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Medical Department in China, Burma, and India
The responsibility for giving field medical training to thousands of foreign (Chinese) troops and for supporting them with a considerable portion of their hospitalization and medical supplies distinguished the Medical Department's experience in the China-Burma-India theater from that in other areas. Besides supporting the U.S. Army Air Forces and the, relatively few ground troops in the area, the U.S. Army Medical Department was called on to train and support medically Chinese divisions for the struggle against the Japanese in Burma and China. Army doctors in the theater labored under two handicaps which affected all U.S. Army effort there: the low priority of the theater for supplies and personnel, and the isolation of the China side of the theater from the India side by the Japanese invasion of Burma (map 13).
Map 13.- Area of operations, Asiatic mainland, 1942-45
With the lowest priority of all the theaters of World War II, the China-Burma-India theater was treated like a "stepchild" from the outset, as the surgeon of its Services of Supply put it.1 Throughout the period 1942-44, the medical sections of its top commands lacked sufficient Medical Department
1 Letter, Col. John M. Tamraz, MC, to Col. Joseph H. McNinch, MC, Editor, History of the Medical Department in World War II, 13 Feb. 1950, and inclosure.
officers qualified for major administrative positions. Other difficulties derived from the Japanese invasion of Burma in 1942. As a result of Japanese occupation, the theater had two distinct areas of combat operations-one in northeast India and Burma, and the other in China. Only by the hazardous Right across the Hump could medical men and supplies be transferred between China and India. The few U.S. Army doctors who served in an administrative capacity in China could keep in touch with the medical plans of Chinese military and civil authorities but it was hard to coordinate these with supplementary medical resources to be furnished by British and Indian authorities on the western side of the theater. The division of the theater into two areas of military operations accounts in large measure for the unorthodox location and functions of the top medical offices maintained by the American Army during the period 1942-44, as well as for the lack of centralized direction of medical service.
The Army's medical work was also affected by the lack of unity in the top commands. Although U.S. Army commands worked in close cooperation with commands and governments of the various Allies throughout the area, the China-Burma-India theater was never dominated by a strongly unified Allied command as were the North African and European theaters and the Southwest Pacific Area. The Chinese and the British theaters of operations comprehended areas distinct from those of the American China-Burma-India theater. Lt. Gen. (later Gen.) Joseph W. Stilwell was responsible to Generalissimo Chiang Kai-shek as the latter's chief of staff and later to Admiral Lord Louis Mountbatten, Supreme Allied Commander, Southeast Asia, as Admiral Mountbatten's deputy. The divided responsibilities entailed by General Stilwell's subordination to commanders whose interests diverged at times from paramount American interests- as well as from each other's- have been frequently pointed out.2
Nor was the organization of the American theater a well-integrated one. During the early period of the theater's existence, General Stilwell had four distinct and widely separated headquarters, each of which issued orders, sometimes in conflict with each other, to the theater surgeon in his name. Friction among the purely American commands- the theater command, the, Services of Supply, and the Tenth and Fourteenth Air Forces- was unceasing. This dissonance naturally hindered attempts to estimate theaterwide medical requirements and to maintain centralized control of medical service. The fact that the Tenth and Fourteenth Air Forces constituted the major American combat forces in the theater (most other U.S. Army troops were those of the Services of Supply) abetted the characteristic effort of air force doctors to operate independently of a theater surgeon. It is interesting to note that such freewheeling "old China hands" as the commander of the Fourteenth Air Force, Maj. Gen. Claire L. Chennault, had a few medical counterparts. Dr. (later Lt.
2 (1) Romanus, Charles F., and Sunderland, Riley: Stilwell's Mission to China. United States Army in World War II. Washington: U.S. Government Printing Office, 1953, pp. 87-89. (2) Romanus, Charles F., and Sunderland, Riley: Stilwell's Command Problems. United States Army in World War II. Washington: U.S. Government Printing Office, 1956, pp. 28-31,138-139.
Col., MC) Gordon Seagrave (fig. 112), the well-known "Burma surgeon," whose hospital served at Ramgarh, India (fig. 113), and later along the Ledo Road, struggled hard to maintain the separate identity of his mission hospital group within the complex U.S. Army medical organization.3
The geographic regions comprised in the theater varied greatly in climate and terrain. In this area of multitudinous diseases and much famine, medical resources were meager. The variety of national and cultural types, military and civilian, thrown together during the campaigns in Burma made it difficult to effect uniform measures to prevent disease. The fighting forces were Americans, Chinese, British, Indians, and Africans; many local tribesmen- Nagas, Karens, Shans, Kachins, and others- were employed by the American Army. The total effect of this cultural heterogeneity upon U.S. Army medical service
3 (1) Interview, Brig. Gen. Robert P. Williams, MC, 22 Aug. 1951. (2) Diary, Col. John M. Tamraz, MC, vol. I, 29 Mar. 1942-1 June 1944. (3) See footnote 1, p. 505. (4) Letter, Brig. Gen. R. P. Williams, MC, to Col. Calvin H. Goddard, MC, Editor, History of the Medical Department in World War II, 24 Dec. 1952, and attachments. See also Seagrave, Gordon: Burma Surgeon Returns. New York: W. W. Norton & Co., 1946, especially pp. 199ff., for Seagrave's own account of his experience with Army administration. In order to obtain a regular flow of medical supplies for the Seagrave Hospital, it was necessary that it be carried, at least on paper, as an orthodox unit. The theater surgeon solved the problem by requesting assignment to the theater of the 896th Clearing Company "minus personnel." Seagrave absorbed the equipment of the clearing company, and doubled as its commanding officer, although he continued to fear that his own unit might lose its identity.
is not measurable, but differences in dietary habits undoubtedly complicated the administration of Army hospitals, while customs and taboos of religion and caste sometimes hampered efforts at disease prevention. The fact that under the caste system in India only the lowest caste could engage in certain duties, such as the handling of water supplies, became an important factor to Army doctors in a theater where it was necessary to depend heavily upon local labor.
THE CHINA-BURMA-INDIA THEATER: 1942 TO OCTOBER 1944
When General Stilwell set up headquarters for the U.S. Army Form in China, Burma, and India at Chungking, the wartime capital of China, in March 1942, he had at his disposal a few Medical Department officers who had come to China with special missions. Two had accompanied the mis-sion headed by Brig. Gen. John Magruder which had arrived in the fall of 1941 to expedite the sending of lend-lease supplies to China. Two others had accompanied General Stilwell's own American Military Mission which had superseded General Magruder's mission after the United States had entered the war.
No formal organization of medical service was possible at this date. The Japanese capture of Rangoon in March had closed the Burma Road, severing communication between China and India. China was practically cut off from supplies in every direction. General Stilwell, who had been made chief of staff for Generalissimo Chiang Kai-shek and commander of Chinese troops in Burma, as well as commanding general of the American theater, went into action with the Chinese troops in the First Burma Campaign. Three of the Medical Department officers who had come with the special missions went to Burma to give direct care to U.S. Army troops serving there. The senior officer, Col. Robert
P. Williams, MC (fig. 114), became General Stilwell's staff surgeon. These officers accompanied General Stilwell during his retreat on foot from Burma to India. During the trek out of Burma, Colonel Williams had firsthand experience with the health hazards of the region, treating cases of malaria, dysentery, sore feet, and other ailments of the weary force accompanying General Stilwell.
Major Medical Offices in 1942
Only after the return to India could Colonel Williams build up his medical staff. When he reached India in May, a medical section had already been created for the Services of Supply (established in April). It was headed by Col. John M. Tamraz, MC (fig. 115), who had been assigned to Brig. Gen. (later Lt. Gen.) Raymond A. Wheeler's U.S. Military Mission to Iran and Iraq and had been transferred with General Wheeler to the Services of Supply for the China-Burma-India theater. The Services of Supply headquarters, briefly in Karachi, was set up in New Delhi in May 1942 and remained there throughout the life of the theater (fig. 116). Colonel Williams established his own office at General Stilwell's rear echelon headquarters, also in New Delhi. His staff at this date consisted of only a, few Medical Department officers who arrived in the theater in late May of 1942. Meanwhile one of the officers who had come out with the
Magruder mission had been left behind in Chungking to represent Colonel Williams at General Stilwell's forward echelon headquarters there.
During this period, the middle of 1942, the theater surgeon and the Services of Supply surgeon, both in New Delhi, were able to keep in close touch with each other. Both Colonel Williams and Colonel Tamraz spent much time in 1942 in tasks that would customarily have been delegated to subordinates personal inspection of troop areas and hospital buildings being constructed by the British and Indian Armies under reverse lend-lease, investigation of the extent to which American troops sent to India had been immunized against various endemic diseases, and other activities in preventive medicine. Colonel Tamraz' chief task was to establish the station and general hospitals of a Services of Supply. During the first half of 1942, the British furnished hospitalization to the 3,000 American troops in India.
For some time Colonel Tamraz had to use the Dental Corps officer who headed his dental service for the very uncommon assignment of chief medical supply officer as well. But Colonel Tamraz fared somewhat better as to staff when his office was enlarged by the addition of 14 U.S. Public Health Service officers. These men had been sent as a commission, under the direction of Lt. Col. Victor H. Haas, late in 1941 to aid the Chinese Nationalist Government with public health services for thousands of Chinese workers building the
Yünnan-Burma Railway. Financed with lend-lease funds, the railway had been designed to carry supplies into China from Burma. The U.S. Public Health Service officers had been forced out by the Japanese invasion of Burma.
This group included men qualified in medical specialties, as well as sanitary engineers, entomologists, epidemiologists, and malaria, control experts. Those trained in preventive medicine were the only experts in that field available to the Army for about the first year of the theater's existence. The U.S. Public Health Service officers did not become permanent assets to the Services of Supply headquarters but were soon sent to its area commands. Most went to sites between Karachi and Chabua, India, tentatively selected as bases for the Tenth Air Force, to make sanitary and malaria surveys, thus initiating the theater's malaria control program. In 1942, trained personnel and antimalaria supplies were wholly inadequate.4
Medical intelligence work for the theater was carried out at New Delhi under the auspices of the American Observer Group sent in March 1942 to get advance information on British and Indian experience which might be useful to incoming American troops. This group was transferred within a few months to G-2 of General Stilwell's command. Throughout 1942 and early 1943 Maj. (later Col.) Earle M. Rice, MC, the medical officer originally assigned, was engaged in appraising medical problems and practices of the British and Indian Armies. He prepared many intelligence reports on the
4(1) Van Auken, H. A. : History of Preventive Medicine In the United States Army Forces In the India-Burma Theater, 1942 to 1945. [Official record.] (2) Stone, James H.: Organization and Administration of the Medical Department in the China-Burma-India Theaters, 1942-1946. [Official record.) (3) See footnote 1, p. 505. (4) Williams, Ralph C.: The United States Public Health Service, 1798-1950. Washington: U.S. Public Health Service Commissioned Officers Association, 1951, pp. 685-691.
following subjects, among others: Yellow fever quarantine; the prevalence of malaria, cholera, filariasis, and other tropical diseases in various areas of India and Burma; methods of immunization against and treatment of tropical diseases; medical problems connected with evacuating troops and refugees from Burma during the retreat; and assessment of stocks of quinine and other medical stores in various areas.
