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ACCESS TO CARE
Chapter XIII - continued
Fresh supplies of meat, oranges, et cetera, are being unloaded today. The food on the whole has been very good, and there are some excellent cooks and bakers here. Sanitation is not all that it should be, owing to the laxity of the medical officers and their failure to appreciate the importance of good sanitation. There were almost no flies when we first landed; now there are swarms of them. Even after a month very few messes have been screened. However, we have had no dysentery problem.
The mobile surgical units, mounted on trucks, would be a tremendous asset in this kind of warfare. This type of setup would save much labor, while providing facilities in the early stages of combat. I have yet to see a place where a hospital was needed that could not be reached by these trucks.
The foreign body localizer is valuable, but it should be constructed to stand up under damp tropical conditions and function on a battery. A blower is needed to dry plaster casts.
Guadalcanal, Monday, 6 December
Took off from Cherry Blossom in a Catalina yesterday at 1600. We skirted the edge of the island with 10 fighters, then over to the Treasury Islands, and landed at Ondongo at 1730. There were no planes going to Munda, so we started out in a personnel boat. With the aid of a light, great caution, and good luck, we made a landing in pitch dark at 2030. Colonel Hanson came down to take us to the 24th Field Hospital, where we had a good meal and quarters.
This morning we took off by SCAT for Guadalcanal. Colonel Caton is using the 21st Evacuation Hospital for all initial admissions on the island. Patients are distributed from there to the other hospitals. Visited Colonel Taber at the 52d Field Hospital.
Tuesday, 7 December
Two years today since Pearl Harbor. What would people in the States have said if they were told at the time of Pearl Harbor that in 2 years Japan would have achieved most of its imperial aims and have conquered the Philippines, Malaya, and the Dutch East Indies, and that all we would have taken back were two or three islands in the Solomons that few had even heard of before.
Spent the day with Paul Kisner at the 20th Station Hospital. He is already beginning to bring order out of chaos. He wants a chief of surgery, for he cannot raise the level of surgery by himself. He also wants a laboratory man, a trained lab technician, and an eye man.
Visited Mobile 8 and talked about debridement and gas gangrene. They have had about 300 compound fractures with 20-plus cases of gas gangrene, resulting in 2 deaths. The estimate is that 8 to 10 percent of the patients with compound fracture have gas gangrene. Treatment was conservative for the most part. The cases from Bougainville came in with either poor debridement or none at all. I saw some cases, in which the patient had not even been shaved.
Nouméa, Wednesday, 8 December
Off at 0830 for New Caledonia with freight cargo including a 5,000-pound Allison motor. It was raining, and we went up over 10,000 feet to get out of the bad weather-very bumpy ride. I kept wondering what we would do if the motor got loose. However, we landed at 1430 without mishap, and once again sat down for cocktails at the Grand Hotel Central.
Friday, 10 December
Much surprised and pleased to receive a promotion to full colonel today. It looks as though Hal Sofield will be assigned with me as orthopedic consultant.
Tuesday, 14 December
Spent the last 2 days trying to get boat passage to Fiji, but gave up owing to the weather and will try NATS [Naval Air Transport Service].
Wednesday, 15 December
Found out that Ben Baker and Kaufman had returned. Heard that mobile surgical hospitals were on the way. Will they have qualified surgeons? Read Churchill's [Col. Edward D. Churchill, MC, Consultant in Surgery, North African and Mediterranean Theaters of Operation, U.S. Army] report on North Africa. His problems are the same as those met in this theater.
Fiji Islands, Thursday, 16 December
Off at 0800 for Suva, arrived 1330.
Saturday, 18 December
Flew to Nandi where I was met by Colonel Ruppersberg, 71st Station Hospital. While at supper, much to my surprise, in walked Gen. George C. Marshall. He stayed for a few minutes and rushed on. He appears to be vigorous and full of energy. I talked to the hospital staff this evening.
Sunday, 19 December
Went to the 7th Evacuation Hospital in the morning, and gave a talk there at lunch time; then to Americal Division headquarters from 2 to 4 o'clock for a talk; after that back to the 71st and a talk from 6 to 8 in the evening.
Monday, 20 December
Flew over to Suva this morning and spent the afternoon at the 142d General Hospital. Talked to the 182d Infantry [Americal Division] in the evening, about to embark for Cherry Blossom. The 142d General Hospital has a fine plant, and I am told that the Fiji Government proposes to take it over after the war. This hospital is doing a good job in pilonidals. The had a large number of corneal ulcers among the survivors of a torpedoed ship (fig. 321). The exact cause of this is unknown and the really bad ulcers cause permanent damage.
FIGURE 320.-"They are well pleased with the surgical teams." Bougainville. A. A surgical team operating in its underground surgery. The floor is about 4 feet below ground level; the sides are built up with sandbags, and it is roofed with heavy logs. (Left to right: Capt. Charles E. Troland, MC, Assistant Surgeon; Sgt. William T. Marsden, Scrub Nurse; Capt. William G. Watson, MC, Chief Surgeon; Capt. Harold C. Schulman, MC, Anesthetist.) B. A surgical team, operating in a clearing station, 17 December 1943. Note the improvised lighting and the use of combined intravenous and endotracheal anesthesia.
FIGURE 321.-Survivors of the torpedoed U.S. Army Transport Cape San Juan. Col. George G. Finney, MC (left center), Commanding Officer, 18th General Hospital, Fiji Islands, supervises transfer of survivors ashore, New Caledonia, 14 December 1943.
The Medical Corps officers of the 182d Infantry wanted to know why they were kept out here away from home for 3 years when so many people were sitting at home. When this campaign is over they are turning in their resignations [sic]. They want postgraduate work after the war, and the AMA has done nothing about it.
The British authorities (minor officials) have shown reluctance to cooperate in sanitation and venereal disease control. Many of the water supplies are contaminated, and there have been outbreaks of dysentery. "I've drunk this water for 20 years, and it is good"-in spite of the bacterial count. It is against the law to examine food handlers here. Prostitution is ignored by the Home Officer, although it exists everywhere.
Tuesday, 21 December
Toured the 142d General Hospital. It is a good institution. They need an otolaryngologist and cannot spare a surgeon.
Nouméa, Monday, 3 January 1944
Since my return to New Caledonia, I have been very busy checking on personnel. We still have a great dearth of qualified surgeons. The men we have are a cross section of American surgeons. We have many specialists, such as gynecologists, whom we must put in charge of station hospitals; and it is unfair to expect too much of them. There is still too much concentration of
talent in the affiliated hospitals, which appears to me to hinder the total war effort. Such men may set a high standard in these hospitals, but, as in civilian life, they have too little influence on the total problem. Their influence is even less than it would be were they in civilian life, for these rear area hospitals cannot function as educational centers. The portable surgical hospitals, as judged so far, are not fulfilling their function, because they lack qualified surgical personnel. No amount of good surgery in the rear can make up for poor surgery at the front.
Wednesday, 5 January
I am starting an educational program-have acquired a 35-mm. projector and am now having film strips made. It seems to me that this has great possibilities. I have designed a fly net to be used inside the tent.
Met Captain Hook [Capt. (later Rear Adm.) Frederick R. Hook, MC, USN], Chief Force Surgeon, Navy. He is a fine person with a good knowledge of surgery and a determination to get things done-the best of the lot. Surgery in this neck of the woods will unquestionably improve under his influence.
Guadalcanal, Tuesday, 11 January
Off at 0500, island hopping to Bougainville. Left Tontouta Airbase, my first stop, at 0900. Arrived at Espíritu Santo, 1200. Left at 1300, arrived Guadalcanal, 1700. Stayed with Colonel Caton at the service command. He is dubious of the 137th Station Hospital, and the 9th Station Hospital has not yet proven itself surgically. The 21st Evacuation Hospital is now ready to move forward.
Bougainville, Wednesday, 12 January
Up at 0400 and left Henderson Field at 0530. Landed at Munda where we picked up a fighter escort and left again at 0810. Arrived in Bougainville at 1000 and landed on the new bomber strip. There has been an amazing transformation on this island in 6 weeks. Forty miles of roads have been built.
Thursday, 13 January
Went over the supplies of the portable surgical hospital with Colonel Hallam. Together they weigh 8 tons, so our next problem is to break them down for at least three purposes: (1) To function intact (adjacent to a clearing station or in a stable situation), (2) to function adjacent to a collecting station in a forward area-capable of being easily broken down and relocated, and (3) to function over distances and thus be air transportable. Max Michael will instruct on blood transfusions and falling-drop protein method [for hematocrit determination].
Visited Colonel Collins, division surgeon, at the Americal Division. They have an excellent operating room setup, neat and screened. They have no definite scheme yet for a convalescent camp. Each division plans on operating its own camp, and there must be a third one for the nondivisional units. This setup has its advantages in that the doctors know the men from their division. But no one has considered the inefficiency of operating three camps when one would do.
The 52d Field Hospital is being set up. Major Davidson, a bright young chap, is Chief of Surgery. He may do all right, or better. The surgical teams left Bougainville this morning.
