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Chapter XIII - continued

Contents

Chapter XIII - continued

857

FIGURE 334.-A scene at the 116th Station Hospital, Leyte Island, December 1944.

passable. The Japanese came into a signal company first, and the guards were ordered out to the perimeter. By this time, the Japanese had machineguns set up on three sides of the hospital. There was an all-night fight, and in the morning they found 23 dead Japanese. Two officers of the hospital were wounded. None of the hospital personnel had had training in firearms other than squirrel shooting. The commanding officer suggested, before leaving the States, that they should have such training, and he was told that all the training they would need was in getting into formations, so as to be able to march on and off the trains.

Wednesday, 20 December

Today, I tried to drive to the 44th General Hospital, but the bridges were still out and the roads were impassable. D+60, and no general hospital has been set up as yet to receive surgical patients. Visited the 116th Station Hospital which never took any patients and is now moving (fig. 334).

Saturday, 23 December

Much conversation during the last few days regarding the use of blood and how to get it distributed. Much careful sidestepping to avoid stepping on toes, which have been rendered more sensitive than usual because their owners have missed so many boats. But, slowly the plan is being accepted and cooperation is being achieved. The prima donnas and the weak egos undoubtedly retard military accomplishment. In the Army as in civilian life, if nonmedi-


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cal men are to assume administrative responsibilities for medical care, they should be educated in medical problems, at least to the extent of being able to identify a competent surgeon.

This morning, I visited the general's (MacArthur's) quarters situated on the beach. Adjacent to these quarters are frame buildings for the staff. The general's house is huge and beautifully furnished.

Sunday, 24 December

Saw Col. Morris Bradner [Col. Morris R. Bradner, MC] of New York. An excellent surgeon who thought he could do more good in this war in an administrative capacity. He was surgeon of the 248th Garrison Force attached to the XXIV Corps. They started for the Palaus from Hawaii, target then changed to Yap, then changed to the Philippines.25 They were at sea for 54 days and debarked on Leyte D+12. Of this force, apparently only the XXIV Corps was wanted, and now, D+60, the garrison force has not been used and they do not know what their assignment is to be. These hospitals have therefore gone through 4 months of training in Hawaii and have spent 54 days at sea and 2 months on Leyte. Colonel Bradner is discouraged, he has offered his services through the usual channels, but no one seems to want them. Another good surgeon gone to waste in a campaign where surgeons were at a premium.

Monday, 25 December

Visited LST 1018-Lieutenant McDermot, surgeon. They had cut watertight doors between the tank deck and the troop quarters, where they made a dressing room and washing room for patients and an operating room. There was space there for the seriously wounded and 200 patients could be put on the tank deck. Certain equipment was lacking, such as anesthesia machines, water pitchers, and some means of keeping hot soup or coffee. They were staffed with a minimum crew of 2 doctors and 10 corpsmen, which is not enough during an assault. All LST's are to be converted in this manner-they now have 17 converted. In addition, such ships as the LST 464 are needed as floating hospitals.

7th Amphibious Force: 70 LST's, 17 now converted for surgery; No. 464, a hospital LST with complete staff and 60 corpsmen; and 23 surgical teams (5 surgeons, 18 corpsmen each).

Navy doctors say that the initial phase of surgery on land is poorly done. On S.S. Bountiful every CC [compound comminuted] fracture was found to be infected. Captain Walker, 7th Amphibious Force, gets a report-name, rank, and serial number-in all cases of improper handling.

The handling of blood is improving but still needs much supervision. Need a system for dropping blood from "Cubs" by parachute when the roads go out. There is a plan for 96 L-5's ("Cubs") to transport casualties. They can carry one litter and two sitters and operate from an 800-ft. runway.

25How could anything but confusion result from such a change of plans? Yet the Medical Department had no choice-Yap Island was never invaded!-J. M. W.


859

FIGURE 335.-Wards of the 165th Station Hospital, Leyte Island, December 1944.

A better plan for marking hospitals is needed. Some commanding generals are said to be afraid of signs.

Visited Abuyog, the eastern terminal of the road from Baybay. One platoon of a clearing company is here to transfer patients to DUKW's [amphibious trucks 2-ton] to go to Dulag-about 200 daily. Those who did not stand the trip well (4 hours over bad roads) from Baybay are held here at Abuyog. More serious patients come from Ormoc by boat. Air evacuation from Valencia began on D+60.

Wednesday, 27 December

The 165th Station Hospital (750 beds) was sent in as an evacuation hospital to support the 96th Division. They had two additional surgeons attached. The 76th Station Hospital (500 beds) was to act as an evacuation hospital in support of the 7th Division.26 Because of the terrain, weather, and tactical situation, these two hospitals were placed adjacent to each other and received patients from both divisions. They were situated about 500 yds. from the beach at Dulag. The site was very poor, so low and muddy that it severely handicapped the functioning of these hospitals.

The 165th Station Hospital usually has about 300 surgical patients, the rest are medical (fig. 335). Since 1 December, they have performed 17 major and 353 minor operations. There were 44 deaths, of which 14 were postoperative (5 abdomen, 9 other) and 30 were nonoperative. The operating room is well set up, but aboveground and without sandbag protection. Wards are of the "T" variety with pyramidal tent junction. Equipment is adequate. This hospital could be improved by a better planned layout. All hospitals that have

26The 96th and 7th Infantry Divisions comprised the XXIV Corps and took part in the initial landings at Leyte.


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not functioned in the field should receive instruction as to planning from those who have had such experience.

On A+1, 21 October, word was received on shipboard that four surgical teams were needed ashore. They started ashore but were driven off by mortar fire, then went 5 miles down the beach toward Abuyog and landed. They found a few soldiers there who knew nothing of the local situation. They then started up the beach and dug in for the night. Next day they still could not find out who had wanted the surgical teams. They set up at this site on A+4 and immediately received 200 civilian casualties in bad condition. The G-2 [intelligence] was not good, and much of the land and roads that were thought to be usable were actually under water. They had many more casualties than could be handled during the first week, and large numbers were evacuated without being seen. After the first week, by dint of very hard work, they were able to see most of the casualties. However, the job done forward was not entirely satisfactory. Again, this was due to the excessive work that was demanded of the forward installations. Many patients had incomplete debridement. This necessitated the frequent changing of dressings in order to determine the condition of wounds, some of which were labeled "moderate debridement." Since the four surgical teams could not work 24 hours a day, only two surgical teams were operating at a time.

The number of beds available in support of the divisions was inadequate: 750-bed station hospital, 500-bed station hospital, two 400-bed field hospitals-total 2,050 beds. These were situated behind the clearing station to serve three divisions-about 700 beds per division. Result: Large numbers were evacuated from the island who might otherwise have been returned to duty; inadequate surgery and lack of beds prohibited reparative surgery.

There is too much emphasis on planning the rear echelon hospitals. More emphasis is needed on staff planning for hospitalization in forward areas.27

Friday, 29 December

Flew over to Valencia, Bohol Island-a former Japanese strip-this morning in a "Piper Cub."

Drove over to Headquarters, 77th Division.28 The roads were crowded with thousands of natives transporting their household goods on their heads or on the backs of water buffaloes. This migration was coming from the mountains. The GI and the native women were all bathing together in the streams we crossed-danger of schistosomiasis.

Colonel Ivins [Lt. Col. John C. Ivins, MC], surgeon of the 77th Infantry Division, was out. The 95th Portable Surgical Hospital was functioning with the clearing station here. The surgeons of the clearing station were alternating with the surgeons of the portable hospital so that they each did about the same amount of surgery. Reports from the field hospital indicated that the

27I agree, but task force commanders determined the number of beds in forward areas.-G. B. D.
28The 77th Division, which had been engaged in the recapture of Guam, was sent to Leyte in late November 1944 to reinforce the embattled XXIV Corps. On 7 December 1944, it had made a surprise landing near Deposito and had driven through the Ormoc Valley to effect a junction with the 1st Cavalry Division near Valencia, Bohol Island.


