolation, boredom, lack of recreation, adjustment problems, and a feeling of contributing little to the war effort combined to pro-
duce relatively high neuropsychiatric rates.
The general health of the U.S. troops in Iceland, excellent at all times, steadily improved throughout the war. The non-effective rate for 1942 was 29.5 per 1,000; in 1943 it was only 25.37; and in 1944 it was a startling 16.28. There were, of course, no combat wounds, and the accident rate--primarily plane crashes--was relatively low.
The dental service in the Iceland Base Command encountered no unusual difficulties. Dispersal of troops made it expedient to assign dentists to areas rather than to clinics, but for the most part the work itself was routine. The Veterinary Corps encountered more serious problems, stemming largely from inadequate sanitary standards on the part of the local authorities. From their arrival on the island, U.S. veterinary personnel worked with the Icelandic authorities and with individual farmers and food processors to improve methods and standards.
Greenland Base Command
After months of indecision, officials of the State, War, and Navy Departments agreed early in February 1941 that airfields and other facilities in Greenland would be needed for hemisphere defense, and that in view of the Monroe Doctrine the United States could permit no other power--not even friendly Canada--to take the initiative there. A survey expedition sailed in March. Less than a month later, on 9 April, the project received formal sanction when the Danish Minister in Washington (still recognized by the United States) and the Secretary of State signed an agreement under which the United States guaranteed the security of Greenland in return for the right to construct, maintain, and operate the required facilities. The first echelon of the Greenland force--469 officers and men-- sailed from New York on 19 June and anchored off Narsarssuak on the southwest coast of Greenland on 6 July.6
To the United States and Great Britain, Greenland was considerably more than the "raw structure of rock and salt water and ice, all united by the eternal cold" that Col. Bernt Balchen had described. It was a potential stop on an air ferry route that could enable fighter planes to move from American factories to British bases under their own power; it was the only known commercial source of natural cryolite, invaluable as an electrolyte in the production of aluminum; and it was the gathering point for the storms that would influence air and naval activity in western Europe. The Germans had recognized the importance of obtaining weather data in Greenland and had established several meteorological stations that were subsequently eliminated by the British in the summer of
6 Sources for this section are: (1) Conn, Engelman, and Fairchild, Guarding the United States and Its Outposts, ch. XVII, ch. XX; (2) Craven and Cate, eds., Plans and Early Operations, pp. 122-23, 157-58, 342-48, 641-44; (3) Bernt Balchen, Corey Ford, and Oliver LaFarge, War Below Zero: The Battle far Greenland (Boston: Houghton Mifflin Company, 1944); (4) Annual Rpts, Med Dept Activities, Greenland Base Comd, 1941-44; (5) Annual Rpt, Base Hosp, Greenland Base Comd, 1946; (6) ETMD's (Essential Technical Medical Data), Greenland Base Comd, Jul 43-Nov 45; (7) Interv with Lt Col Otho R. Hill, 6 Sep 44; (8) Interv with Lt Col Norman L. Heminway, Dec 43; (9) Annual Rpts, 188th, 190th, 191st Sta Hosps, 1943-44; (10) Annual Rpt, 189th Sta Hosp, 1943; (11) Med Hist Rcd, Oct-Dec 44, app. E, AAF N Atl Wing, ATC; (12) Ltr, Norman L. Heminway to Col Goriup, 16 Aug 59; (13) Ltr, John R. McBride to Goriup, 28 Jul 59. Both letters comment on preliminary draft of this volume.
1940. Later, however, another German weather station was believed to be in operation. This was located and destroyed by an American force, but the Germans continued to obtain Greenland weather reports from a submarine kept in the area for that purpose.
In addition to its responsibility for the health of Army and Air Corps personnel and employees of civilian contractors stationed there, the Medical Department in Greenland supplied hospital facilities for the crews of Navy, Coast Guard, and merchant vessels and of transient aircraft. A small detachment of Medical Department officers and enlisted men arrived with the first contingent at Narsarssuak, where the first U.S. military post, BLUIE WEST 1, was established. In August 1941 the medical detachment there set up a 10-bed field-type tent hospital, which operated for two months before a suitable building could be erected. A 5-wing cantonment-type building was eventually built. The wings were connected by heated corridors. Supply rooms and the mess hall were off the main corridor, opposite the clinic and hospital wings. Initially, only one wing with twenty beds was required for inpatients. It was not until January 1943, when survivors from the torpedoed USAT Dorchester were brought to BLUIE WEST 1, that two other wings were made ready, expanding capacity to approximately sixty beds.
In October 1941 a post was established at the head of Søndre Strømfjord on the west coast of Greenland about fifteen miles inside the Arctic Circle. Known as BLUIE WEST 8, this post was under command of the famed arctic explorer, Capt. (later Col.) Bernt Balchen, with Maj. (later Col.) John R. McBride as surgeon. BLUIE WEST 8 included civilian construction workers, who had been there since September, and Army engineers. The engineer medical officer, Capt. (later Lt. Col.) Stephen W. Ondash, was responsible for the health of the civilians. The first hospital set up on the post, an engineer unit available to all, opened on 10 December 1941.
In November a post was established at Angmagssalik on the eastern coast of Greenland about forty miles below the Arctic Circle. BLUIE EAST 2, as the new post was called, was primarily a weather and communications station. It included a medical officer and an engineer dispensary operated by civilians. In March 1942 a post was set up at Ivigtut, about 100 air miles west of Narsarssuak, where the cryolite mine was located. The Ivigtut base was called BLUIE WEST 7. By June a small building had been erected for a dispensary.
The Greenland Base Command, with headquarters at BLUIE WEST 1, had meanwhile been formally activated on 26 November 1941, although Army forces in Greenland had been using that designation since their arrival. There was no surgeon for the whole command, however, until November 1942, when Colonel McBride, as the senior Air Forces medical officer on the island, was assigned that responsibility. He was succeeded in March 1943 by Maj. (later Col.) Norman L. Heminway, commanding officer of the 188th Station Hospital and surgeon of the BLUIE WEST 1 base. In December Colonel Heminway was transferred, being succeeded in each of his three capacities by Maj. (later Lt. Col.) Otho K. Hill.
Under War Department authority granted in September 1942, four num-
bered station hospitals were activated to replace the makeshift units then functioning. (See Map I.) Cadres were drawn from Medical Department personnel already on the ground and actually operating the existing hospitals and dispensaries that were to be elevated to numbered status by the new arrangement. Authorizations were given for hospitals of 250, 200, 150, and 25 beds, for BW-1, BW-8, BE-2, and BW-7 respectively. Construction of buildings began in the fall of 1942, continuing into the late months of 1943. The bulk of the work was completed by the end of that year, when the troop build-up reached its maximum strength of about 5,300. The unduly long construction time was due in part to weather hazards, in part to low priority in a very restricted labor market, and in part to the necessity for importing all building materials from the United States.
Largest of the hospitals, the 188th Station, opened at BLUIE WEST in its new buildings in December 1943. One of the finest examples of an overseas hospital, the installation was located for maxi-
mum terrain protection. It was built at a cost of $1,769,022. Its 32 cantonment-type buildings on 22.5 acres were connected by heated and insulated corridors. Central heating, electricity, running hot and cold water, and a modern sewage system made it a comfortable haven in the frozen wasteland of Greenland. The 188th Station, in addition to its function as post hospital, received patients from other units, mostly by air, who required further observation or treatment. It also acted as clearing and processing point for cases being evacuated to the United States.
Additional hospital construction at the smaller posts in Greenland during 1943 made conditions less crowded, but bed requirements were never as great as had been anticipated. The 190th Station Hospital, originally authorized as a 200-bed unit, was reduced to a 50-bed hospital by the time it moved into its permanent quarters at BLUIE WEST 8. The 191st Station at BLUIE EAST 2 also operated as a 50-bed unit, although its original authorization had been for 150 beds. The smallest of the four Greenland hospitals, the 189th at BLUIE WEST 7, remained a 25-bed unit throughout its period of operation. At none of the four post hospitals was medical service seriously interrupted during the period of construction. New plants were occupied by echelon, as space became available, without closing down the old until the new was functioning. Such unavoidable curtailment of minor services as occurred was compensated for by treating as many cases as possible on a "quarters" basis.
During the greater part of the year, transportation by water was very difficult or impossible. Therefore, each of the four main Army bases in Greenland had to be largely self-sufficient from the standpoint of supply. In practice this imposed no handicap as supplies for the base command as a whole were more than ample throughout the war. The months of isolation envisaged by the planners never materialized.
In addition to the four bases themselves, there were a dozen or more weather observation and radio posts operating out of one or another of the BLUIES. For the larger outposts of this type a medical officer was provided; for the smaller, only a trained Medical Department enlisted man could be spared.
Although the climate was much more severe and the setting far more bleak than anything the men had before experienced, there were no adverse effects on health. There were no indigenous diseases. The native Eskimos suffered heavily from tuberculosis, but contacts between the natives and the U.S. troops were so infrequent as to remove the hazard. The only venereal cases were among those who had been infected outside of Greenland. Respiratory diseases made up the largest item in the disease category, with newly arrived troops the most frequent victims. On the whole, however, the incidence of disease in Greenland was very low. Injuries, directly related to the treacherous and rugged terrain, ship loading and unloading, and construction work accounted for the largest number of patients admitted to hospitals, as well as about a quarter of all those evacuated to the zone of interior. The second largest group returned to the zone of interior, accounting for about 18 percent of the total, were the neuropsychiatric cases, stemming from the prolonged service in an isolated, unpleasant environment, combined with constant
monotony and a complete lack of normal social contacts. A general apathy, called by the men stationed in Greenland, "The Arctic Stare," developed in a majority of troops after a years stay on the island. It was notable, however, that even in the most difficult year, 1944, neuropsychiatric cases constituted only about 4 percent of hospital admissions. The suicide rate was also relatively low. Admissions for all causes to the main hospital of the command, the 188th Station Hospital, numbered 1,821 in 1943 and 2,137 during 1944. 7
Evacuation of patients within Greenland moved from the outposts to the main bases, where the permanent hospitals were established, and thence, if more elaborate treatment or ZI evacuation were indicated, to the 188th Station Hospital. Patients could be evacuated to the 188th from other parts of Greenland only by air and by sea, while those within BW-1 came in by bus or ambulance. Most of the patients sent to the zone of interior for further treatment were transported there by air; a few went by ship. Weather problems frequently complicated evacuation procedures in Greenland. Poor flying conditions or ice packs--which prevented the passage of ships-- were responsible for many delays. Greenland Base Command sent an average of 15 to 25 patients a month to the United States for general hospital treatment. Beginning in 1944 the personnel of the 188th Station Hospital and the Air Transport Command fed and furnished professional services to transient patients being evacuated by air from Europe to the United States. From May to October, 471 such cases passed through the command, 34 of which were temporarily hospitalized.