Saturday, 15 January
I've been giving talks every night. The 37th Division has had an increase of neuropsychiatric patients and raises the question of a correlation between this and the use of Atabrine. The mosquito net tent has proved a success. We will need 15 per division for a start, though the tents will have to be reinforced at the top and at the door. Collecting companies should have a larger sterilizer (14- or 20-inch) and blood pressure apparatus. They need a small autoclave, for these units often occupy isolated positions. Each clearing station needs a horizontal field sterilizer. Many of the gas casualty kits have deteriorated and need replacement. Ambulance headlights should be sent up for the Americal, and five sets should be supplied to each division. The Americal needs Mayo stands. They could use an anesthetist. They have Stokes litters, which should be provided for the other divisions.
I visited the frontlines today and could see the Japanese positions. This is beautiful mountain country, and I was amazed at how well our positions have been dug in. Some of the aid stations were right on the rifle line.
Those wounded while out on patrol have a bad time, for a litter carry through the jungle takes 8 or 10 hours. Each battalion should have about 30 more men for litter bearers as it takes 8 men to carry back 1 casualty over this rugged terrain, and the battleline is so thin that infantrymen cannot be spared for this purpose (fig. 322). There are no natives here that could be used as carriers.
Sunday, 16 January
Hal and I spent the Sabbath watching the bombing of "Unknown Hill." As I went up to within 100 feet of the line, we were greeted by strains of "Vienna Waltz." This came from the 145th Infantry and I have never seen a more spic and span outfit. Everything on the frontline is clean and in its proper place, sanitation is perfect, and the food is superior. The climax of the morning was the large bamboo settee constructed by the command post, with its sign, "for visitors only."
Wednesday, 19 January
I have been giving talks each evening. Each night brings the air raids and the need to get up and take cover. Those who are protected in foxholes are almost 100 percent safe. The papers have stated that there is no malaria on Bougainville, yet the 3d Marine Division came down with malaria at an almost 1 to 5 ratio.
The portable surgical hospital needs electric headlights, gowns, caps, and half sheets. Having no generators or sinkers, they are forced to function close to the clearing station.
Guadalcanal, Thursday, 20 January
Left Bougainville this morning without a fighter escort. Since one plane recently disappeared with all on board, everyone must now wear lifebelts. No
smoking is permitted on the plane, and the auxiliary gas tanks have been removed. I have been troubled with prickly heat and with generalized skin edema, so I am not displeased to leave this buggy place where the bugs are more abundant and bigger than anywhere else. We went nonstop to Guadalcanal. Went to see Colonel Caton and then to stay with Paul Kisner at the 20th Station Hospital, where Hal [Sofield] was put to bed with boils on his fundament.
Friday, 21 January
Visited 21st Medical Supply. Sent suction apparatus and sterilizer to Americal Division and sterilizer to 52d Field Hospital. Supplies are coming in very slowly, and there is a considerable amount of loss. Apparently people are helping themselves along the line.
Saturday, 22 January
Visited Colonel Bolend, commanding officer of the 21st Evacuation Hospital. He is one of the finest commanding officers I've met. "No man should command a unit from his home town," said he, to which I agreed. Very few people can be really objective in such a situation, particularly if they must go back to the town to live with these same doctors. Difficult situations have arisen where some bad appointments have been made in order to keep the peace. So far, I can see nothing to justify the affiliated unit and a great deal that speaks against it. Besides, talent should not be concentrated to the extent that it is in the affiliated unit, from which it is extremely difficult to transfer personnel. A good distribution of qualified doctors is essential to the welfare of
the Armed Forces. Colonel Bolend has his hospital well covered from every angle and can spare three surgeons. We could use such men on our surgical teams.
Sunday, 23 January
Visited the 9th Station Hospital. Colonel Walker says that he and his men have lost their pep-and they have. There are 14 officers here who have been out of the States for 2 years, and they certainly need some new blood. The 20th Station Hospital needs three surgeons-a chief of surgery, an assistant chief, and a genitourinary man.
This afternoon we had a meeting of the portable surgical hospitals. Three of them are good and the other three cannot be used, for they lack qualified personnel. I cannot understand why such unqualified personnel are given rank and sent out here to do a job they cannot do well.
Monday, 24 January
Visited 40th Division headquarters. Major General Brush [Maj. Gen. Rapp Brush] is commanding general. The division surgeon, Colonel Ghormley [Lt. Col. (later Col.) Verne G. Ghormley, MC] is a fine person. He says that they have already weeded out the senile and incompetent. This looks like a good outfit, but Ghormley says that the exact quality of the surgeons is an unknown factor. Much equipment is still lacking: Three number 2 chests so that the clearing company can be split up for the three combat teams, three anesthesia sets, X-ray apparatus, 5-kw. suction generator, Mayo table, instrument table, laundry or washing machines, refrigerator, and reefer.
The National Guard divisions range from good, indifferent, to bad. The medical personnel of those I have seen have, in the initial periods of their operation, always had poor leadership, which resulted in unnecessary loss of life among our men. This tragic situation is due to the two types of men kept on as division surgeons-the senile and the incompetent. It apparently takes about 2 years to get rid of these people. Commanding generals usually do not know enough about medical problems to be able to do anything about this stumbling block. One cannot blame them. One commanding general, who is a good tactician and has splendid morale in his division, does not know the difference between general hospitals and field hospitals. I have never seen a commanding general who did not want to do the best job possible. But, just as they do in civilian life, some unqualified and incompetent doctors sell themselves on the basis of their personality or loyalty. There should be some method of weeding out such division surgeons before going into combat, so as to avoid the unnecessary sacrifice of human life.
Espíritu Santo, Wednesday, 26 January
Plane yesterday to Espíritu Santo. Visited the 122d Station Hospital. They need an EENT man and a young orthopedist. They are also short three doctors, but two could hold them for now. Moreover, the hospital has 21 nurses of 2-years-plus service, of whom 10 are sick at present. There is a question
as to whether promotion of nurses should be done on the basis of 50 percent of T/O strength or 50 percent of actual strength. As for technical difficulties, there is a dust problem in their operating room.
Thursday, 27 January
Visited the 31st General Hospital. The hospital is on a beautiful site overlooking the bay and shows promise of development. They are building the surgery and have not as yet taken any surgical patients. The chief of surgery is a proctologist.
Nouméa, Friday, 28 January
Off at 0330 by NATS to Nouméa, where I found a pile of mail and other documents waiting for me.
Sunday, 30 January
Conference with Captain Hook, Captain Kern, Commander Reynolds, and Emile Holman. The Navy is loathe to adopt the idea of consultants, since they have not had the long experience with this type of work that the Army has had. Captain Hook says that they must "go slow." They would be pioneering and would have to proceed by trial and error. The Navy likes the surgical team idea and wants to use it on its next move. We should supply them with material on this subject.
Guadalcanal, Saturday, 11 March 1944
This book has been neglected this past month owing to several factors. For one, I suffered a pigskin heat rash and probably some mental depression. I have been engaged in a long struggle to get some things done. The major projects I've been trying to push through are adequate record and filing systems, on which the general [General Maxwell, Chief Surgeon, USAFISPA] finally agreed to back me. I think that he remained very skeptical though, and I hope that I have not asked for too much. The following information on each patient should be recorded: Name, serial number, diagnosis (according to nomenclature), operation performed, total days in hospital, and disposition. This will enable me for the first time to answer some questions on surgery. The Surgeon General's Office has been asking repeatedly for information which we could not hitherto furnish. A study on wound ballistics has been organized. Ben [Baker], Hal [Sofield] and Max [Michael] got off to New Zealand, and 10 days later, after my work was cleaned up, I joined them.
The 39th General Hospital, with formal flower gardens, is spic and span as an insane asylum. The interior is also shipshape. I wonder what the feeling of the staff will be when they go home to the ordinary dirt of civilian hospitals. It was good to see all my friends again-good for the ego. Col. Don Longfellow, MC [Commanding Officer, 39th General Hospital, U.S. Army Forces, Pacific], did not want to part with Eddie [Colonel Ottenheimer, Chief of Surgery, 39th General Hospital], so we may take Frick on our next move.
I left Auckland via NATS stopping 4 days at Headquarters [Nouméa] to catch up on some last minute things. Then I was off to Guadalcanal, leav-
ing Tontouta at 0830 and arriving at Guadalcanal, 1600. We had a warm front and some very rough weather between Espíritu and Guadalcanal. It was raining hard at Guadalcanal when we arrived, and I went to the 20th Station Hospital with Paul Kisner.
At Guadalcanal, I went over plans and supplies with Colonel Ghormley, Surgeon, 40th Division-a superior fellow. Saturday night festivities were the best in the Pacific and better than the majority of New York clubs. The local talent is amazing and in sharp contrast to the very average talent sent down from the States. Saw Emile Holman, Bruce, Calloway, McMaster and Rogers. They still know little of the plans.9
Monday, 13 March
Finney, Sutherland, Hull, Greiner, McQuinton, Troland, and Sofield arrived today. I spent the day chasing supplies. Saw Colonel Lobban and his staff playing poker in the mud, and I extracted three X-ray technicians and two stenographers from the group.