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surgery of the clearing station was not good and that they were doing other than emergency surgery. Furthermore, the emergency surgery was not well done.

Talked with General Bruce [Maj. Gen. Andrew D. Bruce, Commanding General, 77th Division] who is very medically minded. He says that the foot problem is most important and he wants one pair of socks brought up with the rations each day. He was unhappy with Navy evacuation and stated that 100 wounded men were left on the shore because the boats would not wait. Broken glasses are a major problem. He wants an extra case issued to each man for replacement lenses and frames, especially as he has many men of 35 years or older (average age in the 77th Division, 29 years). Morphine seems to be very beneficial for morale; the surgeon said he had seen no ill effects. General Bruce also wants a bag in the hat for a latrine at night. Evacuation is being done extensively by Cub and this is good for morale. They badly need ambulance Cubs.

Drove to Ormoc, Leyte, to visit the 36th Field Hospital. Lt. Col. Devine [Lt. Col. John L. Devine, Jr., MC]  is commanding officer-a superior officer. This hospital is set up in a shelled 16th century cathedral. There is no roof, but the thick walls provided good protection. They will need much equipment and some personnel before their next operation. Generators and X-ray machines are worn out. They need two surgeons capable of heading a team-one general, one orthopedic. They are short 3 officers and 12 enlisted men. Colonel Devine believes that many of the officers and men, having been on five missions, are fatigued. In common with other commanding officers, he emphasizes the need for nurses early in a campaign.

The 36th Field Hospital had 1,884 patients in 17 days, mostly surgical. They averaged 125 per day, 250 patients on the top day. They did definitive surgery mostly-2,600 in a month with three moves. This hospital has kept permanent records for its own use. They are abstracted and typewritten on all field records. The surgical records are superior. They received casualties from the 7th Division, the 77th Division, and the 1st Cavalry Division.

More directives and instruction are needed. Limbs are still being lost due to tight casts. One patient had a cast on over a clove hitch. Result: loss of foot. These hospitals, the 36th and 69th Field had never heard of the copper-sulfate method for protein determination. The 36th Field does not have a qualified anesthetist or anesthesia apparatus.

Saw Colonel Kamish [Lt. Col. (later Col.) Robert J. Kamish, MC] division surgeon of the 7th Division, and talked with General Arnold [Maj. Gen. Archibald V. Arnold, Commanding General, 7th Division]. He is very medically conscious and recommended Kamish for the Legion of Merit. The XXIV Corps under General Hodge has offered full support and recognition to the Medical Corps, and any shortcomings cannot be attributed to lack of support by the commanding generals. Unfortunately, many of the good division surgeons do not and cannot be expected to appreciate surgical principles, since they are not surgeons. Having developed through the field service, they are


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prone to believe that field surgeons are better qualified to do surgery than is actually the case.

Saturday, 30 December

After seeing Colonel Kamish this morning, I drove to the 69th Field Hospital which has been set up for about a week near the airport at Valencia. The hospital commander is ill and has been evacuated. Maj. Fielding Williams [Maj. Fielding P. Williams, MC] is acting hospital commander. They have no anesthesia machines. This hospital needs at least one surgeon qualified as chief of service. The laboratory has never heard of the copper-sulfate protein method.

Waited at the airstrip and watched a number of patients evacuated by Cub. Compound comminuted fracture of the femur, belly, head wounds, and so on; all evacuated sitting up. They appeared to stand the trip from the clearing station (20 minutes) very well. Ambulance Cubs are needed for economy of operation (three planes needed now where one ambulance plane could suffice) and welfare of patient.

Sunday, 31 December

Spent the night at the 69th Field Hospital and on to the airfield the next day. While at strip, saw General Hodge, Commanding General, XXIV Corps, who stated that he was pleased with the medical service but felt that hospitalization was inadequate. General Richardson [Lt. Gen. Robert C. Richardson, Commanding General, U.S. Army Forces, Pacific Ocean Area] came in, and a guard of honor was present. Came back to Sixth U.S. Army headquarters [the Sixth U.S. Army was comprised of the X and the XXIV Corps] in a "Cub" and spent the afternoon looking over the harbor for Captain Walker.

Monday, 1 January 1945

Japanese started the celebration by bombing last night, and at midnight our boys responded. Felt less safe than in an air raid. Arrangements made for Lingayen operation. I am to go on an LST (H) [landing ship tank (casualty evacuation)] and remain at target.29

Aboard LST 1018, Wednesday, 3 January

Boarded the general's crash boat, then on to Wasatch, flagship. Left some luggage with Captain Walker who invited me to join him after we reach the target. Left Wasatch in search of LST 1018. The coxswain of the boat had received instructions, but got mixed up between true and relative bearings, and we ended up on the opposite side of the bay. We boarded the LST 1018 at supper time after two hours' search.

There is a surgical team aboard of four doctors plus the ship's doctor. This appears to be a capable surgical team that is well organized, but they are

29The Biennial Report of the Chief of Staff, U.S. Army, for the period from 1 July 1943 to 30 June 1945, to the Secretary of War states: "In the first week of January [1945] a new American assault force gathered east of Leyte, slipped through the Surigao Strait * * * and passed into the Mindanao and Sulu Seas. This American force was treading its way through the heart of the Philippine Archipelago and through waters where the Japanese Navy and air forces had for two years maintained unchallenged supremacy, to invade Luzon by effecting a landing in Lingayen Gulf * * *." D-day was 9 January 1945 and, in this case, was formally designated "S-day."


863

short of supplies because they were not notified that they were going to function as a hospital ship. Supplies were not available in Leyte, and they could not return to Hollandia or Manus. Furthermore, the other hospital ships have not had the supplies, or they have been reluctant to part with them.

Thursday, 4 January

Clear, set sail at 0600, about 80 ships in sight in the convoy.

1600. Have met a large convoy presumably from Hollandia-numerous battlewagons, cruisers, destroyers, flattops.

1800. Apparently, this convoy is to be about 75 miles long and we have joined up too soon, so we are now going back past innumerable ships to get into position before darkness.

2000. We have now turned around and are heading into Surigao Strait toward a golden glow beneath thick laden clouds.

Friday, 5 January

1400. Sailing through Mindanao Sea-smooth and hot. Bohol fading and Cebu Island can be seen in the distance off starboard.

1830. Negros Island off starboard, like a camel's hump in the clouds-a beautiful golden sunset.

Saturday, 6 January

Negros still off starboard. Smooth sailing through the Sulu Sea.

Sunday, 7 January

Peaceful ships and a clear, bright, hot morning. Japanese attacked at 0600. We are about 8 miles off the lower end of Mindoro Island.

Monday, 8 January

1100. The mountains of Bataan are plainly visible off our starboard. It has been quiet since 0900, and two carriers can be seen between us and Bataan. The convoy plows steadily northward.

Tuesday, 9 January

D-day, reveille 0500.

0600. Up on the bridge; clear starlight with a sliver of an old moon. The dim outline of Mount Santo Tomas on the portside. We are well into the Lingayen Gulf and moving steadily ahead. The dim silhouette of the battlewagons can be made out.

0700. All the battleships opening fire on the portside, followed by the guns on the starboard. We are in the middle. There are two task forces, one off the port (the landing is to be made on WHITE, RED, and BLUE beaches near Mount Santo Tomas) and the other off the starboard bow, preparing for a landing at the town of Lingayen. The shelling starts rather slowly and continues with increasing tempo.

0815. We have moved through the haze nearer the shore, and I can now see the church in Lingayen.

0850. Bombardment continues. Our bombers can now be seen bombing the shore, and great clouds of smoke and dirt shoot into the air in 1-2-3 order. The first wave of small boats loaded from the transports behind us are now passing. They are scheduled to reach the beach at 0930 (fig. 336).