General reductions in strength during 1944 resulted in practically all ground force units being withdrawn from the command, leaving mostly air and service personnel. The base established to protect the cryolite mine at Ivigtut closed during the summer, and the 189th Station Hospital, which was located there, ceased operations in August. At the end of that month, Colonel Hill left the Greenland Base Command, being succeeded as post surgeon and commanding officer, 188th Station Hospital, by Capt. (later Maj.) John A. Jones, and as Greenland Base Command surgeon by Maj. Andrew W. Shea. Medical units operated below T/O authorizations when possible. Excess medical personnel and large amounts of surplus medical supplies were returned to the United States.
Greenland Base Command had become primarily an Air Transport Command stopover and a weather forecasting center a year before the ATC assumed full responsibility for all U.S. activities on the island in January 1946. Only the hospital at BLUIE WEST 1 continued active at this time.
Newfoundland Base Command
The island of Newfoundland lies on the great circle route between New York and the British Isles, controlling both sea and air lanes and blocking the mouth of the St. Lawrence. Its strategic importance had made its defense an object of concern to the United States and Canada early in the war. The right to establish U.S. bases there was given at the time of
7 No detailed admission statistics are available for the other hospitals of Greenland Base Command, but admissions to the 188th Station Hospital constituted the bulk of all hospital admissions
the destroyers-for-bases agreement of early September 1940, and an engineer survey party arrived on the island on 13 October. The first of the garrison troops followed late in January 1941 when the 21,000 ton USAT Edmund B. Alexander, first ship of her size to attempt the narrow, rocky entrance to the harbor, anchored at St. Johns. The transport carried 58 officers and 919 enlisted men, including personnel to operate a 40-bed hospital, which was activated on shipboard.8
The St. Johns base, to be known as Fort Pepperrell, was not yet ready to receive either troops or hospital. For the next four and a half months the Alexander served as a floating barracks, while the hospital continued to function on the ship. Medical supplies could not be reached until the ship was partially unloaded, but needed items were procured ashore. Civilian hospitals in St. Johns cared for engineer troops and civilian construction workers until late February, when an engineer medical officer arrived and opened a small dispensary at the base. The dispensary grew into a 25-bed hospital, opened 16 June 1941. By this time the transport had been recalled, and the station hospital had moved from its shipboard quarters to a country estate about two miles from the city. Equipment for a 50-bed hospital had been unloaded from the transport, but could not be uncrated until covered storage space was found. At the beginning of December another move put the hospital, then known as Station Hospital, Newfoundland Base Command, into a newly completed barracks at Fort Pepperrell. Designed to accommodate 125 men, the building was readily converted into a 60-bed hospital, to be occupied pending completion of a suitable hospital building. (See Map I.) The commanding officer of the hospital, Maj. (later Col.) Daniel J. Berry, also acted as Newfoundland Base Command surgeon.
A second U.S. hospital had meanwhile been established at Newfoundland Air Base near Gander. The base, still under construction but already occupied by units of the Royal Canadian Air Force, was one of the largest in the world. The American portion of the base, called officially U.S. Army Air Base, Newfoundland, but unofficially known as Gander Field, was occupied in May 1941. A 25-bed hospital to serve the base was activated at the same time and sited in a portion of the RCAF hospital functioning there. Evacuation was to Fort Pepperrell, 250 miles away by rail but only half of that distance by air. The hospital moved into its own building in December 1942 with a rated capacity of 150 beds.
A third U.S. Army hospital was set up originally as a 25-bed dispensary in January 1942 at Fort McAndrew, near the naval base of Argentia, seventy-five miles
8 The main sources for this section are: (1) Conn, Engelman, and Fairchild, Guarding the United States and Its Outposts, ch. XIV; (2) Watson, Chief of Staff, pp. 479-81; (3) Annual Rpt, Sta Hosp, Newfoundland Base Command, 1941; (4) Annual Rpt, Med Activities, Newfoundland Comd, 1942; (5) Med Bases in Newfoundland District doc included in Health Service, Caribbean, Apr 42; (6) Annual Rpt, Sta Dispensary, U.S. Army Air Base, Newfoundland, 1941; (7) Annual Rpts, 308th Sta Hosp, 1943, 1944; (8) Annual Rpt, 309th Sta Hosp, 1944; (9) Annual Rpts, 310th, 311th, Sta Hosps, 1943; (10) Arctic Laboratory, Sep 41-Jun 44, AAF, N Atl Wing, ATC, apps. I, J; (11) ETMD's, Newfoundland Base Comd, Jul 43-Dec 45; (12) Ltr, Col Daniel J. Berry (Ret) to Col Goriup, 2 Aug 59; (13) Ltr, Col Emmett L. Kehoe to Col Goriup, 2 Aug 59 (14) Ltr, Gunnar Linner to Goriup, 10 Aug 59. Last three letters comment on preliminary draft of this chapter.
308TH STATION HOSPITAL AT FORT PEPPERRELL, Newfoundland. The basement, shown rising above ground level, was a completely self-contained bombproof unit to which patients could quickly be moved down ramps.
west of St. Johns. For the time being a small engineer hospital already on the ground handled cases beyond the capabilities of the dispensary, but a station hospital was formally activated in May and opened in June 1942, eventually absorbing the engineer unit. Last of the U.S. bases to get into operation was Harmon Field near Stephenville on the western coast of Newfoundland. Here a medical officer, a dental officer, and four enlisted men opened a 25-bed hospital in a small barracks in March 1942.
At each of the four U.S. bases, the hospital commander served also as surgeon of the base and as commander of the medical detachment.
The four U.S. Army hospitals were designated as numbered station hospitals on April 1943. At that time the base unit at Fort Pepperrell became the 308th Station Hospital with a Table of Organization calling for 250 beds. With this enlargement of the hospital, its commanding officer, Lt. Col. Gunnar Linner since October 1942, was relieved as Newfoundland Base Command surgeon by U. Col. William J. Eklund. The 308th Station moved in June into a permanent all-concrete building designed for its special needs. There were two stories above ground, with a basement blasted from solid rock and protected by a thick concrete slab. The basement, which
could be immediately converted into an underground hospital should the upper portion of the building be bombed, had complete facilities, including operating rooms, kitchens, refrigerators, stored food supplies, and a diesel electric power plant. It could be completely sealed and supplied with air drawn in through decontamination canisters. Patients could be moved down ramps from the main hospital in a matter of minutes. Located at base command headquarters and adjacent to the capital and principal port of Newfoundland, the 308th took patients by transfer from the smaller and less well-equipped units and processed all patients being evacuated to the United States.
The post hospital at Fort McAndrew became the 309th Station Hospital, with a T/O of 100 beds. The 310th Station (150 beds) succeeded the post hospital at Gander Field, and the small Harmon Field unit became the 25-bed 311th Station Hospital. Maximum T/O bed strength of 450 was reached at this time, to serve a troop strength of approximately 9,000. Troop strength increased to a peak of 10,500 in June 1943 but soon fell back below the 9,000 level. The 310th and 311th both passed to the jurisdiction of the Air Transport Command in September but continued to report to the base surgeon until July 1944, when both were disbanded. The bulk of the personnel and equipment were allotted to newly organized dispensaries, which were really small hospitals under the North Atlantic Wing of the Air Transport Command.
By mid-1944 the Newfoundland Base Command was little more than a stop on the air route to Europe. Lt. Col. Emmett L. Kehoe, who had relieved Colonel Eklund as base surgeon in January 1944, also relieved Colonel Linner as commanding officer of the 308th Station Hospital in March, thus recombining the two positions. In December 1944 the 308th Station was reduced to 150 beds and the 309th to 75. In September 1945 the 309th was disbanded and the 308th reduced to 25 beds. On 1 January 1946 all remaining installations were turned over to the Air Transport Command.
Evacuation from Newfoundland was never a problem, though evacuation within the island was often difficult owing to the virtual absence of roads. Gander and Harmon Fields were connected with St. Johns by railroad but the distances were considerable--250 rail miles from Gander and close to 500 from Harmon--and the service in winter was erratic because of the heavy snow-falls. Air evacuation was faster, but it was even more subject to the hazards of unpredictable weather. For this reason, a medical officer of better than average surgical skill was assigned at each hospital. Evacuation to the United States was by sea until late 1942, when transport planes equipped with litter racks also began to be used.
After the invasion
of Normandy in June 1944, Harmon Field became increasingly important as
a stopover point for patients being evacuated from Europe. A 72-bed transient
hospital was built to accommodate these patients when poor weather conditions
made it impossible to continue the flight. A new post hospital of 75-bed
capacity, completed in March 1945, also had more than
9 See Clarence McKittrick Smith, The Medical Department: Hospitalization and Evacuation, Zone of Interior, UNITED STATES ARMY IN WORLD WAR II (Washington, 1956), pp. 174-75.
half of its beds available for transients. When flights were not interrupted, litter patients were given a warm meal on the planes. Plasma and whole blood were available for those who needed them. Fresh milk was flown up from Presque Isle, Maine, especially for use of evacuees passing through Harmon Field.
In general the health of the command was good. The climate was relatively mild, resembling that of northern New England. Although the winters were characterized by sudden changes from sunshine to snow or sleet, with a penetrating northeast wind, the thermometer seldom dropped below zero. The troops were housed in permanent buildings and had proper clothing. The incidence of respiratory diseases was not unduly high, and intestinal diseases were at a minimum. In 1942 there were 25 cases of catarrhal jaundice, which, like the parallel but more severe outbreak in Iceland, were apparently related to yellow fever immunization.
A venereal disease rate that climbed to 35 per thousand per annum in October 1942 and averaged in the neighborhood of 20 during 1943 was considered excessive by Medical Department officers in Newfoundland, although that rate compared very favorably with those in other areas.10 The establishment of prophylactic stations and the issue of individual prophylactics to the men, together with a stepped-up educational program and excellent co-operation from the local authorities, brought the rate down to a negligible figure by 1945. A local health problem was tuberculosis, which was widely prevalent among the Newfoundlanders and thus constituted a serious threat to U.S. troops. Diphtheria, also common among the residents, never seriously menaced the American forces.
On the supply side, there were early difficulties brought about more by lack of storage facilities than by lack of supplies themselves. After the bases were well established, medical supplies were quite adequate--large quantities were even returned to the United States during 1944. The base medical depot at Fort Pepperrell was discontinued late in 1943, the function passing to the 308th Station Hospital.
