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Chapter XIII

Contents

CHAPTER XIII

From Auckland to Tokyo

Ashley W. Oughterson, M.D.

INTRODUCTORY NOTE

The material in this chapter is derived from the official wartime diary of the late Ashley W. Oughterson, M.D., and is presented in substantially the form in which the then Colonel Oughterson prepared it. The original plan was for Dr. Oughterson to write this chapter, from his diary and other official papers. With his untimely death, that plan became impossible, and, since no one else possessed the information, the best solution seemed to be to use the material he had recorded during the war.

Dr. Oughterson, Clinical Professor of Surgery at the Yale University Medical School, entered active duty in the Medical Corps of the U.S. Army in January 1942 as a lieutenant colonel (fig. 300). His first assignment took him to the Army Medical School, Walter Reed Army Medical Center, Washington, D.C. From April to June 1942, he was at Lovell General Hospital, Fort Devens, Mass., as chief of the surgical service. He was next assigned to the 39th General Hospital, a medical unit sponsored by and affiliated with the Yale University Medical School. The unit was staged at Camp Edwards, Mass., and was subsequently shipped to New Zealand, where it established facilities at Auckland in November 1942. Colonel Oughterson served as chief of the surgical service of the 39th General Hospital until March 1943, and then as hospital commander until July of the same year.

It was after this experience that Colonel Oughterson received his first assignment as a surgical consultant. As the tempo of fighting in the Pacific accelerated, he was moved from one key assignment to another, wherever the services of a medical officer of his capabilities were urgently needed. As a result, Colonel Oughterson eventually served as a surgical consultant in every major command in the Pacific theater of war. His account may overlap portions of others in this section on the activities of surgical consultants in the Pacific areas, but his outlook and perspective differed somewhat from those whose interests were perhaps more parochial. Related accounts are also presented in chapters XVII and XIX of "Activities of Surgical Consultants, Volume I" of this historical series. These chapters, by Dr. Frank Glenn and Dr. Frank J. McGowan, respectively, pertain to consultation in surgery in the Sixth and Eighth U.S. Armies, which served in the Southwest Pacific Area.


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The diary material has been compiled and edited by Maj. James K. Arima, MSC, and Pfc. Jacques Kornberg of The Historical Unit, U.S. Army Medical Service, but editing has been kept to a minimum.

Since this account was prepared, for the most part, from handwritten notebooks maintained by Dr. Oughterson during his war service, as Editor-in-Chief of the historical series, I considered it advisable to have the manuscript reviewed by the former chief surgeons of the commands in which Dr. Oughterson served. They were Brig. Gen. Earl Maxwell, MC, USAF (Ret.); Maj. Gen. John M. Willis, MC, USA (Ret.); and Maj. Gen. Guy B. Denit, MC, USA (Ret.). These reviewers were asked to verify the general authenticity of Colonel Oughterson's statements, and, especially, to add any comments whereever their broader knowledge of the events discussed might place the data in better perspective for the reader. They were also asked to review the manuscript in the light of subsequent events, just as Dr. Oughterson might have done had he lived to do so himself.

FIGURE 300.-Col. Ashley W. Oughterson, MC

The general comments of these reviewers follow in this introductory note. Their comments on specific passages are included as footnotes in the appropriate places. The reviewer making the comment is identified by his initials.

With respect to the entire manuscript, General Maxwell commented:

I have made very few corrections or comments since it [the diary] was so typically the thoughts of such a great organizer. To change the wording or to delete some of his caustic remarks I think would detract from the entire theme of the manuscript.

I will assure you that the entire diary is exactly the thinking of a mature mind on a very difficult subject. Dr. Oughterson, or "Scotty" as we all called him, believed in saying exactly what he thought and I believe if he could have edited this manuscript he would still think and write the same context.


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General Willis wrote:

I do not mean to be disparaging toward Colonel Oughterson's service, because I think he did a magnificent job. I do not, however, believe that he realized that the tactical use of medical units had been a subject of study by experienced officers ever since the end of World War I, nor do I believe he realized that these tactical units were "personneled" by officers of little military experience, and necessarily there were many square pegs in round holes and vice versa. These could only be "fitted" by removal from one place to another, involving transportation which was at a premium.

* * * I firmly do not believe in placing the highly experienced surgeon in the Battalion Aid Station or even an Advanced Surgical Hospital. I think they could be of greater use to a greater number further back.

In explanation of the latter point, General Willis noted: "[Dr. Oughterson] entered active duty * * * with a wide experience in peace-time general surgery. Unfortunately, there were too few such qualified surgeons and even fewer who were available to the Military Service." Had the type of surgeons Dr. Oughterson desired been provided, as he advised, in sufficient numbers "to man the Clearing Stations, the Portable Surgical Hospitals, the Field Hospitals, and the Battalion Aid Stations, the evacuees at the general hospitals, both advanced and at home bases, would have suffered, and many of those still training would never have arrived at the front to relieve the tired and wounded already engaged in combat."

General Willis also noted that certain conditions in the western Pacific in late 1944 and early 1945, upon which Dr. Oughterson had commented adversely, existed as a result of policies and practices in effect before his (General Willis') arrival on the scene, and "everything by that time had been formulated and was going." Moreover, General Willis informed me in a telephone conversation on the Oughterson diary in February 1959: "* * * I arrived in Hawaii around the middle of November in '44 and left there on the 31st of January or the 1st of February with Kirk, Simmons, and Welch and that group down there and went over to the South Pacific. Of course I didn't have anything to do with the South Pacific-but it [the tour] did include Saipan and those places, so I went with them to see that, and, being with them, I had to go all the way around."

Another point is evident from General Willis' remarks, that, when Colonel Oughterson was himself in the Marianas, he might not have been fully aware of the planning that was going on in Hawaii and also might not have appreciated the time required to put theater plans into effect so that results would be noticeable at the working level where he was. He might, General Willis thought, have taken into more consideration the fact that many of the problems that faced the medical service in the Pacific existed, and continued to exist, as a consequence of circumstances outside the control of the Medical Department.

Finally, General Willis wrote: (1) "The early sections of Col. Oughterson's report deal with observations, comments and criticisms without giving the credit to the younger and perhaps less talented medical officers who were work-


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ing in the most unfavorable conditions, but nevertheless were giving everything they had"; (2) "The routine ½ gr. of morphine, the too-tight plaster bandage, the poorly kept records and the failure to transmit them with the patients were the results of 'hurried-up training' at the home training centers, but such was necessary because of the pressing need of replacements;" and (3) the slow evacuation sometimes evident in the Pacific was "the result of the lack of sufficient transportation and the distances involved."

General Denit's comments were as follows:

Thank you for letting me see Colonel Oughterson's manuscript. I am glad it is to be published. I think it is very interesting. I wish I had been able to keep notes as he did.

My general comment is that I am not inclined to take exception to anything he has to say. After all he gives the picture as he sees it.

Let me say here about any medical history of the Pacific Areas, the organization of the Pacific was so complicated that in order to understand how the medical services functioned, one would have to study the overall administrative volumes of the history of each headquarters of the Pacific Areas. To do this would require many months of study. Therefore, to write a correct history and to find out who did what in the various medical headquarters would be impossible unless one had had experience in all areas of the Pacific. Now take General MacArthur's headquarters. He did most of his fighting with so-called task forces. The CG of the task force, most often General Krueger, but not always by any means, would determine his needs to carry out his missions. This of course included medical units. I sometimes got a chance to review and comment but no amount of pleading could change things if the CG, task forces, ruled otherwise. Of course I never thought enough medical means were provided. Often I was right.

Then when the means in way of organizations were provided, the task force commander would not force his engineers to build minimum facilities for the hospital. Hence my remark [p. 852] that the Army wouldn't obey orders. Many times, in fact at all times the engineers were way behind schedule in helping the medical service build its own hospitals. But such is war in the jungles. No one who hasn't experienced it can believe the difficulties encountered.

For instance * * * the Signal Officer * * * was next to General MacArthur and had his ear. In every area he got the high ground for radio; I took what was left. Not only that, but he said our X-ray and diathermy machines caused interference with his sending and receiving communications, so we had to be a certain distance from his installations. Hence the frog ponds for hospital areas. In truth, though, all areas at certain seasons in the tropics are mud holes.

I wish it were possible for me to tell of how the complex organization made it impossible for the Chief Surgeon of the American Forces in the SWPA [Southwest Pacific Area] and USAFFE [U.S. Army Forces in the Far East] to force upon the various commands his ideas. Even when his recommendations to GHQ were accepted they were not carried out by the task force commanders. Possibly in a number of instances tactical considerations governed.

I will say this. The medical service knew what it wanted, its planning was good, and, considering all factors, the medical service of the Southwest Pacific Area was superb. General MacArthur said so repeatedly.

*   *   *   *   *   *   *

I had a great admiration for Colonel Oughterson and gave him the job of "thinking" and advising me on how surgery and care of the wounded could be improved. I didn't want him to have any administrative authority. I wanted him to (1) see, (2) think and (3) advise. Often when one tries to correct he loses his value as an adviser.

*   *   *   *   *   *   *


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FIGURE 301.-Tontouta Airfield, New Caledonia, August 1943.

The use of Colonel Oughterson's diary was necessary, as already noted, because of the information contained in it and not available elsewhere. In the light of the comments of the chief surgeons under whom he served, its publication in essentially the form in which it was written by him during his wartime service seems even more justified.

Col. JOHN BOYD COATES, Jr., MC, USA
Editor in Chief

Auckland, Friday, 6 August 1943

Orders today from COMGENSOPAC [Commanding General, South Pacific], permanent transfer to USAFISPA [U.S. Army Forces in the South Pacific Area].1

Nouméa, Wednesday, 11 August

Took off in a B-24 at 0730. Down at Tontouta Airfield, 1400 (fig. 301).

Quartered at Nouméa [Headquarters for USAFISPA was at Nouméa, New Caledonia] in the Grant Hotel Central which I am told was formerly a house of ill repute (fig. 302).

1U.S. Army Forces in the South Pacific Area was established in July 1942 with responsibility for the administration, supply, and training of the U.S. Army ground and air troops stationed in the South Pacific Area.


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FIGURE 302.-Nouméa, New Caledonia. An aerial view of the central part of the city.

Saturday, 14 August

Looked over the medical supply situation with Colonel Stuart [Col. Samuel E. Stuart, MC, Deputy Surgeon, USAFISPA]. Met Maj. Gen. Robert G. Breene, chief of SOS [Services of Supply]. "We are fighting the Japs, not each other."

Monday, 16 August

Visited the 31st Station Hospital. Poor site-hot-construction fair. Records fair. No monthly records are kept on surgery. Excellent equipment. They are having trouble with skintight plaster casts. A vaginal insufflator is needed.

Espíritu Santo, Tuesday, 17 August

Arose at 0200. Drove to Tontouta Airbase. Arrived at Espíritu Santo Islamd [New Hebrides]. Visited the 25th Evacuation Hospital, Chicago group-excellent. Casualties are arriving here with dirty wounds. Lt. Col. (later Col.) Willis J. Potts, MC, the chief of surgery, wants a proctoscope, Berman locator, smaller catgut, plaster knives, shears, Roger Anderson pins, light bulbs, lead letters for X-ray, jars for sutures. He has too many silver clips.

Wednesday, 18 August

Made rounds at the 25th Evacuation Hospital. Saw about 35 patients. Maj. (later Col.) Harold A. Sofield, MC, is in charge of orthopedics. They


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do elective operations on patients remaining on the island-knees, removal of large chondroma. Very few infections have occurred.

Visited the 122d Station Hospital.

Guadalcanal, Thursday, 19 August

Off at 0800 in General Owens' [Brig. Gen. Ray L. Owens, Deputy Commander, Thirteenth Air Force] plane. Arrived at Guadalcanal at 1130. Lunch at Thirteenth Air Force with Maj. Gen. (later Lt. Gen.) Nathan F. Twining [Commanding General, Thirteenth Air Force]. Then to Service Command Headquarters, Col. Russel J. Caton, MC, Surgeon. Watched LST [landing ship, tank] unload 200 patients on the beach. Most of these were wounded on Monday. Today is Thursday; thus 72 hours have elapsed. Most of the wounds were dressed in a short time except for the 20 caught on Baanga Island (?) for 4 days without medical care. Need better facilities on the LST.

Visited the 21st Medical Supply, "Hicks' Guadalcanal Pharmacy." Captain Hicks is a livewire from Shreveport, La. Visited the 20th Station Hospital. The buildings are thatch tents with grass and canvas, which last about 3 months here. This is actually a 500-bed hospital with facilities for 840 beds. The operating room is of the quonset type. They are doing little elective surgery, but have done a few open reductions in the past. This island already has miles of good road. The drainage system is improving.

Went to the 52d Field Hospital, which has done most of its major work under Major Baker-well trained. Saw a patient who had suffered a compound fracture of the tibia yesterday at 1100, on an island off New Georgia. He was brought here by boat and SCAT [Service Command Air Transport] in 24 hours. A good debridement had been done, dry gauze left in place.