864

FIGURE 336.-Troops of the 37th Division coming ashore, Lingayen Gulf, 9 January 1945.

0920. The roar is deafening and continuous. The shore has disappeared in a great wall of smoke and fine into which the small boats disappear.

1000. The naval bombardment has nearly ceased, like an intermission when one can relax. From out of the smoke toward the shore comes the sound of distant mortar fire. A great pillar of black smoke appears from the general direction of Clark Field, Luzon.

The smoke is lifting, and once again I can see the shoreline. Everywhere, small boats, like water bugs, are darting hither and yon. The great symphonic overture is over.

Wednesday, 10 January

0500. General quarters; Japanese torpedo boats are among the fleet. Went on deck. Very dark night plus a smokescreen. The Infantry is putting up flares on shore so they can see the Japanese, and we are putting up a smokescreen so the Japanese cannot see us.

0600. Japanese planes overhead, and everybody shooting at things they cannot see.

0645. Another plane raid. This time I saw them diving into the smoke, with tracers going in every direction. Most of the fighting today is in the San Fabian beach section.

Aboard LST 911, Thursday, 11 January

1000. The usual air raid this morning. Went toward shore to visit LST 911 which was unloading on the beach and had a surgical team aboard. A heavy surf-6-foot waves-was running, and I felt and acted like the man on the flying trapeze when boarding this LST.

The 911 had excellent plans worked out for triage, records, and available beds. They have a surgical team of 5 doctors and 11 corpsmen headed by Dr.


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Sasnow of San Francisco. They, as well as LST 1018, are short of supplies and equipment for adequate performance in case of heavy casualties. They tried to obtain these from the hospital ships but were unable to do so. Apparently, hospital ships are not fulfilling their function as supply ships. This ship was unable to receive casualties until D+2 as it was not loaded for assault shipping. They have shot down five Japanese planes. As near I can learn, out of some 230 LST's, only one has been hit on this mission, and that by a torpedo. The risk to an LST therefore seems to be slight. Furthermore, they now carry a lot of firepower-ten 20-mm. and seven 40-mm. guns. (Interrupted by another air raid.)

The Wasatch, Friday, 12 January

0700. Heavy air raid. This afternoon I went to the Wasatch to see Capt. Albert Walker and Lt. Col. Stuart Draper, MC. The latter is a Sixth U.S. Army evacuation liaison officer with the 7th Amphibious Force. I found out that two other LST's are functioning as surgical ships on WHITE beach, where most of the casualties have been received.

Returned to LST 1018, packed my duffle, and returned to the Wasatch at Captain Walker's invitation. This is Admiral Kincaid's flagship.

Saturday, 13 January

Visited all the beaches today and went up a river to deliver a Filipino to his family. This chap had 25 years' service in the Navy and had hidden out in Manila for these 3 years. Yesterday he reported to the flagship for duty. He went ashore proudly, dressed in white, to visit his family. On the beaches, the surf was very high, and not one LST was unloading although several were beached. The pontoons were washed up on the shore.

The Blue Ridge, Sunday, 14 January

Went with Captain Walker and Commander Klein, who is Walker's assistant, to visit two LST's that are functioning as surgical ships. Water and steam are piped to the tank decks. There are auxiliary lighting facilities and surgical faucets. Steam and water are available in the head for cleaning bedpans. About 50 percent of the cases here have had debridement and casts applied in the clearing station. Some were well done and others poorly. The blood appeared to be in good condition, dated 1 January, "West Coast," and was well refrigerated.

DUKW's bring patients out from the beach and drive them up on the ramp for unloading. However, when weather is rough this may be difficult. The beach setup is splendid. A Navy medical officer and four corpsmen are assigned to the beach. He sets up adjacent to or with a medical company of the special engineer brigade. The engineer medical company designates patients for evacuation and the Naval beach officer is responsible for obtaining the ships and supervising the loading. This plan has been slowly evolved through experience and is the best that I have seen in the Pacific. It could be improved upon with better equipment [in the LST's], such as (1) portable anesthesia machines Heidbrink, (2) intratracheal anesthetic apparatus, and (3) portable orthopedic tables. The personnel of these ships may be overworked, and Army sur-


866

gical teams functioning on these ships would be of great assistance until shore installations were ready.

This afternoon I heard that the Blue Ridge, Admiral Barbey's flagship of the 7th Amphibious Force, was to return to Leyte, so I transferred to her.

SUMMARY OF MEDICAL CARE AND EVACUATION DURING THE LINGAYEN CAMPAIGN

1. The plan.

a. General objective.

(1) The distance involved in evacuation made it imperative that definitive surgical care be provided at the target. Emphasis was placed on early and adequate surgical care at the target rather than on speed of evacuation to the rear areas.

(2) Cooperation of Navy and Army planning was emphasized, and a close liaison was maintained between the commander of the Seventh Fleet and the commander of the Sixth U.S. Army and subordinate units.

b. Fleet surgical facilities and supplies at combat area.

(1) Numerous and varied types of vessels carrying combat supplies and personnel to the target were equipped to provide surgical care. Evacuation from the Lingayen Gulf to Leyte was by APH, APA, and LST.

(2) Near the beaches, main reliance for surgical care was placed on the LST's. Eighteen of these ships had been converted to provide facilities for surgery. Six of these converted LST's were staffed with augmented surgical teams (5 doctors and 18 corpsmen). These ships were under the control of CTF [Commander, Task Force] 77. After unloading, they were to anchor near the flagship for ease of communication. The medical representative of the Commanding General, Sixth U.S. Army, was also aboard this ship. The ships were to remain in the combat area, receiving casualties day and night, and be on call to proceed to beaches or go along the side of damaged ships as needed. One of these LST's was assigned as support for each beach. As they became loaded, and according to the condition of the patient, the casualties were transferred to APA's or APH's for evacuation to Leyte.

(3) In addition to servicing the ships in the harbor, three PCE (R)'s [patrol crafts, escort (rescue)] were stationed near the flagships. These ships  proceeded immediately to any vessel that was hit.

(4) Whole blood was available from S-day onward on flagships, on any surgical LST, and at reefers on BLUE and ORANGE Beaches.

(5) Supplies were available, as follows (fig. 337):


Location

Organization

Period of time

WHITE Beach

I Corps Medical Dump

S-day onward

ORANGE Beach

XIV Corps Medical Dump

S-day onward

LST's 564, 118, 704, 202

Medical Exchange Units

S+2 onward

WHITE  Beach

21st Medical Supply Platoon

S+4 onward

Dagupan, Luzon

49th Medical Supply Depot

S+4 onward

ORANGE Beach

55th Medical Supply Depot

S+4 onward

 


867

FIGURE 337.-The extent of supply operations, Lingayen Gulf, January 1945. A. Closeup, unloading landing craft. B. Panorama of beach and bay, showing supply dumps.


868 

FIGURE 338.-Ground being hollowed out for a bomb shelter and a beach aid station, Lingayen Beach, 11 January 1945.

(6) Beach medical party consisting of one doctor and two corpsmen acted as liaison for Army evacuation from the beach. This officer maintained contact with the beachmaster and the medical company ESB [engineer special brigade] which performed triage for the Army during the early phases of the assault and later acted as a holding hospital on the beach.

c. Army surgical facilities at combat area.

(1) Each division was to be supported by one field hospital; one evacuation hospital; one clearing company, separate; one collecting company, separate; and one medical company, engineer special brigade.

(2) The medical company of the engineer special brigade was to be the first medical facility ashore. It was established on the beach and remained there, allowing the divisional medical units to proceed inland with the troops (fig. 338). It acted as a holding station on the beach for patients transferred to the LST's and also cared for the casualties that had been wounded on the beach.