Bermuda Base Command
Geographically, Bermuda was the key to the North Atlantic defenses. It lies near the center of a line from Nova Scotia to Puerto Rico, which is to say the center of an arc shielding the Atlantic coast of North America whose ends are Newfoundland and Trinidad. Only Newfoundland preceded Bermuda among the bases acquired from Great Britain. As in Newfoundland, engineer troops were first to reach the island, the vanguard arriving in November 1940. An engineer medical officer reached Bermuda in January 1941, but no engineer hospital was established until August. The Bermuda Base Command, meanwhile, had been activated on shipboard on 18 April 1941 and established headquarters two days later in the Castle Harbour Hotel some two miles across the water from the site selected for the U.S. Army base and airfield near the eastern end of the islands. (See Map I) 11
10 See pp.
A small station hospital landed with the original troop complement and established itself in the headquarters hotel, where it eventually occupied rooms on ground, mezzanine, second, and third floors. The first patient was received on 23 April. The hospital commander, Col. E. M. P. Sward, also served as surgeon, Bermuda Base Command. He was responsible for the health of all Army troops, including Air Corps, in Bermuda; for U.S. civilian construction workers; and for the on-the-job health of locally procured labor. The Navy had a hospital of its own at the naval base and air station at Kings Point projecting into Great Sound at the western end of the main island.
of Staff, pp. 481-82; (3) Annual Rpts, Surg, Bermuda Base Comd, 1941, 1942-45; (4) ETMD's, Bermuda Base Comd, Jul 43-Dec 45; (5) Hist Monograph, U.S. Army Base, Bermuda, by N Atl Div, CE, OCMH files; (6) Hist of Preventive Medicine in World War II, Eastern Defense Comd, Tab: Bermuda Base Comd; (7) Med Hist Rcd, Oct 44-Dec 1944, app. L, AAF, N Atl Div. ATC; (8) Ltr, Col. E. M. P. Sward (Ret) to Col Goriup, 27 Jul 59; (9) Ltr, Col Paul A. Keeney (Ret) to Col John Boyd Coates, Jr., 29 Oct 59. Both letters comment on preliminary draft of this chapter.
On 1 December 1942 the base hospital was designated the 221st Station Hospital, with a T/O capacity of 250 beds. Army medical personnel in Bermuda at this time numbered 29 officers and 137 enlisted men; troop strength in the islands was approximately 4,000 climbing to a peak of about 4,500 in March 1943.
The hospital moved from the Castle Harbour Hotel on 1 May 1943 to a new, modern building of concrete and coral only a quarter of a mile from the Air Transport Command terminal at Kindley Field, the newly completed American air base that was the principal installation of Fort Bell. A dispensary previously maintained at the field was closed, but the hospital continued to maintain other dispensaries wherever the troop population warranted.
Since by mid-1943 construction was largely finished and military activities were of a routine nature, the need for hospital beds was beginning to decline. An agreement with the Navy was reached during the summer, and in September 1943 the naval hospital transferred all patients to the 221st Station, preparatory to closing. Thereafter all Navy personnel requiring more than dispensary care, including transients from the Atlantic Fleet, were treated at the base hospital. Col. Paul A. Keeney was hospital commander and base surgeon.
The work load had lightened appreciably before the end of 1943, with troop strength standing at 2,800 in November. As of 1 June 1944, with less than 2,300 U.S. troops still in the command, the 221st Station Hospital was reorganized as a 150-bed unit, and in August 1945 was further reduced to too beds. Troop strength was then below 2,000. On 1 January 1946 the hospital passed to control of the Air Transport Command.
Evacuation to the United States was irregular. In the absence of hospital ships or medical air evacuation planes, patients were evacuated by commercial airline or by any available ship equipped with adequate hospital facilities. There might be weeks between planes and months between ships. In these circumstances, the 120-day evacuation policy was sometimes exceeded, and the 221st found it necessary to give more comprehensive medical care than was normal for station hospitals.
In August 1944 Bermuda became a stop on one of the main air evacuation routes from Europe, Africa, the Middle East, and the China-Burma-India Theater. A medical air evacuation detachment consisting of nurses and enlisted men was stationed at Kindley Field to rotate with personnel of incoming planes of the 830th Medical Air Evacuation Transport Squadron. At the Bermuda base, the 221St Station Hospital was responsible for feeding transient patients, treating them where necessary, and, if circumstances required, hospitalizing them. Although the hospital had been reduced to 150 beds before this time, ample accommodations were available. Indeed, in January 1945, when the USAHS St. Mihiel ran aground in the vicinity, the 221st Station cared for more than 500 patients of the hospital ship for two weeks. From September 1944 until several months after the end of the war, well over 1,000 patients a month passed through Bermuda on their way to the zone of interior. March 1945 was the peak month with 1,837.
The medical service of the 221st Station Hospital saw only routine cases, with
even the venereal disease rate relatively low. The surgical service dealt with a number of accident cases, but the only combat wounds hospitalized there were suffered at sea by personnel of the Atlantic Fleet or one of the Allied naval units based on Bermuda.
U.S. Army Forces in the Azores
U.S. planners in 1941 contemplated the occupation of the Portuguese Azores by a U.S. military force, but the project was postponed in favor of relieving the British garrison in Iceland, where the urgency seemed greater. In mid-1943, after defeat of the German and Italian forces in North Africa and the subsequent conquest of Sicily, the use of the Azores as a link in a new central Atlantic route to Europe, the Middle East, and Asia was definitely planned, pending agreement with the Portuguese Government. In October 1943 the British succeeded in getting permission to use the islands for military purposes under the terms of an old treaty. A British naval base and an air base near Lagens on Terceira Island, were quickly established, and in December American personnel began to share the airfield with the British. This joint occupancy continued until September 1944, when the Portuguese finally gave the United States permission to establish an exclusively American base on Santa Maria Island, about 150 miles southeast of Terceira.12
Organizationally, the U.S. base in the Azores was set up as part of the North African theater, but did not long remain in that status. In May 1944, under the designation U.S. Army Forces in the Azores, jurisdiction over American personnel and installations in the islands passed to the Eastern Defense Command. In February 1945 the North Atlantic Division of the Air Transport Command took over control of all U.S. interests in the Azores.
Medical support of U.S. Army troops on Terceira Island consisted initially of a dispensary with evacuation to a British hospital for cases requiring more than a few days confinement. By February 1944 the dispensary had grown until it occupied several Nissen huts. Other prefabricated buildings were added between February and May. Forty-four regular beds enabled American troops to be hospitalized in their own area, which greatly facilitated the operation of the medical service. In addition, another 35 or 40 beds were available to accommodate evacuees from other theaters on their way to the zone of interior. A 170-bed medical installation was requested by the Azores Base Command, but no such unit was established there until after the war. On Santa Maria Island the Medical Department began operating a dispensary with the arrival of the first troops in September 1944. During the remainder of the year the Medical Department on the island acquired frame buildings and tentage to maintain a 120-bed dispensary. The dispensaries on Terceira and Santa Maria remained in operation through the end of the war and into the postwar
12 Sources for this section are: (1) Matloff and Snell, Strategic Planning for Coalition Warfare, pp. 44-45; (2) Hist of the Med Dept. ATC, May 41- Dec 44; (3) Arctic Laboratory, Sep 41-Jan 44, AAF, N Atl Wing, ATC, pt. I, pp. 40-43, pt. II, pp. 1-5, and app. L; (4) Med Hist Rcd Oct 44--Dec 44, AAF, N Atl Div. ATC, pt. I, pp. 30-35, pt. II, pp. 2-6, and apps. K and P; (5) Annual Rpt of Med Dept Activities, Base Hosp, Azores Air Transport Sta, Atl Div, ATC, 1947.
period, when the one on Terceira Island became a 50-bed hospital. Both installations had been in effect hospitals from the start, but continued to be called dispensaries because of the reluctance of the Medical Department to assign hospitals to Air Forces commands. They served a combined U.S. troop population that averaged about 1,200, plus an indefinite number of transients.
The threat of plague was the most serious medical problem facing the Medical Department in the Azores. It had occurred sporadically for a number of years in all three forms: bubonic, pneumonic, and septicemic. The latter two types invariably proved fatal. All troops destined for the Azores received one inoculation of plague vaccine before departure from the United States and another after arriving in the islands. The Medical Department in the Azores conducted a vigorous rat extermination program and regularly inspected the quarters and all other buildings used by the Army. Not a single case of plague developed among U.S. Army troops in the Azores. Typhoid fever and venereal diseases were two other dangers to the health of troops, but control measures prevented the former and lessened the latter disease. As in most of the other North Atlantic bases, respiratory diseases and injuries accounted for the majority of cases requiring hospitalization.
Air evacuation to the United States through the Azores began on a large scale after the invasion of western Europe. When most of France fell into Allied hands, it was possible to evacuate casualties direct from the Continent to the United States. By the end of 1944 a winter evacuation route using the Azores rather than Iceland was adopted, thus offsetting the disadvantages of cold weather operations in northern latitudes and reducing evacuation time from France to the United States. About 2,000 patients a month passed through the Azores during the winter of 1944-45.
U.S. Army Forces in Eastern and Central Canada
The primary mission of the U. S. forces in eastern and central Canada was to speed delivery of planes to the United Kingdom--first lend-lease planes for the hard-pressed Royal Canadian Air Force, then fleets of bombers and fighters to be flown in combat by American crews. The quickest, and in the long run the safest, way to deliver a plane was under its own power. It needed only a line of bases close enough together to be Within the range of fighter craft, and adequate weather information. A direct route for heavy and medium bombers from Newfoundland to Scotland had been pioneered in 1940, but it was hazardous at best. Greenland was the key, and the way was cleared for its use in the spring of 1941. The first U.S. troops in the areas designated for bases in eastern and central Canada were Engineer Corps personnel under direct command of the General Staff. l3
13 Principal sources for this section are: (1) Conn and Fairchild, Framework of Hemisphere Defense, ch. XV; (2) Samuel Milner, "Establishing the Bolero Ferry Route," Military Affairs, vol. XI (Winter 1947). pp. 213-22; (3) Craven and Cate, eds., Plans and Early Operations, pp. 313-18; (4) Colonel Stanley W. Dziuban, Military Relations Between the United States and Canada, 1939-1945, UNITED STATES ARMY IN WORLD WAR II (Washington, 1959) ; (5) Arctic Laboratory, Sep 41-Jun 44, AAF N Atl Wing, ATC, pt. I, chs.1 and 2, and apps. D, G, H, and K; (6) Med Hist Rcd, Oct 44-Dec 44, AAF N Atl Wing ATC, apps.
The Air Ferry Routes
An air ferry route from Presque Isle, Maine, to Prestwick, Scotland, was well along by the end of 1941. The first hop would be to Gander, Newfoundland, or alternatively, because of crowding at Gander, to Goose Bay, Labrador, where the Canadian Government began construction of an airfield late in September. BLUIE WEST 1 at the southern tip of Greenland, under construction since July, would be the second stop, and Reykjavik, Iceland, the third. Air distances were approximately 570 miles from Presque Isle to Goose Bay, 775 miles from Goose Bay to BLUIE WEST 1, another 775 miles to Iceland, and the final and longest hop of 840 miles from Reykjavik to Prestwick. Fighter planes would need extra fuel tanks, but they would make it. Weather stations established in September 1941 at Fort Chimo in northern Quebec Province, at Frobisher Bay on Baffin Island, and on Padloping Island off the shore of Baffin Island just above the Arctic Circle were to supply information for the guidance of pilots. These weather stations were designated respectively CRYSTAL 1, CRYSTAL 2, and CRYSTAL 3.