New Georgia, Saturday, 21 August

Up at 0330 and drove to Henderson Field. Took off at 0530 in a transport plane. Landed at Segi, a small airstrip built in 10 days on the lower end of New Georgia.2 The Russells are beautiful, and at 0630 the view from Segi is the most beautiful that I have seen in the South Pacific. We were joined by another transport and took off for Munda with four fighter escorts. The airfield is in good condition except for the litter of Japanese planes and materials (fig. 303). Drove over some of the worst roads I have ever seen to headquarters of the XIV Army Corps. Met Maj. Gen. Oscar W. Griswold [Commanding General, XIV Corps]. Talked most of the morning with Col. Franklin T. Hallam, MC, surgeon to the XIV Corps-a fine person doing a grand job. He needs more help to do it.

Drove to Laiana Beach in the afternoon, through a devastated area, and was amazed at the size and number of Japanese foxholes at about every 30 feet or less. Shellholes were almost continuous. Materiel and firepower played

2The capture of New Georgia Island with its important Munda Airfield was accomplished by Maj. Gen. Oscar W. Griswold's XIV Corps. The first landing in force was made 30 June on nearby Rendova Island. Elements of the 37th and 43d Divisions then landed on New Georgia enveloping the western end of the island. After our forces were reinforced by troops of the 25th Division. Munda was captured on 5 August.


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FIGURE 303.-Munda Airfield, New Georgia.

an impressive role in getting the Japanese out with so few casualties on our side. There was an estimated 4,000 to 5,000 Japanese [there were 9,000 Japanese troops defending New Georgia] on this island, but it took the better part of three divisions to get them out. Many Japanese skeletons were lying about in their clothes.

Visited the clearing station, 37th Division-100 patients-well run (fig. 304). These clearing stations require either a full complement of personnel or outside help, in order to set up. In island warfare they sometimes assume the function of surgical or field hospitals. The 37th has about 100-plus cases of diarrhea per day, returns more than 40 per day-more than most clearing stations. Must look into the sedation that is being employed here. Ten thousand units antitoxin being given as prophylactic for gas gangrene. Chest wounds are well handled. There are no nets in use here.

The clearing station is surrounded by barbed wire on which tin cans have been placed. Some Japanese have raided the hospital. War here appears to be more vicious than in most places.

Patients are evacuated to the beach through 3 to 5 miles of circuitous roads (fig. 305). An LCT [landing craft, tank] takes them to the 17th Field Hospital on Kokorana Island. From there they are transported by LST or by SCAT to Guadalcanal. The trail for jeeps and ambulances is very rough. Some with severe fractures die as a result of the ride. Very impressed by


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FIGURE 304.-A clearing station, 37th Division, August 1943.

"carryall" which will go through mud that the jeep cannot maneuver. The boats should have regular schedules for stopping along shore to transport the wounded. As it is now, the wounded must take thier chances on the supply boat reaching them in time.

Colonel Hallam-"War neurosis starts with the pool officer who cracks up-for then the men go."

Staying here at headquarters at the eastern end of Munda strip on a hill overlooking Rendova Island. Most of nature's creatures here are harmless, except for man. Many flies get in your mouth, but mosquitoes are very rare. There are red ants in the area, but they don't bother us much. Some masks have been found that were used by the Japanese for terrorizing purposes. This climate is hot and wet; everything molds, including the feet. No wonder fungus infection is a problem.

Here is one place where folks don't want to wear medals or anything else to distinguish themselves. Everybody from the general on down wants to be as inconspicuous as possible. The wounded do not complain and are quiet. I suppose there is relief in the knowledge that they are out of it now. My impression is that this is a good Army, with wonderful equipment, which moves forward slowly, and ponderously, but inexorably. It is amazing how the jungle is transformed into "civilization," at least superficially.


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FIGURE 305.-Evacuation to beach by litter bearers and by jeep, New Georgia, 1943.

Sunday, 22 August

Drove to Headquarters, 25th Division-Lt. Col. Raymond H. Bunshaw, MC, Regular Army, is division surgeon. The roads are almost impassable. The clearing station is with headquarters in a hollow 1½ miles from Munda Field. The food here is only fair. There are flies everywhere. Operating tents are screened with mosquito netting. Bunshaw says that ear dermatitis is caused by swimming in streams.

Owing to the fact that the clearing station is split up, one platoon being on Vella Lavella Island, the other on Guadalcanal, they are short of equipment. Bunshaw lost three surgeons to Guadalcanal and is short of both surgeons and men. Most of the doctors are young and inexperienced. Colonel Bunshaw says that he needs two surgeons for each platoon. He thinks that rotation of 3 to 4 months is not enough.

Captain Silverstone, in charge here, says that they use a lot of oxygen, but have no apparatus. Should clearing stations have a rebreathing outfit and so save the O2? Suction apparatus is also badly needed. A folding Mayo table is urgently needed. Water is a problem here as it must be transported to this spot, and the roads are in bad condition. Water is now being brought in by 5-gallon cans. Why not have a canvas storage tank to tide them over when roads and weather are bad? They need a gasoline washing machine too,


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FIGURE 306.-A 2½-ton truck evacuates casualties to the beach, New Georgia, 1943.

and a refrigerator for serums. Many eyeglasses are broken and because of this the men must be evacuated or placed on limited duty.

The mud is knee deep; the woods are thick, hot, and steaming, but not real jungle. Because of the greasiness of this mud, hobnails are needed for the stretcher bearers. The wounded are evacuated here from as much as 5 miles away-some through swamps-and 2 days are sometimes required for a litter to get through. The ½-ton ambulance does not have enough power to get through these roads; the ¾-ton is okay (fig. 306).

War neurosis is less in this division than in others. This is because of better leadership; 40 percent of the officers are Regular Army. Both Colonel Bunshaw and Colonel Hallam believe that weak leadership is the chief cause of war neurosis.

Kokorana Island, Monday, 23 August

The road to the front is closed to all but engineer and signal troops, so I decided to go with the patients who were being evacuated to the 17th Field Hospital at Kokorana Island, which is off Rendova Island and about 14 miles from Munda (fig. 307).3 We left the 25th Division clearing station at 0830 and arrived at the 17th at 1230. The boat trip was pleasant for a well man, but there were no facilities for the patients. I climbed from the LC [landing

3The 17th Field Hospital arrived on Russell Island on 31 March 1943 and received patients the first day. On 16 July and 25 July 1943, the 1st and 3d platoons, respectively, left to take part in the New Georgia operations, while the 2d platoon continued to operate a 100-bed hospital on Russell Island.


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FIGURE 307.-A screened underground operating room at the 17th Field Hospital, after its move to New Georgia, 27 October 1943.

craft] to an LCT and then to shore, only to find that we were at the 118th Medical Battalion. So we embarked again to find the 17th Field. This moving about is tough on very sick patients.

The 17th has a beautiful location in the middle of a coconut grove. The climate here is cooler and dryer than New Georgia. This hospital has been bombed and strafed. Six or eight tents were knocked down by 500-pound bombs, and eight corpsmen were killed. They have done an impressive job. Two operating rooms have been built underground, but again there is no screening. The mess tent is screened, but, as in all these places, the tables are not. Why not have a little more screening in order to protect the food? The flies swarm on the food, though somehow diarrhea has not become a problem here. However, the 37th Division clearing station has had a lot of diarrhea. Major Willis [Maj. James G. Willis, MC], the surgeon, is cognizant of the fact that too many dressings are taken down, but this appears to be necessary since there is no way to tell if they have been properly done at the forward area. Many wounds are dressed 4 to 6 times before definitive treatment is given. Undoubtedly, many wounds are infected in this manner. There is little reason for screening a division clearing station and not screening the succeeding stations where dressings are done. I have not seen a mask here, and yet sore throats are frequent among the medical personnel. Instruments are kept in sterilizing solutions, usually alcohol.


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Evacuation has been a problem in this area. The LST's carry supplies which they land at another island, and they do not like to remain around here too long. They do not always take the time to run over to the 17th. The movement of patients from island to island, or along the shore, is not under unit or Army control. This lack of organization results in many delays. Can this movement be correlated with the Navy? The suggestion that more surgery be done on the LST appears unsound only because not enough good surgeons could be obtained for this purpose. Why not?

Tuesday, 24 August

Remained at the 17th Field today. Talked long with Colonel Bell, the commanding officer. The morale of this outfit is low; the old problem of rotation and promotion.

Many ear conditions here, canal furuncles and fungus. It is thought to be due to the moisture in the air and not due to swimming. Many of these ears appear to be filled with scaly exudate. It occurs in both the healthy and the malnourished. Another problem is refractions. There are many broken spectacles and new cases requiring refraction, but no sets. Tonsils all bled, so they gave up operating on them. They want tuning forks to test hearing. There is a need for sulfamicro drugs for wound dressings. They must also have more ready-made splints, sealing dressings against flies and ants, and soap solution. The orthopedist says that cases arrive in good condition except during a push. A few cases have arrived in a state of shock. He has seen a few skintight plasters. He believes that a portable Hawley table would be of great help in the field hospital.

Visited the 25th Division casualty setup adjacent to the 17th Field, in charge of Major Klopfer. The clinic is excellent. This unit really functions as a convalescent camp, since many patients enter from the 17th Field without a diagnosis. Those with war neuroses may be kept here for one month to see if they can make use of them.

Major Klopfer believes that one month is too long a period to keep men in the line. The men may have only three hot meals during the whole time. They get little sleep and they must fight all day. As he said, "it takes a superman." He finds that a considerable number of the war neurosis cases are due to exhaustion. He thinks the situation would be helped by shorter periods at the front. The men should also be able to look forward to something in the way of relief after the job is done. Malingering is not high here.

Conversation with Capt. Benjamin A. Ruskin, MC, a psychiatrist. He divides neuropsychiatric cases into two categories: Group I, those who have had trauma; and II, those who are afraid of trauma. The functions of these psychiatrists seem to be: (1) Sorting out the patients who can be saved, (2) educating officers and enlisted personnel, and (3) therapy. They do not appear to have enough diversional activity; more books, movies, and games are needed.


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Rest camps should be set up only where these activities can be provided. The morale of the 25th Division is poor because of the length of time away from home plus the long campaigns. Efficiency is dropping rapidly.

New Georgia, Wednesday, 25 August

Left Kokorana Island at 1030 on a mail barge from Munda Beach. We were accompanied by boats of all varieties: personnel barges, LC's, LCT's, et cetera. All kinds and combinations of uniforms were to be seen. Some men were stark naked; others wore only a hat or shoes. One sergeant had all sorts of insignia on his hat. Asked why, he said that they all came in handy, depending on where he was. A boatload of men went by looking more like a band of pirates than soldiers. One man in a mottled jungle suit appeared in our boat. Someone asked him a question. He promptly lay down, saying "I don't know or give a damn,"-and went to sleep. We arrived at XIV Corps headquarters, 1400, to find that Colonel Hallam has been down with dysentery for the last 3 days.

Although it had been on the same site for 1 month, the 17th Field Hospital on Kokorana had screened only the mess building, and that just partially. It would have taken very little more to have screened the entire mess. If not with screen, mosquito bars would have done for 1 month. The latrines were open and poorly constructed. Operating and dressing rooms were not screened. No effort has been made to improve conditions, although it is true that they have been expecting to move. Since only a minimum of lighting is available, everyone goes to bed at 1830. The 25th Division operating room is screened with a mosquito bar, although they are working under more difficult conditions.

Thursday, 26 August

Slept soundly in spite of an alarm and the sounds of 105 mm. guns shooting over our heads. However, this morning my head feels as though it had been pounded. Went over to the 37th Division clearing station (fig. 308) and also visited the 43d Division. Men of the 37th say that they are handicapped because the clearing company does not function as a unit. They are more short of enlisted men than officers, although the new T/O [table of organization] cuts their enlisted strength even more. Whenever they have had to move, they have had trouble in getting help to set up and have not been able to get bulldozers. Help is most needed in the initial stages, for screening, etc. Anopheles are getting worse in the Laiana Beach area, and there is not enough mosquito bar for screening. There has also been some trouble and confusion in connection with priority of location for the clearing station, and some unnecessary moves were made. Headquarters seems to decide on one location and then change its mind. Lt. Col. Hobart L. Mikesell, MC, is division surgeon [acting]. He thinks that the triangular division splits up medical personnel too much for island warfare. Could doctors be obtained by substituting MAC [Medical Administrative Corps] officers to do the routine administrative tasks in the collecting company, since these units function chiefly during battle?


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FIGURE 308.-A surgical team completing a thoracic operation at the Clearing Station, 37th Infantry Division.

The men of the 37th Division came on New Georgia with inadequate equipment, for some things had to be left behind. Many left their bags behind, hence they do not have enough socks, shoes, etc. They need a refrigerator for serum and cold drinks, and a washing machine. The sterilizers are too small. How to blackout! Allowed four basic instrument sets, they found out that they only had two. There are no batteries for lights, but they are short of bulbs anyway. Splints and litters tend to run out. Wire ladder splints are needed. No screening anywhere, neither in latrines, mess or operating room-and flies are swarming. I wonder if they do enough debridement?

Guadalcanal, Friday, 27 August

Batteries in headquarters camp began a barrage at 0430, and I was sleeping in the corps surgeon's tent on a small hill directly in front of the guns. Japanese planes came over and bombed us at 0530. They did not hit the field, so I took off at 0800.