2. The functioning of the plan.

a. Combat loading of surgical LST's.-In order that these ships may be able to perform their function in providing early surgical care during the initial phases of the assault, it is necessary that they be loaded with combat supplies having an early priority on the beach. One of these ships, transporting bridge pontoons, was not unloaded until S+5. Part of this delay was due to the very heavy surf which prevented the LST's from getting closer than


869

500 feet from the shore; the remainder of the distance had to be spanned by pontoons.

b. The surf was so heavy that when pontoons could not be maintained only DUKW's were suitable for the transfer of casualties to the LST's.

c. The LST's appeared to be relatively immune from air attack as there were so many more profitable targets. It is likely that LST's are hit only when they become targets of opportunity.

d. The equipment of the surgical LST's could be improved upon by the addition of portable anesthesia apparatus, intratracheal anesthesia sets, and portable orthopedic tables. Those ships acting as surgical stations should also have portable X-ray apparatus. An additional number of pitchers and bowls should be provided to facilitate the distribution of liquids and soup.

3. Observations.

a. The LST converted, equipped, and staffed as a surgical hospital for use during the initial phases of the assault has many advantages:

(1) They provide adequate facilities for early definitive surgery at a time when this cannot be provided on shore.

(2) They provide adequate facilities for handling a large number of casualties (185 casualties) in comparative comfort.

(3) They remove the wounded from the immediate frontline and provide a sense of relative security.

(4) The LST is less likely to be attacked than a larger ship. It carries more firepower than the smaller craft and is less likely to incur serious damage when attacked as a target of opportunity.

(5) When beaching is possible, the transfer of casualties from shore is accomplished with the greatest ease (fig. 339). Transfer of casualties to the deck of APA's or APH's is facilitated from the deck of the LST.

(6) A surgical hospital available to the beach at all times is essential until surgical facilities can be established on shore. This can be provided by the LST with a minimum loss to combat shipping. Inasmuch as several ships are available, they may be dispensed with as the need diminishes.

(7) The presence of such a hospital facility afloat diminishes the need of establishing operating facilities ashore until this can be accomplished adequately and in safety.

(8) There are now 60 LST's converted for surgical use. It is desirable that all LST's be constructed or remodeled so as to be used for patients.

(9) Two types of LST's are needed for surgical care. One functions primarily as a cargo ship, with casualties incidental, and does not remain at the target. A second type, with adequate equipment and a surgical team aboard, remains as a hospital ship at the target.

b. Shore units and control of evacuation.

(1) The beach medical officer and two corpsmen are stationed at each beach and function with the medical company, ESB. The medical company, ESB, performs three functions: Care of beach casualties; triage for casualties


870

FIGURE 339.-Patients being transferred from an ambulance to a beached LST, Lingayen Gulf, February 1945.

before evacuation; and holding casualties on the beach so that ships do not need to wait for casualties.

(2) The beach medical officer is essentially a traffic officer, for liaison between the Army ashore and the Navy afloat. He is familiar with the surgical ships available and is responsible for seeing that casualties are properly distributed so that ship hospitals do not become overtaxed. For example, when casualties are heavy, minor wounds cannot always be treated ashore and should be sent to any ship that has a doctor aboard, while the serious casualties should be sent to the surgical LST's. When the operation is on a large scale, specialized surgical teams may be spotted on certain LST's.

(3) In heavy surf, as at Lingayen, the DUKW appears the safest means of transporting casualties to ships.

4. Recommendations.

a. Use of medical company, ESB, to act as holding hospital on the beach and for triage.

b. Use of beach medical officer (Navy) to correlate Army-Navy shore-to-ship evacuation.

c. Use of LST's as surgical hospitals. Conversion of all LST's so that they may be used surgically, since the loading and unloading of LST's cannot be controlled according to ship. Certain LST's that have early priority in unloading should be used as evacuation hospitals and remain on the beach until shore facilities are established (one LST to each beach or Army division).


871

These ships must be adequately equipped for major surgery, including anesthesia.

d. At least one of the surgical teams to be employed (five per division during combat) should function aboard the LST until the shore facility is ready for use.

e. More indoctrination of corps and division surgeons concerning the function of various units, such as clearing stations, surgical teams, field hospitals, and evacuation hospitals.

f. Clearer definition of evacuation policy. Too many men are evacuated who are well before they reach the next echelon.

g. More prompt establishment of convalescent hospitals or units so as not to overutilize the beds of acutely needed surgical hospitals [for those with minor wounds] and so as not to force evacuation of minor wounded from the island.

h. Clearer definition of policy concerning priority for hospital sites and assistance in construction. When hospitals are expected to provide their own construction, they should have the requisite equipment.

Saturday, 13 January

Set sail at 1700 with two APA's and a convoy of destroyers. This should be a fast trip.

Leyte, Wednesday, 17 January

Not one single Japanese attack. Today we passed a slow convoy going south and another one going north. The Sulu Sea seems like an American lake.

Tonight Admiral Barbey invited me up on the bridge for a chat (fig. 340). He is known as "Uncle Dan the amphibious man." The admiral is a large, dark-complexioned man with a friendly, jovial, simple direct manner. He is medically curious and deserves great credit for his cooperation and enthusiasm in developing the medical service for amphibious warfare. He thinks the Japanese conceded the Philippines after the Leyte Campaign, and that Luzon will be only a delaying action while they marshal their forces for the next line of defense.

Sailed into Leyte Gulf and over along the coast of Samar, then straight into our anchorage in front of Tolosa. It began to rain, and I went ashore to what was left of Sixth U.S. Army Headquarters with the Admiral's jeep. The storm increased and reached typhoon proportions during the night.

Thursday, 18 January

Went down to stay in the 118th General Hospital. In the mud and confusion of construction, I had a fine talk with Col. Jim Bordley [Col. James Bordley III, MC] and his colleagues, in the middle of their frog pond.

Peleliu Island, Friday, 19 January

Signed out at Sixth U.S. Army. Boarded plane at Tacloban Field at 1000 hours. Landed Peleliu Island [Palau Islands] at 1400. Went directly to the 17th Field Hospital, now under Navy management. Its chief function is to act as a transfer or holding point at the field. Still raining, but the island is coral and not muddy. Cordially received by Commander Kelley, pediatrician.


872

FIGURE 340.-Aboard U.S.S. Blue Ridge, 3 January 1945. (Left to right: Maj. Gen. Innis P. Swift, Commanding General, I Corps; Vice Adm. Daniel E. Barbey, Commander, 7th Amphibious Force; and Maj. Gen. Leonard F. Wing, Commanding General, 43d Division.)

After cleaning up I was taken to [U.S. Naval] Base Hospital No. 20 and shown the sights of Bloody Nose Ridge. There I found Emile Holman, somewhat lonely, a bit discouraged, but carrying on. As usual, a fine type of quonset hut construction-1,000 beds. There is no anchorage here, and the only casualties coming in are expected by air.

Guam, Saturday, 20 January

Off at 0945 hours, and arrived at Guam at 1515 hours, after severe rough weather. Amazed at the transformation here since my last visit. After Leyte the air terminal here looks like Grand Central Station, and the paved roads are impressive. Went directly to the 204th General Hospital.

Sunday, 21 January

The 204th General Hospital is set up in tents, with the exception of the operating room, laboratory, X-ray, and nurses' quarters. Their semipermanent installation is being built. They are now operating more than 1,000 beds but at present have only 150 patients, owing to the fact that evacuation to Guam by ATC will not begin until 1 February. This hospital is one of the best set up tent hospitals I have ever seen.

Guam, Friday, 26 January

Have spent the last 4 days recuperating from a cold and visiting the 373d Station Hospital.


873

Saipan, Monday, 29 January

Arrived at Saipan. Saw Colonel Longfellow and learned of the arrival of the 39th General Hospital. He had sent in an advanced party from Auckland. Ottenheimer had not been sent forward to check on the plans.