The Tenth Air Force was built up in India in 1942, around a nucleus of air force personnel newly arrived from Java and the Philippines, under the command of Maj. Gen. (later Lt. Gen.) Louis Brereton. It, too, had headquarters at New Delhi at a later date. In these early days of theater organization, the Tenth Air Force constituted most of the American military establishment in India. Its medical section, headed by Col. H. B. Porter, MC (fig. 117), worked in a dual capacity throughout 1942 as the headquarters medical section for the Tenth Air Force and for the Air Service Command, India-Burma Sector, China-Burma-India theater.
In China, General Chennault's American Volunteer Group, which eventually became the Fourteenth Air Force, was still under the control of Generalissimo Chiang Kai-shek. In July 1942, what remained of it was inducted into the U.S. Army as the China Air Task Force, a, complement of the India Air Task Force, both of which were elements of the Tenth Air Force. Dr.
(later Col., MC) T. C. Gentry (fig. 118), who had been surgeon of the Ameri-can Volunteer Group, continued to head the medical work under General Chennault until the latter relinquished command of the Fourteenth Air Force in August 1945. Throughout the life of the China-Burma-India theater, General Chennault's air element constituted the bulk of the U.S. Forces in China-an element greatly outnumbered by the troops of the Services of Supply and the Tenth Air Force in India.5
In the fall of 1942, a shift of emphasis took place in the responsibilities of the theater surgeon. It had become clear that Chinese Government authorities at the wartime capital, Chungking, would not cooperate with the young major who was assistant to the theater surgeon. Indeed, Colonel Williams' own lack of rank was a handicap in dealing, as he was constantly required to do, with lieutenant generals of the Chinese, British, and Indian Armies.6 With the defeat in Burma, however, the urgency for on-the-spot action in
5 (1) Medical History of the Tenth Air Force,
22 Aug. 1944. [Official record.] (2) Annual Report, Surgeon, Fourteenth
Air Force, 1943. (3) Medical History of the Fourteenth Air Force in China,
28 Aug. 1944. [Official record.] (4) See footnote 4 (2), p. 511.
India by the theater surgeon had subsided. U.S. interests were consistently focused on China, and close cooperation with the Chinese Nationalist Government was vital to the success of the medical training of the two Chinese divisions which had escaped from Burma. These young men, malnourished and ill with dysentery, malaria, and tropical ulcers, were to be rehabilitated in India for the return to Burma. In addition, Colonel Williams was to plan the medical phases of the training program for 30 Chinese divisions which General Stilwell expected to mobilize in southwest China. Hence he transferred his main office to General Stilwell's forward echelon headquarters at, Chungking and placed his deputy in charge of the office at rear echelon headquarters in New Delhi.
After the transfer, Colonel Williams' main effort was devoted for some months to liaison activities in connection with the training of Chinese troops in India and China. Until July 1943, he was the only medical officer on duty at the Chungking headquarters. At first his office consisted of a, typewriter at the foot of his bunk; he did his own typing. Housing was scarce in the much-bombed Chungking, and at this date few men had been flown over the Hump. After some weeks Colonel Williams had a battered desk and a few enlisted men to help him; he worked in a room with several other members of the special staff. It was not until 1944 that a, headquarters was built and he got an office of his own.
Colonel Williams' main office remained in Chungking until the spring of 1944, although most of his staff stayed at his rear office in New Delhi. The division of the theater medical section into two offices, one at Chungking and the other at New Delhi, lasted until the theater was split into two theaters in the fall of 1944.
At the end of 1942, the following major medical offices were located at New Delhi: The theater surgeon's rear headquarters office (consisting of only two Medical Department officers and two enlisted men until early the following year), the Services of Supply surgeon's office, and that of the Tenth Air Force surgeon. The surgeon of the Indian Sector of the Air Transport Command's Africa-Middle East Wing was then stationed at Karachi, the eastern terminal of the wing. The theater surgeon's main office, was in Chungking. General Chennault's China Air Task Force, later incorporated into the Army as the Fourteenth Air Force, was also based in China at K'un-ming.7
Beginning in the autumn of 1942, the U.S. Army undertook at Ramgarh (Bihar Province) the rehabilitation and training of two divisions of Chinese troops. These escapees from Burma, together with men later flown over the Hump from China, made up the Chinese Army in India under General Stilwell's command. The Services of Supply was responsible for giving hospital care to the Chinese troops and for furnishing them medical supplies, obtained
7 (1) See footnotes 4 (2), p. 511 ; 5 (1) and (6), p. 513 ; and 6, p. 513. (2) History of the Medical Department Air Transport Command, May 1941-December 1944. [Official record.] (3) Letter, Brig. Gen. Robert P. Williams, MC, to Col. Joseph H. McNinch, MC, Editor, History of the Medical Depart-ment in World War 11, 21 Feb. 1950, and inclosure.
from the British in India,. Under direction of the theater command, American staff officers and training instructors of the Chih Hui Pu, or headquarters for the Chinese Army in India (activated in October 1942 and located at Ramgarh), developed and put into effect the training program. Over 53,000 Chinese officers and men, most of them flown in from China, were trained at Ramgarh between August 1942 and October 1944.
The office of the post surgeon at Ramgarh had charge of sanitation in and around the approximately 1,000 buildings on the post, which was located in partially cleared jungle and abandoned rice paddies. This office directed the work in control of malaria and venereal disease. It also supervised the post hospital, which for some months was operated by Dr. Gordon Seagrave, the "Burma surgeon," who had accompanied General Stilwell on the trek out of Burma. The same office was responsible for the work of veterinarians on the post, both in animal care and food inspection. As the commander of the Ramgarh Training Center was directly responsible to the Commanding General, Services of Supply, rather than to the commander of the base section in which the center was located, the post surgeon reported to the Services of Supply on the technical aspects of his duties.
A separate group of Medical Department officers, together with some English-speaking Chinese medical officers and 11 European civilian doctors hired by the Chinese Red Cross, gave medical training to the Chinese officers and soldiers at Ramgarh. Chinese officers and men were trained as members of field medical units; medical officers were given both basic and refresher courses in anatomy, practical surgery, preventive medicine, and other subjects. Officers of the Pharmacy Corps were given dental training; in the Chinese Army the pharmacy corps officer was responsible for dental as well as pharmaceutical work. The group of Army Medical Department officers in charge of training was responsible to the theater surgeon, reporting to him through his deputy at his rear echelon office in New Delhi. Some were assigned as liaison officers with the larger Chinese units and helped Chinese surgeons to establish unit dispensaries and field hospitals, later accompanying them to Assam, where in the fall of 1943 the front was reopened for the invasion of Burma.8
Base and Advance Sections
Colonel Tamraz' office had responsibility, through surgeons assigned to advance, intermediate, and base sections, for the usual medical functions of a Services of Supply in a theater of operations. Fixed hospitals for the theater got under way when a station hospital began receiving patients in May 1942. By October 1944, when the China-Burma-India command was divided into 2 theaters, 7 general hospitals, 22 station hospitals, 3 medical depots, and a
8 (1) See footnotes 4(1) and (2), p. 511; and 7(3), p. 514. (2) History of the Services of Supply, China-Burma-India, 28 Feb. 1942-24 Oct. 1944. [Official record, Office of the Chief of Military History.] (3) Annual Reports, Camp Surgeon, Ramgarh Training Center, 1943 and 1944. (4) Annual Reports, Medical Sub-section, Ramgarh Training Center, 1943 and 1944.
Map 14.- China-Burma-India theater, August 1944
medical laboratory were serving the Services of Supply organization; the great majority of these installations were in India. The Services of Supply furnished medical supplies and hospitalization to the Tenth Air Force in India, a few U.S. Army ground troops, the Fourteenth Air Force fighting in China., Air Transport Command personnel, the troops of the Services of Supply itself, and to patients of the Chinese divisions (or X-Force) based in India and committed in the Second Burma Campaign.
The area commands of the Services of Supply were created during and after the summer of 1942 (map 14). The layout of the theater, with two separate fighting fronts, led to advance sections in both India and China. Some area commands were of brief duration, and the usual changes in names and boundaries to accord with shifts in the tactical situation took place. Five regions of the theater remained fairly stable entities for Services of Supply administration, however, despite their shifting roles.
Army stations on the western half of India were organized into a base section with headquarters at Karachi, the principal American military port in the early months of the theater's existence. In 1942 the medical supply depot at Karachi was very active; it had inherited many tons of lend-lease, medical supplies, including equipment for more than a dozen small hospitals, intended for the Yünnan-Burma Railroad. Several small station hospitals and one general hospital served in this base section. But the base section in eastern India later became more important, for Calcutta, headquarters of the base section, became the major receiving port. Here troop concentration became heavy with
the buildup of the air forces for carrying supplies over the Hump to China. At one time the base section surgeon had as many as 10 Army hospitals under his supervision. The provision of hospitals for XX Bomber Command elements based west of Calcutta was a major project of 1944. An important job in Cal-cutta, requiring joint action with British and Indian authorities, was the, main-tenance of satisfactory sanitary conditions in the notoriously ill-kept restaurants of the city. Toward the end of 1943, British and American military forces created an Allied Hygiene Committee to make regular inspections of the restaurants and recommend as to whether they should be placed out of bounds to Allied troops. This work, important in the control of enteric diseases, continued to the end of the war.
In the advance section (later an intermediate section), located in the upper Brahmaputra valley of northeast India, the commander of the station hospital at Chabua, headquarters of the section, doubled as section surgeon. In the spring of 1943 some veterinary officers and a Sanitary Corps officer were added to the medical staff, but not until April 194:4 was the position of section surgeon separated from that of hospital commander, This was a highly malarious area and troops were greatly dispersed, both among the airbases and along the railway, pipe, and signal lines leading to Ledo. Some half dozen small station hospitals, a number of malaria control units and food inspection detachments, and a medical laboratory served the advance section. Within the boundaries of the section, but not a part of its organization, was " the office of the Surgeon, India-China Wing, ATC (Air Transport Command), which was also at Chabua, the western terminal of the Air Transport Command's route. over the Hump between India and China. The wing surgeon supervised medical service for aircrews transporting men and supplies back and forth across the Hump, as well as for personnel stationed at the India-China Wing's bases.