We made an unexpected stop at Russell Island, so I got out to visit another platoon of the 17th Field, which is in command of Major Addison, who is also the island surgeon.4 They need an intensifying screen for the X-ray, as the X-ray generator fluctuates too much. The incidence of malaria on Russell is more than was anticipated. Dental work is behind, and some patients

4See footnote 3, p. 777.


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are evacuated because of the lack of dental facilities. A dentist reported here today. There is not much surgery to be done here. They have done only one major surgical operation this month and a moderate amount of minor surgery. Malaria and dentistry are the big problems. The splitting up of these field hospitals takes away a certain amount of equipment and cuts the personnel, particularly corpsmen. As a result, these hospitals leave much to be desired.

In this rapidly moving front of island warfare, a field hospital cannot stay put very long. As a result, they do not put much effort into keeping up to the highest possible standards and tend to get into slovenly habits. The 1st and 3d Platoons of this hospital were located on Kokorana instead of at the forward area on New Georgia, thus adding 4 to 5 hours' delay to the care of casualties. The hospital has remained there for nearly a month, though this location is not particularly invulnerable. It has been bombed and had 8 or 9 deaths-more fatalities than even the dressing station on Georgia. With better forward clearing stations and LST's with an adequate operating room, the field hospital here would act primarily as a holding and evacuation station.

I caught the 1530 plane for Guadalcanal and met Capt. Richard A. Kern, MC, USNR., and Cdr. Theodore E. Reynolds, MC, USNR, medical and surgical consultants for the Navy. There was an enormous amount of destroyed Japanese shipping between Florida Island and Guadalcanal. The loss of materiel and personnel must have been very great. This was the show that definitely stopped the southward advance of Nippon. The Canal is one great dust cloud and fairly cool in contrast to the steamy heat and mud in New Georgia. I put up at the Service Command in a new screened and floored tent. The eternal cry is "screening."

Saturday, 28 August

I spent the day going about with Captain Kern and Commander Reynolds. Visited several Seabee installations and they are splendid. Their ingenuity is astounding. Washing machines were improvised out of gasoline drums. The Seabees and the LST ships are the greatest innovation I have seen in this war.

Filariasis has now been found here. Some native villages still remain as close as one-quarter of a mile from the camps. This may be a problem (fig. 309). The Navy experienced a severe amount of dysentery on landing here. Again, screening is the answer. More dental equipment and dental officers are needed here too. This seems to be true in all echelons.

I visited the Mobile 8 [U.S. Naval Mobile Hospital No. 8]. Capt. William H. H. Turville, MC, USN, is commanding officer. He is an intelligent, able disciplinarian, who has built the best naval hospital I have seen in the South Pacific. The total area covered is 79 acres. The hospital is of prefabricated construction. It took 2 months to build, and has 400 patients at the moment; it is expanding, however, to a 1,500-bed hospital.


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FIGURE 309.-Blood specimens being taken to determine the index of malaria in a native labor camp near a military base, Guadalcanal, August 1944.

Sunday, 29 August

On this rainy day I am plagued by a head cold and diarrhea. I visited the 24th Field Hospital. Lt. Col. L. B. Hanson, MC, is the commanding officer. He is one of the finest commanding officers I have seen in any hospital. His unit has not yet seen action. They are a hand-picked group of men with varied talents. In ingenuity they compare favorably with the Seabees. A field hospital is supposed to have 150 tons of equipment. Hanson now has about 300-plus, including cement, lumber, screening, two refrigerators, one large reefer (freezer), numerous engines, an ice cream unit, etc. This looks like the Army's number one field hospital. The generators furnished to the field hospitals are inadequate for the load. Not enough mess equipment or carpenter tools are being supplied.

Twenty-plus cases of gangrene occurred during the month of July at the 20th Station Hospital and the 52d Field Hospital. A tremendous amount of debridement was done at the 52d Field Hospital. Why so much here-more should be done forward?

Monday, 30 August

Spent the day at the 52d Field Hospital. The location is not too good. The site is hot, on low ground, and on the dusty side of the road. It has an advantage in being between two airstrips, affording the use of a Japanese powerplant and water supply. The hospital is now in command of Major


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Baker, who is well trained and has good judgment. The orthopedist is also good. Tents are built off the ground. The operating room is well screened with good fly locks. This hospital has an adequate amount of screening, which is well distributed, except that the mess kitchen and mess tables are located in separate tents, while they should be combined. The patient is sprayed before he enters the hospital. He is marked "today" for dressings. A large sterilizer was obtained, since the pressure cooker was too small. The sterilizer is heated on a field range. They refill bottles and make their own sterile water with an autoclave. They have averaged about 325 patients per day and use about 3,000 gallons of water per day, kept in tanks which last from 2 to 3 months. The 14 Japanese treated here have been good patients. The only cases of tetanus seen have occurred among them. Many patients are waiting for new spectacles.

It seems that the splinting done in the forward echelon is frequently inadequate to immobilize and does not extend over the adjacent joints; for example, the ankle. Applying one layer of sheet wadding and then plaster, would be a better method. The area should be shaved and washed with green soap and water. Debridement is frequently inadequate, dirty clothing and dead tissue are not removed, and hemorrhage is not adequately controlled.

In the beginning of the New Georgia campaign many of the wounded never went through a clearing station, and treatment was delayed for from 48 to 96 hours. The 17th Field was established about 4 weeks after the landing on Rendova, and patients were then evacuated in much better condition. Before this there were, for example, casualties with the femoral artery and vein severed that were not ligated upon evacuation.

LESSONS OF THE NEW GEORGIA CAMPAIGN

There is, in general, too much dependence on sulfonamides and not enough on debridement. There is a tendency to dump sulfonamides into wounds that are not deeper than 1 inch. The same is true for larger wounds in the application of debridement. One doctor here found that spores and grams and rods are common in these wounds and sometimes exist in almost pure culture. The only complications caused by sulfonamides were seen in five or six cases of suppression of urine with blood, and all of these cases recovered. Some through-and-through wounds have come in with a sponge in either end (plug), held in by a catgut suture.

Fifty percent of the tags attached to the patients are useless, and rarely do they contain clinical information. The chief question that is to be answered is what was done when, and when the wound needs a dressing. The people here would like to know what eventually happens to the gas gangrene cases and if any new ones develop later on.

I have now collected data on 20 cases of gas gangrene from the 52d Field and 20th Station Hospitals. There appear to be at least two underlying reasons for the occurrence of gas gangrene:


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FIGURE 310.-A casualty of jungle fighting being loaded aboard a Higgins boat for evacuation by sea, New Georgia, July 1943.

1. The reasons of organization and administration, which contribute to delay in the treatment of the sick and wounded. Hence, the failure to provide adequate medical care in the forward areas during the New Georgia campaign. Some of this was probably unavoidable and was caused by such incidences as the bombing attack on the beachhead shortly after the invasion. With the difficulty of communication in island warfare, there are plausible reasons why all patients do not go through a clearing station. However, this lack of medical facilities resulted in long delays in the treatment of casualties. Although sulfanilamide was applied rather routinely in the early stages, this did not prevent gas gangrene. However, gas gangrene occurred only in very severe wounds.

2. Professional care was at times inadequate due to: (a) Failure to appreciate the importance of thorough debridement-in many instances it was superficial only, (b) failure to control hemorrhage, (c) inadequate cleansing with razor, soap and water, (d) doctors in clearing stations said that patients were in too great a state of shock to permit more thorough debridement; also, the number of casualties that passed through the clearing stations were at times greater than could be cared for adequately, and (e) patients transported on LST's to Guadalcanal received inadequate care. The trip lasted from 20 to 24 hours. Only one doctor was assigned to each boat, and there were no adequate facilities for operating or dressing wounds (fig. 310).


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The following is an extract on the problem of gas gangrene from the sanitary report for July 1943, Headquarters, XIV Corps, Forward Echelon, New Georgia Occupation Force:

Hospitals in rear areas began to report, early in July, the occurrence of gas gangrene among battle casualties arriving from the New Georgia area. Immediate investigation as to the probable causes of gas gangrene infections was undertaken, both by the rear echelon of the Corps at Guadalcanal and by the forward echelon at New Georgia. It was found that the main causes were lack of early debridement, primary closure of wounds, tight packing to prevent hemorrhage, and a lapse frequently as long as 72-96 hours from time of injury before definitive treatment could be instituted at Guadalcanal.

Immediate steps were taken to minimize the incidence of gas gangrene among battle casualties. The division in combat at that time was notified of the occurrence and probable causes of the gangrene. Large quantities of gas gangrene antitoxin were sent to New Georgia with instructions to administer prophylactic doses wherever indicated. Medical facilities aboard LST's, which carry patients to the rear areas, were increased by the Navy.

It should be remembered that, while the occurrence of gas gangrene among battle casualties is unfortunate, division medical service was the only source of medical treatment of battle casualties in the New Georgia area during the first 28 days of July. Facilities for definitive surgery were lacking north of the Guadalcanal-Russell Islands area. The 24-36 hour trip by LST from the combat area to Guadalcanal, during which time the wounds were not redressed, except in emergency, provided an excellent incubation period.

The establishment, toward the middle of July, of the policy that all casualties should be cleared through the division clearing station before evacuation to the rear on the LST's, did much to prevent long journeys to the rear by casualties who had received only aid station care. The arrival during the latter part of July of 21 medical officer replacements and elements of the 17th Field Hospital did much to provide adequate early surgical care, and the occurrence of gas gangrene was reduced to a minimum.

FRANKLIN T. HALLAM
Colonel, Medical Corps

It should be noted that the above use of antitoxin is of questionable value. It should in no way minimize the surgical care (debridement). The increase of medical facilities on LST's (September 1) consisted of two doctors instead of one. Their facilities were still inadequate.

Tuesday, 31 August

A boy was riding on the fender of a truck when a bullet from a machinegun, one of ours, hit him in the back. He was instantly paralyzed. This happened at 1700. He arrived by plane at the 52d Field Hospital at noon next day. A boy, the tail gunner in a B-24 on a bombing mission on Bougainville, parachuted from his burning plane, and was strafed by the Japs. He was shot through the belly and the right side, and had a large exit wound just to the right of his spine. There were six perforations of the intestine and the missile had passed medial to the right kidney. He was operated on at the 20th Station Hospital within 2½ hours and is doing well this afternoon. A boy, belly gunner on a bomber, was shot through the upper third of the left leg. Both veins and arteries gone, and a compound comminuted fracture-amputation was necessary. He was operated on within 3 hours and is doing well. Air transport of the sick can accomplish wonders, but it should not supplant proper


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FIGURE 311.-Evacuation by C-47 transport plane from Munda Airfield, New Georgia, August 1943.

surgical care in the proper place, which is still forward (fig. 311). A detonated dud hurt no one but a cook 200 yards away in the messhall. The fragments took out both eyes and the bridge of the nose, passing very cleanly sideways. He is in good condition and wants to know about his eyesight.

Spent the day at the 20th Station Hospital. Col. Harvey Laton is commanding officer. They landed on Guadalcanal January 16th, and took patients on the 24th. They have been flooded out once. The area is low and hot and unsuitable for a station hospital.

Colonel Rosenzweig, a gynecologist, is chief of surgery. Captain Kluger, orthopedist, is young and very good. He states: "All wounds with gas gangrene gave evidence of hasty treatment and inadequate debridement." They are short 1 officer and 40 men. The ophthamologist emphasizes the need for spectacles. More than 100 men are waiting in the convalescent camp for spectacles. Major Lechen, an otolaryngologist, wants to know about doing tonsils. Infected ears have been cultured and a variety of fungi found. The incidence of optic neuritis and choroiditis is out of proportion. There have been many cases of concussion deafness, and a set of tuning forks is needed to differentiate the degrees of deafness. The lab needs facilities for anaerobic cultures. Pyrogallic acid is in demand. The dentist is short of articulation sets.

It is desirable to have a well-qualified surgeon in the forward echelon for each of the following jobs: Neurosurgery and thoracic, orthopedic, and gen-


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eral surgery. The latter is the most important. Too much assembly line treatment occurs in forward hospitals. The extension arm splints were found to be no good.

This hospital appears to be doing a good job. Their records are fair; eye, ear, nose and throat care is okay; the X-ray service is good; the lab is fair; the food is fair; the library is good. Staff meetings were held formerly but are irregular now.

Wednesday, 1 September 1943

Visited the convalescent hospital under Major Kellefer, an orthopedist. They have not begun to keep systematic records yet. I talked to him about this. He thinks that 80 percent of the war neuropsychiatric histories are poor; that sorting is done on snap judgement. The chief problem in choosing psychiatrists is separating the sheep from the goats. He raised the question of reclassifying doctors at home.

The 43d Division attacked Rendova on 1 July. The beach was bombed and strafed by the enemy on 2 July. There were more than 350 casualties. No clearing station had been set up, and the casualties were loaded directly onto an LST. For some reason the LST could not get off, and all the patients were transferred to another LST during the night. The 43d never had a clearing station on New Georgia Island.

Major Barker, medical inspector of the 37th Division, is down with dysentery at the 20th Station Hospital. Barker thinks that some of the dysentery contracted was due to the use of halazone tablets. How many tablets to a canteen would be safe? Look up the division sanitary reports.

The 37th Division medical service was operating with a shortage of 8 officers and 100 enlisted men. The eight officer replacements had no field training but were put out into the field nevertheless, and one of them cracked up within 24 hours. One officer and six enlisted men were killed.