The air ferry route through Labrador, Greenland, and Iceland was barely operational when the whole program was revised and enlarged in the middle of 1942. The enlarged project was known as CRIMSON. Entry of the United States into the war had increased the pressure to get planes to the British Isles, and the entire Eighth Air Force was to be flown to its British base. The new plan in no way canceled out the old, but added to it a route through central Canada that would tap the aircraft production centers in California and the middle west. Stations on the central route would be Great Falls, Montana, The Pas in west central Manitoba, Churchill on Hudson Bay in northern Manitoba, Coral Harbour on Southampton Island just below the Arctic Circle, and thence to BLUIE WEST 8, the northernmost Greenland base, and on to Iceland and Scotland. Additional airfields were to be located at Mingan on the north shore of the Gulf of St. Lawrence, about midway between Presque Isle and Goose Bay, and at the weather posts at Fort Chimo and Frobisher Bay. Nine additional weather observation posts were to be established in the central area.
Work on these arctic bases went forward feverishly during the brief summer season of 1942. Engineer troops were supplemented by Air Corps ground crews as runways neared completion, and before the winter of 1942-43 closed in, nearly 900 planes of the Eighth Air Force were flown to Scotland by one or another of these routes. The number of U.S. military personnel in central and eastern Canada, including those assigned to the CRYSTAL and CRIMSON projects, climbed from 1,891 in March 1942 to more than 17,000 in August, then dropped abruptly to 2,571. For the first six months of 1943 the average troop strength was about 1,350. By that date the project stage was past. In July 1943 the United States Army Forces in Central Canada was set up as an independent
D, G, and J; (7) ETMD's, USAFCC, Oct 43-Sep 45, and USAFEC, Oct 43-Sep 44; (8) Annual Rpt. 4th Sta Hosp, 1943; (9) Final Rpt, Surg, USAFCC, 29 Sep 45; (10) Annual Rpt, Surgeon, USAFEC, 1943; (11) Rpt of Inspection, Med Serv, Crimson Project, Eastern Sector, by Brig Gen Albert W. Kenner to TSG, n.d., inspection between 20 and 30 Jul 43.
command. At the same time jurisdiction over the bases in eastern Canada was assigned to the North Atlantic Wing of the Air Transport Command. A theater-type organization, the U.S. Army Forces in Eastern Canada was created early in September, but with little change in anything but name. The Commanding General, North Atlantic Wing, ATC, doubled as Commanding General, USAFEC, until October 1944, when the theater organization was discontinued and the Air Transport Command resumed direct control.
Medical Support on the Air Ferry Routes
No Army hospitals went into either eastern or central Canada until November 1942, when the airfields and weather stations had assumed the character of permanent operating posts. The construction and maintenance crews that had swelled the personnel totals in the summer of that year had been cared for in temporary engineer hospitals and in dispensaries set up by Air Forces medical detachments.
While the eastern route was in use first, the earliest U.S. medical support, other than the transient engineer and air units, went to bases in central Canada. Adequate hospital facilities were available in the eastern sector at Presque Isle, at Gander, and in Greenland. Of the major fields along this route, only Goose Bay was without U.S. hospital facilities, but for the time being the Royal Canadian Air Force hospital there served personnel of both nations.
On the central route, every effort was made to supply medical service for all bases before the winter of 1942-43 brought varying degrees of isolation. A 25-bed dispensary was set up at Coral Harbour, Southampton Island, on 17 August 1942. The 131st Station Hospital, of 100 beds, opened at The Pas on 10 November, and two days later the 4th Station, also a 100-bed unit, got into operation at Churchill. The theater surgeon, Capt. (later Maj.) Michael Q. Hancock, was based at the Winnipeg headquarters of the U.S. Army Forces in Central Canada, where a one-man dispensary supplemented the facilities available in Canadian Army and Air Force hospitals. The various weather observation posts, each in charge of a noncommissioned officer with 5 to 9 men, relied on the skills of medical enlisted men. Emergencies were diagnosed, and treatment was prescribed by radio until one of the theaters 4 medical officers could reach the spot, or until the patient could be brought out.
By the end of 1943, with the submarine menace virtually eliminated and good alternative air routes to share the load, the air ferry route through central Canada declined in importance. The two hospitals were inactivated in December and moved from the theater, each being replaced by a 10-bed dispensary, operated by a medical officer and eight enlisted men. In April 1944 Capt. (later Maj.) Allen G. Thurmond succeeded Hancock as theater surgeon, and was relieved in turn by Capt. Werner Lehmann, formerly post surgeon at Churchill, at the end of the year. The dispensaries at Churchill and The Pas were both inactivated in July, as was the dispensary at Coral Harbour in August. The headquarters dispensary, last U.S. medical installation in central Canada, closed late in September 1944 as the theater itself
passed out of existence.
In eastern Canada the 6th Station Hospital (150 beds) was established at Goose Bay in April 1943. In the same month two 50-bed units were opened farther north--the 133d Station Hospital at Fort Chimo, Quebec, and the 34th at Frobisher Bay on Baffin Island. In August a 10-bed dispensary was set up at Mingan, Quebec, south of Goose Bay. The 6th Station, meanwhile, had been reduced to 75 beds. The authorized bed strength of the 133d and 134th Station Hospitals was similarly halved in September. A medical officer and a quantity of medical supplies continued to be maintained on Padloping Island because of its remote and isolated position.
All of the Army medical installations in eastern Canada were withdrawn in July 1944 so that the reorganization of October did not affect the Medical Department as such. Medical service at Goose Bay and such other fields in the sector as remained in use was thereafter exclusively supplied by the North Atlantic Wing, Air Transport Command. The change in command, so far as the medical service was concerned, was nominal, since the wing surgeon, Col. Gordon G. Bulla, had served also as theater surgeon throughout the life of USAFEC.
The problems faced by the Medical Department in Canada were initially those of getting established in an unfamiliar and often inhospitable environment. In arctic and subarctic stations, weather was always a factor. Clothing originally issued quickly proved inadequate, but the men were not long in adopting the Eskimo mukluks, Indian moccasins, or the heavy felt shoes sold by the Hudson Bay Company as preferable to the shoes issued by the Quartermaster. There were similar difficulties with mittens and parkas. Suitable housing for medical installations offered another problem. The 4th Station Hospital at Churchill, for example, occupied buildings without insulation, with unheated corridors, and with cracks in eaves and window ledges through which snow sifted. A modern, completely insulated hospital plant, with hot and cold running water, electric lights, and steam heat was constructed, but owing to labor shortages and low priority it was not finished until January 1944, after the hospital had been inactivated.
In addition to Army and transient Air Forces personnel, all the Army hospitals treated civilian construction workers. Those farthest north also treated local Eskimos and Indians, who were at first sent to the American doctors by the Royal Canadian Mounted Police and later came of their own accord.
Once the difficulties of adjustment were overcome, the health record was remarkably good. Cold injury was a rarity, upper respiratory diseases were less frequent than experience in cold climates would have indicated, and venereal diseases, though by no means unknown, were largely the result of exposures outside of the theater. Even neuropsychiatric disorders-a frequent accompaniment of service in isolated posts--were relatively infrequent.
Evacuation was by plane from the remote areas such as Coral Harbour and Padloping Island, and emergency evacuation was always by plane if feasible. In Manitoba routine evacuation was by rail, with one train a week between Churchill and The Pas, and on alternate days from The Pas to Winnipeg. The more isolated weather stations could be reached only
by planes equipped with skis or pontons, and at times only by tractor or dog sled. A plane normally based in Winnipeg was available on call for emergency evacuation and could be notified by radio when on a mission. Evacuation from the post hospitals and dispensaries was normally direct to Army hospitals in the United States, but Canadian hospitals were always available in emergency.
Medical supplies were adequate, even abundant--at times large surpluses piled up and eventually had to be returned to supply depots in the United States.
The Caribbean Defense Command
The Caribbean Defense Command, authorized by the Secretary of War in January 1941, was officially activated the following month, but its organization was not completed until 29 May 1941. It included the existing Panama Canal and Puerto Rican Departments, and U.S. bases and other Army operations in Central America, the British and Dutch West Indies, the Guianas, Venezuela, Colombia, and Ecuador. For administrative purposes the command was set up with three main subdivisions: a Puerto Rican Sector, a Panama Sector, and a Trinidad Sector. The Puerto Rican and Trinidad Sectors were merged in June 1943. The top command and its administrative divisions supplemented rather than supplanted the existing commands in Panama and Puerto Rico, which remained throughout the war the two major administrative elements in the Caribbean area.
The Caribbean Defense Command had no surgeon until October 1943, when Brig. Gen. (later Maj. Gen.) Morrison C. Stayer assumed the duties as its surgeon, but without giving up his assignment as chief health officer of the Panama Canal Zone. He had been advising the Commanding General, Caribbean Defense Command, informally since the activation of the command. General Stayer was succeeded in both capacities March 1944 by Brig. Gen. Henry C. Dooling.
The Panama Canal Department
By the beginning of World War II the Panama Canal Department had functioned as a military organization for more than a quarter of a century. It was therefore one of the well-established, permanent garrisons of the U.S. Army. Army planners regarded the canal as the
keystone of Western Hemisphere defenses. Indeed, as early as 1938 the Chief of Staff had sought to increase the Panama garrison on the ground that troops could be quickly dispatched from the Canal Zone to any threatened area in South America. Basically, however, the Army's mission in Panama was to guard the canal itself from attack by air, sea, or land, and to protect it from raids by enemy commandos or saboteurs. The better to carry out this mission, the jurisdiction of the Panama Canal Department was extended to the various countries of Central America and the Pacific slope of South America as it became necessary for U.S. forces, primarily Air Corps and Engineer Department troops, to move into these areas. The initial task of providing proper defenses also involved the expansion of all the necessary supporting services, including the Medical Department.14
Hospitalization- Military strength in the Panama Canal Department remained at a fairly constant level in the first half of the decade before World War II, ranging between 9,000 and 10,000 troops. In 1936 the average strength rose to about 14,000, where it remained until 1940, when it again increased markedly. Six small hospitals and four dispensaries provided most of the necessary medical service. In 1939 there were approximately 260 dispensary and station hospital beds in the department, but only 50 were actually in a hospital building. The rest were housed with other activities, usually in post administrative buildings, which were noisy and inadequate in size. In addition to these hospitals and dispensaries, which provided beds for less than 2 percent of the command, the
14 General sources for this section are: (1) Conn, Engelman, and Fairchild, Guarding the United States and Its Outposts, ch X; (2) Caribbean Defense Comd, Organization, Development and Reorganization, MS, OCMH files; (3) Hist of the Panama Canal Dept. vols. I-IV, MS, OCMH files; (4) Organization and Reorganization [Panama Canal Dept, 1911-47]. MS, OCMH files; (5) War Plans and Defense Measures [Caribbean Defense Comd], MS, OCMH files; (6) Annual Rpt of TSG, U.S. Army, 1940; (7) A Hist of Med Dept Activities in the Caribbean Defense Comd in World War II, vols. I-III; (8) Annual Rpts, Dept Surg, Panama Canal Dept, 1940-45; (9) Clarence McK. Smith, Monograph, Building Army Hospitals in Panama, A Prewar Construction Problem, 1939-1940; (10) Annual Rpts, Off of Surg, Caribbean Defense Comd, 1945-44; (11) ETMD's, Caribbean Defense Comd, Oct 43-Dec 45; (12) Annual Rpts, 218th Gen Hosp, 1941-42; (13) Annual Rpts, 210th Gen Hosp, 1942-45; (14) Annual Rpts, 262d Gen Hosp, 1944-45; (15) Annual Rpt, 333d Sta Hosp, 1943; (16) Historians Rpt, 568th Sta Hosp, 1946; (17) Rpt of Med Activities, Pan American Highway, to 30 Jun 43; (18) Ltr, Brig Gen Henry C. Dooling (Ret) to Col Goriup, 5 Aug 59; (19) Ltr, Col John W. Sherwood (Ret) to Col Goriup, 2 Aug 59. Both letters comment on preliminary draft of this chapter.