Wednesday, 15 March
Worked on final preparations and went with Colonel Ghormley, Ben [Baker] and Moe [Kaufman] to visit Captain Hughes of the I Marine Amphibious Corps, who told us that the show was off. Apparently, final plans had been completed as of midnight last night. Quite a letdown! Reasons unknown.
Saturday, 18 March
The FOREARM plan being off, our plans are changed, and the extra surgeons are greatly disappointed. Had cocktails and a swim with Admiral Halsey and then saw General Harmon [Lt. Gen. Millard F. Harmon, Commanding General, USAFISPA], who had just returned from Cherry Blossom and is having trouble with his knee. I had a talk with General Harmon and had no trouble in convincing him that a wound ballistics study was desirable, and he wired instructions.
Sunday, 19 March
Everyone is feeling optimistic over the recent change in plans, for it looks as though many lives might have been lost.
Tuesday, 21 March
The wound ballistics team will go to Bougainville by order of General Harmon and at the request of General Griswold of the XIV Corps. Persistence certainly paid off in this case. The team consists of Harry Hull, surgeon; Dan Greiner, pathologist; Frank Sutherland, surgeon; two enlisted men; and one photographer (fig. 323).10
FIGURE 323.-The wound ballistics team at Bougainville. (Rear, left to right, Maj. Francis A. Sutherland, MC, Col. Ashley W. Oughterson, MC, Lt. Col. Harry C. Hull, MC, Maj. Daniel J. Greiner, kneeling, left to right, T/4 Charles J. Berzenyi, T/4 Charles R. Restifo, and Sgt. Reed N. Fitch.)
George Finney, Bill Potts, and Captain McQuinton are staying on to help these hospitals straighten out some of their problems. I found that they were injecting gas gangrene antitoxin into wounds and into the tissue around the wounds, but not introducing enough antitoxin intravenously. Cases were coming down from the front without adequate information on operations or drug therapy. Some had a red blood count of 1.5 million, and some patients have been sent down in poor condition or too soon after an operation. Others, with compound fractures of the humerus, were in hanging casts. Once again it must be concluded that not enough emphasis is being placed on getting the best men into the forward hospitals.
Bougainville, Wednesday, 22 March
Up at 0330 with the ballistics team and off to Bougainville (map 5).11 We landed at 0830 on the fighter strip, since the other two strips were being shelled. The Torokina fighter strip is also under fire, but is nevertheless functioning. Colonel Hallam met us at the airport-a very efficient, pleasing, and cooperative fellow. He took the team to the 21st Evacuation Hospital for rations and quarters and then showed them his bug and butterfly collection and introduced them to the 37th Division crowd.
Thursday, 23 March
Toured the frontlines of the 37th Division. The collecting station of the 129th Infantry is about 200 yards behind the front, and they have cleared out a beautiful garden here in the jungle with lots of tomatoes, cucumbers, melons, radishes, and some corn.
The Japanese came over the Numa Numa Trail with one-regiment-plus and hit the 129th at a strongly fortified point (fig. 324). Some 400 of them are now being buried by our bulldozers. By climbing over their own dead until our machineguns jammed, they had managed to take some of our forward pillboxes. They would also walk in file straight across a minefield, advancing over the bodies of those who had blown up the mines. However, their losses were too heavy, and except for a few snipers the main body withdrew today. There is no question about their morale and courage. No prisoners are being taken.
The roads here are good right up to the frontlines, and the wounded are quickly brought back to the evacuation hospital. In the cases of the seriously wounded, the clearing station is bypassed. If the wounded man can be reached, he will find himself in the hospital within from 1 to 4 hours. This is the first time in the South Pacific that an evacuation hospital has been able to function as such.
This particular hospital is in front of the artillery, or rather in the middle, as the 155's and 105's are behind us and the 75's are in front. The 155's go chugging overhead night and day. The chugging noise is made by the wobble of the shell as it passes above. The wobble then diminishes, and the shell moves into a straight path. The sounds coming from this change of motion make it seem as though the shell were falling, although of course it doesn't, and it lands about a mile beyond the hospital.
We also visited Hill 700 where elements of the 145th Infantry are located (fig. 325). This is a very rugged section, and the Engineers have done a really superb job in putting a road right behind the frontline. However, the wounded could not be transported along the road except in armored halftracks because the Japanese have the road covered. It is amazing when one considers that the Japanese tried to attack at this point, for the line runs along a hill which is too steep in spots even to crawl along. They did manage, however, to take the top of the hill, though the ravine below was piled deep with Japanese
bodies. Thirteen hundred corpses have been counted and buried so far in the area that our burial parties have dared to cover. This is an important problem as the unburied attract swarms of huge black flies as big as bumblebees, and the leaves of vegetables are black with them. The hill was retaken by us at a cost of about 60 dead and 300 to 400 wounded.
We saw General Griswold, Commanding General, XIV Corps, and his chief of staff, General Arnold, who furnished us a vehicle and a driver. Saw Lieutenant Torrance of the Graves Registration Service, Quartermaster Corps. Our dead, as they are brought to the cemetery, will be detoured a short distance away to the morgue of the 21st Evacuation Hospital where Greiner, the pathologist, with two stenographers and a photographer, will be set up to do his job.
Friday, 24 March
Of all the islands I have visited in the Solomons, Bougainville has the best climate. The nights are always cool, and a blanket is often necessary. The air is also dryer because of the sand subsoil that permits good drainage and because of the slight elevation of the land.
The 21st Evacuation Hospital is a clean and well-organized institution. Colonel Allen [Lt. Col. (later Col.) Robert E. Allen, MC], Commanding Officer, was the former executive officer. Everyone in the XIV Corps is well pleased with them, and they have a good esprit de corps.
We visited Colonel Collins of the Americal who has a splendid clearing station, really more elaborate than is needed. But now that they are getting a number of casualties it has come in very handy for taking in a heavy load. They have underground operating rooms and wards with forced ventilation. This clearing station has been shelled almost daily, and a direct hit was made on the division surgeon's office. Fortunately, he wasn't there at the time. The 52d Field Hospital has also been shelled and took a direct hit on one of its wards. Several patients were wounded although there were no fatalities.
The Japanese hand grenades do not appear to be too effective.12 It seems that the explosive charge is too small. Five grenades were thrown into one of our foxholes without killing a man, though no one escaped being wounded. Two men are needed to fire our bazooka; the forward man frequently gets powder burns while the man behind may suffer hand injuries. We will examine this problem.
Saturday, 25 March
A small sector of the 129th Infantry was infiltrated the night before last by about 200 Japanese. As a result of this action, 100 of our men were wounded and 30-plus were killed. The ballistics team had more work than they could handle at one time.
The surgical service at the 21st Evacuation Hospital is doing a good job, although the hospital is inadequately designed for the load that it has to carry. For example, the original operating room was made far too small (fig. 326). An operating room in a 750-bed evacuation hospital should provide facilities for eight tables to function at once. It should be centrally located and easily accessible to the laboratory and X-ray. The shock room should be adjacent to the operating room and large enough to hold 30 to 40 patients at one time. When the operating room is placed in front of the artillery, as is the case here, underground wards should be available for at least 200 patients. At the present time this hospital has nearly 100 litter patients aboveground and approximately 120 below ground. Many of these patients are thrown into a state of shock during the process of being transferred underground. Fortunately, shelling and bombing have been light in this particular area. Furthermore, X-ray equipment has been kept together, and one hit could have done away with it all. Part of the X-ray equipment should be located in, or adjacent to, the shock ward, and part in the operating room. This hospital could benefit by instruction on such subjects as sterile technique, the use of plaster, records, et cetera. This will have to be arranged.
Visited the EENT clinic. There are many middle-ear cases, a large number of whom can give no story of how their drum was perforated. One man even had a complete absence of the drum. I believe that a great many men suffer ruptured drums from explosions and do not report this fact. Many of them probably don't recognize any symptoms until their ears become infected.
There are many men in combat who have defective vision and bad hearing, which are particularly dangerous in jungle warfare. I heard about one man who was up for court-martial during the fighting on New Georgia. He had turned his Browning automatic on a patrol returning to our lines, with disastrous results. The fellow could barely distinguish a man at 200 feet, let alone be able to tell the difference between friend and foe.
Saw Maj. Paul Troop of the 145th Infantry this morning. He had a minor wound caused by a "hung bomb" which had caused a tree to burst within the area, killing one and wounding nine.
A Japanese message intercepted yesterday indicated that they would begin an attack. Hence, our heavy artillery barrage last night. Our Cubs have spotted most of their gun positions, and we can only hope that we have knocked them out. Anyway, it appears that we have stopped them for the time being. Yesterday, the Japanese used machineguns to shoot down several of our planes which were flying low over the lines. Americal headquarters is jittery, for the Japanese naval 6-inch guns on Empress Augusta Bay are dropping shells around the general's tent. Everywhere the story of Japanese morale is the same. The Japanese soldier when cornered shouts back that the Japanese Army never surrenders. So far they are right.