The base section which included the northeastern province of Assam eventually became, with the advance into Burma, an advance section which embraced the neighboring reconquered parts of Burma. Its headquarters was at Ledo, the starting point of the Ledo (Stilwell) Road, being constructed to connect with the Burma Road to China. Its original surgeon, Lt. Col. Victor H. Haas of the U.S. Public Health Service, faced the difficulties posed by the task of the base section and its location- at the end of a tenuous line of supply, in a region of enervating climate, many disease vectors, and contaminated water sources. The base section served the thousands of laborers, as well as service troops, who were building and protecting the Ledo Road- a. medley of British, American, and Chinese soldiers and Indian workmen. The surgeon's office, established toward the end of 1942, included a "Chinese Liaison" unit and an "Indian Medical Service" unit to handle arrangements made with the Indian and Chinese Governments for furnishing hospitalization and other medical care to Chinese and Indian troops. The threat of malaria was recognized early; three specialists in malaria control were assigned to the surgeon's office. before malaria control and survey units arrived from the States. The small number
of officers allotted to the medical section- only 5 in mid-1944- had to be supplemented by 11 others attached for "special duty." Troops of the Chinese Army in India and the, Northern Combat Area Command engaged in Burma received hospitalization at installations- including the large 20th General Hospital, a University of Pennsylvania-affiliated unit of 2,000 beds- maintained by the advance section. At the end of 1944, when the Ledo area had become part of the new India-Burma theater, the advance section, as it was now termed, was responsible for medical service for about 160,000 Chinese and American troops and 15,000 animals.
Units of General Chennault's Fourteenth Air Force predominated throughout the advance section (Advance Sections 3 and 4 until January 1944) in China. The air force had its own dispensaries, actually small hospitals, at towns such as K'un-ming and Kweilin, where its units were based. Since the Chinese Government supplied these rapidly shifting air units with food and lodging, and since the U.S. Army had no responsibility for supporting Chinese troops in China with fixed hospitalization, the role of the Services of Supply in China was a limited one. At K'un-ming, the eastern terminal of the Hump route, the India-China Wing, ATC, maintained the usual separate medical service. Hence the advance section surgeon at K'un-ming never had any extensive staff. His duties- supervision of the section's only hospital at K'un-ming, a small medical supply depot, and a few other medical installations- were originally performed by a medical officer on General Chennault's staff and later by the commanding officer of a station hospital. Only in March 1943 was a Medical Corps officer separately assigned as surgeon. The SOS (Services of Supply) Advance Section in China later established a provisional hospital at Kweilin, as well as the station hospital at K'un-ming; these installations furnished fixed hospitalization to the troops of the Fourteenth Air Force and to the XX Bomber Command elements that moved to China bases in 1944.9
Functions and Staffs in 1943
The tasks performed respectively by the theater surgeon and the Services of Supply surgeon, as well as their relations with each other, were affected by a number of factors, some of which were mentioned at the beginning of the chapter: the split of the theater into two distinct regions; the numerical preponderance of American air force and Services of Supply troops over ground troops; responsibility of the Army Medical Department for large numbers of Chinese troops in India, later in Burma; and the lack of coordination and scattered locations of headquarters of the top commands. Close rapport between the theater surgeon and the Services of Supply surgeon was not possible, although Colonel Williams conferred with Colonel Tamraz whenever he flew across the
9 (1) Annual Reports, Medical Department Activities, Base Section 1, 1943 and 1944. (2) Annual Report, Medical Department Activities, Base Section 2, 1942. (3) Annual Reports, Medical Department Activities, Base Section 3 (Advance Section 3), 1943 and 1944. (4) See footnotes 4(l), (2), and (4), p. 511; 6, p. 513; 7(2), p. 514; and 8(4), p. 515.
Hump to inspect medical installations and units on that side of the theater. During the 17 months that he was stationed in Chungking, Colonel Williams made six flights over the Hump to India, conferring with Colonel Tamraz on each occasion. Not until mid-1943 did Colonel Williams have any commissioned assistant; thereafter he had only one or two officers and clerical assistants. His rear echelon office in New Delhi was headed by a number of deputies, most of whom served for short periods, several being sent back to the United States because of illness. The frequent change of deputy hampered effective coordination between the theater surgeon's two offices.
Colonel Tamraz, lacking a medical inspector, had to spend much time in inspection of hospitals and medical supply depots throughout the base sections of India-at Calcutta, Gaya, Ramgarh, Chabua, Agra, and so forth. He handled problems of medical supplies and equipment, which entered the theater at Indian ports, and of station and general hospitals. The theater surgeon was chiefly concerned with developing plans, in conjunction with Chinese governmental authorities in Chungking, for the medical training of the Chinese, troops in India and China and for furnishing medical care in U.S. Army field hospitals to the Chinese on the Assam front; he also personally inspected the training and care furnished. Beginning in the spring of 1943, his responsibility for planning for Chinese troops was greatly expanded when the development of the Y-Force got under way in southwest China. In this situation the Services of Supply medical office developed somewhat independently of the theater surgeon.10
Largely through force of circumstances, Colonel Williams' job came to be unlike that of the orthodox theater surgeon. His chief activities- planning in cooperation with Chinese authorities and inspection of the medical service for Chinese and American troops during the Second Burma Campaign- resembled those of General Kenner at Supreme Headquarters in the European theater. Colonel Williams found that he encountered difficulty in swing General Stilwell and, since the latter did not readily delegate authority to subordinates, getting command decisions. Not until the advent of Maj. Gen. Daniel I. Sultan as General Stilwell's deputy early in 1944 did Colonel Williams find it possible to got prompt command backing for his recommendations.11
In 1943, during periods of stay at the Chungking office, Colonel Williams had conferences about once a week with the Surgeon General of the Chinese Army and with the Director General of the National Health Administration. Both had offices near Chungking. With the former and with Madame Chiang Kai-shek, then the Generalissimo's representative on medical affairs, he frequently discussed matters of lend-lease medical supply for the Chinese and medical training and hospitalization for Chinese troops. The task of building
10 (1) See footnotes 1, p. 505; 3 (1), (2)
and (4), p. 507 ; and 4 (2), p. 511. (2) Letter, Col. John M. Tamraz, MC,
to Col. Joseph H. McNinch, MC, Editor, History of the Medical Department
in World War II, 27 Feb. 1950.
up the Chinese Army's medical service was arduous, both because of the dearth of doctors and because of the diffusion of responsibility.12
During 1943, Colonel Williams traveled to many areas of India and China, inspecting dispensaries, evacuation, station, and general hospitals, medical depots, and other medical installations, both American and Chinese, particularly in Base Section 3, where work on the Ledo Road was in progress. After the opening of the Second Burma Campaign in October, he visited many sites in the combat zone by plane, concentrating upon the "trouble spots" of medical service for the Chinese troops and conferring with Chinese and American medical officers. During 1943, the chief surgical and the chief medical consultant of the Surgeon General's Office, the chief of preventive medicine of that office, General Fox of the U.S.A. Typhus Commission, and the Secretary of War's representative on bacteriological warfare (John P. Marquand, a novelist) visited the theater. Colonel Williams conferred with all of these. The chief medical consultant, accompanied by Colonel Williams, made a thorough study of American and Chinese hospitals in eastern India.13
The theater surgeon had to make a special effort to exercise any supervision over the medical service of certain subordinate commands; the geography of the theater aggravated the difficulty of integrating their medical service into a theater-wide system. Medical Department officers of the air forces, especially of General Chennault's Fourteenth Air Force and of the Air Transport Command wing, made the usual efforts to achieve am autonomous medical service. The XX Bomber Command, which was based in India and China from June 1944 to March, 1945 during its long-range bombing of Japan, was a part of the Twentieth Air Force, which for some time was under direction of the Washington headquarters of Army Air Forces; its headquarters medical staff dealt directly with the Air Surgeon in Washington in outlining its medical requirements. Medical Department officers assigned to the infantry regiment known as "Merrill's Marauders" and those of the "secret hospital" serving with Detachment 101 of the Office of Strategic Services worked entirely on their own for some months after their arrival in the theater, as the existence and missions of the outfits which they served were perforce kept highly secret. Colonel Williams was not informed of the arrival of either of these elements. When he learned of their presence by accident he sought out their surgeons personally and made special arrangements to assure them medical supplies and to evacuate and hospitalize their patients.14
The Services of Supply surgeon, Colonel Tamraz, found his assignment difficult, and the diary which he kept during the war years is tinged with melancholy. In his opinion, his office was never properly staffed. He received complaints about some seven or eight Medical Department officers in adminis-
12 See footnotes 4 (2), p. 511; and 7 (3),
trative positions in the Services of Supply (commanding officers of hospitals in a few instances). The charges included drunkenness, malingering, undue harshness, and mental or physical deterioration. In some instances he shifted these officers to other localities or other types of work. In July 1943, he wrote to the Personnel Division of the Surgeon General's Office, complaining of the quality of Medical Corps and Medical Administrative Corps personnel being sent to the theater.
To Colonel Tamraz, the low rank of Medical Department officers- there was no Medical Department general officer in the theater at any time during the war- compared with the rank held by officers of other services constituted ground for further dissatisfaction. He lamented, as did Medical Department officers in all theaters in which the British were present, the higher rank commonly held by a British medical officer performing the same tasks as an American medical officer. Occasionally he recorded his objections to being bypassed on decisions on medical matters by line officers, to adverse decisions on his recommendations by line officers who seemed unsympathetic to the medical service, and to the shifting of Medical Department enlisted men to duties other than medical. He noted the usual efforts by air force commands to set up their own medical supply depots and station hospitals and deprecated duplications in medical service caused by the presence of several commands within a given area. He experienced some of the usual difficulties with medical supply: low priority in transport, losses when ships were sunk, and occasional theft. In May 1943, he reprimanded a Medical Department officer for a reason not commonly recorded: in a station hospital's monthly Sanitary report the officer "had criticized the activities of the Medical Department something scandalous."15
Although some additions were made to the, staffs of the theater and Services of Supply surgeons during 1943, no consultants were added to either. The chief trend in the organization of these two offices during 1943 was the transfer of personnel responsible for major phases of preventive medicine, particularly malaria control and venereal disease control, from the office of the Services of Supply surgeon in New Delhi to the theater surgeon's rear echelon office in the same city. Colonel Williams wanted as complete a staff as possible in his New Delhi office to prepare and issue theaterwide directives.
As a result of sending the U.S. Public Health Service officers to the bases where they had directly initiated malaria control programs, by early 1943 malaria control had become largely a Services of Supply responsibility. The Services of Supply surgeon's office had acquired a, Sanitary Corps specialist in food and nutrition and a venereal disease control officer. In early 1943, the theater surgeon transferred the venereal disease control officer to his own office in New Delhi and made a similar move with respect to the malaria control staff. When the standard type of malaria control organization recommended by the Surgeon General's Office was under discussion early in 1943, Colonel Tamraz'
15 See footnotes 1, p. 505; 3 (2), p. 507 and 10 (2), p. 519.
office drew up a plan for malaria, control organization under the aegis of the Services of Supply, to be supervised by a malariologist on Colonel Tamraz' staff, with malaria control officers attached to the headquarters of base, intermediate, and advance sections.