Lt. Col. James H. Melvin, MC, Surgeon at the Service Command here, and Major Barker both agree that a force medical supply unit should accompany the infantry in island warfare. Many of the units lost part of their supplies during the landing, and there was no source of replacements short of Guadalcanal. Captain Hicks, 21st Medical Supply, agrees that it would also simplify his problem. He found it impossible to get supplies to the various isolated units whose supplies would get lost on some island, since frequently he did not know where they were. Recommend that the force medical supply unit function as in quartermaster exchange of property on LST's. The problem here is chiefly one of making litters and blankets available for the wounded. Since the men must frequently sleep in foxholes, it is to be expected that cots or litters may be used for casualties, and allowance should be made for this in the exchange of supplies. This new plan, by giving a division the things it needs when they are needed, would avoid burdening the divisions unduly.

All agreed that since clearing stations frequently function as field hospitals, they should also be provided with washing machines. The 24th Field Hospital has three. There is no time to build these things during a "push,"


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when they are most needed. Improvisations of all sorts can be done in a quiet time, but by then the need has largely disappeared and the damage has been done.

Thursday, 2 September

Spent the day reading, arranging transportation, writing, and treating my feet for the "rot."

Espíritu Santo, Friday, 3 September

I rose at 0300, although we did not leave the airfield until 0630. Arrived at Espíritu Santo [New Hebrides], 1030. Called Colonel Morgan Berry, MC, and stayed with him. Met Lt. Col. Benjamin M. Baker, MC, medical consultant for this command, who was on his way north to the Canal. He has worked chiefly on the problem of malaria. I attended a session of the Espíritu Santo Medical Society, which meets every other Friday. The hospital staff put on a good program. Reports were given on: Subphrenic abscess, malaria and dengue, internal derangement of the knee joint, anesthesia-very good.

Capt. Richard A. Rose, MC, 321st Service Group, wants a transfer for duty as an anesthesiologist. I talked to Captain Miller, who was on an LST that was bombed and sank off Vella Lavella Island. He agrees that they need an operating room aboard, preferably on the side forward where the carpenter shop is. This side is relatively quiet and easier to lightproof. Better arrangements should also be made for keeping food dry.

The loading of patients must be planned out before the boat comes in, so that those who are seriously wounded will be put in the proper place and receive earlier attention. Miller suggested that two men be used for this purpose, one of whom would remain at the landing point. He says that two doctors aboard the LST would not be enough, and that four to six corpsmen were needed, two of whom should be of top caliber. These measures would apply only at the time of a "push."

I talked with Colonel Potts and Major Sofield regarding a policy on leaves. Six months or more of continuous duty in the islands seriously affects morale. Moreover, some men have been here longer than others due to lack of replacements. It is also important to keep up the morale of the men who treat the sick.

Saturday, 4 September

I spent the morning on the wards with Colonel Potts and Major Sofield. I saw a compound fracture of the lower third of the humerus with a hanging cast, and unfinished at that. There was a knee case that had to be reoperated. What was supposed to be a cyst turned out to be a ruptured muscle. Evidently more information must be entered on the EMT [Emergency Medical Tag]. Baker left today. We will meet again in Suva [Fiji] on the 18th. I am scheduled to fly to Nandi [Fiji] on the 15th.

I saw another disturbing case. This soldier had been wounded in the arm late one afternoon during the New Georgia fighting. The wound was dressed almost immediately. He was evacuated the next morning at 1000 and reached the 17th Field Hospital at 1500. Only the 25th Division clearing


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FIGURE 312.-An aid station on Rendova Island, Solomon Islands, 12 July 1943.

station had moved forward on New Georgia. If just one platoon of the 17th had been near the beach, he could have been debrided. Debridement with anesthesia wasn't done at the 17th, although he was there for 4 days. He was then sent to Mobile 8 on Guadalcanal, where a Roger Anderson splint was applied. From there he was sent to the 25th Evacuation Hospital [Espíritu Santo]. He continues to have fever and a great deal of pus from his wound.

Folding fracture tables are needed for field hospitals.

MANAGEMENT OF CASUALTIES IN THE NEW GEORGIA CAMPAIGN

1. First aid treatment was usually promptly received by the injured (fig. 312). The delays that did occur were usually unavoidable. A shortage of litters and of hobnailed shoes for the litter bearers was partially responsible for the delay.

2. Clearing Stations.

a. They get little or no help to set up at a time when casualties are coming in heavy, and do not have enough time with the help available to give adequate care to patients in a "push."

b. Supportive treatment appears to be good.


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c. Debridement is inadequate in many cases because the men are pressed for time. Furthermore, some of them do not even understand the principle of debridement. Not enough soap and water are used. More instruments and a larger sterilizer-or preferably two sterilizers-are needed. More good surgery is needed in the clearing station and nothing should be spared to make this possible. In island warfare the field hospital may be so far from the clearing station that many serious cases must receive definitive treatment here. Better sorting of cases at the clearing station and a more efficient system of transportation to the field hospital is needed.

d. Records on the EMT are poorly kept. Enlisted men should be trained to put down what was done, and when the next dressing is due.

e. Fracture treatment is poor and is characterized by inadequate debridement, inadequate immobilization, and inadequate use of plaster.

f. Sanitation methods must be improved. The screening of messes should include the space set aside for eating. Flies are present in abundance. The operating tents must be screened.

3. Field hospitals should be placed as far forward as possible. The inadequacies mentioned above with regard to treatment in the clearing station apply to the field hospital too. The field hospital should go in with a full complement of supplies. Dividing up of supplies has proved a serious drawback in many instances. They should have help immediately on landing, in order to set up one good-sized bomb shelter. The clearing station or the field hospital should be located on or near the beach, in order to have the best possible liaison with the LST's.

4. Hospitals that are to be used in the line of evacuation should have more clearly defined locations. If station hospitals are to be used in evacuation, their personnel should be picked accordingly, with at least one first-class surgeon. The less well trained men should be used in hospitals that are off the direct line of evacuation. The 25th Evacuation Hospital is too far back now to perform the functions of an evacuation hospital.

Sunday, 5 September

I spent the day with Harper [Lt. Col. Paul Harper, MC, Malaria Control Unit] and Sapero [Cdr. James J. Sapero, MC, USN, CINPAC] who are doing a fine job. Commander Sapero was teaching in the Navy school in Washington before the war and has had some experience in malaria work. He was ordered out here during the thick of the crisis, when 16 percent of the men who had landed here [Efate Island, New Hebrides] were in the hospital as a result of malaria, the noneffective rate growing steadily. They had a so-called commission on Efate Island when he arrived, which did not even know to look for breeding places of Anopheles but set out to destroy all mosquitoes. Malaria control is just now getting under way, 1 year from the time of our arrival here. Only one educational directive has been published, and a command directive is just now being written. Sapero should be encouraged and his work recognized.


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Monday, 6 September

Visited the 25th Evacuation Hospital-Col. Morgan Berry is commanding officer. They have two good orthopedists. Maj. Harold A. Sofield is chief orthopedist. He could be used as a consultant in the teaching program, being put on detached service at first. The orthopedic and surgical service in the 25th Evacuation is well covered, so that this is not entirely unfair to Colonel Berry. At the 25th Evacuation Hospital, 35 percent of the casualties are fractures, of which 93 percent are compound, 15 percent femur. Next to general surgery, the biggest surgical problem is orthopedics. However, Lt. Col. Willis J. Potts, the chief of surgery, is well qualified. He is a competent surgeon and a good administrator with a pleasing personality. The 25th Evacuation Hospital is a well-run hospital doing professional work of a high quality.

UTILIZATION OF MEDICAL FACILITIES IN A THEATER OF OPERATIONS

In general, the surgical care of the wounded does not appear to be badly done, and the Medical Department is doing a good job under difficult circumstances. However, there is room for improvement.

1. The problems are: To provide the best possible early treatment for the wounded at the front during the "golden hours"; to insure the same high quality of treatment all along the line of evacuation.

The above can be accomplished by:

a. Planning good locations for facilities to be set up promptly when needed, and a well-organized system of transport.

b. Adequate trained personnel: Since we are short of trained personnel, this problem resolves itself into one of distribution of the best-trained personnel in key positions. The distribution of personnel along the line of evacuation must be such as to make them available to the greatest number of patients. This means that the line of evacuation must be planned out carefully, since the number of trained specialists is limited. Transportation under conditions of battle does not always allow for the proper sorting of casualties. The first wave of patients that arrived on Guadalcanal were transferred to hospitals on the basis of the seriousness of the case in relation to the condition of the roads and distance of the trip. This whole problem might have been eliminated by the proper location of facilities. Furthermore, not enough consideration was given to the personnel available at these hospitals. Thus, if only one orthopedist or neurosurgeon is available at a certain hospital, the patients that fall under these specialties should be sent there. This sorting should be a function of the island or service command surgeon, and should not be done solely on the basis of the number of beds available. However, if there is only one hospital on an island, this procedure is not necessary. Economy of supplies and personnel is one of the advantages of centralizing hospital facilities.

2. Medical officers, especially those in the forward echelons, should receive some instruction in the care of wounds and the treatment and trans-


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portation of fracture cases. These are the two major problems in the care of battle casualties, and it is here that instruction is most urgently needed. In order that this instruction may reach personnel in as short a time as possible, the instructor should visit the forward echelons. It would be particularly desirable that they first visit troops and installations that are about to go into action.

3. Since there are extreme fluctuations in the casualty load in island warfare, a more flexible medical service should be provided. This can best be done by using surgical teams, operating under the direction of the corps surgeon. Such teams could be drawn from hospital installations in the rear echelons, provided that these are kept up to strength.

4. The policy of promoting officers in order to fill the T/O (table of organization) of an installation-even when the best available men are chosen-has often resulted in placing officers in positions which they were not qualified to fill. The promotion of any medical officer to the grade of lieutenant colonel or colonel, should receive very careful consideration from both the professional and the administrative standpoint. The essential problem is to find posts that they are qualified to fill. When they are not qualified for such posts, either professionally or administratively, the question of promotion should be precluded.

It has rained buckets all day and night.

I visited the 122d Station Hospital, which is making excellent progress. Major Camp has built a well-designed surgery, though it is much larger than is necessary for a 500-bed hospital. They expect to open the surgery in 2 weeks. The personnel of this hospital is young and enthusiastic, but not well qualified.

Capt. Gilbert N. Haffly, MC, of the 25th Evacuation Hospital, an excellent EENT [eye, ear, nose and throat] man, is training a general practitioner to do EENT work in this hospital. Captain Haffly says that nose and throat maladies constitute 65 to 70 percent of his work. Not a single paracentesis has been done here so far. He does not think anyone with a chronic ear condition, or with a history of recent ear trouble, should be taken in the Army. Exposure to a tropical environment results in an acute exacerbation of chronic trouble. Otitis externa is a big problem. Haffly intends to report further on this. He recommends the application of 1 percent thymol in 50 percent alcohol, or thymol iodide powder. He does not think that this inflammation is contracted by swimming in the local waters.

It was raining by the bucketfull all day, and all flights were grounded. My plans to travel to Efate must await the favorable decision of the gods. I spent the afternoon talking with the Navy consultants, Captain Kern of Philadelphia, the medical consultant, and Commander Reynolds of San Francisco, the surgical consultant, and with Cdr. Emile Holman, MC, USNR, and Lt. Cdr. James C. T. Rogers, MC, USNR. They have just returned from Tulagi and Florida Islands [the Solomons].


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Surgical and medical care for the Marine Raiders appears to be a very difficult problem, since they carry so little medical equipment. They do not even carry a stretcher-nothing but fighting equipment and a little food. Losses in the 4th Marine Raider Battalion, which made initial assaults on New Georgia, were: 33 killed, 134 wounded, 170 medical casualties, or 48 percent casualties, of which almost half were surgical cases. In the action at Bairoko Harbour [New Georgia Island], there were approximately 600-plus casualties. Four hundred were evacuated by PBY ["Catalina"] flying boats, one hundred by APD [transport (high speed)] fast destroyer transport, and one hundred by LST. The second wave of Raiders carried some dressing station, but these did not usually get set up until some 2 or 3 days later. Hence there is very little substantial treatment until the wounded are evacuated to Guadalcanal.

While at the Mobile 8 Naval Hospital, I heard it stated that, since practically all head wounds, most chest wounds, and the majority of the belly wounds turn out to be fatal, these casualties should be considered lost and no attempt be made to save them. Someone added that perhaps this was the right thiing to do and that only the minor cases should be treated. The point here, I suppose, is to utilize personnel and equipment as efficiently as possible. I objected, for I believe that every effort should be made to save lives, if this can at all be done without materially jeopardizing the outcome of the war. We must consider that morale would go to pot in a hurry if the soldier thought that in certain instances no attempt would be made to save him. It is true that many men have been wounded and a few killed while trying to save a wounded man. I know of one instance when three were killed by Japanese snipers while trying to help one wounded man. The Japanese use our casualties as bait for a kill.

Captain Kern thinks that the men should be instructed to crawl for cover when wounded. The white dressing of a wounded man makes a beautiful target. The Japanese have foreseen this and use a green triangular dressing as a covering. Some of our men smear mud over their dressings so that, they are not conspicuous. Another practice to correct is that of giving all of our wounded one-half grain of morphine. Because of this, many walking cases are converted into litter cases. Kern is much concerned over the absence of camp sanitation. Piles of tin cans, partly filled with food, act as fly breeders.