Saw Capt. Carnes Weeks [Cdr. Carnes Weeks, MC, USN] who now appears to be Halsey's personal physician. Had luncheon with him and Admiral Halsey several times on Guadalcanal.
The Fiji Scouts are here in force (fig. 327). Their officers are New Zealanders. Both officers and men have won the admiration of all the units here. I just watched a battalion go down the road with a snap that is never seen in our troops. Their casualties are heavy, and the Japanese fear their courage and their ability as natural jungle fighters.
The dead are not coming in so rapidly now, only about 10 to 15 per day, so that Greiner, assisted by Hull and Frick can keep up with the post mortems. Two stenographers are there to take dictation, and they have a photographer there to take the pictures. We have two undertakers who take charge immediately after our work is done. They sew up and wash the body and wrap it in a mattress cover. This project shows earmarks of being a valuable study.
Monday, 3 April 1944
The action is quieting down, although Greiner still averages about six post mortems a day, about half of which are Fijis who were on patrol duty. Opinion differs as to their value as soldiers. They are universally liked, and everyone agrees that they are good on patrol, but apparently they do not stand mortar fire well.
The morale of our troops is high, although we have quite a few neuropsychiatric cases. However, the vast majority of these were neuropsychiatric problems before they entered the Army and cannot serve as an index of the morale of the troops in general. One lieutenant cracked up because he had to lead his men on six assaults of a hill, incurring 50 percent casualties. He felt that he was to blame for the casualties, although he was only obeying orders.
The food here is excellent. Almost every installation now has a garden, and some of these are on a grand scale. Sweet corn, tomatoes, potatoes, onions, radishes, okra, carrots, and the like grow well.
The question of rotation versus leave has now become optional for officers below the grade of lieutenant colonel who have 2 years of oversea service. Most of the doctors prefer rotation to leave. They feel that they have been overseas long enough, 24 to 28 months, and that something has been put over on them by the doctors who have remained at home. The stories of doctors who are "cleaning up" at home does not help morale. This attitude is also in evidence among enlisted men. Obviously, the morale of those serving overseas is in inverse correlation to the income of the people at home. If the income of the civilian population were limited to the corresponding Army income, this factor would be eliminated.
Tuesday, 4 April
Activity is steadily quieting, and nothing is coming in but patrol casualties. Yesterday I completed the initial records of the 37th Division.
Last night, had dinner with Col. Eddie Grass at the 33d Portable Surgical Hospital. Major Tyler, of Denver, is Commanding Officer. This unit wants to stay with the 37th Division. They are set up beside the collecting station and have taken the more seriously wounded who could not stand transportation to the evacuation hospital. They received a direct hit from a 500-pound bomb
early in the battle, which wiped out their equipment, including even the pots and pans in the kitchen. All the personnel were in foxholes, and there were no casualties, although the bomb dug a 20- x 6-foot crater. They have been reequipped since then and have only had to contend with mortar fire and sniping. The operating room should obviously have been placed underground. Digging tools and one power saw should be a permanent part of their equipment.
Thursday, 6 April
The cards have been made for all those killed in action and wounded in action on Bougainville since February 15, and some 200 are completed. We found some wooden bullets yesterday. They are said to be used by the Japanese for close-range fighting in order to avoid injuring their own men.
I had dinner last night with General Beightler of the 37th Division. General Griswold, XIV Corps, told me that the 37th was the "banner division" of the South Pacific. General Beightler is one of the world's fine people-simple, modest, and direct. He can also be tough if that is necessary. The general is intent on maintaining high morale and a pride of accomplishment among the men. This is best attained by the careful selection of leaders, fairness, and recognition for a job well done.NOTES
1. The 9th Station Hospital needs an EENT officer. He will be provided by the 29th General Hospital.
2. Complete field X-ray equipment should be kept in the forward area. In general, more supplies should be kept in the forward area rather than at Nouméa.
3. It should be possible to return an officer from the tropics without a recommendation for either promotion or reclassification. Many of them are inefficient in tropical service and do not fall into either group. Here is a case in which administrative redtape is working against the best interest of the service.
4. More of the following items must be obtained: Scales, blood pressure apparatus, otoscope, sterilizer (Wilmot-Castle), small burners for sterilizer, orthopedic tables; powersaws, axes, and ventilation fans for underground wards and operating rooms; headlights; sclerosing solution for hemorrhoids, eye anesthetic, copper sulfate for phosphorous wounds.
5. Spectacles are still a problem. Do all the men have a second pair?
6. The journals are still not coming through.
7. Replacements should come in early enough for prior training.
8. The Japanese make better use of cover than we do and dig in quicker, using smaller, better constructed foxholes. Every recruit should learn how to dig fast. This is of more value than walking in jungle warfare. The men must also learn to dig deeper and narrower foxholes. They are far too large. Many buttocks wounds are seen in the wards. The soldier must be advised to get his backside down. Careless exposure of the silhouette is too frequent.
We must learn to crawl more often. The Japanese stick closer to the ground. Furthermore, our boys frequently don't wear their helmets on patrol, for they soon find the helmet too tiring.
9. Should patrols (fig. 328) be accompanied by a medical officer? Not unless the medical officer has enough equipment to do more than an aidman's job. Small patrols of less than nine men have an aidman along, and many of them are lost on patrol. One patrol had a battalion aid section of 28 men of whom 10 were wounded in action and 4 seriously. General Hodge [Maj. Gen. (later Lt. Gen.) John R. Hodge, Commanding General, Americal Division] gave orders for a doctor to accompany a reinforced company of 175 men, although no equipment was carried. Citations for medical aidmen are insufficient. However, an infantryman who takes no more risks gets a citation. One battalion commanding officer insisted on bringing back his dead at great risk to the aidmen. Aidmen have been used to carry the dead down from the aid station. Since there are a limited number of aidmen, they should not be used for this task.
10. The 37th Division clearing station performed primary suture of the minor wounds of about 30 men. Almost all healed per primam.
11. More instruction is needed on sucking chest wounds and the proper way of sealing them, which is with a tight adhesive over a pad and gauze, the latter impregnated with petrolatum jelly.
12. Statistics gathered from the 21st Evacuation Hospital:
Note: Second echelon medical service must have thoracic surgery.
13. We need a movable metal pillbox. It would be of great value in going over a ridge against Japanese positions. A periscope could be attached, so one could look over the ridge. Many Japanese are killed by heavy fire because of their concentration prior to an attack.
14. Captain Dick states that about 5 percent of the men take sulfa tablets by mouth when wounded. It might be better to discontinue this practice entirely, unless they are out on patrol. The full dose, given by a doctor, would more quickly assure an adequate blood level.
15. The Japanese hand grenade is grooved, but does not fragment along its grooves. Having so much powder, it is almost pulverized; hence, its burst is not effective very far. Men sitting in a foxhole in which a grenade has been tossed have been known to put up their feet and come off without serious wounds. However, the blast effect is considerable. Small skin puncture wounds and extensive damage to muscles occur as a result of the blast. A Japanese grenade was seen to go off under a man and lift him 2 feet in the air.
Sunday, 9 April
I was under the impression that the Japanese had finally been driven away, but I was awakened this morning by the shelling of the fighter strip. Last
night I had a long discussion with the officers. They complain that many hospital staffs are kept inactive over long periods of time. They contend that under such circumstances the men should be sent home, since many planes and ships go back empty. These people refuse to recognize that the difficult problem is to bring men out here. They only see the issue in terms of available transportation back to the States. It was remarked that morale is bad because the Army hasn't been keeping its promise to ship people back on rotation. These men complain that they were not told that the Army's promise would be fulfilled only "if the tactical situation permitted."
Saturday, 15 April
We have been interviewing line soldiers and get much valuable information from privates and noncoms. Many discrepancies having to do with the circumstances in which wounds occur are corrected. It appears that these statements may be taken as about 85 or 90 percent accurate. There is general agreement that every man should know the principles of first aid treatment since regular aidmen cannot get to them at night.
More attention should be given to having better pillboxes, sacrificing camouflage if necessary. The Japanese knew where they were located anyway. Windows on the pillboxes should be screened with chicken wire or, better still, some kind of rubber wire off which the grenades will bounce. The pillbox should slope down at the sides so that the grenades will roll off. Barbed wire should be used more freely. A telephone is needed in every pillbox. These
telephones should be attached to the ear in order to leave the hands free. Our logging trails, which were cut for timber, were used by the Japanese for their main attacks. Flamethrowers would be useful on the defensive against mass attacks. A flamethrower with a long hose is more efficient than a tank when the position of the dug-in enemy is known. Our minefields limit our means of withdrawal, but kill many Japanese. A bulletproof vest might be useful in this type of warfare. Inside the pillbox, the noise of firing is intensely annoying, and the helmet makes it even worse. The 60-mm. mortar shell flare is okay, but the airplane flare is too bright. The frontlines should be cleared for 300-yard lanes of fire. The bazooka is very useful against banyan trees. More men are needed who are trained in the use of bazookas, as many of these guns were available and stood idle. More Browning automatics are needed, and every pillbox should have one.
Tuesday, 25 April
Went over our results with General Griswold. He is skeptical about our figures on machinegun casualties, probably because of the gun's highly lethal effect.