With the assignment of Colonel Rice as theater malariologist in February 1943 and the arrival about 3 months later of antimalaria units from the States, the theaterwide program for malaria control got under way. Colonel Rice was assigned to the theater surgeon's office from the outset, and in June four assistant theater malariologists who had arrived with the units were assigned to the same office. Thus by mid-1943, the theater surgeon bad concentrated in his office the direction of two important phases of preventive medicine- venereal disease control and malaria control. The trend continued in the fall when the Chief of Preventive Medicine, SOS, who had arrived in the theater early in the year, was transferred to the theater surgeon's office. In Colonel Williams' opinion it was preferable, in the absence of sufficient Medical Department personnel to staff both offices with preventive medicine specialists, to station those assigned to major control programs at the higher level in order to enable them to make their policies effective throughout the theater. From this level they could issue theaterwide directives and could enter the combat zone, where General Stilwell was unwilling for Services of Supply personnel to go. Colonel Tamraz, on the other hand, came to regard removal of personnel from his medical section to Colonel Williams' New Delhi office as interference with the medical work of the Services of Supply. By the end of 1943, the theater surgeon's New Delhi office had the following personnel engaged in preventive medicine: A medical inspector, a venereal disease control officer, a malariologist, and three assistant malariologists. One aspect of preventive medicine- nutrition -remained in the office of the Services of Supply surgeon throughout the existence of the theater; studies of the troop ration, Army messes, and hospital diets were made by nutritionists assigned to the base, intermediate, and advance sections. Since the Services of Supply was responsible for supply of rations, it was logical to handle the medical aspects of nutritional problems through that command.16
At the end of 1943, Colonel Williams had in his office at forward echelon headquarters in Chungking only an assistant dental surgeon (actually on duty as station dental officer at the K'un-ming headquarters of the Fourteenth Air Force), an administrative assistant, and four enlisted men. As assistant theater surgeon, Col. George E. Armstrong, MC (fig. 119), entered on duty in the Chungking office early the following year. At his New Delhi office, Colonel Williams had, besides the preventive medicine group mentioned above, a deputy, a theater dental surgeon, a theater veterinarian, a medical supply officer, an executive officer, and seven enlisted men. At the same date the Services of
16 See footnotes 3 (1), p. 507; and 4 (1) and (2), p. 511.
Supply surgeon had in his office, besides the nutrition officer, the following Staff: An executive officer; a dental surgeon; a chief of veterinary service, SOS; an administrative assistant and records officer; and a medical supply officer and four assistants.17
Training of Chinese Combat Forces
Plans for the training of Chinese troops contemplated two groups of 30 divisions each; one group was to consist of the divisions being trained in India, separately referred to as X-Force, and of the divisions, termed Y-Force, which would be developed in Yünnan Province in southwest China. The other group of 30 divisions, called Z-Force, would be assembled and trained in southeast China. The job of planning the medical phases of this training fell to the small group of Medical Department officers who comprised the theater surgeon's Chungking staff during 1943 and 1944. As noted above, training of the X-Force took place at Ramgarh, India. An operation staff was established for Brig. Gen. Frank Dorn's Y-Force in April 1943 and one for Z-Force in Jan-uary 1944. To each staff a few U.S. Army Medical Department officers and men were assigned to aid in giving field medical training to the Chinese and to act as liaison or staff officers in the field with Chinese units.
17 See footnote 4 (2), p. 511.
A surgeon and a veterinarian were included in the medical section at Y-Force Operations Staff headquarters in K'un-ming, other Medical Department officers being assigned as liaison officers with the units. Medical training given the Chinese was designed to supply medical personnel to accompany the combat troops, and to staff units concerned with evacuation; that is, to equip the Chinese divisions with the first and second echelon medical service similar to that in the U.S. Army. The Infantry Training Center at K'un-ming was the prototype of several centers at which medical training was given. The Surgeon, Y-Force Operations Staff, with the aid of six U.S. Army officers and the same number of enlisted men, set up the medical section at this center. Medical, dental, and veterinary training was given to Chinese officers and men of Y-Force at training centers at Kweilin, Tali, and Yenshan, as well as at K'un-ming.
At the outset of the Salween River campaign, one U.S. Army medical officer, one veterinary officer, one Medical Department enlisted man, and one veterinary enlisted man were detailed to each army group, army, and division of the Y-Force. Officers who had lived in China or who spoke Chinese were used as American staff officers insofar as they were available. The Chinese Army Medical Department supplied the chain of evacuation as the Y-Force cleared the Burma Road and thrust westward to join the X-Force advancing through northern Burma. Ten U.S. Army portable surgical hospitals and three field hospitals had to be used to strengthen this chain, for the Chinese Army Medical Department was inadequately supplied with hospitals of these types, chiefly because of the dearth of surgeons to handle emergency surgery near the front. Eighteen U.S. Army veterinary detachments were used in the care of thousands of pack animals transporting personnel and equipment of the Y-Force. The field and portable surgical hospitals were among the units moved by pack animals.
The 30 Chinese divisions planned in southeastern China never really developed; the Japanese offensive toward K'un-ming in the summer of 1944 suppressed Z-Force in its infancy. The significant medical work undertaken by U.S. Army Medical Department officers assigned to this force was the conduct of a training program similar to that for Y-Force. Medical training for Z-Force was centered in the Infantry Training Center at Kweilin, where Z-Force had its headquarters, from late 1943 to the summer of 1944. Dental and veterinary training were also given. When the school closed on 25 July 1944 it had graduated 535 Chinese medical officers, 24 pharmacy officers (given dental training), and 412 veterinary officers, enlisted technicians, and horseshoers. The coordination of procedures for handling medical supply became, as in Y-Force, a major problem. Again the U.S. Army had to takeover. Beginning in July 1944, two medical maintenance units per month were delivered to Chabua and flown over the Hump to K'un-ming for the use of Z-Force. By October 1944, the Japanese drive had doomed Z-Force to extinction as an effective fight-ing force. In November, the Y-Force and Z-Force Operations Staffs combined
to make up the Chinese Combat and Training command of the newly formed China theater. 18
The Air Forces
The medical section of Tenth Air Force, the chief American combat element in the theater, was at New Delhi in 1943; it doubled as the medical section of the air force service command. Until March 1943, when the Fourteenth Air Force was created, the Tenth Air Force theoretically supervised the medical activities of two major fighting components- India. Air Task Force which protected the air route between India and China from its bases in Assam, and General Chennault's China Air Task Force based at K'un-ming. Because of the remoteness of General Chennault's component from the New Delhi headquarters of Tenth Air Force, little effective control was exercised over its medical service by the Tenth Air Force surgeon, although the Tenth Air Force Service Command gave medical support to the Fourteenth Air Force.
In August 1943 the Army Air Forces, India-Burma Sector, was created with three major components: the China-Burma-India Air Service Command, China-Burma-India Air Forces Training Command (engaged in training of Chinese personnel at Karachi), and the Tenth Air Force. First surgeon of the new India-Burma Section was former Tenth Air Force Surgeon, Col. Hervey B. Porter. He was relieved in March 1944 by another former Tenth Air Force Surgeon, Col. Clyde L. Brothers, MC (fig. 120). At this time the medical section consisted of five officers- two Medical, two Veterinary, and one Dental- a warrant officer, and eight enlisted men. This office served also as the medical section for the China-Burma-India Air Service Command. Both the, training command and the Tenth Air Force had Separate medical sections. The China-Burma-India, Air Service Command furnished medical supplies to the Fourteenth as well as to the Tenth Air Force.
In October 1943, the Tenth Air Force medical section moved with its headquarters to Calcutta. The following April the Medical Section, Army Air Forces, India-Burma Sector, made the same move. While the latter medical office remained there, that of Tenth Air Force went forward to various sites in Burma during the Northern Burma Campaign in 1944. The chief diseases faced by air force troops on the India-Burma side of the theater were malaria, the gastrointestinal diseases, and venereal disease. During the summer of 1943, unit and group surgeons of the Tenth Air Force took refresher courses at the Tropical School of Medicine in Calcutta.19
On the China side, of the theater was the Fourteenth Air Force, as General Chennault's fighting force was named after March 1943. Its K'un-ming head-
18 Smith, Robert G.: History of the Attempt
of the United States Army Medical Department to Improve the Efficiency
of the Chinese Army Medical Service, 1941-1945. [Official record.]
quarters and its China bases, amounting to 28 by the end of 1943, were far removed from Services of Supply and the various air force headquarters in India. Medical supplies had to be flown to Fourteenth Air Force over the Hump. The complete dependence upon air transport prohibited the construction of the usual living facilities at the bases, and Fourteenth Air Force units had to live off the land. The Chinese Government maintained hostels close to the airbases to house and feed Fourteenth Air Force troops. Throughout the life of the theater this dependence upon the Chinese for food and lodging subjected Fourteenth Air Force personnel to the unsanitary conditions and diseases prevailing among the Chinese people. The refusal of the Chinese to accept pay for the services rendered made it difficult to insist upon U.S. Army standards of diet and sanitation. Another factor affecting its medical service was the extreme mobility of the air force. General Chennault shuffled his squadrons from base to base. As bases outnumbered squadrons, most bases were occupied only a part of the year, and maintenance of a stable medical service was correspondingly difficult.
An interesting feature of the Fourteenth Air Force was its Chinese-American Composite Wing (Provisional) which was composed of from 30- to 40- percent American and from 60- to 70- percent Chinese personnel. It was created and trained in Karachi, whence its squadrons were fed to the Fourteenth Air Force in China. Although Chinese patients from this unit were
usually cared for in hospitals of the Chinese- air forces, the close cooperation of Chinese and American medical personnel in the outfit afforded some experience with the process of building up an integrated medical service among Allied air troops.
The Fourteenth Air Force had, of course, the usual flight surgeons as signed to units. By the end of 1943, 10-bed dispensaries operated by a surgeon and a few enlisted men were being established at each base. Besides receiving emergency cases arising from accident and combat, these installations took care of minor cases which would otherwise have had to be evacuated by air to the station hospital maintained at K'un-ming for air force personnel. Dental officers were scarce and were rotated among the base dispensaries. Nursing service was provided by nine Chinese nurses; General Stilwell opposed the use of American nurses in China, although the air force surgeon stressed the need for American nurses. By July 1944, the medical strength of the Fourteenth Air Force, which had been served by 10 Medical Department officers (including a dentist) and 34 enlisted men when it was created in March 1943, amounted to about 50 Medical Department officers, including 10 dental officers, and approximately 150 enlisted men. The strength of the command was then a little over 8,000.20
Elements of the XX Bomber Command that came into the theater in 1944 with the mission of bombing enemy-held industrial targets in Japan, Manchuria, and southeast Asia, settled into bases in the Kharagpur area west of Calcutta, in Assam and northern Burma, and in China between K'un-ming and Chengtu. The command's medical section was located at command head quarters at Kharagpur. The usual air force dispensaries served XX Bomber Command bases. Patients requiring hospitalization were sent to the fixed hospitals maintained by the Services of Supply base, advance, or intermediate sections.21
The air forces in the China-Burma-India theater never developed such specialized means of coping with special stresses to which flying personnel were subject as did the air forces in some oversea, areas, probably because of their small size and lack of the necessary medical resources. They developed no central medical establishment, and instead of creating convalescent centers they sent men who had been under severe physical and mental strain for long periods to mountain resorts to recuperate. The Tenth and Fourteenth Air Force surgeons agreed with the Air Surgeon in Washington that the air forces in the theater should control hospitals caring for air force personnel. Colonel Gentry voiced the most telling argument, basing his objection to hospitalization of troops of his air force in Services of Supply hospitals on the remoteness of the Fourteenth Air Force from the India bases where the hospitals of the
20 (1) See footnote 5(2) and (3), p. 513. (2)
Annual Report, Surgeon, Fourteenth Air Force, 1944. (3) Medical History
of the Fourteenth Air Force in China (second submission), May-October 1944.