The Navy badly needs 6-inch prepared plaster. That is the first thing I have heard of that the Army has, and that the Navy doesn't have. The Navy has given us just about everything else, and perhaps we can help them out in this case. The Navy has been well supplied with washing machines, refrigerators, tables, quonset huts, and what-have-you. Their equipment for tropical warfare, as one New Zealand officer, Colonel Twhigg [Col. John M. Twhigg, New Zealand Army Medical Corps] remarked, includes, "everything that opens and shuts." However, Reynolds and Kern observed that the greater mobility of Army equipment is an important asset and that the Navy is not prepared to


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move fast. However, most of the comforts of tropical warfare are furnished by the Navy.

Kern and Reynolds are both in favor of surgical teams, particularly as the Navy has a surplus of doctors in their rear echelons. They told me about some Marine divisions, which among their medical staff did not number a single qualified surgeon. On the whole, their care of the wounded and their organization of evacuation lines is in a worse state than the Army's. We are still making many of the mistakes of the last war and are not getting all of the square pegs into square holes. These Navy people are beginning to recognize, I think, the importance of having adequate medical facilities on the LST's. However, "the skipper would never give up his carpenter shop." We will see what happens.

Efate, Wednesday, 8 September

I left Espíritu Santo Island this morning at 1000, had lunch at the Efate Island airstrip, then drove to headquarters of the island command at Vila. Headquarters is situated on a fine hill overlooking a beautiful harbor. Colonel Carroll is the island surgeon-a pleasant fellow. The 48th Station Hospital is under the command of Lt. Col. (later Col.) Lester F. Wilson, MC. It is the only large Army medical installation on the island. Parts of two platoons are set up on the far side of the island to act as a field clearing station for emergencies.

U.S. Naval Base Hospital No. 2 is the largest hospital on the island and has a beautiful location on a hilltop. It is well equipped and well run, although I am a bit skeptical of some of their talent. They now have some 700 to 800 patients, half of which are Army personnel. Most of the patients from the 20th Station Hospital, and the 52d Field Hospital, both at Guadalcanal, have been evacuated here. There has been some trouble with records and some friction with the 48th Station Hospital. The Navy does not send their records along with the patients. I don't see any reason why hospitals should keep the records of their patients. Certainly all of his records, and not only the EMT, should accompany the patient. There are a great many orthopedic cases here.

The 48th Station Hospital is being enlarged to a 500-bed hospital and has about 300 beds at present. Colonel Wilson is a general traumatic surgeon and does some surgery. The hospital has a beautiful site on the hillside overlooking the harbor view. Most of the buildings are quonsets, with a boardwalk running between them. The messes are excellent, clean, and well screened. Good planning is everywhere in evidence. A very good medical supply unit, the 24th, is part of the hospital. The staff was drawn mostly from the 12th General Hospital, which is the Northwestern [University] group. They are young but energetic. The chief of the medical service is good. The chief of surgery, Major Douglas, is young but well grounded. Unfortunately, they have no orthopedist. Captain Lindberg, laboratory head, is excellent. Morale is good.


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They are having trouble with their water supply-inadequate filter. The proctoscope bulbs are all out, owing to line fluctuation. Can a Castle light battery be used instead? They have a good GU man, but no cystoscope for him to use. It has been on order for 6 months. Is there one at Nouméa? They are out of 2½ percent sodium citrate ampules. Their needles and sutures are too large. Check on maintenance at Nouméa; this is a general complaint. Opium powder is needed for the pharmacy, and more class IV supplies for the laboratory: beakers, flasks, glassware. They also want washing machines and gaskets for sterilizers.

Colonel Carroll says that the dental problem is considerable here. Seven to ten percent of new arrivals from the States have deficient teeth, but the hospital is short of dental equipment. They have seen three cases of yaws among Army personnel here.

Captain Lindberg has found that low glucose tolerance occurs in cases with jaundice and small livers. He needs brown sulphaline. He has a new, quick, thick-smear Giemsa stain-takes 10 minutes.

I saw a femur fractured up to the trochanter that had been kept here 12 weeks. The fellow also had a compound fracture of the wrist and hand. He should have been evacuated, since they have no orthopedist here. But apparently the boats do not come in often. Why can't air evacuation be used for these cases?

I left Efate at 1400 and arrived at Nouméa, 1615 hours, with Charles G. Mixter. He says that only 50 percent of their planes are used for the evacuation of patients. Personnel is available, but the planes are being used for other than ambulance transport purposes. There is too much of this lack of good management. I have observed plenty of patients who would benefit by air evacuation. This source of assistance has been neglected, however, simply because people don't get together on these problems.

Nouméa, Thursday & Friday, 9 & 10 September

I spent these two days getting organized here at headquarters, writing reports, letters, etc. Two eye magnets are available for shipment. I took up the question of screening with Major Moore of the Engineers. How much should a hospital or medical installation take with them to the forward areas?

Saturday, 11 September

Worked on reports today. I received a splendid report from Major Barker, the 37th Division Medical Inspector. His findings sounded as though I had written them up myself. It is amazing how closely our observations have coincided.

Wednesday, 15 September

I was supposed to be in Fiji today and have my orders to proceed there. But it seems as though fate orders otherwise. Went for a 5- or 6-mile walk with Paul Harper Sunday evening and felt fine. I had on a new pair of shoes. Awoke that midnight with a very severe shaking chill. It was so severe that I could not get out of bed for some time. By morning the chill had subsided,


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although I knew I was not quite all there when they took me to the hospital. I thought surely it was malaria, but to my amazement it turned out to be a lymphangitis. It is now subsiding. I suppose it will be a week before I get going again.

Friday, 17 September

Sulfadiazine is certainly amazing. I now learn that I came in here quite balmy with a temperature of 104-my WBC [white blood count] was 19,000 on Monday. I now feel fine but Captain Dietrich won't let me up. He has done a good job of keeping tabs on my blood count, urine, etc. My blood level was 5.5, but WBC fell to 3,000, so he stopped the drug. I have a little residual redness, soreness, and swelling of the right leg. But I don't think there is any thrombosis, although the captain thinks differently.

Brig. Gen. Fred W. Rankin [Director, Surgical Consultants Division, Office of The Surgeon General] just walked into my room. He is along with a troop of Senators, and they wouldn't leave him alone long enough to let him chat with me. The Senators, as usual, were all interested in people from their own State. He has been to Australia. Colonel Pincoffs [Col. Maurice C. Pincoffs, MC] is Chief of the Professional Service [Headquarters, USAFFE] and, he says, a trouble shooter for Col. (later Brig. Gen.) Percy J. Carroll, MC [Chief Surgeon, USAFFE]. Fred doesn't think he is as much use there as he would be in the job of consultant. Fred says he wants to stop the practice, among soldiers, of self medication with sulfonamides, but is a little afraid of public opinion. I wish he had stayed longer, for I could have told him a lot of things. However, it is nothing that he could do much about. I presume it is our job to try to straighten things out.

Tuesday, 21 September

Discharged from 27th Station Hospital today (fig. 313).

Listened to a talk by Maj. Gen. Brehon B. Somervell, Commanding General, Army Service Forces. He says that in 3 months we will have as much shipping available as we did at the beginning of the war, but that it will be next spring before our facilities for passenger shipping reach that stage.

Wednesday, 22 September

Spent the day writing directives on medical specialty boards, and on debridement and the care of wounds. Had a conference with Captain Kern and Commander Reynolds of the Navy.

Fiji Islands, Thursday, Friday, and Saturday, 23, 24, 25 September 

Arose at 0300 hours-turned my ankle in the dark. Arrived at Tontouta Airfield 0500, from which we flew to Plaine de Gaiacs, New Caledonia. Had fresh eggs for breakfast. Took off at 0945. Arrived at Fiji at 1430. Nandi [on the western side of Viti Levu Island, the largest island in the Fijis] is in a valley surrounded by high mountains. The grass is green and the island appears fertile. Talked with a captain who had been at the 39th General Hospital as a patient. He was stationed at Bora-Bora, Society Islands, with the 8th Station Hospital, 280 beds. There are only about 1,500 men stationed


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FIGURE 313.-An aerial view of the 27th Station Hospital, New Caledonia, February 1943.

there now, and about 35 to 50 in the hospital, which has 10 officers. Three officers would be plenty now. Colonel Sherwood plans on sending those patients who have been here over 1 year back to the States, because of the prevalence of filariasis. Certainly no replacements are needed here or possibly some could be taken out.

Monday, 27 September

Flew from Nandi to Suva [on the eastern side of Viti Levu Island] in a New Zealand de Haviland. We went above and through the clouds, over mountains, and then down through a hole into Suva. I prefer to take my chances over the ocean. Checked into the Grand Pacific Hotel. Met Ben Baker and Colonel Dovell, island surgeon.

Tuesday, 28 September

Spent the day at the 18th General Hospital-a grand crowd. The hospital is on the grounds of Victoria College, the Fijis' institution of higher learning-a fine location.

They need masks, bladders for the anesthesia machine, intratracheal anesthesia sets. They have five National field sterilizers we can have, and an extra 230 kv. electric sterilizer. They also have horizontal autoclaves, utensil sterilizers, and hot water sterilizers-all of them run on steam. The supply unit is well equipped.


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They have done a fair amount of work but less than the 39th General Hospital and not enough to keep the men busy or happy. Much of their work is ordinarily done in a station hospital. These hospitals are chiefly taking in malaria patients from the Americal Division. They have more surgeons than they need for the work they have been doing. It seems that through ignorance of the functions of the different types of hospitals, the 142d General Hospital was originally set up in the field. Eventually, it was brought over to Suva. Now, however, there are two general hospitals at Suva. Colonel Dovell thinks that the 7th Evacuation Hospital, part of which is on Tongatabu, South Tonga, is of no use at Nandi and that it should come over to the Suva area to function as a convalescent hospital. While it is true that there should be a convalescent hospital at Suva, the personnel of the evacuation hospital should not be used for this purpose.

Wednesday, 29 September

Spent the day at the 142d. Lt. Col. Murray M. Copeland, MC, is commanding officer. Lt. Col. Harry C. Hull, MC, is the chief of surgery (fig. 314). Their physical plant, an old New Zealand hospital, is better than that of the 18th General Hospital. Very little surgery is being done. There are 160 patients, with space here for 450. They still work on a 60-day evacuation policy.

They have no intratracheal closed-tube anesthesia set, no Roger Anderson splints, or tincture of Belladonna; are short of sodium morrhuate, phenobarbital, resorcinol, sodium citrate ampules 2½ percent, aluminum sulfate, traction bows, and wood applicators. Gigli's saw and Steinmann pins are of poor quality. They have an extra water bath setup and three National field sterilizers. Their biologicals are getting out of date.

Thursday, 30 September

Back at the 142d General Hospital. An excellent orthopedist here. They are about to lose two men from their surgical staff of nine. The mess is excellent. As at the 18th General, all of these men are anxious to go to the front with a surgical team. Colonel Dovell thinks that it is a great mistake to send good men to the front where they may be lost. However, he can be convinced.

Friday, 1 October 1943

Left Suva in the morning with Col. George G. Finney, MC, and Col. Murray Copeland and drove to Nandi via the Queen's Road. Had a pleasant luncheon on the beach with Colonel Dovell and Miss Donohue [Lt. Regina M. Donohue, ANC], Chief Nurse at the 142d. Arrived in the evening at the 7th Evacuation Hospital, which is situated in a delightful valley near a mountain range, about 10 miles from the Nandi Airport and 18 miles from the dock. Lt. Col. Robert B. Lobban, MC, is commanding officer. Lt. Col. McKelvie is chief of medicine, and Maj. Robert S. Ackerly, MC, is chief of surgery. They came from the States last spring, first to Tongatabu and then to Fiji. They never functioned as an evacuation hospital and have done very little surgery. They acted as a station hospital in demalarializing the American Division.


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FIGURE 314.-The staff of the 142d General Hospital at New Caledonia, before going to Fiji, June 1943.


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A good staff, but no talent to spare. Most of their surgeons are young, with few specialists and no orthopedist. This hospital was first built by the New Zealanders and is now partly under wood and canvas. Had dinner-good food with sauterne.

Saturday, 2 October

Made the rounds at the 7th Evacuation Hospital. They need portable lamps, microscopes (now have one field microscope), antigen for Kahn test, homatropine, and pyrogallic acid. They have a portable orthopedic table, which could be used with a Hawley table. Scissors are of poor quality. Two utensil sterilizers, the 240 and large field sterilizer, have been acquired. No special anesthetist is assigned here. They would like Lt. Fred Dye, who is with the Americal Division.

Visited Lt. Col. James F. Collins, MC, Division Surgeon of the Americal Division. Appears to me to be a fine person doing a good job, and he has plenty of ideas which he promises to put down on paper. He is now short 15 men, and 6 of his doctors are sick. He believes that the old system of three clearing companies is better than the present one clearing company setup.