Russell Islands, Saturday, 13 May 1944
Off this morning for the Russells. Went to the 222d Station Hospital. Colonel Currie is commanding officer. This shows promise of being a fine hospital, and the morale is good. Visited Colonel Bell at the 17th Field Hospital where the same old problem seems to exist. Went to the 41st Station Hospital where construction has been stopped. Colonel McLaughlin [Lt. Col. William B. McLaughlin, MC], Commanding Officer-a fine type. They need a laboratory officer. None of these hospitals has a well-trained anesthetist.
Nouméa, Monday, 15 May
I am now back at Nouméa. Left Bougainville the first week in May for New Georgia Island. Stopped at Ondongo Island, then by boat to Munda. Stayed at the 144th Station Hospital on New Georgia. Colonel Haines [Lt. Col. Hilton D. Haines, MC] is hospital commander.
Friday, 14 July 1944
Today is Bastille Day, and tonight the natives are in the square across from Le Grand Hotel Central, beating tom-toms and having a great time shouting and singing-a regular old shakedown (fig. 329). I felt rather under the weather from around May 15th until early in June, although I kept going. Had no appetite, which caused a loss of weight, and had sporadic diarrhea. Stool examinations did not reveal any ameba.
Hull, Greiner, and Sutherland stayed on to help with the reports. I have learned how necessary it is to be careful when choosing people for such work, and I would never again attempt it with anyone whom I did not know was definitely interested in the problems.
Admiral Halsey and his staff departed on about June 15th, and General Maxwell, Hal Sofield, and General Harrison left for Washington 5 days later.
Everybody here is full of rumors as to what will happen next, but fortunately I have been so busy that I have not had time to think about it. Around July 1st, Col. Maurice C. Pincoffs, MC, came over from Australia and spent several days gathering data, as New Georgia and Bougainville pass to the SWPA (Southwest Pacific Area).13 They (i.e., SWPA) either have no regular allotment for consultants, or someone else has filled them, and Col. Wm. Barclay Parsons, MC [Consultant in Surgery, Office of the Chief Surgeon, U.S. Army Services of Supply, SWPA], must be carried as the commanding officer of a hospital. Moreover, being in Services of Supply, they have nothing to do, except by invitation, with combat troops. I realize now what a very fine situation I have had here in comparison. "Pink" [Pincoffs] suggested that the Sixth U.S. Army should have a consultant and asked if I would not consider it. No news has come from Washington so I will sit tight as I have a lot of reports to finish.14
Tuesday, 18 July
Heard that we will go under the Central Pacific but do not know as yet what is to be done with the consultants.15 The ballistics report has been completed except for the typing.
Auckland, Tuesday, 8 August 1944
Today I received orders to go to New Zealand. The plane coming over flew at 10,000 feet, and I was uncomfortably cold in spite of the woolens I wore. Arrived at Auckland at 1600 hours and went out to the 39th General Hospital. Colonel Longfellow is looking well. They have 300 patients, and most of these will soon be gone. The grounds are beautifully landscaped, and the hospital itself is immaculate. It has stood up very well. Gave two talks on wound ballistics.
Nouméa, Saturday, 12 August
Received orders from the Commanding General, South Pacific Base Command, to return. I was having a gastrointestinal series done and had to leave in the middle of the series. Arrived August 15 at Nouméa to fluid that I have been ordered to Headquarters, USAFPOA (U.S. Army Forces, Pacific Ocean Areas), Hawaii.16 Eddie Ottenheimer's orders are out, following Colonel Longfellow's okay. He will be invaluable in compiling surgical statistics for the theater. Furthermore, General Maxwell, who has returned, wants to use him as a historian.
Saturday, 19 August
Eddie arrived today, and I have started him on the analysis of surgical records. General Gilbreath [Maj. Gen. Frederick Gilbreath], who is now Commanding General, South Pacific Base Command, has made many reforms, and life for the officers is not generally as pleasant as it was. But there are compensations in better discipline.
Tuesday, 22 August
Drove out to Tontouta and spent the night with Colonel Shope, now commanding officer of the airbase.
Wednesday, Thursday, 23, 24 August, Oahu, T.H.
At 1300 I got on a C-54 coming through from Sydney. These planes are like huge flying boxcars. Arrived at Nandi Airport at 1715 and had supper. Took off at 1815 in a beautiful sunset. Arrived at Canton Island, Phoenix Islands, at 0200. As the plane taxied down to the end of the field on takeoff, it was discovered that the hydraulic system was leaking. This was repaired by about 0600, and we finally took off. We landed at Hickam Field at 1600.
Passed through Army Customs and went out to Fort Shafter, Oahu, T.H. [Headquarters, USAFPOA], where I signed in and looked up Colonel Young [Col. Charles T. Young, MC, medical consultant] who fixed me up for the night in the old Tripler Hospital. Here everyone is dressed up, and there is little evidence of war. Today, Wednesday (having crossed the date line again), I met Brig. Gen. Edgar King (Chief Surgeon, USAFPOA), my new commanding officer. Although he has a fearsome reputation, my first impressions are very good. Colonel Gates [Col. Kermit H. Gates, MC], Deputy Surgeon, is a very busy and pleasant person. Thursday, I visited Lt. Col. (later Col.) Forrester Raine, MC, of Milwaukee, who has been acting surgical consultant for the Central Pacific Base Command. He tells me that there are only four board members in the whole area and that there is a great dearth of good surgeons.
Saturday, 26 August
The general had asked me to write down some of my ideas on the function of a consulting surgeon, which I did and which he approved. He has taken quickly to all my suggestions, and I think that I am going to like working with him. The only aspect of the work that I dislike is that I also have some functions as an inspector. I am afraid that this may strain my pleasant relations with the surgeons. Perhaps this need not happen.
Monday, 28 August
Today I lectured to a medical group and afterward traveled to the northern side of the island to deliver the same lecture to the 71st Medical Battalion. I am beginning to think that my illustrated lecture on debridement must be good, as I could hardly fool all the people all of the time.
Tuesday, 29 August
Spent the day with General Bliss [Brig. Gen. Raymond W. Bliss, Chief of Operations, Office of The Surgeon General, and Assistant to The Surgeon General] and General Rankin [Brig. Gen. Fred W. Rankin, Director, Surgical Consultants Division, Office of The Surgeon General] visiting the North Sector Hospital [219th General Hospital]. Colonel Green [Col. Philip P. Green, MC] is commanding officer, Fisk of Boston is Chief of Surgery, and Robertson [Col. Robert C. Robertson, MC] is Chief of Orthopedics [and Consultant in Orthopedic Surgery, USAFPOA]. Then we were off to the 204th General Hospital of which Col. Tracy L. Bryant, MC, is commanding officer. I had not seen him for the past 25 years. Thence to Doris Duke's and to the Moana Hotel for drinks.
Thursday, 31 August
Off at 0630, visited the jungle course over the Pali [Camp Pali]-a very profitable forenoon (fig. 330). Maj. Bryant Noble, MC, in charge of medicine, is doing a good job. Thence to Koko Head, to visit the field and portable surgical hospitals just out of Saipan. Colonel Pettit-very able. Major Tinkers, who is the son of Dr. Tinker of Ithaca, was in command of a portable surgical hospital on Saipan and did a fine job-2 to 5 percent mortality on the
island. Back to the office and off with General King to a large dinner party for Generals Bliss and Rankin, given by Colonel Streit [Col. Paul H. Streit, MC, Surgeon, CPBC] at the Pacific Club. A good dinner.
Saturday, 2 September 1944
Went out this morning to see General Hodge [Maj. Gen. John R. Hodge, Commanding General, XXIV Corps]-"Old Corkie." The next operation (Leyte Campaign) was explained by Colonel Potter [Col. Laurence A. Potter, MC, Surgeon, XXIV Corps] in a most excellent manner. While there, we received word of an emergency meeting with General King at 1300 hours. Five of us were called; Col. Charles Young, Kester [Col. Wayne O. Kester, VC, Chief Veterinarian, USAFPOA], Lt. Col. Moses Kaufman [now neuropsychiatric consultant for USAFPOA], Diver, and myself. We were brought before a huge table holding 50 items-planning for the next year, involving 50,000 medical personnel. Our conclusions were due immediately, so we had only a half hour to look the situation over. I hope the corrections we made turn out to be right.
Wednesday, 6 September
Still snowed under with work. Checked reports of the Marianas Campaign. The portable surgical hospital, while well adapted to jungle warfare,
appears ill-adapted and wasteful when communications are good. Furthermore, their talent is poor and not as well attuned to needs as is the personnel of the surgical teams. Generally speaking, the larger installations are more efficient as regards such things as specialized talent, protection (guards), laundry, triage, and the treatment of shock. On the other hand, in amphibious operations, size is a limiting factor. The 400-bed evacuation hospital is about right for these operations, as is also the field hospital if properly staffed.