(4) "Stilwell Report": History of the China-Burma-India Theater,
21 May 1942-25 October 1944. [Official record.]
Services of Supply were located. The Services of Supply maintained no general hospitals in China, and only one station hospital. Colonel Gentry stated that delays had occurred in returning Fourteenth Air Force patients hospitalized in India back over the Hump to China.
Colonel Gentry expressed the opinion that the theater surgeon had treated Medical Department officers of the Fourteenth Air Force like stepchildren in consonance with the policy of the theater organization toward all Army Air Force activities. This charge reflected not only the Air Force's usual tendency toward autonomy; it was also a faint echo of the quarrel between General Stilwell and General Chennault over the combat role of General Chennault's Fourteenth Air Force in the theater. Air force surgeons also complained of insufficient medical supplies. As late as June 1944, shortages still existed in some items of basic equipment for air force medical units. Their protests led to the sending of the Voorhees mission to the theater to investigate the situation in 1944.22
The India-China Wing of the Air Transport Command, a semiautonomous command within the theater, was first established under that name in December 1942. It originally had headquarters at Chabua, where the headquarters of Advance Section 2 was located. About a year later, it moved to New Delhi and in April 1944 to Calcutta. Its primary mission was the transportation of sup-plies and personnel from India over the Hump to China. During 1942, after the disaster in Burma, the air shipments into China over the Himalayas had been accomplished by planes of the China National Aviation Corporation, the Tenth Air Force, and the First Ferrying Group, a forerunner of the India-China Wing. These agencies had also undertaken air evacuation of the sick and wounded from Burma into India. They had flown out thousands of men and dropped supplies by parachute to those retreating on foot. Within a few months after the newly created India-China Wing assumed the ferrying task, a wing dental officer was assigned, and Lt. Col. (later Col.) Don Flickinger, MC, was appointed surgeon. The strength of the wing was then only about 300 officers and 1,500 enlisted men. As in other Air Transport Command wings, the wing surgeon supervised the aviation medical dispen-saries-in reality small hospitals-assigned to the wing. Six such units arrived in July 1943 and were located at wing bases in Assam. The chief health menaces with which Medical Department officers of the command had to cope were malaria and dysentery, unsatisfactory food and water supplies, and neuroses among the aircraft crews flying at the extreme altitudes of the Hump route. The surgeon of the Air Transport, Command's Washington headquarters, who visited the wing in May 1943, labeled Colonel Flickinger's task as the "toughest job in the Air Transport Command." Colonel Flickinger estimated that 70 pilots of his wing would need replacement monthly for medical reasons.
22 (1) Letter, Surgeon, Army Air Forces, India-Burma Sector, to Deputy Air Surgeon, 2 Oct. 1944. (2) Memorandum, Lt. Col. Lamar C. Bevil, for the record, 10 June 1944. subject: Interview With Colonel DeWitt.
The India-China Wing came to have heavy responsibility for air evacuation of the sick and wounded. It handled air evacuation of casualties en route to the United States and intratheater air evacuation from station hospitals to general hospitals along Air Transport Command routes from China to India and within India. A medical air evacuation transport squadron, the 803d, stationed at Chabua, performed this phase of the wing's work, while another, the 821st, evacuated thousands of wounded Chinese, Burmese, Kachins, Gurkhas, and Japanese from airstrips near the Assam and Burma fronts to U.S. Army hospitals in India. The terrain and flying conditions in the Himalayas called at times for spectacular efforts on the part of medical personnel of the wing. In August 1943, for instance, Colonel Flickinger and two enlisted men landed by parachute in a remote area southeast of Chabua to aid a group (including the war correspondent, Eric. Sevareid) who had to bail out of a C-47 after motor trouble over the Hump. All except the copilot, killed in the landing, came out alive. In a number of instances, missionaries stationed in remote areas of China aided in rescuing downed aviators and nursing them back to health.
Provision of pure food and water at the wing's bases proved to be a, major problem. In 1944, a sanitary engineer was given the task of insuring a pure water supply, and a nutritionist was assigned to the wing to analyze foods received at the various bases and to make recommendations to improve the healthfulness of the diet. Trained entomologists carried on experiments in malaria control in the wing laboratory.
By August 1944, the India-China Division (as the wing was now called) had 17 stations in the theater- 12 in India, 4 in China, and 1 at Colombo, Ceylon. At this date, the strength of the command amounted to about 15,600 men, including approximately 1,600 attached personnel. Medical Department officers serving the command totaled 81 near the end of July. Nearly 400 Medical Department enlisted men served the wing.23
The Allied Chain of Command
Col. Earle M. Rice, MC, was the only U.S. Army doctor assigned to the Medical Advisory Division on the staff of Admiral Mountbatten's Southeast Asia Command, created in the fall of 1943.24 The Allied command had operational control over United States and British land, sea, and air forces in Burma, Siam, Malaya, Sumatra, and Ceylon, and the northeastern fighting front in
23 (1) See footnotes 7(2), p. 514; and 20(4),
p. 527. (2) Memorandum, Brig. Gen. Fred W. Rankin, for The Surgeon General,
2 Nov. 1943, subject: Remarks on Recent Trip Accompanying Senatorial Party.
(3) Report, Col. I. B. March, MC, Office of Air Inspector, 21 Aug. 1944,
subject: Summary of Medical Inspection of Air Transport Command and Stations
in the China-Burma-India Wing.
India. Its jurisdiction did not extend to American forces in China or to those with the Services of Supply in India. The group of experts in tropical medicine and hygiene who made up the Medical Advisory Division was headed by a British medical officer, Maj. Gen. Treffery Thompson. The Southeast Asia Command operated medical facilities for the British and American forces (ground, naval, and air) assigned to the command, but the chief work of this medical staff was to investigate the best means of disease prevention and recommend measures to be adopted. It met with the heads of medical service of the various commands of the Allies operating in Asia and with their senior experts in malaria control and sanitation. It kept in touch with such special projects as the control of scrub typhus, undertaken by a team of the U.S.A. Typhus Commission in cooperation with British and Indian experts.
Although Colonel Rice was stationed at the headquarters of the command at Kandy, Ceylon, he spent a good deal of time at various critical areas of malaria control. He took a leading part in experiments which the U.S. Army made with airplane spraying of DDT in India. In 1944 and 1945, he made trips to England and the United States to got sanction for large quantities of antimalaria supplies for the theater.
The Southeast Asia Command appears to have left the administration of medical service within the individual commands largely up to those commands. Although the existence of Admiral Mountbatten's Allied headquarters might presumably have caused some confusion as to medical responsibilities of subordinate commands of the Allies in Asia, as it did with respect to military responsibilities in general, no record has been found of any serious conflict over medical matters arising from its activities. Since the Southeast Asia Command did not have jurisdiction over the U.S. Forces in the China-Burma-India theater, the office of the surgeon of the latter command had little contact with the Medical Advisory Commission except with the American representative (Colonel Rice) at Admiral Mountbatten's command in connection with malaria control among the troops fighting in Burma.25
American, British and Indian forces-service and ground troops-reinvading Burma were organized into the Northern Combat Area Command, created in February 1944. Commanded by General Stilwell, it was subordinate to Admiral Mountbatten's Southeast Asia Command. Combat Troop Headquarters had been formed in October 1943 as an American headquarters for the American service units in the Chinese Army, and Col. Vernon W. Peterson, MC, was made its surgeon. He continued in this capacity for the final Allied tactical command. Colonel Peterson's medical section was never large. At its peak it contained an assistant surgeon, who acted as forward echelon sur-
25 (1) See footnotes 3(2), p. 507; and 4(2), p. 511. (2) Letter, Lt. Col. Hardy A. Kemp, MC, to Col. Robert P. Williams, MC, 21 Nov. 1943. (3) Letter, Earle M. Rice, M.D., to Col. Calvin H. Goddard, MC, Editor, History of the Medical Department, U.S. Army, in World War II, 6 Dec. 1951, and attachment. (4) Letter, Lt. Col. B. L. Raina, Chief Collator and Editor, Official [India-Pakistan] Medical History of World War II, to Col. R. G. Prentiss, Jr., MC, Executive Officer, Office of The Surgeon General, 25 Mar. 1952.
geon and medical inspector, a company grade officer in charge of medical supply, and a few enlisted men. Certain officers in the field handled special problems for the surgeon. The commander of a malaria control unit, for example, acted as malariologist for the command, and Veterinary Corps officers assigned to Chinese troops acted as sector veterinarians. Colonel Peterson obtained his medical supplies from the medical supply officer at advance section headquarters in Ledo. On technical medical matters he dealt with the theater surgeon, or with his deputy in New Delhi. The U.S. Army Medical Department units assigned to Northern Combat Area Command treated over 20,000 Chinese patients for diseases, injuries, and battle casualties during the period 1 January- 26 October 1944. Except for a continued shortage of personnel, which placed exceptional demands on the endurance of the Northern Combat Area Command Surgeon and his staff, no particular organizational problems occurred in this element of the medical service.26
Disease Control: Malaria
Among the insectborne diseases which menaced U.S. Army troops in the China-Burma-India theater were malaria, scrub typhus, and dengue. Other diseases which occurred among the civilian populations of the theater were the diarrheal diseases, which gave the U.S. Army serious trouble; the venereal diseases; typhus; cholera; plague; smallpox; typhoid and paratyphoid; and acute meningitis. Epidemics of several of these occurred at intervals among the civilian populations. Approximately 25,000 troops in the Calcutta area were menaced by a cholera epidemic during the period February-June 1945. Another cholera epidemic raged during the summer of that year in cities and towns of the Yangtze River Valley, resulting in six cases among American troops of the Fourteenth Air Force. The prompt institution of. preventive measures prevented epidemic rates among troops, but rates of incidence of the dysenteries, malaria, and scrub typhus were high enough to demand extra efforts.27
Malaria incidence never became as serious a problem in the China-Burma-India theater as in some other theaters where ground troops were engaged in combat in highly malarious areas for long periods. In 1943, this theater's rates were appreciably below those for other theaters of comparable malaria incidence among the civilian population. On the other hand, the rate did not undergo a decline comparable with that of other theaters, and the lack of centralized authority for the antimalaria program led, as in some other theaters, to certain administrative difficulties.28
26 See footnotes 4 (2), p. 511 ; and 20 (4),
As noted above, initial attempts at malaria control in the theater were undertaken by the group of U.S. Public Health Service officers assigned to the office of the Surgeon, Services of Supply, who went to the various bases. The full malaria control organization for the theater- malariologists and control and survey units- was not established until early in 1943, concurrently with its development in other theaters. The three control and survey units which the Surgeon, Services of Supply, requested, together with some assistant malariologists, arrived within a few months. By late 1944, when the theater was divided into the India-Burma and China theaters, 6 survey units and 15 control units were in operation. Additional ones had just arrived, and still others were scheduled to go to the two new theaters.