I put George Finney on a plane and spent the night at the 71st Station Hospital, which is now under construction on a good location. They will be ready to take patients in 2 weeks and could even do so now. Lt. Col. Anthony Ruppersberg, Jr., MC, an obstetrician, is commanding officer. He is energetic and is doing a fine job. The hospital will have 250 beds and eventually expand to 500. They need an EENT man. Check with the possibility of getting Bodein from Americal. Are they getting the journals here? Major Heyer, chief of the medical service, wants an EKG machine. Carbon dioxide tanks with proper connections for frozen sections are needed in all general hospitals.

Sunday, 3 October

Drove from Nandi via the King's Highway to Suva (180 miles), thus circling the island.

SUMMARY OF THE FIJI TOUR

1. Hospitals.

a. The 18th General Hospital is about to expand to a 1,000-bed T/O. They have excellent talent. Should this hospital be enlarged, however, it would take considerable building.

b. The 142d General Hospital is also about to expand to a 1,000-bed T/O. They also have excellent talent. This hospital is on a good site, which can easily absorb some additional construction.

c. The 7th Evacuation Hospital should be divided up in order to provide a convalescent hospital, and could be best placed in Suva in the camp partly occupied by the Quartermaster. The remaining units of this hospital could be utilized to supplement the 142d General Hospital, or to form a smaller evacuation unit.

2. At present there are approximately 2,500 beds on Fiji and too much concentration of medical and surgical talent. One general hospital, the 142d,


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with a capacity of from 1,000 to 1,500 beds, one convalescent hospital with 2,000 beds, and one station hospital on the north side of the island would be ample. This would leave from 3,500 to 4,000 beds on Fiji and free the talent of the 18th General Hospital for assignment nearer the zone of combat.

3. At least two well-equipped surgical teams can be provided from Fiji. Colonel Dovell tends, as usual, to push off the less-qualified and less-experienced men for duty at the front. We should first give it a try with the best men.

Nouméa, Monday, 4 October

I was up at 0400, took off at 0600 in a GI clipper ship, landed at Espíritu Santo 1100 hours, then to Efate, and arrived at Nouméa 1500 hours.

Sunday, 10 October

Hal Thomas [Lt. Col. Henry M. Thomas, Jr., MC] arrived yesterday on his way to the Southwest Pacific as medical consultant. I'm still working on directives and hope to finish up in a few days. Ed Ottenheimer [Lt. Col. (later Col.) Edward J. Ottenheimer, MC, Chief, Surgical Service, 39th General Hospital] says he will send us Claiborn [Lt. Col. Louie N. Claiborn, MC] and Post for the surgical teams.

Tuesday, 12 October

Completed the gas gangrene directive. Experimented with insufflators for sulfanilamide; perhaps I can stop its too liberal use in wounds. Met Colonel Ward, who is going to Fiji. Col. (later Brig. Gen.) Earl Maxwell [Surgeon, USAFISPA] is off on a trip to New Georgia and will try to straighten out the morale of the 17th Field Hospital. He will see Maj. Gen. Robert S. Beightler of the 37th Division and lay plans for our next move.

Wednesday, 13 October

Dinner last night at Mobile 8 with Jack Carmody [Lt. (later Cdr.) John T. B. Carmody, MC, USNR] and Frank Hauter. Mobile 8 has a new clubhouse with a large fireplace and a bar. Drinks are the best ever. Ten to fifteen cents is what they charge. Chatted with Captain Dearing after dinner concerning plans for Bougainville, our next major military objective.5 He is a very pleasant fellow. General Rankin met him at the hospital.

Sunday, 17 October

Spent yesterday at the 8th General Hospital (fig. 315) with Colonel Miller. They have no urologist and can use a major or a captain. He might be exchanged for an anesthesiologist whom they could train here. They also have no neurosurgeon.

The problem in Army medicine is, as in civilian medicine, one of getting the right man in the right place at the right time. Here, under the conditions of

5Bougainville was to provide the Allied forces with important airfields from which Rabaul and the remaining Japanese installations in the Solomons could be neutralized. New Zealand troops occupied two islands in the Treasury group of the northern Solomons late in October. The 3d Marine Division of the I Marine Amphibious Corps landed on 1 November at Empress Augusta Bay in western Bougainville. On 11 November, elements of the 37th Division entered the line. On 15 December, command of the beachhead passed to the American XIV Corps, which had been reinforced by the Americal Division.


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FIGURE 315.-Construction of a native-style barracks for the 8th General Hospital, New Caledonia, September 1943.

island warfare, we are trying to make each island a unit in itself, with all branches of medicine adequately covered. But there are just not enough qualified men to go around. This is particularly true for the forward hospitals. Field hospitals have had to perform the work of evacuation hospitals in these areas. I've seen three divisions here without one competent surgeon. Hence it is no wonder that the early treatment of wounds is not good. It would take a lot of shifting to change the situation, and they are a little loath to move people for fear of not getting their cooperation.

One of the great difficulties of getting adequate personnel in the right places is due to the fact that too many high-ranking officers have been promoted without the proper professional qualifications. Every commanding officer wants to promote the officers in his own organization. Even some old Army men look more to their own organization than to the good of the service. Moreover, I am very, very doubtful of the wisdom of having affiliated units. This results in too great a concentration of talent. The area surgeon does not feel free to move these men about.6 Hence there is no way of strengthening the weak spots in the command.

6Colonel Oughterson has answered his own criticism: "There are just not enough qualified men to go around". They are all "agglutinated" in the affiliated units, and it is difficult to pry them out. See also p. 823.-J. M. W.


804

Tuesday, 19 October

Lt. Col. Paul Kisner, MC, and I left Nouméa in a staff car at 0730 to drive to Plaine de Gaiacs, a distance of 160 miles. The road beyond Bouloupari was very rough. We arrived at Bourail, Headquarters, New Zealand Forces, South Pacific, at 1200 and had lunch with Colonel Twhigg. I acquired a new pair of New Zealand army boots, and then on to Plaine de Gaiacs at 1600. We looked over the hospital there and had a good supper.

The 331st Station Hospital now has 50 beds and 50 more that are almost ready for occupancy. Maj. Hugo A. Aach, MC, is commanding officer and has one lieutenant who assists him. He is doing a good job developing the hospital. Laboratory facilities are meager. He has had quite a number of accidents from the ATC (Air Transport Command) base. Eight patients with burns have been treated, one of whom died. The grounds are very dirty, and under these conditions burns treated with paraffin can easily become infected, as these did. They soon after adopted the practice of bandaging these burns. His equipment is good and he has no needs except for more medical personnel.

After supper we drove back to Bourail where we stopped at the New Zealand Hospital. Up at 0500 and arrived back at Nouméa, noontime. During this 2-day trip, I wore the seat out of a new pair of cotton trousers. There is no argument about trauma aggravating pilonidal cysts.

Friday, 22 October

Visited the 31st Station Hospital today. Lt. Col. Corren P. Youmans, MC, is commanding officer. This is the breakdown of the University of Minnesota hospital group after a change in T/O. There are five young and energetic surgeons here. They should have a chief of surgery sent in if they are going to expand to a 500-bed hospital. Not that the young men are bad, but they are immature.

Six hundred patients have been transported here by air since 15 September. These are seen at Tontouta Airfield by the 31st Station Hospital men. The sick cases are kept at the 31st Station Hospital and the others are sent on to the 8th General Hospital. Many patients who have recently been operated on have been shipped down here. These surgeons are objecting to what has been done at other hospitals. A directive is needed regarding records and X-ray procedures. They think that too many cases with simple ailments are being evacuated. Besides, patients with psychosis are being sent down with an organic diagnosis, which throws them off the trail here and obviously makes treatment more difficult. This is a rather dirty hospital, hot, and on low, mosquito-ridden grounds.

Espíritu Santo, Monday, 25 October

I left this morning with Ben Baker on a Navy flying boat. Left at 1200. Sandwiches and coffee served en route. Stopped at Efate-Havannah Harbour is full with battlewagons. Arrived at Espíritu Santo, 1730 hours. Stayed at the 25th Evacuation Hospital.


805

Tuesday, 26 October

Saw Lt. Col. Arthur G. King, MC [Surgeon, Service Command]. He is not doing a bad job-efficient. Sofield's orders arrived (assigning him to SPA [the South Pacific Area] as orthopedic consultant). The 10th Medical Supply Depot under Capt. E. Lucas is doing better and is nearly all undercover. Found three anesthesia chests and two field sterilizers. Visited the 122d Station Hospital. Major Camp seems the head here and he has done a good job planning. The hospital now has 500 patients, although capacity is rated at 1,000.

Guadalcanal, Wednesday, 27 October

Arose at 0400 and after a good breakfast of ham and eggs we took off for Guadalcanal in a B-24 Liberator.

Arrived at Guadalcanal 0930 and reported to the 37th Division headquarters. Met Col. Edward J. Grass, MC, a pleasant division surgeon from Washington, D.C., who was very cooperative. He plans on using surgical teams in the collecting stations. This should work out well, since there is a collecting company with each combat team. For a second echelon hospital, we shall use the clearing station. Will the combat operation be such as to make this practicable? Distance is the determining factor. Major Bliun, Commanding Officer, Company D, 112th Medical Battalion, is a fine fellow. There is the utmost spirit of cooperation, and I think that the venture will succeed.

The supply problem has not been cleared up. Plaster of paris in cans has been issued in quantity for the combat teams, but only 24 dozen bandages are on hand. We will change that. Prophylactic kits are still being issued, with no females within 1,000 miles of here. Other uses have been found for them, such as covers for pistol barrels, watches, and pocket drug kits. Started Atabrine therapy today. Two ships were sunk offshore carrying power generators for the 37th Division. Mono was taken by the Marines today.7

Thursday, 28 October

Went over the supply question with Lieutenant Rhodes, medical supply officer of the 37th Division. The maintenance lists are not adapted to this area. There is a surplus of some items; for example, mops, prophylactic kits, tons of cotton, and not enough of other items. What good are mops with no floors to mop? We talked about the plan for surgical teams. Since they still do not grasp the principle of time relationship in the treatment of casualties, it will take a lot of conversation to convert them. There will be trouble getting lighting facilities, since there are no generators.

Visited Capt. George Ellis [Capt. James W. Ellis, MC, USN], Surgeon, 1st Marine Amphibious Corps, at the old Imperial Japanese Headquarters-a lovely site on the beach. Emile Holman [Cdr. Emile F. Holman, MC, USNR, Surgical Consultant, 1st Marine Amphibious Corps] was there as a consultant surgeon to the Marine Corps. They plan to evacuate serious casualties from Bougainville to Vella Lavella Island by destroyer, which again means from 3

7See footnote 5, p. 802.


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to 4 hours by boat, and a total delay of approximately 8 or 12 hours. It will be interesting to compare Army methods with those of the Navy in this operation. Only the two anesthetists, Lieberman and Rose, have arrived so far.

Friday, 29 October

Plans today for the movement of three combat teams. The plan is to use surgical teams in the collecting stations. The two surgeons, one anesthetist and two corpsmen of the surgical team, with its extra equipment, will be attached to the four officers and men of the collecting company.

We have no generators for the collecting company, so I have spent the day in pursuit of three light generators and so far have found none. Major Smith, a pleasant fellow from the Engineers, offered one 5-kilowatt generator weighing 1,800 pounds-a fine piece of equipment, but a white elephant to move. Eleven generators were lost in the two boats the Japanese sunk off the shore the other day. Why do they still put all their eggs in one basket? The Navy doesn't have any either, so they say. The Seabees are making three plaster supports for shoulder spicas, using heavy steel since it is the only thing available. Weight could be saved by using an alloy.

Acquired a carbine today. This is a fine outfit: Colonel Grass, surgeon; Maj. John Bliun, commanding officer of the clearing company; and Vic Kolb, an excellent officer. They put on a fine review this afternoon.

Saturday, 30 October

Went to see the the 117th Engineers about digging in for operating rooms, and so forth. Surgeons for the teams arrived today. They are Shackelford, Watson, Manwell, Post, and Troland. Three anesthetists, Schulman, Rose, and Lieberman, and a bacteriologist, Michael, also arrived (fig. 316).8

Monday, 1 November 1943

Navy started shelling Bougainville yesterday. Had conference with General Beightler [Maj. Gen. Robert S. Beightler, Commanding General, 37th Division] and staff this morning.

Friday, 5 November

A busy few days, mostly spent in gathering supplies. Eighty-eight hundred pounds of supplies were supposed to arrive on the Currey and did not. Headquarters, USAFISPA, informed us by radio that they were put on the boat. After I had given them a reply, we received a radio saying that the supplies had been found and were to be shipped by air. Yesterday 34 of 48 boxes arrived. Today they were sorted and put aboard ship. Almost all personnel were on board today. Don't know where I am supposed to be, but I will board the President Adams tomorrow.

The cooperative spirit and morale of this division, and of the officers and men of the forward area, appear wonderful. The soldiers are not worried about the outcome of the war, but they are full of doubts and fears for the

8So far as they could be identified, these officers were: Capt. William G. Watson, MC, Maj. Edward J. Manwell, MC, Capt. Charles E. Troland, MC, Capt. Harold C. Schulman, Capt. Max Michael.


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FIGURE 316.-Surgical team with equipment (left to right: Capt William G. Watson, MC, Capt Charles E. Troland, MC, surgeons; Capt. Harold C. Schulman, anesthetist; Sgt. William F. Marsden, Sgt. Murray M. Lemish, technicians), Bougainville, 13 December 1943.

future. The bold confidence of a century ago, or even of the last war, is not to be seen. They are not sure why they are fighting. They want to go home, since they feel they have done their bit. Nevertheless, they carry on.

