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Report of Medical Department Activities in Pacific Ocean Areas
Report of 61st Medical Battalion, Annual Report for 1944 Medical Department Activities in PACIFIC OCEAN AREAS
Paul H. Streit
Central Pacific Base Command
Interview with Paul H. Streit, Colonel, M.C.
21 May 1945
(Colonel Streit received his M.D. degree at the University of Texas in 1916. He accepted a commission as 1st Lieutenant in the Medical section of the Officers' Reserve Corps 17 July 1917 and entered on active duty the following day. He is a graduate of the Medical Field Service School (1922) and of the Army Medical School (1923). He departed from the United States for his latest tour of duty overseas in June, 1942, remained in POA as Surgeon of the Central Pacific Base Command until May, 1945, when he returned to the U.S.)
ORGANIZATION AND PERSONNEL.
The headquarters of the C.P.B.C. was located at Fort Shafter until about a month ago, when they moved to Fort Ruger. However, the office of the Surgeon was not moved but remained at the old Tripler General Hospital across the street from Fort Shafter, occupying some seven or eight ward buildings and the headquarters building of the old Tripler General Hospital.
The C.P.B.C. is a part of the Pacific Ocean Areas and includes the Hawaiian Islands, the Gilberts, and more recently the Marshalls and the islands down toward Samoa--Canton, Christmas, Fanning, and a few others of that group.
Our office was organized and the functions established. First, there was the Office of the Surgeon, as a member of the staff of the Commanding General of the Base Command and its numerous subdivisions, and secondly, as commanding officer of the Medical service. In this latter capacity we had command and supervision of all Medical units in that area, including hospitals, ambulance companies, concentration centers, rehabilitation centers, sanitary companies, dental clinics, and of course, the station and general hospitals, both there and on the other islands, and of all veterinary units. We also supervised the Anti-Biological Warfare units which were engaged in checking on various measures connected with the protection of the military and the civilian personnel against sabotage. These were the two main divisions of the office. The Surgeons Office was divided into the usual sections, such as the personnel division, the administrative division, etc. There was a message center with complete files, a supply division, a dental division, and a nursing division, There was also a preventive medicine division, a large section which included such sections as industrial engineering, venereal disease, statis-
tical, and others of that type. There was also a hospitalization division which checked on various disposition boards and special boards, form 38's, homosexual cases and that sort of thing, and the evacuation and statistical divisions which dealt with the evacuation of cases to the mainland. They made all the arrangements for transportation to the mainland, wrote the orders on these cases, and prepared all statistical reports of their own section and of other sections, such as the main sections of the Surgeons office and those of the Medical Service. In addition, there was an operations section, which was charged with the serviceability inspections of units staging in the islands preparatory to going forward to combat zones. This office dealt with the special services, such as the education and information service and the athletic division, which sponsored athletics and amusement features in the hospitals, and with conservation and inspection of supplies in the various medical units. It had command supervision over Medical units under me, such as the ambulance battalion.
There was one large concentration center where as many as eight or nine hospitals were quartered at one time, staging. Other units would also occasionally be found there. In addition to the operations section, there was also a personnel section, which dealt with administrative problems and cases dealing with arrests of personnel that came through channels for corrective action, such as courts-martial. There was a section devoted to transportation, which supervised and assisted in every way they could to maintain proper supervision of garages and repair units in the hospitals arid other Medical facilities on the island.
Other types of units often presented a personnel problem for us, because they were constantly taking our personnel and not giving us replacements, which meant that we had to recondition and retrain other personnel in these units. For this purpose there was established in the Medical service a training division. This was a very large unit, which established definite training programs in all hospitals and other Medical units. These
programs included training in the technicians' branches, such as anesthesia, surgery, medicine in the hospitals, and X-ray, and extensive training in other fields as well, for instance, physical training, training in automotive repair, etc. We did not have an automotive pool ourselves, but sent men to schools conducted by the base commands.
Part of the physical training program was the swimming program. When I left the area, this had made such good progress that practically one hundred percent of the personnel were able to swim fifty yards. All units that were staged there underwent a course in amphibious training and another in jungle training which was very rigorous. All nurses, as well as the officers and enlisted men, took this training. We conducted a school for nurses who were staging there, for one thing, to keep them busy while they were waiting to go forward, and also to acquaint them more
thoroughly with camp life. There were infiltration courses under fire and in the amphibious training courses they were taught how to climb up and down these dukws, in and out of the water, and things of that sort. These courses lasted six weeks to two months.
At one time we had more nurses than we needed, because many field hospitals had staged there and on moving out had left their nurses behind, and so we continued with the training program and, I thought, did a very nice job.