Army had an allotment of some 400 beds in two hospitals operated by the Panama Canal Health Department--the Gorgas Hospital on the Pacific side of the canal and the Margarita Hospital on the Atlantic side. It was the continuous availability of these hospitals--especially the Gorgas Hospital--for handling unusual or difficult cases that kept the medical service at a high level despite inadequate bed strength at the military posts. The policy of allocating beds in the Panama Canal Health Department hospitals continued during the war, but with the allotment reduced to 250 beds after 1943, by which time new Army hospitals had become available. (Map 2) The Panama Canal Department surgeon when the United States entered the war was Col. John W. Sherwood, who was succeeded in May 1943 by Col. Wesley C. Cox.
A plan for the construction of permanent Army hospitals in the Panama Canal Zone was developed in 1935 by the Panama Canal Department surgeon in co-operation with The Surgeon General of the Army. Congress approved the plan in 1937, authorizing the construction of a 528-bed hospital at Fort Clayton on the Pacific side of the canal, a 401-bed hospital at Fort Gulick on the Atlantic side, and a 60-bed hospital for the combined posts of Fort Kobbe and Howard Field in the Pacific sector. Funds for the hospital construction program did not materialize until a year later, by which time construction costs had so increased that it became necessary to reduce the capacity of the two larger hospitals by 150 beds each. The War Department approved the plans on that basis in 1939, but there were further delays. The Medical Department was not satisfied that the program as approved was adequate; the governor of the Canal Zone thought the construction of Army hospitals unnecessary; there were delays in the preparation of plans and specifications; funds were inadequate for the number of beds desired; there were difficulties in obtaining materials and equipment; the heavy rainfall hampered construction.
By June 1940 the Panama Canal Department had doubled its 1939 strength, but still no beds were added to the already insufficient number. The bed shortage was reported critical by representatives of the Medical Department returning from the Canal Zone. As an expedient, temporary beds were installed in a converted barracks, while station hospitals were expanded, pending the construction of permanent medical facilities. In general, expansion of the department dictated that hospitals be operated at nearly all posts in the command.
The new Army hospitals at Fort Gulick and Fort Clayton, finally completed in September 1943 opened with rated capacities of 251 and 378 beds, respectively. By making full use of the very spacious porches, the hospitals almost doubled their capacities. A third new hospital, located at Fort Kobbe and ready for use in June 1943, never functioned as originally intended, but served as a dispensary through the war years. The maximum strength of the Army in Panama, about 65,000, had been reached late in 1942, well before the completion of the permanent hospitals. As a result, hospitals operating in converted barracks and other nonhospital buildings cared for the peak loads of patients. With the two largest hospitals completed and occupied by the end of the summer of 1943, the other post, or station, hospitals
in the Canal Zone were reduced to dispensaries. The Panama Canal Department had an average of 2,120 beds available during 1943, roughly 4 percent of the average strength of the command.
The Medical Department units that operated the major hospitals in the Panama Canal Department did considerable shifting about, both in place and in designation, because of construction delays and reorganizations. The two largest units, the 210th and 218th General Hospitals, arrived in Panama in January 1942. The 210th upon arriving at Fort Gulick, the site of the new permanent hospital then still in the process of construction, immediately occupied fourteen recently finished permanent barracks on the post and began admitting patients three weeks later. The 218th General Hospital, which was to occupy the new permanent hospital building at Fort Clayton, could not do so because construction on this post was far from completed. Its personnel was thereupon split up and dispersed on temporary duty mainly to post hospitals at Fort Amador and Fort Kobbe on the Pacific side of the canal, and in smaller numbers to several other posts in the Canal Zone, pending the completion of the Fort Clayton hospital.
The 218th General was redesignated the 333d Station Hospital in April 1943, but the hospitals personnel were not brought together until September 1943, when it moved into the newly completed Fort Clayton hospital. It continued operating this plant as the 333d Station Hospital until April 1944, when the unit again became a general hospital with a capacity of 750 beds. The 262d General Hospital, as it was then called, ran the Fort Clayton hospital for the remainder of the war. Over on the Atlantic end of the canal, the 210th General Hospital, which had operated in barracks buildings since January 1942, moved into the new hospital plant on the Fort Gulick post in September 1943. This general hospital was reorganized as the 368th Station Hospital (450 beds), in April 1944, the chief reason being the decrease in the number of troops in the Atlantic sector of the Canal Zone. It continued operating at Fort Gulick throughout the remainder of the war, but was further reduced to 300 beds in December 1944.
The new hospital construction in the Canal Zone followed the pattern of the Gorgas Hospital, that is, tropical construction of reinforced concrete, with broad overhanging eaves on each floor for protection against the sun, and wide porches with jalousies to keep out the driving tropical rains. The solidly constructed buildings compared favorably with any hospital in the United States and satisfied the needs of the Army in Panama for years to come.
In the Central American and South American countries under the jurisdiction of the Panama Canal Department, medical service was supplied largely by small hospitals and dispensaries under control of the Sixth Air Force or the Corps of Engineers. During 942 hospitals with capacities of 25 beds each were established at David, Republic of Panama; Guatemala City, Guatemala; Salinas, Ecuador, and Talara, Peru. The Air Forces had a 75-bed hospital constructed on Seymour Island in the Galápagos Island group, strategically located 1,000 miles from Panama in the Pacific Ocean, protecting the western approaches to the canal. (See Map 2.) All of these hospitals were constructed as tempo-
rary, theater-of-operations-type buildings. Eight dispensaries of temporary construction, having 10 beds each, were built at other locations in the Republic of Panama during 1942. Most of the hospitals expanded their capacities during 1943, and an additional 25-bed hospital and two 10-bed dispensaries opened during that year. In 1944 the hospital at David and those in Ecuador and Peru became station dispensaries. Most of the dispensaries had ceased operating by 1945, but three of the hospitals and two dispensaries remained open through the greater part of the year.
Still another Army group maintained a medical service in the area: the Corps of Engineers, who were responsible for building the Pan American Highway. In December 1942 and January 1943 medical personnel arrived to operate dispensaries at various points along the route of the highway in Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama. The health of between 1,500 and 2,500 American workers and technicians employed on the highway, together with that of thousands of local laborers was the chief concern of the Pan American Highway medical service, under the direction of Lt. Col. E. T. Norman. At the end of August 1943 there were 13 medical officers, 2 dental officers, a sanitary officer, and 50 assorted male nurses, attendants, technicians, and pharmacists supporting the highway builders.
Health Problems- Malaria and venereal disease were the two major medical problems in the Panama Canal Department. The work of the Medical Department during 1940-45 succeeded in bringing the admission rates for these diseases down to an all-time low. The admission rate per thousand per year for malaria in 1940 was 57.2. It reached a peak of 116.4 in 1942, but declined steadily thereafter, to the rate of only 9.3 in 1945. A primary factor in the upward spurt early in the war was the establishment of antiaircraft batteries in remote jungle areas; and the removal of troops from screened barracks in sanitated zones to tent camps in more distant locations as a precaution against anticipated air raids. Venereal disease rates amounting to 71.7 per thousand per year in 1940 were also steadily brought down to 17.6 in 1945, the lowest ever recorded in the Panama Canal Department up to that time. The malaria and venereal disease control programs were operated under the guidance of the Medical Department in co-operation with civil health authorities, but basically control measures rested with the individual Army units, whose command responsibility in these matters consisted of thoroughly indoctrinating their personnel.
Medical Supply- Some difficulty was experienced in obtaining medical supplies in adequate quantities during 1940-42, the period of rapid growth of military strength in the Canal Zone. Production facilities were being expanded, shipping was short, and there were many claimants for each item available. In 1942 German submarine activity in the Caribbean was responsible for the destruction of some medical supplies and for delay in the delivery of others. By 1943, however, shortages in medical supplies had disappeared. The system of automatic supply through the shipment of medical maintenance units, which had prevailed during the early period, was
discontinued in September 1943 when the department began making monthly requisitions for all supplies. In common with the usual experience of noncombat areas, an excess eventually accumulated, which was shipped back to the United States in 1943 and 1944. Because of the high humidity, certain medical supplies, notably metal instruments and canvas, were vulnerable to deterioration. The use of dry rooms, equipped with electrical heating units to reduce the moisture in the air, prevented the loss of much valuable equipment.
Evacuation- The volume of evacuation from Panama to the United States never reached a very high level. Hospital admissions consisted largely of disease cases, with a lesser number of injuries, and no battle casualties. Many cases that would have to be evacuated from snore isolated areas in the Western Hemisphere could easily be treated in the modern general hospital facilities in the Canal Zone. Proximity to the United States facilitated the evacuation of patients when necessary. A 90-day hospitalization policy existed in the early
part of the war, but by 1943 it had increased to a 120-day policy, which, in effect, precluded evacuation unless protracted treatment was needed. In general, only men deemed unfit for further duty were returned to the zone of interior. Within the Canal Zone the Medical Department moved sick and injured men from their units to points of hospitalization by motor ambulance. In most instances this procedure meant a trip of less than twenty miles. Boat evacuation was used to transport patients from installations around Gatun Lake and from otherwise inaccessible locations in the interior of Panama. The Panama Canal Railroad transported most of the patients requiring movement from one end of the canal to the other. The air bases in the Republic of Panama and in Central and South America evacuated their patients to Canal Zone hospitals by air. The department sent most of its ZI patients to New Orleans by ship, but a small number of cases made the trip to the United States by air. The latter method was used especially in those cases requiring an immediate change of environment and climate, or for patients needing very specialized treatment of a type not available in Panama.