Saturday, 6 November

1445 hours. Since I could get no information as to what ship I was supposed to go on, I stayed ashore last night. We had an air raid at 0100. Went to the beach this morning and found Captain Ellis, Senior Medical Officer of the 1st Marine Amphibious Corps, and General Craig [Brig. Gen. Charles F. Craig, Assistant Division Commander, 37th Division] sitting on their jungle packs. So I finally climbed on and went out with them to the Adams, where I was put in a large stateroom next to General Gage of the Marines and General Craig of the 37th Division. The room is equipped with a fine shower bath and a fan. Had a fine lunch of iced tea, spaghetti, meat sauce, and apricots. The table was set with napkins and a white tablecloth. I have to pinch myself to realize we are off to invade Bougainville. There are about 20 ships in sight, and the destroyers and cruisers are gathering around, so it won't be long before we are off.

We intend to use the surgical teams with the collecting stations, though this may be too far forward. Ideally the surgical teams should be behind the collecting stations, but General Beightler is afraid of isolating the teams and


808

leaving them open for infiltration. The Engineers have promised to dig us in with bulldozers, if the road comes up with us.

The weight and transportation of equipment is a big problem in island warfare. Each team has a 250-pound chest full of instruments, et cetera. In addition, I have provided sterilizers, autoclaves, anesthesia machines, suction, generators, orthopedic tables, etc. The equipment should be as light as possible for this type of warfare. For example, the horizontal field sterilizer weighs 350 pounds crated. Equipment could be permanently attached to a light truck without great loss, since the truck engine could be used to run the generator. So far I have seen no operating installation where a truck could not get to. However, one disadvantage to a truck would be the difficulty of digging in and the fact that it might be damaged as a result of bombing. This campaign should enable us to discover the best method of handling our equipment.

It is obvious that the clearing company T/O is not adapted for this type of warfare in which combat teams operate independently. The clearing company has one set of equipment and two clearing platoons to be divided into three small hospitals, which is impossible. I would suggest that, given this situation, each combat team should operate as a self-sufficient unit with one collecting station and two small hospitals for each team. Two hospitals are needed in order to "leapfrog." If need be, the collecting stations could be combined with the two hospitals, one of which would operate as a surgical hospital, and the second would care for routine cases not requiring skilled surgery. Thus, if there is a danger of infiltration, they can be combined: hospital number one with number two, or number one with the collecting station. A field hospital can be used to back up the division, both as a rehabilitation camp and to hold patients for evacuation. We will watch this operation to see how the arrangement functions.

The President Adams, Sunday, 7 November

We left Guadalcanal last night at 0100, just as the moon went down. I had a good sleep in spite of the fact that it was hotter than Hades, even with the fan working. This morning we had a wonderful breakfast of ice-cold grapefruit, ham, eggs, toast, and coffee. I can't tell how large the convoy is, for the ships extend further than I can see. We are sailing up through The Slot. New Georgia is on our left and Choiseul Island will soon be on the right. The news says that the Japanese are sending down large convoys from the Truk Islands naval base. A lovely day, with a gentle roll to the sea and lots of flying fish. Apparently we have plane protection from the adjacent islands.

Bougainville, Monday, 8 November

Bougainville, 1400 hours. An uneventful night, but hotter than Hades; cloudy and raining, so there was no bombing. A lovely clear morning-could not see land yet. It appears that we came straight in. The cargo ships are in line, with destroyers on either side. The island has a beautiful skyline with rugged mountains and two volcanoes that are said to be active. One of them


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is directly behind the landing point [Empress Augusta Bay]. Our guns are firing west at the Japanese lines, where they landed several barges last night. As far as we know they have no artillery. We were ordered to land at 0850, and in less than an hour there was nobody left on board but the crew and some supplies.

The terrain near the beach is lava sand, with some swamp behind. However, it is fairly dry now. Tremendous confusion on shore, but after about two hours we found the clearing station and the collecting station. We will stay put here for the night until a plan of the campaign is given us. At 1100 hours, the Japanese came over. I guessed that there were about 25 to 30 planes, later found out there were 70. The ships had 15 minutes' warning and pulled out to sea. The sky seemed full of ack-ack and planes. I hear that one of our ships was hit but stories fly so thick and fast that you can't tell what is really happening. Hal Sofield just came up and told me to put in my diary: "The Adams was hit in the stern a half hour after we debarked." The boys already have the barbed wire up around the clearing station. I have dug a foxhole and put my jungle hammock in it, since we must all stay underground at night.

Tuesday, 9 November

There has been very little infiltration of Japanese. Only a few casualties. The 37th is to take the left half of the perimeter. The Marines have a clearing station in this sector, and so far are doing the surgery under poor conditions. They don't have screening and the debridement is very crude. There is a division hospital (3d Marine Division, I Marine Amphibious Corps), with a Dr. Bruce [Lt. Cdr. Gordon M. Bruce, MC, USNR], an ophthalmologist from New York, in command.

Wednesday, 10 November

Some trouble today on the right flank, about 90 Marine casualties. The beach along the left flank is being evacuated by amphibious tanks. I saw returning tanks, loaded with our dead. We are not yet set up for operating, although fortunately it would make little difference if we were. The planning of this clearing station has been noticeable by its absence, partly due to lack of information, and partly because we are waiting to take over after the Marine division hospital moves out. Finally found Captain Ellis of the Marines in his headquarters about 100 yards behind us in this extraordinarily dense jungle.

Thursday, 11 November

0800 hours. Armistice day and a good joke on the well-known human race. On the present model, all days will eventually be armistice days. Six hours of bombing and strafing last night, from 2000 to 0200, with many humorous situations and much shouting and conversation in one syllable words. Some fellows stayed in the foxhole, but with a little practice, I found I could beat the best of them in the race back. The only trouble was that the first in was at the bottom of the heap. The landing craft carrying the Marines


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FIGURE 317.-A surgical team at work 5 days after the landing, Bougainville, 13 November 1943.

for the main attack on the island took more than 60 casualties. A destroyer and numerous barges are said to have been sunk.

Friday, 12 November

Bombing last night was limited to an attack on the LST's. There is a question as to whether surgical teams will work under the present arrangement. This is a good outfit with a fine cooperative group of men (fig. 317), but after 5 days here we still have no adequate surgical setup and nothing screened, not even a latrine. The surgical team, not being a separate unit, can do nothing. It would be better for the surgical team to go in as a unit with its own command responsibility. Without good surgical care, this outfit would have been sunk if there had been a large number of casualties. Captain Ellis has changed the evacuation policy again. This time evacuation is to be to Vella Lavella Island by boat and PBY ["Catalina" flying boat] but again this is too late for definitive surgery. It must be done on this island to be effective. Admiral Halsey [Vice Adm. William F. Halsey, Commander, South Pacific Area, and Commander, South Pacific Forces] was here this morning.

Saturday, 13 November

0800 hours. The convoy with the 129th Infantry Regiment is coming in. Yesterday we moved to the edge of the [Koromokina] River. The woods here are infested with every kind of bug as well as mosquitoes. I awoke this morn-


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ing with six of them inside my net. Air raids last night at 8, midnight, and 2, 3, 4 and 5 in the morning.

Sniper fire getting closer this morning. The NCO's at the far end of one tent started shooting at what they said were Japanese. The Japanese had infiltrated through this area at the beginning of the week, and shot at the corpsmen in the Marine hospital. I was not too confident and so got out my carbine. The orders are to shoot anything outside the area that moves. Hence, the boys are likely to try out their guns. Some of the Japanese snipers are brought down by this method, and, of course, if one of our boys moves about out there after dark, he can only blame himself for the consequences. The Japanese infiltrates in the night and usually climbs a tree to await his opportunity at daylight. One of them waited until the middle of the day when there were plenty of people about the hospital, and then opened up with a machinegun. Fortunately no one was killed, but several were wounded. This is of course suicide for the Japanese, for he never gets away after that. The 129th Infantry came in, but could not land all its men owing to the high surf. Ben [Baker] and Kaufman [Lt. Col. Moses R. Kaufman, MC, Consultant in Neuropsychiatry, USAFISPA] arrived.

There is dissension between the surgical team and the clearing company. The surgeons were restless because of the slow progress and lack of organization. Surgical patients were coming in, and the surgeons were not being asked to see them. The clearing station personnel, who are not surgeons, were attempting to do the work in the same old fashion. I have asked Hal Sofield if he can get the teams organized and build an operating room. We have been here 6 days with nothing much to do, and still no adequate operating room. There is no provision for blood transfusion, no hemoglobinometer or microscope. These were to be brought up later. I am not yet sure how this experiment of ours will work out. This is a loyal outfit, and for anyone to show them up is of course disastrous. Even though they admit they are not first-class surgeons, nevertheless, the demonstration of this in front of their own company is too much for them to take. I am inclined to think that surgical teams must function as separate units under a separate command. They cannot be held responsible for good surgery without good surgical equipment, and it appears that the teams do not have enough authority to get things done. The unit should have the responsibility under the division surgeon for all surgery in the forward area. Clearing stations, which are without first-class surgeons, cannot be expected to turn out high caliber work.

Sunday, 14 November

We are experimenting with putting one surgeon and one anesthetist from each team with the collecting station and using three of our surgeons with the three doctors in the clearing station, all this in the interest of harmony. I am putting up General Breene's sign, "We are fighting the Japs and not each other." Hal has been working on the surgery. He has it above ground in a


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tent. General Beightler came over and immediately perceived that being situated next to the antiaircraft guns was not the right place for us. We will move in 10 days, but having a surgery is worthwhile even for so short a time.

The Japanese are trying to come over here through two mountain passes.

Monday, 15 November

We opened the surgery today although it is not yet screened. The plain facts are that the medical men of this outfit do not believe in the bacterial theory of disease, or, if they do, they do not appreciate its significance. It is almost hopeless to expect that directives or conversations will quickly change the prevailing concept of surgery. I have yet to see a surgeon who did good surgery at home do bad surgery in the Army. It is my opinion that the sloppy surgery I have observed in the Army is merely a reflection of sloppy surgery in civilian practice.

The Talbot, Guadalcanal, Wednesday, Thursday, 17, 18 November 

Sofield and I were at the beach at 0730 in order to go to Vella Lavella with patients. A Japanese attack came at 0800. I don't know how many planes there were, for the air was full of both theirs and ours. It was fascinating to watch the 90-mm. shells following the planes. The marksmanship was very poor, for the crews were not leading the aircraft sufficiently. They were too excited and shot at anything in sight.

We finally put off for the Talbot, an APD (transport, high speed), and had the 40 patients aboard by 1030. For some reason, we circled around until 1400. Then we started out for Vella Lavella, at 22 knots.

When we approached Vella Lavella, our orders were changed and we went on to Guadalcanal, arriving at 1000. Hence, the trip by fast destroyer transport took about 24 hours. There was only one doctor on the ship, and operating facilities were meager. Patients were carried up and down steep companionways-no way to treat an acute belly. The captain said this was a usual performance and that the schedules of the APD's were not correlated with the needs of the wounded. Two patients have died in transit. Both were in shock when put aboard. We went to the 37th Division rear echelon headquarters, where Colonel Moore gave us some beer and clean clothes, and then to the 20th Station Hospital.

Friday, 19 November

The 20th Station Hospital has poor morale and is doing poor surgery. The beast that should be done is to give them a strong commanding officer and a good surgeon.

Saturday, 20 November

The 25th Division needs more doctors. They now have 35 and should have 49. They could then send out two anesthetists to train others. The 21st Evacuation Hospital is being set up, as is also the 137th Station Hospital. The 9th Station Hospital has not yet opened its surgery. Sofield and I talked to all the doctors on Guadalcanal today, including Army surgeons at the 20th Station, 137th Station, and 21st Evacuation Hospitals.


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FIGURE 318.-"Probably the best constructed, laid out, and equipped field hospital in the Army"-the 24th Field Hospital, New Georgia, 27 October 1943

Sunday, 21 November

Spent the day packing, washing, and trading. Colonel Hallam came over to visit me. The XIV Corps is moving to Guadalcanal and then to Bougainville.

New Georgia, Monday, 22 November

Off at 0500. Stayed at XIV Corps headquarters. The transformation of Munda since my last visit 2 months ago is amazing. The airfield is enormous and there are good roads, quarters, et cetera. Saw Colonel Melvin, who drove us around and arranged a meeting of the island surgeons at the 24th Field Hospital for 1800.

The 17th Field Hospital now has a much better setup and they have profited by experience and example. The morale is better. The 24th Field Hospital, which is on the edge of the airstrip, has a most elaborate layout (fig. 318). Built in a sort of amphitheater cleared of all trees, the buildings form a horseshoe. The buildings extend out, like a series of terraces, giving the hospital the appearance of a stadium, especially when seen from the air. This is probably the best constructed, laid out, and equipped field hospital in the U.S. Army. In fact it is so well and thoroughly set up that it can no longer be called a field hospital.