In mid-1943, final responsibility for malaria control rested with the office of the theater surgeon. The theater malariologist, Colonel Rice, and the assistant malariologists were assigned to that office. The assistant malariologists and the units were attached to the Services of Supply but were responsible to the theater organization rather than to the base, intermediate, or advance section commanders in the areas where they were operating.
In August 1943, advance and base section commanders were given somewhat more authority over the men doing antimalaria work when a new directive authorized them to move malaria control personnel about within their areas without reference to higher authority. The Services of Supply commander was authorized to transfer them from one section to another, with the concurrence of the theater malariologist or his assistants. Thus the theater organization and the Services of Supply shared responsibility for the personnel engaged in malaria control. Similar dual control existed with reference to antimalaria supplies; Services of Supply depots procured and stored them, while the assistant theater malariologists supervised their allocation and distribution. Although the need for placing ultimate control at the highest level was satisfied by this organization, the interposition of two command head-quarters between personnel supervising antimalaria work and those engaged in operations was awkward. Theoretically, in order to give a command to a malariologist attached to the staff of a Services of Supply section commander, the theater malariologist would have had to recommend that the theater commander advise the Services of Supply commander to direct his section commander to give the order to the malariologist. "Except, for the fact that matters were commonly handled much more informally, it was a confusing house that Jack had built."29
The theater malariologist developed a plan, never put into effect, for a tactical type of organization designed to give administrators of the antimalaria program the power of command over antimalaria personnel. He proposed a malaria control "regiment" to be, commanded by the theater malariologist and to be made up of battalions, each headed by a malariologist; the battalions would consist of malaria survey and malaria control companies. The regiment
29 See footnote 4 (1), p. 511.
would carry out the entire program in the theater, while the Services of Supply would come into the picture, merely as the, source for the, necessary items of supply. This scheme went by the board when Colonel Rice proposed as an alternative an increase in the number of control units for the theater, to which the War Department agreed. His scheme is of interest in that it reflects the conviction of some malaria control personnel that the program could be more effectively run by a military type of organization which would exercise the power of command.
In August 1943, the Chief of the Tropical Disease Section of the Surgeon General's Office, Lt. Col. Paul F. Russell, MC, declared that that office was still giving insufficient emphasis to the planning of an effective malaria. control program for the China-Burma-India theater. He wrote the theater surgeon that a large group of Medical Department officers to be sent to the theater under the leadership of Col. George E. Armstrong, MC, to train Chinese doctors in military medicine included 10 dentists but not a single man with special training in malaria control. With the exception of Colonel Armstrong, none had had experience in tropical medicine. "Apparently the idea, is that the Chinese troops shall bite their way through the Japanese."30
By the spring of 1944, the antimalaria drive had received fresh impetus. The more vigorous program of that year reflected greater consciousness of the need for it both on the part of the War Department and by the theater organization; it also marked clearer emergence of Atabrine, as the preferred malaria suppressive and of DDT as the outstanding insecticide. Admiral Mountbatten's headquarters in Ceylon, where Colonel Rice had entered on his new assignment, had clearly stated the responsibilities of command for antimalaria discipline. Experimental spraying of DDT by planes was undertaken in the spring of 1944, and the first use of Atabrine, as a suppressive among large numbers of troops in the theater took place in April among the X- and Y-Forces in the combat zones. Neither Atabrine nor DDT was yet being received in quantities sufficient for large-scale use, however.
At this juncture, except for the theater malariologist who remained on the staff of the theater surgeon and some units which were assigned to the Northern Combat Area Command, authority over most elements in the malaria control organization was turned over to the Services of Supply. Malariologists and units assigned to the Services of Supply were reassigned to base, intermediate, and advance section commanders. The new scheme was not to the liking of the theater organization, the Services of Supply, or the Air Forces. In the first place, no control or survey units were assigned to the Air Forces, which were responsible, under War Department directives, for education of air troops in malaria control, for the individual airman's conformity to antimalaria precautions, and for enforcement of control measures around barracks
30 Letter, Lt. Col. Paul F. Russell, MC, to Col. Robert P. Williams, MC, 21 Aug. 1943. Since the Chinese Army lacked dentists, a good deal of emphasis was placed on training the Chinese in first aid dentistry in order to reduce the number of casualties due to preventable conditions.
and troop areas of the air forces. As a result of the farflung dispersal of air force troops in the theater, an air force unit might be located in several territories under different command jurisdictions. The theater malariologist also objected to the new arrangement, believing himself too far removed from the personnel engaged in the control work to direct the program effectively. Finally, the Services of Supply encountered the usual difficulties resulting from the fact that the Army Air Forces was its coequal in the chain of command; in China the Fourteenth Air Force, with separatist tendencies, was the prominent American command. From the point of view of the Services of Supply, a poor feature of the latest realinement of authority was the fact that no malariologist was assigned to the office of its surgeon.
The consolidation of the staffs of the theater surgeon and Services of Supply surgeon in August 1944 largely solved the problem. After the Services of Supply surgeon became deputy theater surgeon, the f act that the top malariologist was assigned to theater headquarters and other elements handling malaria control to Services of Supply headquarters was of little importance.
After Colonel Rice observed experiments with airplane spraying of DDT during a return visit to the United States in the spring of 1944, he conducted similar experiments around Chabua in order to determine the most suitable equipment for spraying, the desirable weather conditions, and types of terrain where spraying from planes would be most effective. DDT began coming into the theater in greater quantities, and an organization for theaterwide spraying was worked out by fall. It consisted of 1 malaria survey unit to make entomological investigations, 2 control units to handle DDT, 10 pilots and ground maintenance personnel and the necessary modified planes and equipment. The "India-Burma Spray Flight," as the organization was called, was fully developed only by February 1945, after the new India-Burma theater was established. The Services of Supply was responsible for the program and controlled the units; the Air Forces had the planes and pilots; the Northern Combat Area Command was in charge of the combat area in Burma where large-scale spraying was done to keep down the mosquito population of newly captured areas. The "India-Burma Spray Flight" ran into the usual problems resulting from the participation of several top commands but apparently worked effectively. The large-scale use of insecticides to control malaria contributed to the control of the mosquitoborne dengue as well.31
By midsummer of 1944, 4 malaria survey and 15 control units had created a beehive of antimalaria activity in the theater:
The anti-malaria units were deployed from the ports of debarkation at Calcutta and Karachi to the most forward point in the Theater (the Jap-surrounded Myitkyina airstrip). They were protecting the long lines of communication, the newly constructed B-29 Bases, the old "Hump" bases, the advance depots at Ledo and Shingbwiyang, the engineering outfits carving out the Ledo Road, and the combat bases at Shaduzup, Mogaung, and Myitkyina.
31 See footnotes 3(4), p. 507; 4(l) and (2), p. 511; and 8(4), p. 515. See also Medical Department, United States Army. Preventive Medicine in World War II, Volume VI. Communicable Diseases: Malaria. [In press.]
They were using thousands of coolie laborers digging ditches, cleaning out tanks, and larviciding breeding areas. They were putting up roadside signs warning of the dangers of malaria, they were supervising mosquito-proofing projects, distributing mosquito repellent at outdoor theaters, and trucking supplies into forward areas. The survey men were out locating breeding areas, making blood and spleen surveys, and working in their laboratories. In the latter part of the season there was some DDT, and some experiments with its use, both from the ground and the air, were started. There was a constant educational program in progress utilizing radio, movies, GI newspapers, signs, posters, and personal contact. There was a degree of protection for every one, much more than in previous years, but still not all that was desired. More personnel, more equipment, more supplies, and more DDT were ordered for the next year.32
Critical Problems of 1944
The latter half of 1944 was the crucial period for medical service in the theater. By the middle of the year, serious problems had developed with regard to medical supply, hospitalization, personnel, certain aspects of pre-ventive medicine, and the organization of, and relations between, the theater surgeon's office and the Services of Supply surgeon's office. Concern over these difficulties was shared by the theater surgeon and the Surgeon General's Office. Although staff surgeons of the theater's top commands had observed certain deficiencies in the course of inspection trips in 1942 and 1943, the lack of person-nel had prevented remedial measures.
It was one thing to discover that messes were operated without adequate protection from flies, or with help of native personnel who were probably vectors of intestinal diseases, but it was another thing to procure screening or to persuade commanders, already overworking their personnel, to do away with civilian labor or use enough Americans to supervise the native kitchen help.
On the other hand, two special missions sent from Washington in 1944 and a visit of the theater surgeon to Washington to emphasize the theater's medical needs had a salutary effect.33
By the spring of 1944, it became clear that the theater lacked sufficient hospital beds to cope with casualties to be anticipated from the, fighting in Burma and the expected rise of incidence of malaria and other diseases with the impending monsoon season. By midyear the situation in hospitals around Ledo and in northern Burma became critical. The medical resources of the Chinese forces fighting in Burma were inadequate to provide evacuation and hospitalization behind the regimental rear boundary, and the U.S. Army had been called on to provide the necessary units; that is, the usual field and evacuation hospitals of the combat zone, as well as the station and general hospitals which the Services of Supply operated in the base and advance sections. The U.S. Army hospitals had become crowded with disabled Chinese, as well as those requiring long periods of convalescence before they could return to combat.