Puerto Rico and the Antilles
The U.S. Army had maintained a garrison on Puerto Rico from the time that island was ceded to the United States at the conclusion of the Spanish-American War. In the period before World War II troops there were under the jurisdiction of the Second Corps Area. This attachment to the zone of interior ceased when the War Department established Puerto Rico and the Virgin Islands as a territorial department on 1 July 1939. The Puerto Rican Department, as the new command was named, served a dual role: first, as the most advanced U.S. possession from which American sea and land operations could be projected southward or eastward; and, second, as a forward defensive barrier protecting the eastern approach to the Panama Canal. After the destroyers-for-bases agreement of 1940, the U.S. Army extended its fringe defenses of the canal into other islands in the Caribbean, providing at the same time a defense of the bauxite "lifeline" from the Guianas to Trinidad and the United States. Included were bases leased from the British on Jamaica, Antigua, St. Lucia, and Trinidad, and bases on Aruba and Curacao leased from the Dutch Government. Other bases for American troops were established in the Guianas and in Cuba, while U.S. soldiers remained for a considerable time in Venezuela, on training mission. The Puerto Rican Department, renamed the Antilles Department in June 1943, absorbed all the above named-areas during the course of the war.15
15 (1) Conn and Fairchild, Framework of Hemisphere Defense, ch. X. (2) War Plans and Defense Measures [Caribbean Defense Comd]. (3) A Hist of Med Dept Activities in the Caribbean Defense Comd in World War II, vols. I--III. (4) Annual Rpts, Med Dept Activities, Puerto Rican Dept. 1941 and 1942. (5) Annual Rpts, Medical Dept Activities, Antilles Department, 1943-45. (6) ETMD's, Caribbean Defense Comd, Oct 45-Dec 45. (7) Annual Rpt, Med Dept Activities, Trinidad Sector and Base Comd, 1942 and 1943. (8) Annual Rpt, Med Dept Activities, British Guiana Base Comd, 1942. (9) Health Service, Caribbean, 1942. (10) Annual Rpts, Sta Hosps, Borinquen Field, P.R., Losey Field, P.R., Ft. Read, Trinidad, and Aruba, N.W.I., 1942. (11) Annual Rpt, 161st Gen Hosp, Ft. Brooke, San Juan, P.R., 1945. (12) Annual Rpt, Med Dept Activities, U.S. Army Forces in Surinam, 1942. (13)
Puerto Rico eventually had the largest concentration of U.S. Army troops in the Caribbean, outside the Panama Canal Zone. When formed as a territorial department in July 1939, the total strength amounted to 931 officers and enlisted men, serving at the main post of Fort Brooke in San Juan and at the subpost of Henry Barracks near Cayey. By December the strength had risen to 2,913 and continued upward through 1940, reaching more than 13,000 in December of that year. These troops were divided among six posts in Puerto Rico and one in the Virgin Islands. Army strength in the Puerto Rican Department continued to enlarge beyond any legitimate military need, mainly because the operation of the Selective Service System brought more Puerto Ricans into the Army than could be used elsewhere. Military strength doubled in 1941 over that of the previous year and doubled again during 1942. At the time of the formation of the Antilles Department, the command had a strength of over 50,000. It reached a peak of more than 57,000 in September 1943, which amounted to only about 8,000 less than the maximum strength attained by the Panama Canal Department.
Hospitalization- The most important prewar Medical Department facility in Puerto Rico was the old station hospital at Fort Brooke housed in buildings turned over to the United States by the Spanish Government at the conclusion of the Spanish-American War. The hospital buildings dated back to the 18th century, but during the course of World War II, approximately a million dollars was spent to modernize and improve the buildings and to make them more suitable for modern hospital use. In 1941 the hospital had a capacity of about 600 beds and acted as a general hospital for the entire Puerto Rican Department. At Fort Buchanan, about seven miles south of San Juan, another station hospital, originally activated as a medical detachment on the post of Fort Buchanan in October 1939, became the post hospital in late 1941, with a capacity of 150 beds. (See Map 2.)
Borinquen Field, the main air base, located in the northwest corner of Puerto Rico, had a Medical Department dispensary servicing the field from the time the first troops arrived there in September 1939. In May 1941, a 150-bed station hospital began operating at the field. Another airfield, known as Losey Field, situated near Ponce in the south central part of the island, was the location of a 100-bed station hospital, which began operating for the garrison there in April 1941. The old established post of Henry Barracks served as a subpost of Fort Brooke until December 1939. In March 1940, a station hospital of 10 beds was established for the post, and by October of 1941 it had a capacity of 55 beds. Most troops stationed at Camp Tortuguero, a post in the northern part of the island west of San Juan, used the Fort Brooke station hospital. A hospital ward, completed at Camp Tortuguero in July 1941, took care of mild medical and surgical cases. A dispensary, opened in March 1941, administered to the needs of the garrison at Benedict Field, located on St. Croix, Virgin Islands.
In the year before Pearl Harbor, the Medical Department had operated these
Ltr, Cal Dean M. Walker (Ret) to Col Goriup, 18 Jul 59, commenting on preliminary draft of this chapter.
seven stations with a minimum of personnel. There were less than 400 officers and enlisted men of the Medical Department in the command at the beginning of 1941, but the number had more than. doubled by the end of the year. Col. Walter P. Davenport was the surgeon of the Puerto Rican Department.
Growing troop strength in Puerto Rico in 1942 resulted in the expansion of most existing medical facilities and the establishment of others. The Medical Department had little choice in the selection of hospital sites since medical installations had to be located at points where large concentrations of troops existed. New hospital construction in Puerto Rico and other islands of the Antilles was characterized by the use of temporary, wooden, theater-of-operations-type structures. Where a post was planned as a permanent military installation, as in the case of Borinquen Field, hospital construction was eventually of a permanent type.
The main hospital at San Juan increased its capacity to 750 beds during 1942. To it were evacuated all neuropsychiatric patients in the department, all cases requiring lengthy hospitalization, and all those destined for the zone of interior. Most of the other hospitals increased their capacities in 1942, and a new 100-bed station hospital, completed during the year, began serving the troops stationed at Camp O'Reilly in eastern Puerto Rico near the town of Gurabo.
In late 1941 and 1942 garrisons were sent to Jamaica and Antiqua after the Puerto Rican Department was expanded to include these British islands. Temporary hospitals of 25 beds each served the U.S. Army troops there. A small hospital of 18 beds was established on St. Thomas, Virgin Islands, in 1942, and the dispensary that had operated on the island of St. Croix became a 25-bed hospital during the same year.
Medical service in the southern half of the Caribbean area, which included bases in Trinidad, St. Lucia, Aruba, Curacao, British Guiana, and Dutch Guiana, did not come under the jurisdiction of the headquarters in Puerto Rico until the establishment of the Antilles Department in June 1943. Prior to that time, U.S. bases in the area were under the jurisdiction of the Trinidad Sector and Base Command, of which Col. Dean M. Walker was surgeon. American troops moved into Trinidad, southern anchor of a defensive arc that included Newfoundland and Bermuda, in May 1941, but for several months had no medical support other than that supplied by their own medical detachments, backed up by British hospitals. In December 1941 construction was begun on a plant to house a 500-bed station hospital at Fort Read, the principal U.S. base on the island, but it was September 1942 before the hospital opened. By that date an additional temporary hospital plant was under construction to provide transient hospitalization should it be necessary to evacuate substantial numbers of casualties from the forthcoming invasion of North Africa. Since operations in Morocco and Algeria produced only a minimal number of casualties, the temporary hospital was never called upon to serve its original purpose. The main unit meanwhile was redesignated on 1 December 1942 as the 41st General Hospital, and was to have an ultimate capacity of 1,000 beds. The first commanding officer was Col. John A. Isherwood.
The 41st General Hospital served as
regional unit for the whole command, taking patients from all the southern Caribbean and the Guianas. It was supplemented at Port-of-Spain, Trinidad, by a small 20-bed unit established early in 1941 and supplanted in the spring of 1942 by a 200-bed hospital activated as the 255th Station Hospital on 1 January 1943. Both Trinidad hospitals were constructed of wood and regarded as semipermanent structures. St. Lucia had a 25-bed permanent Army hospital, which began operating in November 1942. On the two Dutch islands of Aruba and Curacao, the Army maintained station hospitals of 75 beds each beginning in early 1942. The base in British Guiana had a 50-bed permanent-type station hospital located at Atkinson Field, near Georgetown. Two station hospitals operated at bases in Dutch Guiana, one 50-bed unit at Paramaribo and a 25-bed hospital at nearby Zanderij Field. (See Map 2.)
Coincident with the creation of the Antilles Department in June 1943, many of the post hospitals scattered along the Caribbean island chain and the north coast of the South American mainland were activated as numbered station hospitals, often with T/O bed capacities in excess of those then existing. The post hospital at Fort Simonds, Jamaica, became the 292d Station Hospital, with a capacity of 75 beds. At Antigua the post hospital was converted into the 293d Station Hospital, also of 75 beds. The 294th Station (25 beds) absorbed the post hospital at St. Thomas, Virgin Islands. In Puerto Rico the 295th Station Hospital, of 150 beds, supplanted the post hospital at Henry Barracks; the Camp Tortuguero hospital was redesignated the 296th Station (50 beds) ; at Fort Buchanan the 297th Station (75 beds) replaced the existing unit; and tile 100-bed hospital at Camp O'Reilly was redesignated the 326th Station Hospital with a T/O of 250 beds. Two new station hospitals were also established in Cuba supplanting earlier installations: the 299th (150 beds) at San Julián, and the 300th (50 beds) at Batista Field. Most important of the midyear designations was that of the post hospital at San Juan, which became the 298th Station Hospital with an authorized capacity of 600 beds. Attached to it in September was the newly activated 301st Station Hospital (100 beds) which was moved to Losey Field when the Air Forces resumed operations there in June 1944. At that time the unit was reduced to 25 beds.
Another group of hospitals had their designations, and sometimes their sizes, altered in November 1943. These included the post hospital at Borinquen Field, Puerto Rico, which became the 150-bed 330th Station Hospital; the 41st General Hospital at Fort Read, Trinidad, which was redesignated the 359th Station Hospital with a T/O strength of 600 beds; and the small post hospitals at Zanderij Field, Surinam (352d Station, 25 beds) ; Atkinson Field, British Guiana (353d Station, 75 beds) ; Paramaribo, Surinam (354th Station, 50 beds); St. Lucia, British West Indies (355th Station, 50 beds); Curacao, Netherlands West Indies (356th Station, 75 beds); and Aruba, Netherlands West Indies (358th Station, 50 beds).