The new T/O does not allow enough corpsmen for evacuation of casualties by litter carry, which is so important in tropical warfare. This has often re-


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sulted in late treatment with loss of life or limb and prolonged convalescence. It should illustrate the impossibility of laying down a standard T/O for a worldwide war fought under varying conditions. The surgical teams should carry more than two medical technicians-possibly six. Men sent into the area fresh from the States should not be sent directly to divisions in combat. One-third or one-half of them will usually show up poorly.

There is a general request from doctors for some sort of postgraduate training, since many of them have done nothing but administrative work since the war started.

A urologist and a neurosurgeon are needed at the 8th General Hospital [New Caledonia]. They need three-way stop cocks for anesthesia. Order book, "Fundamentals of Anesthesia," for distribution here. Emergency Medical Tags and indelible pencils are needed. Records of the patients come down late. Division will not send the service records of their men to hospitals because they are afraid of permanently losing their hospitalized personnel.

The 109th Station Hospital [New Caledonia] has 24 officers, and it should have 33. They want Lieberman and need a Medical Administrative Corps officer, an EENT man, and some more enlisted men. An optometrist is needed for both the 17th and 24th Field Hospitals. The 43d Division is short eight medical officers, two dentists, and a large number of enlisted men.

The evacuation from Bougainville was planned by Captain Ellis of the Marine I Amphibious Corps. While at Guadalcanal, we were told that everything was settled and that casualties could be evacuated by APD in 3 to 4 hours to Vella Lavella Island. Just before leaving Guadalcanal, Ellis said this was all off; that all work would be done at Cherry Blossom [Bougainville], and the Army could have the installations at Vella. On arriving at Cherry Blossom, we saw that all of the work was not being done there. Some patients were being taken directly to APD's and transported to unknown destinations. I later met someone who had just come from Vella Lavella. He told me that they had not received a single patient there. Moreover, the trip from Bougainville to Vella takes 10 to 12 hours and not 3 to 4 hours. Emile Holman was there, tearing his hair out.

Tuesday, 23 November

The above was written while sitting on the beach at New Georgia. We took off in a Higgins boat. The youngster in charge drove to the wrong side of the marker, ran on a reef, and then finally deposited us on shore. After a 4-hour wait, we got another boat that took us to Ondongo Island. Cordially received by the Marines, we were treated to excellent food, had clean towels, and slept between sheets in one of their quonset huts. Tomorrow there will be a plane to take us back to Bougainville.

Bougainville, Wednesday, 24 November

We took off at noon with General Harris [Brig. Gen. Field Harris, USMC, Commander, Air Command, North Solomons] in a Dumbo (patrol bomber, "Catalina") with a very competent pilot who had been decorated at Midway.


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Escorted by 10 fighter planes, we arrived at Bougainville in 1½ hours without incident.

They have made great progress here, and the clearing stations have been moved. The boys had many stories of bombing, strafing, and shelling. Ben [Baker] produced the head of a 90-mm. ack-ack shell, which came through his tent and punctured his rubber mattress.

The Marines reported having had eight cases of gas gangrene. Their evacuation is not completely controlled, and some of the patients have been put on the boat without receiving prior treatment. A considerable number of patients died in transit. Colonel Melvin told me of 12 on one LST. Two died on an APD from Bougainville. A complete and unified control of evacuation from an island is necessary.

Thursday, Thanksgiving Day, 25 November

Only one plane dropped its bombs on us last night. The Japanese have some artillery in and are shelling the beach. We had a fine Thanksgiving dinner; very good turkey with stuffing, cauliflower, peas, mashed potatoes, pumpkin pie, luscious biscuits, and coffee. I ate too much as usual.

The construction on the island is developing very rapidly. Planes are now making emergency landings and takeoffs.

Friday, 26 November

Last night we were shelled by Japanese artillery and today everyone is digging deeper. There is still inertia about getting patients underground. They are screening the operating room today (fig. 319). The surgical teams must have the responsibility for building and operating the surgery and furnishing its supplies. Supplies, such as screening, sandbags, et cetera, should not be left under the supervision of any other branch of the service. Experience shows that they are not likely to be on hand when needed. Furthermore, these supplies should go in with the first wave, when casualties are likely to be heavy.

Saturday, 27 November

Last night, the first night on Bougainville without an alert, I had a wonderful, cool, refreshing sleep on my air mattress. Army casualties are still light here. The doctors of the 37th Division have requested that we give nightly lectures on medical topics.

Sunday, 28 November

An uneventful day. Listened to Chaplain Kirker [Lt. Col. Kirker, 37th Division chaplain] talk on "True and False Truth." I remarked that the boys seemed very interested. "That group was christianized by bombs before we got here," said he.

Monday, 29 November

Went out on the right flank to visit a battalion of the 145th Infantry Regiment, who are with the Marines. Went up to within 500 feet of the frontlines, but I could see no Japanese, probably owing to the fact that the land is a dense swamp except along the beach. About 1,000 Marines struck the beach [Koiaris Beach] below here last night. They suffered 40 percent casualties and were lucky to get back with the help of a destroyer. Last night the Japanese shelled


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FIGURE 319.-A screened and dug-out operating room, Bougainville, December 1943.

the beach with 8-inch naval guns, location unknown. They hit a gas dump which caused a tremendous fire. Puruata Island [off Empress Augusta Bay, Bougainville] is certainly one of the most bombed and shelled of islands.

Thursday, 2 December 1943

Nothing new, not even the rain. Talked to a group last night on planned health and had a good response. It seems that mobile surgical trucks would be very useful here.

Sunday, 5 December

Everything okay in Cherry Blossom so I decided to return to Cactus [Guadalcanal] for further organization. Had dinner last night with General Beightler, General Craig, and General Krueger [Lt. Gen. (later Gen.) Walter Krueger, Commanding General, Sixth U.S. Army], and they are well pleased with the surgical teams, with our teaching, et cetera (fig. 320). There has been a lot of discussion about how to keep doctors happy while they are in the service, and the consensus is that it is generally impossible.

We have come down to the beach for a Dumbo. No one knows when it will come or where it will go, and the pleasant part of it is that no one seems to care a great deal. The uncertainty and variability of our movements serve to throw the enemy off, but it is amazing how much does get done in this situation.


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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.


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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.


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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.


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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


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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.


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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


823

FIGURE 322.-Difficulties of litter carry over the rugged terrain of Bougainville, March 1944.

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


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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


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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-


826

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

9The plans were for the proposed invasion of Kavieng, New Ireland, Territory of New Guinea, referred to hereafter by its code name, FOREARM. On 12 March, the Joint Chiefs of Staff canceled the Kavieng operation. Preparations had been far advanced, however, and the men and ships that were to invade Kavieng had already assembled at Guadalcanal.
10See: Oughterson, Ashley W., Hull, Harry C., Sutherland, Francis A., and Greiner, Daniel J.: Study on Wound Ballistics-Bougainville Campaign. In Medical Department, United States Army. Wound Ballistics. Washington: U.S. Government Printing Office, 1962, pp. 281-436.


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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.

11The fighting had not yet ceased on Bougainville. During March, the Japanese made three unsuccessful attempts to dislodge the American forces from the perimeter that they had occupied.


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MAP 5.-Medical units on Bougainville, March 1944.

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.


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FIGURE 324.-Men of the 129th Infantry Regiment, 37th Division, turning a flamethrower on a pillbox occupied by infiltrating Japanese.

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


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FIGURE 325.-Hill 700, Bougainville, March 1944. A casualty being transferred from jeep to halftrack for evacuation to the rear.

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.


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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.

12For data on this and other Japanese missiles, see: Beyer, James C., Arima, James K., and Johnson, Doris W.: Enemy Ordnance Materiel. In Medical Department, United States Army. Wound Ballistics. Washington: U.S. Government Printing Office, 1962, pp. 1-90.


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FIGURE 326.-An underground operating room, of the 21st Evacuation Hospital, Bougainville, April 1944. A. Exterior. B. Interior.


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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.


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FIGURE 327.-Fiji Scouts returning from patrol into enemy territory, Bougainville, March 1944.

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


835

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.


836

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:

41 cases of penetrating chest wounds-12 percent mortality.
21 cases of sucking chest wounds-18 percent mortality.
27 cases operated open-29 percent mortality.

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


837

FIGURE 328.-A patrol crossing the Piva River on Bougainville

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


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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.


839

FIGURE 329.-U.S. Army nurses participating in a native dance at Saint-Louis Village, New Caledonia.

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

13On 15 June 1944, the islands in the Solomons Group north of the Russells were designated as part of the Southwest Pacific Area.
14On 19 June 1944, Colonel Oughterson was awarded the Legion of Merit "for exceptionally meritorious conduct in the performance of outstanding services in the South Pacific Area from 1 December 1942 to 13 June 1944."


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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.

15The U.S. Army Forces in the Central Pacific Area was the forerunner of the U.S. Army Forces, Pacific Ocean Areas, referred to and discussed later.
16USAFISPA was redesignated in July 1944 SPBC (the South Pacific Base Command). USAFPOA was established at the same time as a superior headquarters with jurisdiction over the South Pacific Base Command and what had been USAFICPA (U.S. Army Forces in the Central Pacific Area) which was similarly reduced to a base command, CPBC (the Central Pacific Base Command). Colonel Oughterson was placed on temporary duty as surgical consultant at Headquarters, USAFPOA from the South Pacific Base Command, since there were no position vacancies for consultants of his rank at Headquarters, USAFPOA.


841

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


842

FIGURE 330.-Training in how to live in and on the jungle, at the Jungle Training School, Hawaii.

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,


843

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.


844

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.


845

FIGURE 331.-U.S. Army Hospital Ship Mercy. A. The Mercy. B. Operating room.


846

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.


847

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

17Brig. Gen. Earl Maxwell had been notified of impending assignment to the U.S. Army Forces, Pacific Ocean Areas; however, when official request had been received in South Pacific Base Command, General Gilbreath had radioed back to the Commanding General, the U.S. Army Forces, Pacific Ocean Areas, that General Maxwell was not available as he had no replacement.-E. M.
18The directive published at this time was promulgated by Headquarters, U.S. Army Forces, Pacific Ocean Areas, on 20 October 1944 as Training Memorandum Number 8, subject: Training Program for Medical Officers. Colonel Oughterson later rewrote this directive, adapting the principles in it to Headquarters, U.S. Army Forces in the Pacific, when that command became the superior headquarters in the Pacific.


848 

FIGURE 332.-A-day, Leyte Island, Philippine Islands. Landing craft rendezvous for the assault on Leyte.

(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

19The X Corps from the Southwest Pacific Area and the XXIV Corps from Pacific Ocean Areas made the landing at Leyte on 20 October 1944 under the operational control of the Sixth U.S. Army. The customary "D-day" for this operation was formally designated "A-day," and the terms are used interchangeably by Colonel Oughterson.


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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-

20Attention is called to Colonel Oughterson's statements on the function of a consulting surgeon (p. 841) and his participation in planning, such as it was (p. 842), written before the undersigned reported for duty. The comments on this instance were made only 5 days after my arrival. Consultants working under my command, including Colonel Flick, Colonel Mason, Colonel Loutzenheiser, Colonel Oughterson, and Colonel Ottenheimer, were always consulted on every phase of my duties and at all times were kept aware of any plans involving the medical service.-J. M. W.
21I believe Colonel Finney's comment has reference to the lack of "qualified personnel" previously commented on from time to time. Surely that decision had been made prior to my arrival.-J. M. W.


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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


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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.


852

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.

TABLE 5.-Operations, blood transfusions and deaths, by month, at the 148th General Hospital Saipan, Philippine Islands, during the period August-November 1944


Month

Operations

Blood transfusions

Deaths

August

108

30

6

September

221

10

3

October

248

35

1

November

263

54

1

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


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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.

FIGURE 333.-Brig. Gen. William A. Hagins, Surgeon, Sixth U.S. Army.

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


854

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

22I saw these installations when I was with General Kirk and party in February 1945. The locations were miserable but were all that were available at the time. By February, they had either moved or were in the process of moving. I think the medical service did very well, as did the patients with whom I talked.-J. M. W.
23Dr. Ernest Eric Muirhead, formerly the director of the blood bank on LST 464, in a telephone conference with Maj. J. K. Arima, 11 December 1958, stated that Captain Walker, surgeon of the 7th Amphibious Force, wanted whole blood and had picked Dr. Muirhead to get it, since Dr. Muirhead had had some experience with whole blood before the war. The Red Cross blood was not then available. So LST 464 was set up in New Guinea and then went to Leyte. According to Dr. Muirhead, they (on LST 464) "had to do with what we had." Two kinds of bottles were used-the 1,000-cc. vacoliter bottles and the 20,000-cc. regular laboratory water bottles. Preservative was made from citrate and dextrose because the ACD solution was not yet available. Any number of donors with group-O blood were bled directly into these bottles, appropriate amounts of citrate and dextrose were added, and the bottles were stored in the ship's walk-in type of refrigerators. The blood was not typed for Rh factor, neither was it titered. In times of stress, transfusions were effected directly from the large bottles, which had been adapted for giving purposes with pressure bulbs.-J. K. A.


855

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

24The 7th Amphibious Force under Rear Adm. Daniel E. Barbey, USN, comprised one of the two attack forces of the Seventh Fleet in the assault on the Philippines.


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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-


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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-


858

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.


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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 2½-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.


860

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.


865

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-


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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.


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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


877

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.)

Chapter 13 - continued

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