32 See footnote 4 (1), p. 511.
For reasons which remain obscure, the theater's reports to Washington had included statistics on the hospitalization of American troops, but not of the Chinese, in Services of Supply hospitals. Hence, although the War Department had authorized beds in proportion to Chinese as well as American troop strength and the theater's beds were well below the authorization Washington authorities were unconvinced of an immediate need for more hospital beds, since statistics seemed to show that a goodly proportion of the available beds were unoccupied. Moreover, the transfer of additional divisions of the Y-Force from China to the X-Force in Burma increased the number of Chinese troops for whose fixed hospitalization the U.S. Army was responsible. U.S. Army support of the X-Force with medical units behind the regimental rear boundary had been agreed upon, but this force had been augmented by three divisions flown from China into Assam and committed in the battles of Myitkyina and Bhamo. When the theater surgeon was called to Washington to explain requests for increases in hospital beds and medical personnel for the China-Burma-India theater, he found that the Operations Division of the General Staff recognized only 57,000 Chinese troops under General Stilwell- the authorized number- although the strength of General Stilwell's Chinese Army had reached approximately 83,000 by the close of July 1944. Colonel Williams' trip eventually bore fruit in 4,300 additional beds for the theater.34
Deficiencies had also developed in the handling of medical supply. A statement by an air surgeon returning to Washington that the Services of Supply in the theater had failed to fill air force requisitions for medical supplies led The Surgeon General to send a mission to investigate the medical supply situation in the China-Burma-India theater. The group, headed by Col. Tracy S. Voorhees, JAGD, inquired not only into the medical supply system, which by that date had suffered an acute breakdown, but also the status of hospitalization, the effectiveness of the preventive medicine program, and the quality and sufficiency of personnel in key administrative positions.
The Voorhees mission backed up statements which the theater surgeon had made in Washington on the need for more hospital beds and the need for more medical personnel. It traced most deficiencies in medical service in the theater back primarily to the lack of well-trained personnel in key positions, particularly in the theater surgeon's office and in posts in the medical supply system. Most of the incumbents in the, theater surgeon's office were unqualified for the positions they then held, the report declared, either because they lacked the necessary training or experience, had attained an age which prevented extensive travel to the front, or lacked initiative or some other desirable trait. The report sized up the theater surgeon's staff as generally inadequate both as to numbers and as to qualifications. It noted that a list of positions proposed by the theater surgeon for his staff had recently been cut in Washington. A de-
34 (1) See footnotes 3(4), p. 507; 13(3), p. 520; and 20(4), p. 527. (2) Stone, James H.: The Hospitalization and Evacuation of Sick and Wounded in the Communications Zone, CBI, and India-Burma Theaters, 1942-1946.[Official record.]
cision by the Surgeon General's Office to restrict consultants to the rank of lieutenant colonel made it difficult to get qualified men for those posts.
The Voorhees report stated that the theater surgeon had left responsibility for fixed hospitalization almost solely up to the former Services of Supply surgeon and that the latter had failed to give adequate supervision both to the hospitals and to the medical supply system. The Services of Supply medical section had also been inadequately staffed, and its present chief, Col. Alexander O. Haff, MC (fig. 121), had so far been unable to get the larger allocation of personnel which he had requested. The medical offices of the three base sections and the two advance sections were for the most part satisfactorily staffed. The major problem, as the mission's report saw it, was that the Services of Supply surgeon lacked control over the base and advance section surgeons because of a tendency towards decentralization of administration to the base and advance section commanders. The report advocated merging the theater surgeon's office with that of the Services of Supply surgeon (without indicating whether the combined medical section should be located at theater or at Services of Supply headquarters). Alternatively, it proposed, if the existence of a separate Services of Supply organization should preclude such a merger, to transfer all operating personnel from the theater surgeon's office
to the medical section at Services of Supply headquarters and to make the Services of Supply surgeon deputy theater surgeon.
The Voorhees report did not pin down responsibility for choice of incumbents. Some assignments had been made in the theater, while in other cases the individuals had been selected by the Surgeon General's Office. According to the report, the Surgeon General's Office lacked adequate knowledge of the men occupying posts in the China-Burma-India theater.
The Voorhees report stressed weaknesses in various phases of preventive medicine, terming the poor protection afforded to the food of troops and the unsanitary handling of food in messes the "most striking medical weakness" in the theater. It noted the commonness of acute diarrhea and stressed the danger of returning men with amebic dysentery to the United States. Unsanitary food conditions were ascribed to the lack of veterinary personnel to inspect food and supervise native personnel who handled food in the messes and to the lack of basic directives, bolstered by strong command support, f or methods of eliminating improper food. In this theater the care of animals- and the training of the Chinese in their care- had loomed large as a veterinary responsibility because of the extensive use of animals for transport on fighting fronts in Burma and China. The available veterinarians had been needed for this work; hence, the number to cope with the unsanitary conditions surrounding the preparation of food had been insufficient. Since troops of the Fourteenth Air Force in China were housed and fed by the Chinese Government, rather than at bases maintained by the U.S. Army's Services of Supply, it was more difficult to insure proper protection of food for U.S. Army troops in China. than in India.
The investigating group also called attention to special problems connected with air force medical service. Contrary to War Department policy, the report stated, aviation dispensaries were acting as hospitals, and one or two regular hospitals were being operated by the air forces in China. The Air Surgeon was currently demanding that additional hospitals be turned over to the Air Service Command.
The Voorhees report attempted to point out certain observed deficiencies rather than to appraise the total Medical Department program in the theater. It advised the dispatch of another special mission to the theater to investigate the following matters: The appointment of a surgeon to relieve Colonel Williams who had already been in the theater 2 years; consolidation of the offices of the theater and services of supply surgeons; the sending of consultants to the theater; status of the preventive medicine program, especially in control of diarrhea and dysentery; adequacy of food inspection; a survey of hospitalization in India and along the Ledo Road; and personnel problems.35
35 (1) "Miscellaneous Notes" as to Medical Department Matters in CBI Theater Outside the Scope of the Supply Survey, 17 Aug. 1944, by Col. Tracy S. Voorhees. [Official record.]. (2) Memorandum, Col. Tracy S. Voorhees and others, for Commanding General, U.S. Army Forces in China-Burma-India, 25 July 1944, subject: Medical Supply in CBI. (3) Letter, Col. Tracy S. Voorhees, to Deputy Theater Surgeon (Colonel Armstrong), 18 Aug. 1944. (4) See footnote 8(4), p. 515. (5) Account of Visit to China-Burma-India Theater to Survey Medical Supply, 11 Sept. 1944, by Col. Tracy S. Voorhees. [Official record.]
As a sequel to the Voorhees survey, The Surgeon General sent a mission headed by Brig. Gen. Raymond A. Kelser, Chief of the Veterinary Corps, to the theater in October and November 1944 to survey sanitary conditions and Veterinary and other professional services. Since a reorganization into two theaters was then under way, this mission did not tackle the more purely organizational problems to which the Voorhees report had called attention. The theater commander informed the Kelser mission that he would concur in the reassignment of the present theater surgeon and that, not desiring to replace him with any medical officer then in the theater, he preferred that The Surgeon General select a new theater Surgeon.36
The members of the mission inspected many Army Medical Department offices, including those of base and advance section headquarters, Northern Area Combat Command headquarters at Myitkyina, and Fourteenth Air Force headquarters at K'un-ming. They surveyed the situation as to hospital beds, and inspected medical laboratories and supply depots, veterinary dispensaries, butcheries, piggeries, ice cream plants, egg candling plants, chicken slaughterhouses, and even a puffed-rice plant run by the Services of Supply. The group concentrated on problems of disease prevention, with particular stress on the procurement, inspection, and handling of food and the care of animals; that is, the tasks of Veterinary Corps officers. The mission's report pointed out that reliance on local sources of food was necessary in the China-Burma-India theater, because of the distance from home sources of food supply, coupled with slow transit, local climatic conditions, and poor facilities for storage and refrigeration. As the Voorhees mission had noticed, unusually heavy responsibilities for food inspection and supervision of food-producing establishments, as well as for care of animals and the training of the Chinese in animal care, had fallen to the lot of the Veterinary Corps in this theater. Some major reforms urged by the Kelser group were the reduction to a minimum of foodhandling in messes by native personnel, together with close supervision of the, necessary native foodhandlers by American personnel; the assignment of a Sanitary Corps engineer to the headquarters of each base and advance section to train personnel in the processes of water purification and to advise each Army installation on problems of pure water supply, and the assignment of a few additional malaria control units to the theater. The report also emphasized the immediate need for medical, surgical, and neuropsychiatric consultants.37
Results of the Voorhees and Kelser Missions
As long as the theater surgeon's medical section was divided between the Chungking and New Delhi offices, the functions of the two offices were rather distinct from each other and their work was not well integrated. The Chung-
36 Memorandum, Brig. Gen. R. A. Kelser and
Col. R. H. Kennedy, for The Surgeon General, 18 Nov. 1944, subject: Confidential
Notes for The Surgeon General.
king office formulated theater medical policies and worked closely with Chinese authorities, while the New Delhi office gave technical supervision to Army medical service in India, developed medical supply policy for the theater, conducted a theaterwide program in preventive medicine, and prepared vital statistics. Although frequent interchange of letters and transmission of "information copies" of important papers had taken place between the two offices, the usual problems arose. Typical of them all were separate instructions from the commanding general in Chungking and his deputy in New Delhi as to the same project: and the necessity for completion of plans by the deputy theater surgeon in India before he had time to submit them to the distant theater surgeon.
In the fall of 1943 and the first half of 1944, Colonel Williams made efforts to increase his medical section, including both the New Delhi and Chungking offices, to 34 Medical Department officers, 2 warrant officers, and 36 enlisted men-numbers greatly in excess of those then authorized. War Department restrictions on allotments of personnel for the theater prevented official approval. In the spring of 1944, General Stilwell decided to turn over all operating functions to the Services of Supply, restricting his special staff, including the theater surgeon, to an advisory capacity, and transfer his personal headquarters to New Delhi; these changes affected the responsibilities of the theater surgeon's two offices. Colonel Williams moved to General Stilwell's personal headquarters in New Delhi, leaving only three officers, including an assistant theater surgeon, at forward echelon headquarters in Chungking. This move eliminated problems which the separation of Colonel Williams from the bulk of his staff had brought about.
Although replacements arrived during this period to relieve Medical Department officers due for return to, the States, restrictions on personnel allotments forced the theater surgeon to forego offers from the Surgeon General's Office to send him -specialized personnel, including a director of nurses and professional consultants. Surveys made within the theater by personnel survey boards approved the positions of director of nurses and of consultants but did not approve as large sections for theater and Services of Supply headquarters as their respective surgeons considered necessary to accord with the expanding strength of the theater and cope with casualties expected from the fighting in Burma.