With the Axis virtually no threat to the Western Hemisphere by mid-1943, except for occasional U-boat raids on shipping, the strategic importance of Puerto Rico and other islands in the Caribbean declined. The Medical De-
partment was at peak strength when the Puerto Rican Department and the Trinidad Sector were merged to form the Antilles Department, with Col. Clyde C. Johnston as its surgeon. There were at this time more than 2,200 officers and enlisted men serving in medical installations from Cuba through the Guianas. A steady contraction began in 1944, which continued to the end of the war. The 298th Station Hospital at San Juan became the 161st General Hospital in June 1944, serving the entire Antilles Department, but its T/O still called for only 600 beds. Other hospitals throughout the area reduced bed strength, converted to dispensary status, or disbanded altogether. By the end of 1945, only nine hospitals remained in the Antilles Department, with a total of 1,225 beds. The 161st General Hospital in San Juan, with 600 beds, accounted for almost half of the total. Outside Puerto Rico only the 292d Station Hospital (25 beds) in Jamaica, the 300th (25 beds) at Batista Field in Cuba, and the 359th on Trinidad remained in operation.
Evacuation- Evacuation activities in the Antilles Department followed a pattern much like that of the Panama Canal Department. It was necessary to evacuate only a small number of men during the entire war. Within the various island bases, men needing medical attention were taken to the nearest dispensary or hospital, usually by ambulance but occasionally by air in the case of isolated units. Further evacuation to a larger hospital was normally accomplished by ship, although air transport came into play if great distances were involved. The large hospitals in Puerto Rico and Trinidad enabled the Antilles Department to give fairly definitive care to most serious illnesses, and since the situation was not one of combat there was no pressing need for evacuation to the zone of interior. About half of the patients moreover, were Puerto Ricans, and so would not normally have been evacuated to the mainland under any circumstances.
Medical Supply- Problems of medical supply in the Antilles proved similar to those in Panama, but tended to be somewhat more difficult in the early days. The lack of a well-developed military establishment in Puerto Rico at the beginning of the emergency period in 1939 and the extreme dispersion of island bases in the Antilles were important factors in creating supply problems. The absence of a major United States activity comparable to the Panama Canal also complicated matters. The new island bases felt the scarcity of supplies in the early days of the war much more strongly than the established facilities in Panama.
Common Diseases- As in Panama, the two major health problems throughout the Antilles Department were malaria and venereal disease, and in both cases the answer was found in improved preventive measures. The malaria rate for the department as a whole was cut from 84 per thousand per annum in 1941 and 88 in 1942 to 37 in 1943, 12 in 1944, and 9 in 1945. Measures taken included larviciding, drainage, use of atabrine, and constant education and experimentation. A unique problem existed around Fort Read, Trinidad, where a water-catching parasite on shade trees planted to protect the cocoa plantations proved a prolific breeder of mosquitoes. It was eventually discovered that a copper sulfate spray
would destroy the parasites. In the fight against venereal disease, eternal reiteration of the danger was primary, together with the establishment of well-located prophylactic stations and steady co-operation with local authorities where local laws and customs permitted some measure of control. The venereal rate was reduced from 81 per thousand per annum in 1942 to 72 in 1943, 47 in 1944, and 31 in 1945.
The South Atlantic Theater
It was clear to U.S. and Brazilian military leaders by the summer of 1939 that only the United States could provide the forces necessary to defend the Brazilian bulge in the event of an attack from Africa, a short 1,800 miles across the South Atlantic. Military planning in both countries accepted this reality, although Brazil accepted it with reluctance. The fall of France a year later and the subsequent control of French West Africa by the collaborationist Vichy regime, gave renewed urgency to preparations for defense of the strategically most, vulnerable point in the hemisphere. Army and Navy staff agreements were
negotiated in the fall of 1940. By specific agreement between the two countries in the spring of 1941, Pan American Airways undertook development of airfields in Brazil at Amapá, Belém, São Luis, Fortaleza, Natal, Recife, Maceio, and Bahia. Such a route, jumping off from bases in the Guianas, would permit even short-range planes to fly to the threatened sector. The work had hardly gotten under way before Pan American, at the request of the U.S. Government and with Brazilian concurrence, undertook to ferry lend-lease planes to British forces in the Middle East.16 After U.S. entry into the war, the South Atlantic ferry route passed to military control. Plans were prepared for setting up a theater of operations in Brazil, but were not realized until after Brazil, too, had declared war on Germany and Italy, 22 August 1942.17
The theater organization had its inception in late June 1942, under the aegis of the South Atlantic Wing, Air Transport Command, of which Brig. Gen. Robert L. Walsh was commanding officer and Maj. (later Col.) George E. Leone was surgeon. Wing headquarters was set up at Atkinson Field, British Guiana, on 9 July, moving to Recife, Brazil, in December after formal activation of United States Army Forces, South Atlantic, on 24 November 1942. A few days earlier the Air Transport Command had established its own headquarters at Natal, but the two headquarters were bound together by having the same commander. General Walsh served in both capacities, as did Maj. Gen. Ralph H. Wooten, who relieved Walsh in May 1944. In October of that year, however, the two commands were separated at the request of the Air Transport Command. General Wooten continued as theater commander, while the South Atlantic Division, ATC, passed to Col. Cortlandt S. Johnson. Leone, on the other hand, was replaced as ATC South Atlantic Wing surgeon when he took over the theater surgeon s office. The two positions remained separated until August 1943, when Leone was again named to the ATC post while retaining his position as USAFSA surgeon. He had in the interval returned to the United States long enough to attend the School of Aviation Medicine at Randolph Field, Texas, in order to qualify as a flight surgeon. Throughout the life of the theater close liaison was maintained with the medical service of the Fourth Fleet, and with Brazilian doctors, military and civilian.
During the British Guiana interlude, Leone, who was promoted to lieutenant colonel at this time, surveyed the medical situation in Brazil. Valuable information, particularly as to the incidence of malaria and venereal disease, was secured from the two U.S. flight surgeons already stationed at Brazilian airfields--Capt. Fred A. Heimstra at Natal and 1st
16 See p.
Lt. Francis M. Dougherty at Belém. The successful invasion of French North Africa at that time by American and British ground troops removed any danger that may still have existed of an attack against the South American mainland.
Other than small dispensaries set up at stopping points along the Air Transport Command route, there were no U.S. Army medical facilities operating in Brazil until after activation of the theater. Patients requiring more care than these dispensaries could provide were generally flown to British Guiana or Trinidad. Emergency surgery was performed in Brazilian military hospitals.
In his capacity as surgeon, USAFSA, Colonel Leone asked for three station hospitals in October 1942, but the units requested did not leave the port of embarkation until 29 December, arriving in Brazil in late January 1943. The hospitals were distributed to the major bases
of the theater-the 193d Station Hospital (50 beds) to Belém, the 194th Station Hospital (100 beds) to Natal, and the 200th Station Hospital (150 beds) to Recife. None of the hospital buildings had been completed at the time the units arrived, but by May and early June all began operating. The 175th Station Hospital (150 beds), arrived on Ascension Island, some 1,250 miles east of the Brazilian coast, in March 1942, before the creation of the South Atlantic theater. The U.S. Army had landed some 2,000 men on this British possession with the mission of protecting it from attack and building an airfield. The 175th was under the control of a composite force headquarters until November 1942, when the South Atlantic theater assumed jurisdiction over U.S. troops on the island. (Map 3)
Hospital construction in Brazil followed closely the standard U.S. Army cantonment-type plant common in the United States. The use of local materials, especially hollow tile blocks, which were stuccoed on the outside and plastered on the inside, and red tiles for roofing, resulted in more permanent structures than the wooden ZI-type station hospitals. The 193d Station Hospital at Belém, just below the mouth of the Amazon River, was situated in a tropical location almost on the equator. It furnished care to the immediate area and received patients from the jungle air base at Amapá, the airfield at Sao Luis, and weather stations at Clevelandia and Camocim.
Nine hundred miles east on the Brazilian coastal "hump," the 194th Station Hospital at Natal administered medical care to patients from the air bases at Fortaleza, Fernando de Noronha Island, and from the vicinity of Natal itself. The 194th also accommodated all patients en route from other theaters to the United States. It was a very active unit because of the great number of transients and daily landings and takeoffs.
The 200th Station Hospital, just 150 miles south of Natal near the city of Recife, served as a "theater" hospital since no general hospital operated in Brazil. It received patients from all other medical installations in the command that required prolonged hospitalization or ultimate evacuation to the United States. The 200th was especially well equipped and had a very well-balanced professional staff. Specialists from the 200th made trips to other stations in the theater where they consulted on patients who could not be transferred to Recife. The hospital laboratory was supplemented to function as a provisional theater laboratory.
On Ascension, the steppingstone between Brazil and Africa, the 175th Station Hospital had started operating in a newly constructed hospital in May 1942, providing medical care for U.S. Army and Navy personnel stationed there, transients passing through, and survivors of torpedoed ships. Its buildings consisted of wood-frame tarpaper-covered structures, which lasted satisfactorily through the war. Except for a very small dispensary operated by a retired British naval officer, no other medical facility existed on the island. The 175th ministered to about one-fourth of the total strength of the South Atlantic theater.
The medical service for the South Atlantic theater maintained itself with a minimum of personnel, but still made medical care equally available to all permanent and transient Army personnel, as
well as to members of the U.S. Navy and certain civilians at each base. The theater strength reached its wartime peak of about 8,000 in January 1944. There were approximately 600 Medical Department personnel in the theater at that time, and an aggregate of 500 T/O beds in fixed hospitals.18 In keeping with a declining military population, medical strength was cut to 450 in July 1944 when the 175th Station Hospital on Ascension was reduced to 100-bed capacity; and to 350 in November when the 175th lost another 50 beds and the 200th Station at Recife was reduced to 100 beds. In addition to the beds provided by the station hospitals, dispensaries of from 10 to 20 beds each operated at Amapá, Sao Luis, Fortaleza, Bahia, Fernando de Noronha, and Rio de Janeiro. Except for the unit at Rio, which existed primarily to provide medical care to U.S. personnel of the Joint Brazil-United States Military Commission, these dispensaries were operated by medical personnel of the Air Transport Command. At Clevelandia, Camocim, and Porto Alegre, very small stations where a dispensary could not be justified, Medical Department enlisted men provided emergency medical care.
While there was limited air evacuation of nonbattle casualties from Africa, the Middle East, and even from the China- Burma-India theater before the beginning of 1943 over the air ferrying route by way of Brazil, it was on an individual basis and records as to its extent are not available. Similarly, patients were flown informally from Brazil to British Guiana or Trinidad without being officially recorded. As the war in the Mediterranean spread during 1943 from Africa to Sicily and Italy, air evacuation through Brazil became more general. Late in September of that year the 808th Medical Air Evacuation Transport Squadron took over the flights from northern Brazil to Miami, continuing in operation until the patient load declined sharply late in 1944. All together, 957 patients from other theaters passed through the South Atlantic theater by air on their way to the zone of interior in 1943, and 2,092 in 1944. Only 165 patients followed the Brazilian route in 1945 before the service was discontinued in July in favor of the more direct North Atlantic routes.