Wednesday, 31 January

Construction started on the 39th, and ground cleared. Some of the best level land was not used for the site. No thought to future expansion to 2,000 beds.

Friday, 2 February 1945

Have spent the last 3 days at the 148th General Hospital, which is slowly evolving into a hospital. Construction has been very slow. It still has only a 1,000-bed capacity (total beds available on Saipan, 2,000). Airfields and headquarters have priority.

Saturday, 3 February

Worked on logistics and visited the 369th Station Hospital a well planned and constructed hospital. Colonel Lubitz [Col. Benjamin Lubitz, MC], the commanding officer, was formerly surgeon with the 27th Division.

Monday, 5 February

Visited the 176th Station Hospital, a stone's throw from the 369th. Both have excellent quonset construction. Why two station hospitals should be placed so close together is beyond me. They care for garrison troops scattered over the island. Since these hospitals are not geographically suited for this purpose, they wish to combine them into a general hospital for casualties, thereby correcting one mistake with another. This would entail an unnecessary duplication of skilled personnel as well as equipment.

Tuesday, 6 February

Radio today assigning Baker and me to the 204th General Hospital [Guam]-as this is the only hospital with vacancies for full colonel-and to temporary duty with the Surgeon's Office, Western Pacific Base Command.30 Also, a teletype for me to return to Headquarters, USAFPOA, by 15 February.

En route to Oahu, Hawaiian Islands, Thursday, 8 February 

At 0615, just daylight, we got off and flew all day. At 1800 we landed at Kwajalein, and a nice Navy lieutenant came on board and said that they would give us dinner on the plane and that we could leave in half an hour if it was all right with me. As though I would have nerve enough to tell the Navy what to do! So we left at 1900, and I played poker with four aviators until 0300 of the same day, because we had crossed the dateline. I then went to sleep soundly on my air mattress on the floor until they poked me to tell me that we were starting down. At 0600, with the east in a pink glow, we landed at Johnston Island.

30The Western Pacific Base Command was activated on 25 April 1945. Included in this command were Army units on Saipan, Guam, Tinian, Iwo Jima, Peleliu, Ulithi, and Angaur Islands. The Western Pacific Base Command was subordinate to Headquarters, U.S. Army Forces, Pacific Ocean Areas.


874

En route to Saipan, Friday, 23 February

Arrived at Fort Shafter, Oahu, and found Eddie Ottenheimer very industriously acting as consultant, working on history, personnel, etc. Ben Baker was about to leave for Saipan. Many new officers have arrived. The port still has a peacetime atmosphere and everyone is griping about the red tape, et cetera. Most of my time was spent in helping to put together a concise directive for the Tenth U.S. Army on surgical care in the combat zone.31

Finally, I got the orders through and escaped with Eddie as though from an asylum. We took off on 22 February at 2300 hours. The nurses who were liberated at Luzon were at the field on their way to the States. The band was there playing "Show Me The Way to Go Home" and other similar tunes, and everyone wore leis.

Saipan, Saturday, 24 February

Spent the day touring the island with General Kirk [Maj. Gen. Norman T. Kirk, The Surgeon General], General Simmons [Brig. Gen. James S. Simmons, Director, Preventive Medicine Division, Office of The Surgeon General], General Willis, and General Jarman [Maj. Gen. Sanderford Jarman, Commanding General of the Army Garrison Forces, USAFICPA and USAFPOA].

Found that only one operating room was functioning at the 148th General Hospital. We spent the remainder of the day trying to get some semblance of organization. We transferred large numbers of the 39th General Hospital staff and a large number of nurses. These changes were quickly accomplished with the support of General Kirk and General Willis.

Note [written, apparently, sometime between 24 February and the next entry, 15 March]: The hospital was soon running on a 24-hour basis with four operating teams working continuously, averaging 60 majors per day. In all, 2,200 [sic] serious casualties were treated, with a mortality of 1.1 percent. Considering the circumstances and the character of the casualties received, thus was a splendid record.

Had a meeting with Ben Baker, Colby, General Willis, and General Kirk this evening. Discussed evacuation policy with Willis, with a view to avoiding the loss of shipping and manhours brought about by having to evacuate patients to Oahu, nearly 4,000 miles away.32

NOTES ON RECOMMENDATIONS FOR MAJOR GENERAL KIRK

1. The essence of good surgical care in the Army is to get the right man at the right place at the right time, in adequate numbers and with adequate equipment. None of this can be accomplished without planning. Consultants in the Pacific Ocean Areas have not been consulted in planning as of 10 February 1945. The efforts of a consultant who has not taken part in planning are

31This directive, the subject of which was "Surgery in the Combat Zone," was promulgated by Headquarters, U.S. Army Forces, Pacific Ocean Areas, on 27 February 1945. Colonel Oughterson was later to rewrite this directive at Headquarters, U.S. Army Forces, Pacific, where it was published in that command's The Journal of Military Medicine in the Pacific, September 1945, pp. 11-23.
32The situation was corrected.-J. M. W.


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chiefly limited to trying to lock the stable door after the horse is gone. Under these circumstances, there is a great danger of the consultant assuming a one-sidedly critical attitude, since there is little left for him to do. His mission in planning, to improve the care of the sick and wounded, is blocked at the source.

2. Clinical research, for the benefit of the sick and wounded in this war and in future wars, is a responsibility of the Medical Department of the U.S. Army. It is recognized that the first responsibility is the care of the patient, but there is an equal responsibility for investigative work which will improve the care of the patient. Theater surgeons should be made aware of their responsibility in this field.

3. The essence of good surgical care is to provide good surgeons. The limited number of good surgeons available requires planning in the distribution of skilled talent. Surgeons can be conserved by careful planning of the geographical distribution of hospitals, the size of hospitals, and the type of hospitals. Two or more smaller hospitals should not be used where one larger hospital can do the work. This policy has resulted in a great waste of highly skilled medical talent as well as equipment. Also, the less-skilled surgeon can function satisfactorily in a station hospital, if he is limited to the station hospital type of work.

4. There has been too great a tendency to keep skilled surgical talent in the rear, whereas the most difficult surgical tasks are to be found in the forward area. The wounded soldiers who die, usually do so at the front. Greater mobility of these surgeons through the use of surgical teams is recommended.

5. In the vast stretches of the Pacific Ocean there are a great number of hospitals, large and small. The leapfrogging of these hospitals may involve distances of a few hundred miles or as much as 4,000 miles. Between the time the hospital ceases to function and the time it receives casualties at its new location, several months to a year may elapse. In this manner the 7th Evacuation Hospital was inactive for at least a year. This results in a great loss of highly skilled manpower, as well as a lowering of the morale of the unit. At the same time, the shortage of medical officers, nurses, and technicians in the forward areas has been increased. Air transport should be used to make this idle manpower available.

Saipan, Thursday, 15 March 1945

The major part of the Iwo Jima casualties have now been treated. Plans are now being laid for Operation ICEBERG [the Ryukyus offensive, 25 March 1945]. The shortage of personnel has necessitated that the hospital facilities on this island be organized as a hospital center. Furthermore, the small number of medical casualties has made it necessary to nearly abolish the medical service. Colonel Colby and Colonel Baker have given full cooperation in the face of most trying circumstances. All medical cases are to be transferred to the 176th Station Hospital which, together with the 94th Field Hospital, has five psychiatrists plus other personnel, and functions as a station hospital for medical cases. This frees the 148th and 39th General Hospitals, plus the 369th Station


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Hospital, for surgical cases. The 148th General will take any surgical cases except for neurosurgery, while the 39th will take any surgery, but not thoracic cases. The 148th will have a thoracic team, and the 39th will have a neurosurgical team. The 369th Station Hospital, which is short of qualified surgeons, will handle only soft-tissue wounds.