The personnel problem in this area is rather peculiar. Hawaii served as a staging area for about fifteen divisions during the past two years. When each of these divisions left the islands, it left its unserviceable personnel there, that is, those that they claimed were not fit for combat duty. This included the so-called psychoneurotics--the weak-minded, weak-backed boys--and all the rest of them. They were forced into service units. The Medical Department was forced to take a large part of these men as our filler replacements. The few Medical replacements that came from the mainland were picked up by line units and sent forward with them. For eighteen months we received no Medical soldiers from the mainland, and during that time we gave up innumerable trained men to go forward in various organizations. We were forced to take men of mediocre and even inferior ability, train them and try to utilize them somehow, if we were to operate our hospitals.
The number of troops in the islands was around 250,000, which meant a fair-sized job for the Medical Department. Of course, we also provided care for casualties in the forward areas, to the west of the Hawaiian Islands; we were and are even today mainly responsible for the definitive care of casualties in those areas. Our hospitals are now the only ones out there that have a 120-day policy. The ones forward still have a thirty- and sixty-day policy, so that any seriously wounded come to Hawaii and if they don't recover in the 120 days, are transferred to the mainland.
In addition to these duties, we were responsible for the health of the island, including quarantines, sanitary conditions of restaurants, of dock areas, and possible epidemics. This was necessary because for the first two years the island was virtually under a military dictatorship. Even after that, during the past year, we still had many of these public health responsibilities. At one time there was an outbreak of dengue fever. We put about five hundred people to work killing mosquitoes for a period of a year, and the epidemic didn't make much progress among the military personnel; there were fewer than a thousand cases. Eventually it was completely stamped out.
When a station hospital or an evacuation hospital staged in our area, we would immediately examine it thoroughly to determine whether we could improve on the training of any of the personnel during their stay in our area. Some of them were well trained, especially the various
types of hospital technicians. Many of these units were deficient in the various specialties, such as surgical technicians and X-ray technicians, and we could transfer competent specialists in these fields to their command. When a new unit arrived in our area, we would immediately put as many of their personnel as we could handle into the five hospitals in our area for training. We would put them into these hospitals on temporary duty or detached service and would keep them there for six or eight weeks if their unit stayed there that long. Generally speaking, I should say that most of the personnel had received pretty good training on the mainland. In other words, we established only parallel training, particularly in the technicians' field.
In recent months the staffs of these various units staging in our area have appeared to be well-balanced. Previously, they were very poorly balanced. This was due largely to the fact that we had, at first, the wrong type of units for the operations. There was not a single evacuation hospital in the entire Pacific Ocean area. There were only field hospitals, which had to function both as evacuation and field hospitals. Unfortunately, the field hospitals do not have the specialist personnel that the evacuation hospitals have, and we had to supplement them with properly trained surgeons (and particularly those with specialized surgical training, such as plastic surgeons and maxillofacial surgeons). And anesthetists before they went forward, in order that they might fulfill their function.
We had no surgical teams; the area was woefully deficient in those things. This, I believe, was due to poor planning and an improper concept of the needs. Today there is not a single evacuation hospital in the entire Pacific Ocean area, except one or two that were brought up from the South Pacific. Believe it or not, at the time I left Hawaii there were no evacuation hospitals on Okinawa. It is almost miraculous that those units, supplemented as they were only by the moderate amount of help that we were able to give them, were able to do such magnificent work. There are some twelve or fifteen surgical teams in Hawaii now that have come out within the last few months. Part of the difficulty is due to transportation difficulties. The commanding generals had only so many ships to accommodate their forces. They wanted to get on with the war and push the Japs back as quickly as possible, so they cut everything they regarded as not absolutely essential to a minimum. They felt that they could manage with one field hospital to a division, so that is what they are using over there.
Each division in Europe has an evacuation and a field hospital, plus portable surgical hospitals and a number of surgical teams. The strange thing is that our losses in the Pacific run about five times as great in many of the operations as they ever were in Europe. And yet our divisions were oared for by only one field hospital apiece. Our losses among the wounded were naturally much higher then theirs in Europe. In Europe the
death rate is supposedly three percent; ours runs up to four or five or better. However, I think that this represents a remarkable achievement, considering the available personnel.
A big factor in holding the losses down was transportation. In most of the little operations within a week air transportation was established on these little atolls and the seriously wounded were being sent out by air, being sent promptly to the rear to the next group of islands, where they received definitive treatment. Naturally, those cases that required immediate surgery were lost. At Iwo Jima it was D plus 6 before a field hospital was able to set up on the island. Before that time all casualties were simply rolled up in the dukws and hauled out to the LST's, where whatever surgery possible was done, and then they were shipped down to the Marianas, where definitive surgery was performed. There was a lag of four, five, or even six days before this happened. After D plus 7, C-54's began to land on the islands and were able to evacuate casualties rather rapidly.