For the South Atlantic theater itself, the evacuation policy for all hospitals, except the 200th Station Hospital, was 60 days. Other hospitals sent patients whose condition precluded recovery within this period to the 200th for more extended treatment, or for evacuation to the United States if recovery within 120 days seemed unlikely. Because of the abundance of air transportation available, patients usually traveled to the United States by plane. A smaller number, notably mental cases, sailed aboard ships from the port of Recife. In 1943 the number evacuated from the South Atlantic theater to the ZI was 189, of whom 29 went by sea; in 1944 there were 78 evacuated by water and 268 by air, or a total of 346; and in 1945 the figures were 64 by sea and 151 by air, for a total of 215. The 3-year aggregate was 750, with more than three-fourths being sent by air.
18 See app. A-1. Theater strength exceeded moon for the immediate postwar months of June, July and August 1945, when evacuation from the Mediterranean and redeployment brought about a substantial increase in Air Transport Command strength at Brazilian bases.
U.S. medical officers and enlisted Medical Department personnel helped train Brazilian medical troops before the departure of the Brazilian Expeditionary Force for Italy in July-November 1944, but neither time nor facilities were available to do a completely satisfactory job. Medical personnel of the theater also assisted the Brazilian Army by unloading sick and wounded members of the Brazilian Expeditionary Force returning from Italy by ship and plane.
In the early days the theater experienced some difficulty in procuring medical supplies in sufficient quantities, but by mid-1943 enough stocks had been accumulated to meet the needs of all medical installations in the command. In only two instances were large shiploads of supplies from the United States delayed for so long that emergency air shipments had to be made. A general depot established at Recife in early 1943, provided medical supplies for the entire theater and distributed them to the widely separated medical installations of the command by air and sea transportation. Most items of supply came from the United States, but the Army bought some of the heavier equipment such as chairs, desks, tables, and X-ray units, and also a small quantity of drugs from Brazilian dealers. Before the Recife depot was established, the Trinidad Sector depot at Fort Read was often called upon to send medical supplies both to Brazil and to Ascension Island.
Common Diseases- Because of the absence of land combat in the South Atlantic theater, the operation of a satisfactory hospital system posed no unusual difficulties. The operation of medical installations was generally routine, with emphasis on the control of venereal and tropical diseases. Patients stayed in the hospital for only short periods, since acute diseases of brief duration accounted for most of the admissions. Injuries from plane crashes and other accidents made up the remainder. The general health of the troops was excellent, and tropical diseases never became a problem, due mainly to the preventive measures employed by the Medical Department. The largest single medical problem was the great reservoir of venereal disease near the U.S. Army bases. Prostitution flourished freely with very little being done about infected carriers of venereal diseases. Control measures proved difficult because the Army, being only a visitor in a friendly foreign country, did not have control over the civilian population. Areas and individual houses could be placed "off limits" but residents of these houses could and did find other places to carry on their trade. Consequently, the Army directed its control program at the individual soldier by means of education. The incidence of venereal disease on Ascension Island was zero because of the absence of women, but for the theater as a whole the venereal rate was 83 per thousand per annum for December 1942, averaged 101 for 1943, and 72 for 1944. The rate dropped to a low of 36 in May 1945 but shot up again to 99 in August with the influx of transients. The everpresent danger of malaria in northeastern Brazil resulted in a vigorous control program in collaboration with the Brazilian
health authorities. Individual malaria control measures were also practiced with highly successful results. At no time did malaria become a serious threat to the physical fitness of U.S. Army troops in the theater, although the rate per thousand per annum reached a high of 98 in March 1943. The worst month in 1944 was June, when the rate was 34. The 1945 peak was reached in May and June, with rates of 24.9 and 27.2, respectively.
A good example of how the Army overcame the deteriorative effects of tropical diseases in Brazil was the work accomplished by the Medical Department at the jungle outpost of Amapá
This location is among the most unfavorable of any in the world for the maintenance of good health. During 1943 the rainfall measured around fifteen feet, and in 1944 it totaled almost thirteen feet. The entire swampy area was alive with malaria, which took a heavy toll among personnel of survey teams entering the vicinity in 1942. A small dispensary that arrived there in early 1943 helped keep the state of health of Army troops and Brazilian workers on a reasonably high level, mainly because of immediate evacuation to Belém of all patients needing bed care. During 1944 the dispensaries staff increased, and more supplies and equipment arrived, which
made it possible to care for many more patients on the spot. The men assigned to the dispensary had to be versatile. Each enlisted medical assistant was at some time a laboratory technician, nurse, or even a doctor. In 1944 the base surgeon delivered six babies for Brazilian workers, and in every case the enlisted men assisted the surgeon during delivery.
The Brazilians at the Amapá base suffered from many chronic diseases rarely found among American soldiers. The surgeon explained each case entering the dispensary to the enlisted assistants, who were required to participate in the treatment. With all the bad environment caused by the heat, tremendous rainfall, and poor sanitation of the local population, the dispensary records showed only 600 per thousand illnesses or injuries among Army personnel, which amounted to 131 per thousand less than the South Atlantic theater rate as a whole. Not a single case of malaria developed among American troops during 1944, despite the fact that this disease had previously been highly endemic. At the end of that year this small group, composed of one officer and four enlisted men, were giving valuable medical service to approximately 1,000 people.
The Disinsectization Program- In 1930 a very severe epidemic of malaria had ravaged the area around Natal. The disease proved to be carried by the Anopheles gambiae mosquito, a species common in equatorial Africa but previously unknown in Brazil. It was believed that the vector had been introduced by fast French destroyers from Dakar. It had taken ten years of hard work on the part of the Brazilian Health Department to stamp out the gambiae, and the Brazilian Government was not prepared to see the scourge reintroduced by aircraft from infested areas of Africa.19 Colonel Leone and his staff worked on the problem with Brazilian health officials, representatives of the Rockefeller Foundation, and ground and air commanders. Brazilian officials were not satisfied with the routine spraying of planes after they had landed in Brazil. Between October 1941, when Pan American Airways began its flights between Brazil and Africa, and July 1942, when U.S. Army medical service was established in Brazil, gambiae were found on seven occasions on planes arriving in Natal from Africa. As a result aircrews were given strict regulations on the subject, which included spraying before departure from Africa. Early in 1943, by Presidential decree, the Brazilian health authorities took over responsibility for ridding incoming planes of arthropods. Procedures were stringent, including the closing of all vents and shutting off air renovation apparatus before the plane landed, and disinfestation before any passengers or crewmen were allowed to deplane or any Freight was unloaded. In August Colonel Leone accompanied Dr. Fabio Carneiro de Mendonca, Director of the Brazilian Port Sanitary Service, on a visit to Africa to study conditions at the fields from which planes left for Brazil. At a conference early in November 1943, it was agreed that U.S. Medical Department personnel should supervise the disinfestation at African points of departure, and that qualified Brazilian observers should
19 Elliston Farrell, "The Anopheles Gambiae Problem in Brazil and West Africa, 1941-44," Bulletin, U.S. Army Medical Department, vol VIII. (February 1948), pp. 110-24.
be present at these points, most important of which were Dakar and Accra.
With these practices in effect, the record was impressive. In 1943, gambiae were found on 100 out of 819 planes from Africa. The total number of gambiae found was 281, of which 8 were still living. Although the number of flights increased in 1944 to 2,552, only 30 gambiae, one living, were found, distributed among 9 planes. In 1945 only 9 gambiae were found, all of them dead, distributed among 9 planes out of 4,841.
Dental Service- Dental service began in the South Atlantic before a theater organization was set up. On Ascension Island there was a dental officer with the 175th Station Hospital, but early arrivals at the Brazilian bases relied on local civilian dentists until September 1942. At that time 1st Lt. (later Maj.) Julian M. Rieser of the Air Transport Command arrived with one incomplete Chest MD No. 60. Deficiencies were made up by local purchase or improvisation, and Lieutenant Rieser established his headquarters at Natal, flying the rounds of the other bases.
The station hospitals arriving early in 1943 had dental officers on their staffs but little or no dental equipment. The dentist attached to the 193d Station Hospital at Belém was unable to function until March. The dental officer of the 200th Station Hospital at Recife carried on as best lie could in the field dispensary set up by the Air Transport Command until enough equipment was received from the United States to open the hospital dental clinic in May. The 194th Station was somewhat more fortunate in procuring equipment for its dental officer, whose presence freed the ATC Wing dental surgeon for more extended visits to other bases.
For a time the dentist of the 194th Station also served as theater dental surgeon. In September, with additional dental officers available, a policy of rotation was put into effect, and dentists were shifted from one base to another. At this time Rieser, now a captain, became theater dental surgeon with headquarters in Recife. By the end of 1943 there were eight dental officers in the theater, and equipment was adequate to maintain a clinic at each of die four station hospitals. Complete dental service was available to the entire command and continued to be throughout the remaining life of the theater. The number of dental officers increased to 10 in 1944, and the service became more mobile, dental officers going as far afield as Asuncion, Paraguay, and Montevideo, Uruguay.
Veterinary Service- Like his dental counterpart, the first veterinary officer in the theater, Capt. (later Maj.) James R. Karr, was assigned to the South Atlantic Wing, Air Transport Command. Captain Karr reached Natal in November 1942 and was at once placed on detached service in the theater surgeon's office. Additional veterinary officers arrived in 1943, together with a few trained enlisted men. Their task, in a country of lax sanitary standards, was immense. All neat, eggs, milk, and many other hood products had to be inspected before they could be used. Supervision of slaughterhouses and pasteurization plants was included in the veterinarians work, and before the end of 1943 they were themselves raising thickens and hogs.
For purposes of food inspection, the
Brazilian bases were divided into three areas, centering at the three station-hospital cities. The Belám area included the Amapá and São Luis bases: the Natal area included Fortaleza and Fernando de Noronha; and the Recife area included Bahia. One veterinarian served each area, the Recife man serving also as theater veterinarian and making trips as needed to Ascension Island.
Close-out in Brazil
The Army started planning a general reduction and eventual discontinuance of its activities in Brazil and on Ascension Island in March 1945. The Green Project, which was an air redeployment movement of combat troops from the European and Mediterranean theaters to the United States, for transshipment to the Pacific, suddenly increased activities in the South Atlantic during that summer, but this operation came to an end after the defeat of Japan. Almost half of those sent to the United States under the "Green Project" traveled via the South Atlantic theater. Medical facilities handled the extra load by obtaining additional medical personnel from the Air Transport Command and from among those being redeployed. In early September, preparations for inactivating all station hospitals began, and the plans made the previous spring were put into operation. By the end of the month the 175th and 193d Station Hospitals had been inactivated, followed by the 194th and 200th in early October. The theater itself disbanded on 31 October 1945, and the South Atlantic Wing of the Air Transport Command assumed responsibility for the administration and Operation of the remaining personnel and facilities.