Talent is wasted by using two smaller hospitals to take the place of one larger one. Dumbea Valley is a good example of this. Another mistake is to require station hospitals to do the work of general hospitals, as was the case on Guadalcanal. The fact is that there were too many station hospitals there, and, taken individually, they were too small for the job. We now have a 750-bed station hospital which has been organized by combining three 250-bed station hospitals. We expect to use it as an evacuation hospital, though the staff is inadequate. The chief lack is qualified surgeons. I looked over two portable surgicals and a field hospital and found only two surgeons with ratings better than "C."
Thursday, 7 September
Talked to the 76th Station Hospital this forenoon. This is a good station hospital. If this next action is severe, I would expect trouble, for the 165th Station Hospital is made up of three 250-bed hospitals, and consequently the personnel is poor. The conversion of several smaller hospitals into a large hospital is unsound policy. They don't seem to realize that the quality of personnel in a small hospital is, and must be, different than that of a large hospital. The 69th Field Hospital hasn't any well-qualified surgeon. To expect these hospitals to function adequately as evacuation hospitals requires more optimism than I possess. The 51st and 52d Portable Surgical Hospitals are short on surgical talent. Certainly the portable surgical hospitals are wasteful, and unless their talent is better than in those I have seen, they only succeed in giving the dangerous illusion that a surgical hospital is available.
The general has been very kind and considerate toward the consultants. When I told him of the lack of surgical talent, he said: "I didn't know your standards would be so high."
I looked up some of the anesthetists today, and they are scattered in all sorts of positions. One of the best, with 6 years' experience, is an executive officer.
Friday, 8 September
To Koko Head where I talked at the 69th Field Hospital, which is not too strong in personnel. Spent the afternoon with Robertson who insists that he wants to do hospital work as well as act as a consultant. Thinks catgut is better than silk or cotton.
A three-star general here burned his fingers when a matchbox caught on fire. I went down to see him in response to a call and a two-star general who was there asked why such high-powered talent was needed for such a little thing.
I said: "I thought perhaps things had gotten so hot that there was danger of a general conflagration." This seemed to please the general to the extent of relieving his pain.
Saturday, 9 September
Visited the new hospital ship Mercy, which had Army personnel aboard (fig. 331). Seven hundred patients and only two operating rooms, inadequate for a combat mission. There were only eight medical officers aboard, five of whom are would-be surgeons. The ship should have had the personnel of at least a 400-bed evacuation hospital.
Spent the evening with the general. He is a fine person to work for. Unfortunately, he has not had enough advisers to whom he could delegate responsibility.
Monday, 11 September
Spent yesterday writing a directive on surgery for the forward echelon. The general, to my amazement, insisted I sign it. "It would come better," he said, "from a doctor."
Some doctors are against the use of plaster in the next operation because of gas gangrene. Correcting one surgical mistake with another it would appear. I am more than ever convinced that, as a whole, the amount of gas gangrene is an index of the quality of surgery at the front, and admittedly it was not of the best on Saipan.
Tuesday, 26 September
I am still laboring to get out: (1) An educational directive (none has been issued); (2) a statistical directive (no method exists for gathering statistics on surgery, and one should be set up for POA); (3) a plan for a wound ballistics study (none has been contemplated); and (4) ETMD (Essential Technical Medical Data) reports to this theater, and a plan for developing our own. Discussed some revisions of this plan for ETMD reports with General Bliss. The classification was too high, and subject matter should be concentrated just as in any other medical paper. A consultant, or some one on his staff, should act as editor.
The great shortage in this area is talent. There is only one surgeon here who can qualify as chief of surgery in a 2,000-bed general hospital, and there is a dearth of specialists.
One of the chief functions of a general hospital should be to act as a teaching center; however there is a shortage of good teachers. Very few lives can be saved in a general hospital (area Naval hospital had 1 death in 6,000). The patients die before they reach a general hospital. The shortage of qualified men here is due to the fact that there are no affiliated units. Those from the South Pacific Base Command are tied up by agreement with the Southwest Pacific Area, and personnel cannot be moved although many are idle in that area. The 39th General Hospital has 100 patients.
The portable surgical hospital is too small to function as a hospital and too large to function as a team. It should be disbanded.
Maui Island, T. H., Monday, 2 October 1944
Flew from John Rogers Field to Molokai Island, and thence to Maui Island to visit the 8th Station Hospital. This unit was formerly on Bora-Bora. Lt. Col. Julius Sobin, MC, is Commanding Officer-F.A.C.S., a good surgeon. Chief of surgery is Maj. Charles E. Town, MC. His surgery appears to be good, and he is capable of handling a 500-bed hospital. Capt. Irvin E. Simmons, MC, ENT man, is young but appears capable. Capt. Rosario Provenzano, MC, is in charge of orthopedics-young, but also seems capable. Capt. Leo Tyler, MC, is the anesthetist. This hospital, developed by the 20th Station Hospital from some former school buildings, has barracks-type wards of 750-bed capacity. It has a pleasing location at 1,800 ft., cool, exceptionally well adapted to a station hospital. They now have 600 patients; average census for 1944 was 300. A Marine division is now training here, and they expect an increase in patients. The 250-bed personnel is not enough for present needs, and the Navy has supplied 15 medical and dental officers. The equipment is superior to most general hospitals. In fact, no extra buildings or equipment would be needed to make this into a 500-bed hospital, and their key personnel would be adequate. However, the laboratory does not use the copper-sulfate method. Attended an excellent medical meeting. The staff does not have help enough to offer training courses. They need a dietitian and more enlisted men for the basic jobs.
Hawaii, Wednesday, 4 October
Off to the Large Island [Hawaii] and landed at 1100 hours. Went directly to the 75th Station Hospital, which was organized as a 750-bed and is functioning as a 250-bed hospital. Colonel Underwood of Brooklyn is commanding officer and also functions as district surgeon-a fine fellow doing a good job. Colonel Mayer is Chief of Surgery. He is one of the two or three best-trained surgeons in the CPA (Central Pacific Area). They need a good orthopedist. Pfiffer, general surgeon-young, but has aptitude; Goldman, genitourinary specialist-good; Freidman, ENT-good; Captain Foster (nurse) is the anesthetist. They have one physiotherapist. This service should be developed. One dietitian-good. They need more. The library is good-six textbooks of Christopher and six of Cecil. They do not know the copper-sulfate method at any of these hospitals.
Friday, 6 October
Started off at 0800 to drive around the island through the Kona country. At 1400 we arrived at the 26th Station Hospital on the Parker ranch-35,000 cattle and 10,000 sheep and goats-looks like Wyoming. This hospital has 150 beds and two surgeons. Captain Amstutz is doing an excellent job here. Captain Bigliani, an orthopedist, is assisted by numerous doctors from the Marine division. Cooperation is excellent with the Navy. They need an X-ray man and an ENT man. Anesthesia is done by the nurses-two good ones. Captain Spalletta, laboratory officer, also does cystoscopy. They are doing a lot of work on appendixes and pilonidal sinuses. On the whole they are doing as well as can be expected, and Amstutz is a superior officer.
Saturday, 7 October
Off at 1230 from Hilo and landed at John Rogers Field [Naval Air Station, Honolulu], 1430 hours.
Oahu, Sunday, 8 October
After 6 weeks, I have still not accomplished any of my original projects. There has been a tremendous passing of "buck" slips. It is almost as difficult to get something done here as in a university medical school. The educational directive is under way, stated by G-3 as being long needed. Reproduction of ETMD will be delayed indefinitely, as the photo lab burned down last week. The statistical project is at status quo with more and more excuses developing, such as no help or no room.
There are three ways of determining the quality of medical care: (1) Inspection of hospitals and personnel by consultants and others; (2) statistical record of results (as the cash register is to business, so is the statistical record to surgery); and (3) questions and answers on what the soldier thinks of his medical care. With these three methods correlated, we should be able to determine the quality of medical care and devise means for improving it where needed.
Sunday, 15 October
Still no news from Washington, and General Maxwell is still in New Caledonia.17 The educational directive is about to be published, so my number one project is done.18 Must now get out a directive on reparative surgery and another on penicillin. Penicillin has not been used to the extent that it should be. Reports coming in indicate that we are making the same mistakes in medical planning here that were made in the South Pacific one and a half years ago. This also applies to matters other than medical. This theater is fighting its first battles, and, since none of these men have had experience, they must necessarily learn through trial and error.
Sunday, 22 October
Got out the directive on penicillin. We have not been using enough in this theater, and there is confusion as to when to use sulfonamides and penicillin. Arranged program for a territorial medical meeting. Abstracting and getting out ETMD for all hospitals, divisions, corps, and armies-this has not been done before. I'm working on a gas gangrene, anaerobic wound infection report. Have not yet been able to establish a record system.
I would like to go forward, for the flow of Philippine casualties will soon be coming through. The invasion was announced 2 days ago and is going well
(fig. 332).19 Saw a picture in Time of Carnes Weeks with Admiral Halsey. I envy his seeing the show. Spent a pleasant afternoon at the beach today, swimming with Colonel DeCoursey [Col. Elbert DeCoursey, MC] and Colonel Curtis-both fine fellows. This week should bring clarification of the situation here.