When I left Hawaii, the number of Medical Department personnel was eight thousand. At one time, it had been fifteen thousand, but decreased rapidly, as the number of troops decreased, within the base command.
I was commanding officer of all Medical troops on the island and had every command function connected with these troops. Therefore, we held our own courts-martial. We didn't have general courts-martial, but we did hold summary and special courts, which consisted of our own officers, and I was the final arbiter as to the approval or disapproval of the punishment meted out by the courts. These decisions were reviewed by the Judge Advocate of the base command. During my tour no decision was ever reversed. Whenever we were in doubt about a case, we consulted with the office of the Judge Advocate before making a final decision. Careful records of the arrests among our troops for traffic violations, drunkenness, and other misdemeanors showed that our record compared very favorably with that of other echelons of the command.
The S.O.S. was abolished in our command very promptly. I dealt directly with the Commanding General of the Base Command and had a very close relationship with the Commanding General, POA (General Richardson), for informal consultations with all their branches. General Richardson had a magnificent administrative organization. Because of this direct communication, I was able to accomplish many things very quickly that would otherwise have consumed a considerable period of time. For example, at the beginning of the Iwo Jima operation the Navy suddenly realized that more casualties were coining in than they had anticipated, that their beds
were overflowing, and so they asked us to handle some of their surplus. We handled altogether some four or five thousand Marine casualties for the Navy. We knew that the Okinawa operation was impending, and the Combined staff at Pearl Harbor felt that they had to have more beds. They asked me to provide three thousand additional beds. We checked back with the Office of The surgeon General, through the Surgeon of POA, to see whether we could have two hospitals transferred to Oahu. The Surgeon General agreed to transfer two hospitals promptly to our area for this purpose, although they were originally destined for a later phase of the campaign. When we were given this assurance, we held a conference with the engineers of the base command and with all the personnel who were occupying the barracks that we wanted to utilize for the hospitals. We took over part of the permanent barracks at Schofield and converted them into hospital units. Around one thousand to fifteen hundred men were put to work there--painters, plumbers, and carpenters--putting in the kitchens, operating rooms, nurses' and doctors'
offices, private wards, utility rooms, and all, with electric-light connections everywhere. They made really beautiful hospitals, all in one month's time. Now, if we had had to go through channels and try to obtain authority to spend the money, we would probably never have accomplished it. We actually spent something like two hundred thousand dollars there within one month. No permission was ever given for the project except a directive from General Richardson to me.
In the States if it is necessary to spend fifteen or twenty thousand dollars on a hospital in California, for example, the project has to go ail the way through the Service Forces to Washington for approval. Under favorable circumstances, approval may be secured in six months.
In our command, while normally we go through G-1 for personnel and G-4 for supply, I have always had direct access to the Chief of Staff and to the Commanding General. He said this frequently at staff meetings, so there could be no doubt about it. I never hesitated at any time to telephone him or to call on him personally. He wanted it that way.
When I went over to Hawaii I took with me a general hospital. The C.P.B.C. was organized only about fifteen months ago, and I was put in charge of the Medical service at that time.
One of the greatest problems from the first was supply--logistic support of the forward areas. The base command was responsible for supplying all troops west of us; that included the Marianas, all task forces and operations in that area. We not only had to get the supplies to them, but also had to plan the logistic support for these operations. We encountered some difficulty in the Marianas campaign because of two things. One was the fact that inadequate supply personnel had been provided for the garrison forces in the Marianas, and that this had to be corrected by taking a large portion of our supply personnel on Oahu from Medical supply units there. The other difficulty was that the requisitions originating in the Marianas were not sent in until the Merianas went off automatic supply. During the first six months we automatically sent them
supplies according to a pre-arranged list every two or four weeks. At the end of the six-month period they went on a requisitioning basis. This plan was based on the theory that by then they had accumulated a stockpile large enough to tide them over until the requisitions were filled on the mainland and sent forward. This theory proved false. The plan didn't work out. They ran short of many items. We had to send numerous emergency shipments of special supplies, such as litters, down to tide them over. We sent thousands of the litters, as well as other items, to them by air. This was not the fault of the Medical Department, nor lack of foresight on their part. We bad fought bitterly to persuade them to draw up requisitions four months in advance of the time that they went off automatic supply, but we were overruled by the Commanding General, who said that they didn't have the time nor personnel down there to make out these requisitions. Fortunately, this has not been the case in other operations. In the Iwo Jima and Okinawa operations the requisitions have been on the mainland for months. We prepared the first ones for them. These units had adequate personnel in the Medical depot companies to receive the supplies and to enter them on stock records.