Thursday, 22 March

The chief of the surgical service, 148th General Hospital, Colonel Cornell, has been transferred to chief of surgery, 176th Station Hospital. He deserves great credit for the cooperative spirit and equanimity that he has shown under these trying circumstances. Colonel Ottenheimer was made chief of the surgical service of this hospital and again demonstrated his rare capacity for surgical organization and judgment. Colonel Bishop became chief of surgery at the 39th, and Major Sutherland was transferred to the 148th General, leaving Major Claiborn at the 39th as assistant chief of surgery. Captain Post and Major DeSopo were placed on temporary duty at the 148th to strengthen the thoracic team. This has necessarily weakened the 39th General, but still leaves it with the strongest professional staff in the Marianas.

A meeting was held with General Kirk, General Willis, Colonel Colby, Colonel Baker, Colonel Oughterson, and Colonel Welsh [Col. Arthur B. Welsh, MC, Deputy Chief, Operation Division, Office of The Surgeon General] regarding the medical problems of the Army in the Western Pacific. The question of the medical support of the Tenth U.S. Army was discussed. It was agreed that this was inadequate, but I am not sure that the shortage and seriousness of the situation was fully realized. The need for hospital beds in the Marianas was discussed, and the great shortage of beds was pointed out. The need for investigation of wound ballistics (requested in a previous letter by The Surgeon General), shock, and related problems was discussed. The meeting adjourned after assurances had been made that everything possible would be done.

I made a visit to Guam and found the situation there comparable to the situation on Saipan. However, no effort at triage has been made here. Control was in the hands of the Navy. Had a long conversation with Captain Anderson [Capt. (later Commodore) Thomas C. Anderson, MC, USN], Admiral Nimitz' surgeon, who was most cooperative. The Army does not have the specialized personnel necessary to provide adequate care for the patients on Guam. Only by making Guam a hospital center can adequate care be provided. General Kirk agreed to the consolidation of small station hospitals as a means of saving personnel, and to the use of surgical teams and the inactivation of portable surgical hospitals.

Friday, 23 March

Received word that 5,000 additional beds may be put on Tinian Island-source of personnel unknown. At least some arithmetical facts are sinking into the planners' minds. Had a conference today with the Commanding Officer, 148th General Hospital, and with Colonel Colby, Colonel Ottenheimer, and Colonel Baker. The problem discussed was how to use the engineers in converting the 148th from an old broken-down farm in appearance and function


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to a modern hospital. There are inches of mud and dust in the wards and operating rooms. CinCPac has ordered A-1 priority for hospitals, and not without reason.

Thursday, 29 March

The Tenth U.S. Army has been with us. George Finney, Hal Sofield, Doug Kendrick, Ben [Baker], and I, are in the same pyramidal. All that was needed was a little aisle between the bunks. My orders to go along (to Okinawa) have been canceled, much to my chagrin. They sailed on the 27th. The best that can be hoped for is that casualties will be light.

Guam, Sunday, 1 April 1945

I went to Guam with "Red" Milliken. Stayed at the 204th General Hospital. Colonel Bryant is doing a superior job. This is one of the best organized and planned hospitals, and certainly the best Army hospital in the Marianas. It appears that the Navy has given preference of materials and workmen to its own hospitals. The Army hospitals are not as well equipped as the Navy's, which appears to be the Army's own fault. There appears to be little justification for the great difference, since both Army and Navy hospitals must perform the same functions.

Had a very satisfactory chat with Admiral Laning, Navy medical inspector for Pacific Ocean Areas-a practical, forthright, capable officer. His observations on the Iwo campaign bear out mine on the Luzon campaign, and corrective measures are under way. There was much delay at Iwo in getting casualties from the beach to the ships, which the small boats had trouble contacting. Besides, the medical teams aboard the APA's were inadequate, both in number and quality of surgeons, to cope with the situation. The admiral says that the APA should not be used as a hospital ship, and that we must have more hospital ships. However, as Captain Walker so aptly enunciated, the primary consideration must be that of providing definitive surgical care on the spot, and not that of insuring speedy evacuation.

Visited Tom Rivers [Cdr. Thomas M. Rivers, MC, USNR] and his MRU [Naval Medical Research Unit] No. 2 which is under construction and promises to be de luxe. Rivers was burning with indignation as his first request for research was for a chemical analysis on a ton of beer. Requests for help in investigation far exceed his capacity. His interest in problems with the natives is overshadowed by the Navy demand for military medicine.

Carter [Lt. Col. George G. Carter, MC] started as Chief of Medical Service in the 204th. Woodruff [Maj. William W. Woodruff, MC] has many interesting chest cases and many hemothorax cases needing aspiration. Very few of these cases (Marines) were aspirated, due to lack of adequate surgical help at the front.

Saipan, Wednesday, 4 April

There is, today, no hospital on Saipan able to do elective surgery. There are plans to make a hospital center on Tinian, with an additional 5,000 beds. It appears that the medical bed requirement of the Marianas is finally being


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recognized. However, it should be noted with emphasis that to date no consultant has been used for medical planning by the Surgeon's Office, Pacific Ocean Areas.33 Many lives have been needlessly sacrificed. The hospital planning could have been greatly improved, and both medical and nonmedical personnel could have been more efficiently utilized.

Friday, 6 April

Lt. Col. Pete Bishop came to see me regarding the morale of the 39th General Hospital. They complain that they are not getting a fair break in construction and personnel, which is a complaint common to all hospitals. It appears that their primary need is for leadership among themselves. Some don't like this and some don't like that, and they fight with the engineers doing the construction. One hopes that with the coming activity most of their problems will vanish.

Manila, Tuesday, 15 May 1945

John Flick [Col. John B. Flick, MC, Consultant in Surgery, USAFPOA] arrived, and for the past month I have had a delightful time traveling over the Western Pacific Base Command. The formation of this command has been in process for some time. The new command of the Pacific, MacArthur and Nimitz, was announced, the WPBC [the Western Pacific Base Command] (p. 873) was announced immediately afterward.

John Flick and I visited all the institutions on Guam and were in agreement as to what should be done, but JF asks continually: "What can be done about it?" There are not enough station hospital beds on Guam, yet it is proposed to change the 373d Station Hospital, which is miles from the port, into a general hospital, and without personnel to staff it. One of the chief sources of wasted personnel in the Pacific Ocean Areas has been the failure to distinguish between the personnel and functions of a general and station hospital.

We journeyed on to Tinian. Colonel Shaw is here, doing a splendid job as island surgeon. He has no inferiority complex and seeks advice wherever he can find it. Result-splendid planning. Had a long conference with General Kimball [Brig. Gen. Allen R. Kimball] who emphasized two important points: Plan for what you want in the future and don't try to do it by hidden figures; and the need for recreational facilities (morale and physical). Don't send out people-we have them to burn-but send the equipment we don't have.

Went to Iwo Jima, referred to as a "solidified burp." It is almost as desolate as the atolls of the South Pacific. Colonel Currey, Island Surgeon, is doing an excellent job.

There are three hospitals on this small island-the 38th Field, the 41st Station, and the 232d General Hospitals. Certainly the two smaller hospitals should be combined.

33Colonel Flick was surgical consultant at Headquarters, U.S. Army Forces, Pacific Ocean Areas, at this time, and he was consulted in all planning as were the other consultants at the Headquarters. Colonel Oughterson's comment is not a fact.-J. M. W.


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FIGURE 341.-Destruction in the Walled City, Manila, May 1945.

Returned to Saipan and found radio orders giving Ben [Baker] and myself to Headquarters, USAFFE in Manila.34 Left by NATS on 23 May at 2230, and arrived at Manila the next morning at 0800. The plane circled the city and gave us a good view. While large areas of destruction were visible from the air, it still appeared that most of the city was intact (fig. 341). When we drove through the city we got the reverse impression. Signed in and was quartered in the Avenue Hotel. This hotel is one of the few not totally destroyed.