Thursday, 23 November
Eddie [Ottenheimer] arrived today with many tales, some new stories. He certainly was most welcome as I need him to lift my spirits. Things here have been most discouraging, although I would not have missed the experience, which is unique in my Army career. I begin to appreciate what is meant by the word bureaucracy, although I think Marine terms are probably more expressive. Three months have I labored here and brought forth one directive on the training of medical officers. All others have been blocked for various and sundry reasons.
General Willis [Brig. Gen. John M. Willis, Chief Surgeon, USAFPOA] arrived about 5 days ago. Some personnel have been returned to the States. One officer, in charge of the personnel of a hospital, never developed anything worth the name of a department. There was no name file nor classification of
personnel. The general filing system in the office was reminiscent of my grandmother's attic. Things were probably there, but no one could find them. It was not uncommon to find everyone looking very solemn, as though in conference, then to discover that they were only looking for a lost document.
The prevailing idea seems to be that the consultant is here primarily to make inspections, write long-winded reports about trivial matters, sit on boards, and see patients. In trying to accomplish something, I have encountered resentment and a feeling that I was interfering with things that were none of my business. The consultant takes no part in planning, although the office is making the same mistakes in planning that were made in the South Pacific a year and a half ago. Results: The mortality of wounded on Saipan was twice as high as on Bougainville, and one-third the number of patients returned to duty.20
I spent the evening with the general and accomplished much business very pleasantly. My first impression of the general is that he is outstanding in his desire for, and insistence on, a high standard of work. Being new, he of course does not wish to move rapidly against tradition, although he sees the need clearly. This is a fine education on how to win friends and influence people, but not much help yet to the war effort.
Thursday, 30 November
Dinner tonight with George Finney. Says he: "How can we plan when we don't have anything to plan with?"21 I have now been in this headquarters over 3 months and still have not been asked to take part in future planning; nor after my request, have I been permitted to take part in planning. A field hospital is going in [to the Philippines] with the Marines. They say it will function as an evacuation hospital. The Army says it will not, and I suggest that it should have surgical teams if it is to function. Responsibility is being shifted along. Only God cares for the little fellow! I am wondering when this will crack. It can't go on forever. Once again I must speak to the general or be derelict in my duty. I would rather be out of the thing than in it and wrong.
Friday, 1 December 1944
Ben Baker arrived today. The role of consultants in the Army needs clarification, and Regular Army personnel must be educated as to the medical problems of a theater. There is only one partially qualified neurosurgeon in this area. The determining factor in the distribution of battle casualties was the number of the doctors available, including those in station hospitals. Anesthesia departments, headed by doctors, have not been established. Essen-
tial Technical Medical Data have not been distributed to hospitals. I suggested that it was by the ETMD more than anything else that the world judged the theater and was met by stubborn incomprehension.
Saipan, Thursday, 7 December
Yesterday, having a chill and after numerous inoculations, I received notice at 2200 to appear at Hickam Field at 0015. We took off at 0130, and, fortunately, being the senior officer on board, I had a bunk. Owing to repeated chills, I stayed aboard until Kwajalein where there was a dismal rain, making this dismal place look worse than usual. I have sympathy for the men whose lot it is to stay in such an unattractive part of the world. Arrived just before dark at Saipan.
Today, with Col. Eliot Colby, MC, Surgeon, Army Garrison Force, Island Command, Saipan, we had a hurried preliminary survey of the island, which is far more attractive than I had anticipated. There was a Japanese air attack this morning, and on getting up I was a bit disconcerted to find no foxholes. Found the colonel in charge of ATC digging a foxhole, asked him why, and he pointed to his teeth marks on the floor. The 148th General Hospital is still in tents although prefabricated buildings are under construction. Headquarters is built in quonset huts, and the labor has been used to improve this and other sites. Colonel Colby says that hospitals have "No. 1" priority, but then "No. 1" becomes subdivided into "a, b, c, et cetera." Visited the supply depot in charge of Captain Phillips. Most supplies are out of doors on the ground, although covered with tarps.
Visited the 369th Station Hospital, where I saw Major Goldsmith who is in charge of a civilian section which will be taken over by the Navy on 1 January. According to Colonel Colby, in the original plan the Navy had designated one medical officer and one corpsman to treat civilian casualties. There were a large number of civilian wounded, even on the beaches. One platoon of the 31st Field Hospital was designated as a civilian hospital. This platoon with 100 beds soon had 880 patients. A second station hospital of 500 beds is under construction adjacent to the 750-bed 369th. This total of 1,250 beds requires a duplicate setup of surgeons, administration, equipment, and so on. This does not seem to be good economy of personnel or equipment, but owing to the difficulty of putting these hospitals together under one T/O they must be set up separately. Certainly T/O changes should be made more easily.
Guam, Saturday, 9 December
Left by plane at 0800 for Guam. Visited the 273d Station Hospital-Colonel Batterton, Commanding Officer. This is a 750-bed station hospital at about 20 miles from the port, but fairly close to the airfields. The hospital is now under construction and should take patients in about 2 weeks.
Tinian, Sunday, 10 December
Visited the 289th Station Hospital, under construction at the edge of the depot field-a splendid location. Quonset hut construction, a 100-bed unit expanded to a 200-bed unit. Maj. Paul S. Read, MC, is commanding officer and
also does some surgery. The surgical personnel seems to be about as good as can be expected in a small hospital.
Left Guam at 1900 and arrived at Tinian, passing close to Rota Island which the Japanese still have in their possession. Found Major Shaw, island surgeon-a pediatrician and very energetic.
Saipan, Monday, 11 December
Visited U.S. Naval Base Hospital No. 19 under the command of Captain Mueller, USN. The station hospital at Tinian, the personnel of which have not yet arrived, will be constructed of quonset huts by the Seabees. Shaw had drawn up some very good plans, and this should be a superior station hospital. These two hospitals can provide facilities for 2,000 beds if they get the additional personnel. Flew to Saipan in the afternoon to attend a medical meeting. Pathologist reported findings on autopsies of 60 civilians. About 70 percent were tuberculosis and beriberi, frequently mixed. The next largest group was dysentery and colitis.
Tuesday, 12 December
Drove around the entire island [Saipan] in the afternoon looking at hospital sites. The two general hospitals are toward one end of the island, and the station hospitals are together at the other end. While this is undesirable geographically, it would be unsatisfactory to try to convert the station hospitals into a general hospital. It is understood that all battle casualties will pass through the general hospitals and that the station hospitals will be used primarily for garrison work. The 39th General Hospital is 8 miles from the airstrip, as is also the 148th General; and the 39th is 5 miles from the docks, while the 148th is only 1½ miles from the dock. At present, the 148th General is doing about 40 percent station hospital work. Yesterday, evacuation policy for patients was increased to 60 days for the general hospitals, 30 days for the station hospitals. The 21st Bomber Command has 100 beds to act as a clearing station at the strips, and the ATC has two quonset huts to care for casualties that have arrived or are awaiting evacuation.
Summary of Informal Report to General Willis
There has been a need for sometime for a consultant in this area. The chief problems are: The planning and construction of hospitals; shifting of personnel; and professional questions, especially in relation to the functions of various hospitals.
The 148th General Hospital is now under construction, although they are now functioning in the area under tents. The surgery should be in quonset huts in 2 to 3 weeks. The personnel of the surgical service of this hospital will require strengthening. Further observation at a later date is required for proper evaluation. Approximately 40 percent of the surgery in this hospital involves the garrison forces. Twice the number of beds may be made available for battle casualties by allocating most of the garrison work to station hospitals. This has been discussed with Colonel Colby who has given splendid cooperation.
The 369th Station Hospital, 750 beds, is also under construction and is now functioning in tents in the same area. Lt. Col. Joseph Kuncl, Jr., MC, Chief of Surgical Service, is doing an excellent job, although he is short two Medical Corps officers. The 176th Station Hospital, 500 beds, is also under construction adjacent to this hospital and will be functioning within a few weeks.
I understand the 39th General Hospital is coming here. Neurosurgery and thoracic surgery can be allocated to this hospital, which has qualified specialists. There are also some board members available in this hospital qualified to act as chiefs of service.
I have seen the plans of the 39th General Hospital and there is room for much improvement to insure a better functioning unit. I would strongly recommend that Lt. Col. Edward J. Ottenheimer, MC, be sent here as soon as possible to assist in the planning and construction of this hospital. Colonel Colby concurs and has radioed a request.
With the arrival of the 39th General, the surgical services on this island can be staffed with qualified men, and, with the proper allocation of functions, all specialties could be covered in a superior manner. Guam will be well staffed with qualified specialists, except in neurosurgery.
148th General Hospital.-Of 303 battle casualties received in the 148th General Hospital, Saipan, 149 were evacuated to Oahu and 154 were returned to duty forward. Table 5 shows the number of operations performed during 4 months (August to November, inclusive) in 1944.
Leyte, Wednesday, 13 December
Amid wind and rain, arrived at Isley Field, Saipan, 2200 hours. Wet-slept in ATC holding tent for patients. Plane left at 0200. Sat up all night, arrived Tacloban, Leyte, at 1000 hours and circled for an hour before landing. Drove to Tacloban and met General Denit [Brig. Gen. (later Maj. Gen.) Guy B. Denit, Chief Surgeon, USAFFE, and SOS, SWPA, and later Chief Surgeon, AFPAC]. General Denit: "This damn Army won't even obey orders. Supposed to have 12,000 beds by this time and we have only a fraction." I like the general.