I would say that the Medical service in this base command is adequate. Our great difficulty has been, as no doubt it is in this country, that we have been forced to take in increasing numbers personnel that is not of the best type to care for sick and wounded, while giving up more and more of our well-trained personnel to go to the fighting front.
I believe that our hospitals would compare favorably with the best of those in this country. The week before I left, we opened three thousand more beds; this gave us a total of eleven thousand beds on Oahu. About seventy percent of the available beds were filled.
The casualties we received were of the usual nature. We took statistical analyses of the patients as they came in, and we found that the statistics were almost identical with those on the European patients and pretty close to those in the last war in some of the classifications.
There was one variation in the Pacific; the Japs used far less artillery than the Germans did, and consequently we received fewer of the large, gaping shrapnel wounds than were reported in Europe. However, in the Okinawa campaign the Japs are using a great deal of artillery, and as a result we are beginning to see many of these casualties, so that the most recent surgical picture is almost identical with that in Europe. The majority of the early wounds were caused by small-arms fire and mortar shells.
Evacuation was a very big problem; it was solved beautifully by the Air Force. They did a beautiful job. Most of the patients stood evacuation by air very well, in my opinion, it is the only type of evacuation we should use in that type of warfare, except for the bad psychoses. It has so many advantages over ship travel that in my opinion we should abandon that method except for very unusual cases.
In the case of a patient who had suffered a sucking wound of the chest, he would not be evacuated until the wound had closed. He could then travel by air very nicely. These cases wouldn't be transported in the acute collapsed stage, but would be kept in one of the hospitals close to the front for a week or ten days. Clearing stations, field hospitals, and some portable surgical hospitals are now established near the fighting front within a few days after the landing, and these units have facilities to care for this type of patient for a short period.
There are very few types of cases that cannot be transported by air. We have been transporting even fairly advanced tuberculosis cases and non-violent psychoses, without any difficulty at all. We received patients by air from the forward areas, which are some distance from the base. For instance, from the Marianas to Hawaii is some four thousand miles. The patients arrived in splendid condition, despite the lengthy trip. Each of the planes carried a nurse and, if necessary, a doctor.
We don't regard venereal-disease control as a serious problem in our command. The rate for the Hawaiian Department is about one-tenth of that of the entire Army. We attack it somewhat differently from the general policy in that we keep our cases in the hospital until we are sure that they are cured. This has been done in our area because there are so few of these cases that this is practicable, and by doing this we are sure that they are not spreading infection. Moreover, we have had thorough cooperation from the civil authorities in rounding up female contacts; we immediately hospitalized all contacts and held them until they were cured. As a result, our venereal rate in Oahu for cases acquired there was about one-half of one per thousand per month, whereas the Army rate is about thirty per thousand per month. The total for the island, including cases that came from the mainland, which constituted the bulk of our cases, was about three per thousand per month, and therefore about one-tenth of the Army rate.
Our venereal-disease control officer was under the preventive medicine section. I believe that the methods that we employed in Hawaii are going to be the basis for controlling venereal disease in the United States. I believe that these two principles will be employed, on an Army-wide basis-- first, isolate the venereal-disease case until he is absolutely well, and second, isolate the contacts until they are well.
With the sulfa drugs and penicillin practically one hundred percent of the cases can be cured. I believe one weakness of the present system of treatment is that too much reliance is placed on a speedy cure. An acute gonorrhea case will be given a hundred thousand units of penicillin and turned loose. Some cases when thus treated are still active and will spread the disease. We tried to prevent any such cases from leaving the hospital until they were cured, which made our days in hospital per case seem more than they were in the other theaters, but the results were impressive. Our V.D. rate is so much lower than that of any other theater that it stands out like a sore thumb. Our method required the cooperation of the local police and other local authorities in rounding up these women and keeping the diseased ones locked up until they were cured. Fortunately, we had the whole-hearted cooperation of everyone in our area. Generally speaking, the therapy used was vary effective. One point that must be remembered is that there were many thousand Negro troops over there and that their rate is ten times the white rate. One shipload of Negro troops arrived recently which had staged at Seattle. When they docked at Oahu there were twenty-eight active cases of gonorrhea among them which had developed on board ship, according to the testimony that we could gather. These Negro troops constituted a battalion of five hundred men.
SUPPLY AND EQUIPMENT.