Tuesday, 29 May

Everything here at present is in a state of flux until the new commands are organized. Met General Denit who is full of enthusiasm about my future job to the point where I am loath to think of going home immediately.

Wednesday, 30 May

Colonel Robinson [Col. Paul I. Robinson, MC] and Major Bouldvan of the USAFFE Board came up to see me about the wound ballistics report. They were very enthusiastic about the study that was done and entered wholeheartedly into plans for a future study. In contrast to the attitude in the Pacific Ocean Area, this was as May flowers to a summer drought, and no

34The U.S. Army Forces in the Far East, commanded by General MacArthur, was the highest strictly U.S. Army command in the Southwest Pacific Area.


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salesmanship was required. Spent the remainder of the day trying to rewrite a directive for surgery in the combat area.

Monday, 4 June

Drove out to Sixth U.S. Army headquarters with Earl Moore [Dr. J. E. Moore, Civilian Consultant in Medicine (Venereal Disease) to The Surgeon General], Lt. Col. Tom Sternberg [Lt. Col. Thomas H. Sternberg, MC], Chief, Venereal Disease Control Division, Office of The Surgeon General, and Major Bouldvan of the USAFFE Board. General Hagins was in his usual good form. After lunch we discussed wound ballistics about which he [General Hagins] is very skeptical, but I left him the Bougainville report and will return in a week for discussion.

Saturday, 9 June

Have been engaged for the last few days in surveying the need for civilian medical care in Manila. This has become necessary from a military standpoint because civilians are occupying many beds in military hospitals. The Philippine civil affairs office originally tried to provide such hospitalization. But their efforts have proven to be inadequate to the need.

Even before the war, hospital beds were inadequate to meet the demand. Approximately 4,000 beds were available. In addition, there was one 1,500-bed hospital for the insane with 3,000 patients. The Japanese set these inmates loose, and most of them are said to have starved, although their exact status is unknown. At present, there are 1,419 provisional hospital beds for the mentally ill, part of which are in the old hospital for the insane, and the remainder in schools. There are 2,457 government beds and 1,163 private beds, many now occupied by nonpaying patients. On 1 July, the private beds will all revert to private-paying patients, leaving approximately 3,800 government beds available.35

The Quezon Institute for Tuberculosis-1,500 beds before the war-was always full (fig. 342). The TB death rate was very high. At present the lowest reported TB death rate for Manila has been 80 per week, and the highest was 200.36 However, it is known that the rate exceeds this number.

The former director of the Quezon Institute, Dr. M. Conizares, is now medical adviser to President Osmena. General Valdez, chief of staff of the Philippine Army, member of the cabinet, and politico, is said to be the best doctor in the Philippines. Some think it would be better if the Army controlled the hospitals and tackled the health problem on the islands. The problem is one of admitting civilians to Army hospitals in those cases in which lifesaving procedures must be employed, and of providing facilities for those cases.

35The Japanese allowed such scant rations that most of the patients in the hospital for the insane were said to have starved. There were about 300 left alive when we took over. I am very doubtful as to the figures he gives for the number of civilian and governmental hospital beds for civilians in Manila, which seems too high. However, I know of no way now of obtaining more accurate estimates for that period. (Letter, Dr. Maurice C. Pincoffs to Col. John Boyd Coates, Jr., MC 8 Feb. 1959.)
36The Civil Affairs headquarters at this time estimated the population of Manila at approximately one million. (Letter, Dr. Maurice C. Pincoffs to Col. John Boyd Coates, Jr., MC, 8 Feb. 1959.)


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FIGURE 342.-Quezon Institute, Manila.

The facts are:

1. There are approximately 2,000 nonmilitary personnel in U.S. Army hospitals in the Manila area. These fall into two groups:

a. Filipinos (civilians and veterans of the Philippine Army and guerrillas).

b. Other nationals, more than half of whom are medical cases.

2. A survey of patients at the 120th General Hospital (Santo Tomas) (fig. 343) on June 1, revealed the following:

Nationality


Total number of patients

Number who can pay

American

45

111

Filipino

31

7

Other nationality

56

18


Total

132

20

1American veterans.

3. At the 80th General Hospital (Quezon Institute), there were 6 civilians out of 94 non-U.S. Army patients, and the remainder were men who belonged to various components of the Philippine Army and guerrillas and who required long periods of hospitalization. Surgical cases, 40; tuberculosis, 36; psychosis, 15; typhoid, 1; and leprosy, 2.

4. At present, the number of beds provided for the care of civilians in the city of Manila is 5,000 (government 3,837; private 1,163). At the same time, 4,488 of these beds are occupied. This may be considered as full capacity, as it leaves only 10 percent for distribution. Furthermore, no other beds are available for tuberculosis cases or for the insane, who together occupied approximately 5,000 beds in the prewar period.


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FIGURE 343.-The 120th General Hospital, Santo Tomas University, Manila, June 1945.

5. Other civilian hospitals, such as the Philippine General Hospital (fig. 344), have undergone severe damage. This institution formerly had 1,200 beds and is now functioning with only 236 beds. The government is unable to obtain labor or materials to recondition this hospital. Most of these buildings could be made available with only minor roof repairs, using salvage material. A few of them would require new roofs. This type of reconstruction would provide beds with less labor and material than new construction.

6. We are now authorized to make contracts for the care of Philippine veterans, which includes the Philippine Army and guerrillas. These contracts will be let with the Philippine hospitals to help finance their running expenses. The quality of the care is not high and is uncontrolled. It's sort of like pouring money down a rathole, but there appears to be no other short-term solution.

Monday, 9 July 1945

Had a siege with bad teeth and a hospital sojourn in the 49th General Hospital. I am now assigned as Surgical Consultant, AFPAC, but the general [Denit] has other plans for me.37 He wants me to function as a surgical adviser responsible to him and without administrative responsibility. He wishes to call me a director of surgical research, which I oppose as a title. Have re-

37In April 1945, the operational and administrative authority of General of the Army Douglas MacArthur was extended to all U.S. Army Forces in the Far East and mid-Pacific areas. As his operational and administrative headquarters for these forces, General Headquarters, U.S. Army Forces, Pacific, was established. At this time, U.S. Army Forces, Pacific Ocean Areas, was redesignated U.S. Army Forces, Middle Pacific, a subordinate command under Headquarters, Army Forces, Pacific.


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FIGURE 344.-The main entrance of the Philippine General Hospital, Manila, October 1945.

written a directive on surgery in the combat zone as well as a directive on anaerobic wound infections. Have also completed a program for the training of medical officers. The general has asked for a program that will put surgery in his theater on the map, and I have suggested the following:

1. Publications.

a. Medical bulletins to be started for dissemination of information.
b. ETMD to be organized.
c. History.

All three to be placed under one competent Medical Corps officer.

2. Training Program for all medical officers to consist of:

a. Instruction in a hospital.
b. Instruction in a school of tropical and preventive medicine.

3. Development of personnel files to show:

a. Each unit with MOS [military occupational specialty] classifications.
b. Personnel in each specialty and assignment.
c. Cross index by name and specialty.

We are now short of personnel, but no one knows how much or of what kind. Consultants should be responsible for checking assignments and recommending reassignment. Moreover, personnel should be interchangeable on a theater basis [assignment controlled by theater headquarters?]. At present, lower echelons may change the assignment of key personnel. Promotion should not be made into a position unless the officer is qualified. This is very difficult to prevent as a commanding officer will usually promote on other bases.


884

4. Records.-A uniform report on individual cases by the chiefs of all the surgical services. Reports should include all deaths and complications, and their causes. A report should be made on each illness or injury on duty, and each death or discharge to the States. The report would be incorporated with machine records based on the standard Army diagnosis.