Drove to Sixth U.S. Army headquarters and met Col. (later Brig. Gen.) William A. Hagins, MC [Surgeon, Sixth U.S. Army], a Regular Army surgeon (fig. 333). The most outspoken man I have seen in a responsible
position in this war. Says he: "The casualties are not high enough in headquarters." They do not like the PSH (portable surgical hospital) as a tactical unit, although individual surgeons and units deserve high praise.
Saturday, 16 December
This is a fine country for ducks and it might well be left to them. Instead we fight over it.
Drove to Dulag. Visited the 165th Station Hospital and skidded around the mudholes in which it operates. This is a 750-bed station hospital functioning as an evacuation hospital-840 beds available and 899 patients. The hospital is insufficiently staffed to act as an evacuation hospital. Nurses are badly needed here. Colonel Sneideman, Commanding Officer, appears to be doing a good job under difficult circumstances. Lt. Col. Philip L. Battles, MC, is doing excellent work on disrupted wounds.
Across the road or pond was the 76th Station Hospital. Colonel Bramble [Lt. Col. Russell B. Bramble, MC] is Chief of Surgery. This hospital is on a drier site; it is better laid out, is more compact, and has a splendid underground surgery. Saw many cases coming in from the 36th Field Hospital across the island, a 2-day trip by road from Baybay. Records were good and the patients were in good condition. Observed numerous cases described as trenchfoot, but they do not appear to me to be typical.
The evacuation of patients has not been good. Too many patients have been evacuated from Leyte. Fifty percent of the Leyte patients sent to Saipan have been returned to duty in 1 month. However, there were not enough beds available on Leyte. They were supposed to have 9,000 beds by D+20. Now, D+60, the only general hospital functioning is the 118th with 600 beds. With the beds of the station hospitals this adds up to approximately 2,000 beds available. The reasons for this failure seem to stem from rain and the difficult
engineering problems in this area. Hospitals have not gotten help from the Engineers. Also, hospital sites were poorly chosen.22 Headquarters has one of the best sites along the beach, which I enjoy, but which is not fair to the hospitals and the sick. The evacuation route is hospital to beach, but there is often no LST to pick up the patients. Talked with the skipper of an LST, and he said that the patients were never on the beach when requested. Obviously, an evacuation station should be established on the beach as a holding station to correlate evacuation. Thus, there has been inadequate control of evacuation from the island, and much unnecessary evacuation of patients who could well have recovered here if facilities had been available.
Sunday, 17 December
Went out this morning to visit the Wasatch, flagship, and Captain Walker [Capt. Albert T. Walker, MC], USN, surgeon of the Seventh Fleet. Colonel Kendrick [Col. Douglas B. Kendrick, Jr., MC, Special Assistant for Shock and Transfusion, USAFPOA] and I had a long talk with Walker regarding the blood bank. He impressed me with the soundness of his ideas and has a better grasp of the surgical problems of combat amphibious troops than anyone I have seen in the Pacific Ocean Area. Moreover, he has accomplished more than anyone else. We then visited LST 464, which is undoubtedly the finest medical unit afloat. This is an LST that has been converted into a 200-bed hospital ship-clean, good food, laundry, good operating room. Here is the most concentrated and best organized surgical care I have seen in a forward area in the Pacific.
They're doing excellent investigative work on shock and burn patients, whom they have in great numbers. Japanese suicide bombing results in many burns. For burns, they are using plasma and serum albumin in large quantities, all controlled by hematocrit and protein levels-as much as 1,200 units per patient-plus blood. They find serum albumin better than plasma when the condition is severe. They have their own blood bank. The donors are Army personnel who are picked up on the beach. The LST proceeds to pick up patients while the donors are bled, then the donors are disembarked on the way back. Only 1-qt. containers, discarded vacoliter bottles, are used. For pooled group O blood, eight donors are bled into 10-gallon bottles. Nine thousand cc. blood, plus plasma, were given to one patient.23
Large amounts of citrate may result in carpopedal spasms which are relieved by calcium gluconate. The Navy makes up and distributes sets of copper sulfate for bedside work.
Casualties received earlier were given better treatment than casualties now being received. When the S.S. Bountiful took in one load of patients, nearly every compound fracture was infected owing to the poor setup and overloading of shore facilities. The 7th Amphibious Force now has 70 LST's with surgical facilities and 23 surgical teams.24 Each team is composed of 5 surgeons and 18 corpsmen. These are quickly shifted from one LST to another. This ship [LST 464] also moves about among the fleet, taking cases from ships that have been hit. The LST goes in on the initial landing and remains as a floating emergency hospital. The 60 well-trained corpsmen work most efficiently. The LST unloads its patients to an APA [transport, attack], APH [transport for wounded], or other ship which takes them to hospital ships outside the combat zone. He, Walker, is not informed regarding beds available in the Marianas. See Admiral Laning [Rear Adm. Richard H. Laning, MC, USN, Inspector, Medical Department Activities, Pacific Ocean Areas] about entire theater correlation. Will these LST's and surgical teams later be available for Western Pacific operations?
Captain Walker first described these procedures for the Bureau of Medicine and Surgery in May. They consented to equipping LST's with surgical facilities, but refused to build LST hospital ships on the grounds that conventional hospital ships were being built. They apparently missed the point that hospital ships outfitted in accordance with the Geneva Convention cannot operate in these waters during combat. Three attempts were made to bomb hospital ships, one at night when the ship had to be lit up. Captain Walker asks that I take up the LST hospital ship problem with Admiral Laning. This was the program I tried to institute in the South Pacific a year ago, and which met with Captain Hook's approval but was turned down because of construction difficulties.
Observations on Blood Program
When General Rankin and General Bliss visited USAFPOA, I advocated a blood bank program for all Pacific Ocean areas and suggested that someone who had had experience in the European theater should set it up, Doug Kendrick if possible. Apparently the Navy had also been working on a program, and the first I heard of this was when Blake and Brown came through Hawaii with the blood, on their way West. This had developed into a combined Army-Navy program on the West Coast. The Army was collecting blood in San Francisco and the Navy in Los Angeles. Blood was transported by NATS to Guam under the direction of the Naval District and Capt. Newhouser [Capt. Lloyd R. Newhouser, MC, USN]. The ATC was landing on Saipan, so refrigeration was set up there. But the blood arrived in the Marianas before
any real preparation had been made to receive it. Unfortunately, no one in the Pacific Ocean knew about the program, so it got off to a bad start. The Naval surgeons in CINCPAC [Commander in Chief, Pacific Fleet] were peeved but cooperative. When Kendrick and I arrived at Leyte, considerable time and effort was needed to establish cordial relations. Both Army and Navy had had blood banks functioning for some time in the Southwest Pacific, and the LST 464, especially, had performed outstanding service. The people in the Southwest Pacific Area were perturbed that the first they learned of the blood program was from the newspapers. Consequently, their first inclination was to say that they wanted no part of it. However, in spite of the excellent blood bank already established here, there was a need for still more blood. Many of the hospitals did not know that blood was available. The loss in early shipment of blood to Leyte amounted to approximately 50 percent owing to the fact that arrangements had not been made for proper refrigeration or distribution. The chief reason for this loss was lack of ice. There is a need for a directive on the use of blood and an educational program among the medical officers.
There has been a heavy loss of men from the line because of the lack of hospitals. Although the hospitals are here, there are few good sites, and these have been used for other purposes, such as headquarters. Result: Engineering problems are so great that hospital building has been slowed down. Now, D+60, a 15-day evacuation policy is in force. Patients have had to be transported 1,500 miles to the nearest hospital, and since many are returned to duty, time and transportation are lost unnecessarily.
Tuesday, 19 December
Saw Colonel Wills, Base Surgeon, who was very cooperative in helping to arrange the blood program. Visited the S.S. Mactan, the last ship on which Colonel Carroll came out of Manila. It now serves as the surgeon's office. Major Steinberg is in charge of planning, another young officer with a large job. The Southwest Pacific Area has 44,000 beds, but about 25 percent of these are inactive due to moving. There are 23 general hospitals. Obviously, general hospitals are being used for station hospital work, which is one of the reasons that there are not enough specialists to go around.
The overall plan is to support each division with one 400-bed evacuation hospital, one 400-bed field hospital, one separate clearing company, one separate collecting company, one company from the engineer special brigade, and three portable surgical hospitals. Portable surgical hospitals are used because surgical teams are not available. The general impression is that the portable surgical hospitals are not adapted to this type of land fighting, but that they are useful as 25-bed station hospitals, for example, to support an isolated airstrip.
Saw Colonel Weston, 44th General Hospital. They were set up near an airstrip. About 600 Japanese paratroopers landed on the strip, and a few nights later reinforcements came in to join them. Our men decided to hold the perimeter, as they had about 200 patients in tents and the road in was im-