Supply was really wonderful in our area. I should say that It constituted one of the bright chapters in the story of island warfare. I believe that our hospitals did not suffer for want of any type of supplies. On one or two occasions we were short of penicillin, but that was in the early days, when there just wasn't enough of it to go around.
Equipment was more than adequate. From time to time we made suggestions for minor, improvements, but on the whole the equipment supplied us worked wonderfully well.
OBSERVATIONS AND RECOMMENDATIONS
I believe that as a long-term policy it would be smarter for us to train our technicians for six or nine months rather than for three. It would make them incomparably more useful in the hospitals. However, as long as the generals demand that we give up these men to go to the fighting fronts with combat troops, there is little to be gained by extended training. The Navy undoubtedly has much better qualified noncommissioned and enlisted personnel, because the Navy Medical Department trains them for nine months, in most cases, and then keeps them. Moreover, in the Navy these technicians are of a higher caliber to begin with. If we could establish that principle in the Army for the care of the sick and wounded, it would be a long step forward in the improvement of medical care.
The original organization of the Medical Department in POA had not provided for nearly enough personnel. When General Willis came, he wanted many additional consultants and assistants in the preventive medicine section--eight or ten in there alone, I believe--and in many other sections, and it was agreed to put those people in the base command, assign them there and DS them to the Surgeons office. Those men were largely assigned to our hospitals. (Everything over there is on a T/O basis, with some overhead allowed for the Surgeons office.)
Recently the G-l of POA objected bitterly to our carrying these men in the base command and told General Willis that he would give him sixty days to get rid of them or find a T/O for them. (This was about 1 May.) I understand that General Willis has sent a request to the War Department for an increased allotment, but that he thought he had very little chance of getting it. If he doesn't get it, I am afraid that the General will be out of luck, unless he can persuade someone to let him carry the men on the base command T/O. It is not right to expect the hospitals to do that, when it means that two or three men out of each general hospital are on DS to the Surgeons office. These hospitals are frightfully busy and should have all those men working in the hospitals, taking care of the sick, as was originally intended.
This presented a serious problem. Men were constantly being taken away from me to be used elsewhere, and I had to get along on less and less and try to re-staff the office by one subterfuge or another. I still had an inadequately staffed office at the time I left.
Through the orders of General Richardson, the base command has a surprising amount of independence. We had complete authority for assignment and reassignment of all officers assigned to the base command, and officers could not be withdrawn from the base command, normally, without our approval. However, I always tried to cooperate with General Richardson and General Willis to the fullest extent; but if they said they wanted some individual, and I felt that we couldn't spare him, I didn't hesitate to tell them that we couldn't, stating the reason. Usually, they would accept this and leave the man with us. Sometimes they didn't. Sometimes we lost personnel whom we regarded as essential. If the Surgeons office only had an adequate T/O, these conditions wouldn't exist.
Part of General Willis's troubles were due to his predecessor's lack of foresight, in planning the personnel, not only for his immediate office, but also in the Marianas, for example. The Surgeon there had a large number of hospitals and personnel, but a little, inadequate office force of three or four officers. He was constantly yelling for help and there was no one to give it to him except the base command and our department. As recently as two weeks ago I gave him my adjutant to go down there to set up an office for him. I could ill afford to lose him, but we were getting along pretty well, so I let him go.
I believe, frankly, that the ETMD's are becoming too bulky and lengthy to be of any great service. I found that I was unable to read them any more for lack of time. I would ask officers in my various sections to read them and to give me synopses where there were new data. I couldn't read them any more, thoroughly and carefully.
There is, I believe, another undesirable feature. The information contained in the ETMD's Is extremely valuable to many of the officers in the professional services of the hospitals. Because so many of the data are labeled secret it is extremely difficult to send it to these officer. I once tried to made a little summary of some of the data and sent it out, bit found it had lost all the punch of the original.
The reports themselves are wonderful. These suggestions I have made are the only ones I have to offer. If they could possibly be boiled down a little, I think they would be even more valuable.
Rotation and Morale.
The moral question is beginning to be serious in our area, because of the length of overseas service of some of the units, with no definite prospects of returning home. AS I understand it, rotation has been abolished completely and replaced by the new point system. I don't know what this will actually mean, but I would estimate that from thirty-five to fifty thousand troops there would at least qualify for release. I imagine that this will mean a definite boost in the morale.
The morale of my own troops was better than the average, by far, in that command, I think mostly because they felt that they were doing definitive work. They could see that they were actually helping people. Units that were busy were never bothered very much by morale problems. There were many doctors, of course, who wondered when they would be able to rejoin their families and resume their practice.