5. Planning of operations.-Consultants should be used in planning. Their advice must be given more weight so that the facilities and personnel commensurate with the mission to be performed will be made available.

6. Consultants should be heeded on plans for anesthesia, ophthalmology, neurosurgery, reconditioning.

7. Specialization.-Hospitals should specialize in specific battle casualties and diseases. This will result in better care and a greater opportunity to study diseases.

8. Research investigation of special problems in missile ballistics, body armor, shock, et cetera, should be initiated.

Friday, 13 July

We had a long teletype conference with the Surgeon General's Office for the purpose of finding out why, when we ordered 550 medical officers, they sent us 12. We had a lot of conversation but never found out the reason for the deficit. They said that they would answer by mail.

Monday, 23 July

Have been working the last week trying to get up enthusiasm for a study of body armor and missile ballistics. Splendid cooperation from Colonel Alexander, President, Pacific War Board.

Tuesday, 24 July

Gave some data to Col. Roger Egeberg [Col. Roger O. Egeberg, MC, Aide-de-Camp (Medical) to General MacArthur] in the hope that we may get General MacArthur accustomed to the idea of attaching a missile ballistics team. Working on trenchfoot and wet-cold projects.

Wednesday, 25 July

It appears that, for most people, becoming accustomed to a new idea is like a woman with a new hat. It all depends on what other people think of it.

Friday, 27 July

Today, Japan turned down our surrender terms. Most of the betting here is that the war will end within 3 months.

Visited Sixth U.S. Army headquarters, and spent the night at ASCOM [Army Service Command, SWPA] headquarters. Will try to coordinate the machine records with USAFWESPAC [U.S. Army Forces, Western Pacific, successor on 20 June 1945 to USASOS (the U.S. Army Services of Supply), SWPA] and the training program of USAFWESPAC with ASCOM and the Sixth U.S. Army.

Wednesday, 1 August 1945

Today I flew out to Cabanatuan, Luzon, to visit the 43d Division medical battalion. We flew along the edge of the mountains on the way there and spotted a small group of Japanese who ran off at great speed.


885

Had lunch with General Wing [Maj. Gen. Leonard F. Wing, Commanding General, 43d Division] of Burlington-a rugged, popular fellow. Listened to the usual complaints about not having enough medical personnel, of always going in short, and then attaching portable surgical hospitals, the personnel of which could not be sent into the field. They had been visited by the army consultant only once.

Monday, 6 August

Feverish activity to get the trenchfoot program underway. General Denit left it in my charge. The Quartermaster had already gotten out a wet-cold directive.38 Since the quartermaster activity is primarily for the purpose of preventing trenchfoot, I have developed a program that combines information on the preventive medicine aspects and the clothing aspects of the problem in the following way:

1. A letter from the commander in chief to the commanding generals of all higher echelons emphasizing the importance of the problem and telling them what trenchfoot is.

2. A letter from General Denit to all division commanders emphasizing the command responsibility.

3. A medical directive to doctors.

4. The use of information and education facilities.

a. Directive for training officers, telling them how to do the job.
b. Booklets for all soldiers.
c. Movies-shorts combined with entertainment.
d. Use of radio for short programs combined with entertainment.
e. Yank Magazine and news releases.

Morotai Island, Indonesia, Tuesday, 7 August

A Japanese hospital ship was captured in the Banda Sea and brought into Morotai Island, Indonesia. With Col. Hollis Batchelder of the U.S.S. Mercy to assist, I was dispatched to Morotai by special plane, arriving at Morotai at 1600 hours. We reported to Maj. Gen. Harry H. Johnson, Commanding General, 93d Infantry Division. He is National Guard from Houston, Tex., and a forceful pleasant Texan who gave us real southern hospitality, and as good a steak dinner with hot biscuits as I have ever had. Colonel Jackson is his chief of staff.

Wednesday, 8 August

Went with the division surgeon, Colonel Melaville [Lt. Col. Eugene F. Melaville, MC], to see the port director, Commander Harrison, who gave us permission to board the Japanese hospital ship, Tachi Bana Maru. This ship had been intercepted in the Banda Sea on 3 August. A destroyer flotilla had gone out for this purpose.

Verne Lippard [Lt. Col. (later Col.) Vernon W. Lippard, MC] just came up to tell me the radio announced that the Japanese have accepted the Potsdam ultimatum.

38Medical Department, United States Army. Cold Injury, Ground Type. Washington: U.S. Government Printing Office, 1958, appendix H, p. 533.


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After boarding the Japanese hospital ship with a walkie-talkie [radio], they [the boarding party] found contraband and summoned an armed boarding party to take charge. There were so many Japanese (1,600) on board that they did not dare go below to search. The exterior of the ship was marked according to the rules of the Geneva Convention. The patients were sleeping on mats spread on top of the cargo, which was mostly contraband and consisted of boxes and bales that were packed with rifles, machineguns, mortars, grenades, and ammunition. Boxes were marked with large red crosses.

There were no seriously ill patients aboard, and all personnel walked off the ship. About a dozen were examined on the dock and sent to the 155th Station Hospital with diagnoses of beri beri, malaria, and fever of unknown origin. There were no wounded, and there was only one surgical patient with an infected leg ulcer. The patients, about 1,500, were said to be the slightly ill. On the whole, they appeared healthy and well nourished.

We visited a compound where 97 officers were interned. They were polite, said they were satisfied with their care, and that no one was sick. A visit to another compound of enlisted men showed several sick men. The chief surgeon of the ship said that he did not know that the boxes and bales contained contraband. No records were available to prove whether these had been bona fide patients before embarkation, and the confusion on shipboard was such that records could not be located. Looting by sailors undoubtedly caused part of the confusion. The ship was in a wretched sanitary condition. The stench was terrific. Clearly, this is a violation of the Geneva Convention.

Manila, Thursday, 9 August

Flew back. Left Morotai at 1000, arrived on Leyte at 1500 hours.

Monday, 13 August

Peace seems near, and speculations are mixed as to whether the Japanese will accept. Certain it is that the majority of people here, as well as at home, are tired of war.

Wednesday, 15 August

News that the Japanese have accepted the ultimatum, which included the proviso that the Emperor may remain. The morning news contains the Emperor's rescript to the people, which, true to form, contains no admission of guilt or moral and spiritual defeat. It only speaks of the military decision against them: "The enemy has used a new and cruel bomb * * * and to continue would mean the total extinction of human civilization." This clearly puts the onus of destroying civilization upon us. "Such being the case, how are we to atone ourselves before the hallowed spirits of our ancestors? By working to save and maintain the structure of the imperial state. Unite your total strength * * * so ye may enhance the glory of the imperial state." We are so tired of war that we accept these words as meaning a pledge of demo-


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FIGURE 345.-U.S. Army Transport General Sturgis departing Manila harbor for Japan, 26 August 1945.

cratic government. Truly, so far we have gained a military decision only, not their ultimate defeat.

Tokyo-bound, Saturday, 25 August

Boarded the U.S. Army Transport General Sturgis today at 1500 hrs. General Denit had returned, and I drew the lucky number for this trip. So, with 24 hours to pack and gather up what information I could, I am off for Tokyo (fig. 345).39

39Almost immediately upon his arrival in Tokyo, Colonel Oughterson was named chairman of the AFPAC group that was to participate in the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan. The other two groups of this joint commission were the Manhattan Project Group, headed by Brig. Gen. Francis W. Farrell, and a group of Japanese doctors and scientists, headed by Dr. Masao Tsuzuki of Tokyo Imperial University and the Japanese National Red Cross. The formal report of the commission was edited by Colonel Oughterson in Washington and published under the auspices of the National Research Council. (See: Oughterson, Ashley W., and Warren, Shields: Medical Effects of the Atomic Bomb in Japan. New York: McGraw-Hill Book Co., Inc., 1956.)

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