The merger of the offices of the theater surgeon and the Services of Supply proposed by Colonel Williams prior to his trip to the United States in June 1944, and endorsed on the Voorhees report, proved to be the solution. Since neither of these surgeons had succeeded in enlarging his staff, they agreed willingly to the proposal, and a semimerger was effected. All personnel of the theater surgeon's medical section, except Colonel Williams himself and his assistants in Chungking, were transferred to the office of the Services of Supply surgeon; the latter was made, the theater surgeon's deputy. The addi-
tional assignment as deputy strengthened the position of the Services of Supply surgeon, and the consolidation gave him the bulk of the staff. At the same time it preserved the superior authority of Colonel Williams as theater surgeon. Finally, it achieved the result contemplated in the Voorhees report- a more efficient use of the Medical Department personnel available for the top administrative offices. The combined staff totaled 23 officers and 1 U.S. Public Health Service officer.38
The theater surgeon and his new deputy, Colonel Haff, began to build up the quality of the combined staff as replacements became available for officers who had spent two or more years in the theater, and for those who had been chosen for their positions by reason of the scarcity of better qualified men. Col. Karl R. Lundeberg, MC (fig. 122), who bad come to the theater with the Kelser mission, was retained as the head of preventive medicine for the theater and built up a largely new staff in this field. Development of the professional services staff, long contemplated, continued to incur delay on account of the limitation on rank of consultants to that of lieutenant colonel and insistence by the Surgeon General's Office that available officers of lower rank were not
38 (1) See footnote 3(1), p. 507. (2) General Order No. 104, Headquarters, U.S. Army Forces, China-Burma-India, 22 Aug. 1944.
qualified for these posts. No consultants ever reached the, area until after it was divided into two theaters.39
THE INDIA-BURMA AND CHINA THEATERS
In October 1944, shortly after General Stilwell's recall to the United States, the theater was split into the India-Burma theater and the China theater. At this date, over half of the approximately 204,000 U.S. Army troops in the theater were air troops (including the Air Transport Command and XX Bomber Command) ; less than a third, or about 57,000, were of the Services of Supply, while only about 25,000 were ground troops. Medical Department personnel serving in China, Burma, and India totaled approximately 13,700.40
After the capture of Rangoon in May 1945, the India-Burma theater was no longer an area of combat, but India continued to serve as a supply base for operations against the Japanese in China, and the India-Burma theater furnished medical supplies to the China theater. In China the U.S. Army continued its training and support of Chinese troops, its chief task there. For the most part, medical problems were not as acute as they had been during the days of the China-Burma-India theater.
The India-Burma Theater
After consolidation of the offices of the theater surgeon and of the Services of Supply surgeon in August 1944, a single medical section located at Services of Supply headquarters in New Delhi served as the staff for both surgeons. A few officers at General Stilwell's Chungking headquarters, who represented the theater surgeon for the China side of the theater, still acted in only a theater capacity. When the India-Burma theater came into existence in October, the combined staff, which served immediately under the Surgeon, Services of Supply, included his deputy (who acted in addition as executive officer), a personnel officer, a chief of professional services, a dental officer, two veterinarians, two medical supply officers, a nutrition officer, a venereal disease control officer, a malariologist, an epidemiologist, a statistical officer, a sanitary engineer, and enlisted assistants. This medical section was inherited by the India-Burma theater, the theater surgeon's small staff in Chungking being transferred to the China theater. The theater surgeon for the former China,-Burma-India theater, Colonel Williams, and the Services of Supply surgeon, Colonel Haff, who had served additionally as Colonel Williams' deputy in the former setup, had precisely the same assignments in the new India-Burma theater. In November 1944, a director of nurses (lieutenant colonel, Army Nurse Corps) was added to the medical staff of the India-Burma theater, and a colonel of the Medical Corps took charge of preventive medicine activities. In January 1945, consultants in
39 (1) Letter, Col. Alexander O. Haff, MC,
to Col. Tracy S. Voorhees, JAGD, 6 Dec. 1944. (2) See footnotes 4 (2),
p. 511 ; and 35 (3), p. 538. (3) Letter, Col. Alexander O. Haff, MC, to
The Surgeon General, 8 Sept. 1944.
surgery, medicine, neuropsychiatry, and reconditioning arrived, but they held only the rank of major or lieutenant colonel.41
The usual theoretical distinction between the medical functions of the theater organization and those of the Services of Supply organization prevailed in the new India-Burma theater. The following subordinate commands furnished field medical care and hospitalization to ground and air forces: the Northern Combat Area Command, the Tenth Air Force, and the Air Transport Command. The theater headquarters gave general supervision to their activities. The Services of Supply was responsible for the procurement of medical personnel from the United States, for fixed hospitalization, for the preventive medicine program, and for the procurement of medical supplies. The most active territorial command of the Services of Supply during the Second Burma Campaign late in 1944 and the following year was the advance section in Assam and India. In January 1945, it contained 3 general hospitals, 3 evacuation hospitals, 11 malaria survey and control units, and various other Medical Department units and installations.
On 9 December 1944, the War Department suggested to the commanding general of the India-Burma theater (General Sultan) that Col. John M. Hargreaves, MC, then Surgeon, Air Technical Service Command, whom the Air Surgeon considered "one of the most outstanding Regular Army doctors in the be made theater surgeon. Apparently The Surgeon General Air Forces, (General Kirk) intervened at this point, for 2 days later the War Department asked the theater commander to disregard this former offer and to consider instead Brig. Gen. James E. Baylis, MC (fig. 123), whom The Surgeon General had recommended. General Baylis was made theater surgeon, replacing Colonel Williams who had served as theater surgeon for about 3 years, in February 1945.42 He became Services of Supply surgeon as well and was located with the entire medical section at Services of Supply headquarters. Colonel Haff became Deputy Surgeon, Services of Supply, and remained in that position until May when illness forced his return to the United States.
When the India-Burma theater was established, the top air command in the former theater took over the same role in the India-Burma theater. The
41 Except as otherwise noted, discussion of
the India-Burma Theater is based on the following documents: (1) History
of The India-Burma Theater, appendix 19, Medical Section, 21 May 1945-1
December 1945. [Official record, Office of the Chief of Military History.]
(2) History of the India-Burma Theater, 25 Oct. 1944-23 June 1945, vol.
II. [Official record, Office of the Chief of Military History.] (3) History
of the Medical Department, Services of Supply, India-Burma Theater, 24
October 1944-20 May 1945. [Official record.] (4) See footnote 4 (2), p.
511. (5) Annual Report, Medical Department Activities, Tenth Air Force,
1944. (6) Final Report, Medical Department Activities of Tenth Air Force
in India-Burma Theater, 17 July 1945. (7) Periodic Report, Medical Department
Activities, Headquarters, Army Air Forces, India-Burma Theater, and Headquarters,
India-Burma Air Service Command, 11 Apr. 1945. (8) Memorandum, Chief, Operations
Service, Office of The Surgeon General, for Commanding General, Army Service
Forces, 22 Apr. 1944, subject: Professional Consultants for CBI Theater.
(9) Memorandum, Col. William C. Menninger, MC, for The Surgeon General,
28 Aug. 1944, subject: Neuropsychiatric Consultant for CBI.
medical section at the Calcutta headquarters of Army Air Forces, IBT (India-Burma theater), served also for the large India-Burma Air Service Command, which in April 1945 had a strength of 35,148. During the campaign in northern Burma (July-November 1944) the medical section of Tenth Air Force the chief combat component of Army Air Forces, IBT, shifted to forward areas along with the air force headquarters. It was at Myitkyina, shortly after the fall of this city in November 1944. Later it moved southward to Bhamo and then back again to India briefly before Tenth Air Force was transferred, in July 1945, to the China theater.
By the spring of 1945, responsibilities of the air commands in the theater for the various stages of air evacuation had been clearly defined. The Surgeon, Army Air Forces, India-Burma Theater, was theater air evacuation control officer and had the job of coordinating all phases of evacuating casualties by air within the theater. The Tenth Air Force was responsible for routine, emergency, and mass evacuation by air within the area of tactical operations, the rugged mountainous terrain of eastern Assam and Burma, having taken over the previous unorthodox responsibility of the India-China Wing, ATC, for air evacuation from the front. The 821st Medical Air Evacuation Transport Squadron (minus Flight C, which went to China), operating out of
Ledo, carried out this task, using two C-47's placed on shuttle runs between Ledo and the frontlines in northern and central Burma. The India-China Division Air Transport Command was charged with air evacuation of sick and wounded back to the United States, as well as with intratheater air evacuation from station to general hospitals, both along its routes in India and from India to China. The 803d Medical Air Evacuation Transport Squadron, stationed at Chabua, carried out this mission.
Efforts to prevent disease-especially scrub typhus (tsutsugamushi disease), the dysenteries, and malaria- in India and Burma in late 1944 and 1945 were supported by additional experts and further supplies. Pursuant to the recommendations of the Kelser mission, a dozen veterinary food detachments arrived from the United States early in December 1944; eight more were organized within the theater. The aid of the U.S.A. Typhus Commission to combat scrub typhus was enlisted by the theater surgeon after a Dumber of cases of this disease occurred among Merrill's Marauders fighting through the Hukawng Valley to Myitkyina in the spring and summer of 1944. The group known as the India-Burma field party of the commission arrived in the fall of 1944 and began work around Ledo in December. The field party made its headquarters at Myitkyina,, which was the center of occurrence of the disease as well as the location of Tenth Air Force headquarters. It grew into a large research team of 50 individuals. The group made studies of rates of incidence, the seasonal distribution of cases, and the probable sites of contraction of scrub typhus. A total of 1,098 cases, with a case fatality rate of 8.9 percent, was reported among United States and Chinese troops during the period 1 November 1943 to 1September 1945. The field party remained in the theater until November of 1945, following along with the advance on the Stilwell Road.43
In 1944 and early 1945, 32 malaria control and survey units were in the India-Burma theater. By the fall of 1944, Atabrine began arriving in quantities sufficient to place all troops east of the Brahmaputra on suppressive dosage. The theater surgeon (Colonel Williams) took his cue from the successful control program of 1944 among American and Australian troops in the Southwest Pacific Area, where in 1944 rates of incidence had dropped more rapidly than in the China-Burma-India theater. In December 1944, he personally explained to line and medical officers in northern Burma theories formulated in the Southwest Pacific Area on the use of Atabrine as a suppressive. He also called a conference at New Delhi of representatives from his office, the Southeast Asia Command, Northern Combat Area Command, the Air Transport Command, the India-Burma Air Service Command, and the Quartermaster Corps. As a, result, various directives extending compulsory Atabrine suppressive dosage to additional troops and areas were issued in 1945. Both Colonel Rice, who
43 Maxcy, Kenneth F.: Scrub Typhus (Tsutsugamushi Disease) in the U.S. Army During World War II In Rickettsial Diseases of Man. Washington: American Association for the Advancement of Science, 1948, pp. 36-46. (2 See footnote 4(l), p. 511. (3) Letter, Brig. Gen. James S. Simmons, to Brigadier Gordon Covell, Director, Malaria Institute of India, 6 Oct. 1944.
had brought copies of the Southwest Pacific Area studies on Atabrine suppression to the theater surgeon, and an officer, who had done pioneer work with Atabrine in the Fijis during 1943 and early 1944, participated in the preparation of the new antimalaria. directives. Suppressive treatment and the mosquito control program, both furthered by greater cooperation from the War Department and the Surgeon General's Office, together with the cessation of combat, led to a marked decline in malaria rates in controlled areas in the summer and f all of 1945. In the Tenth Air Force, a sharp drop occurred in 1945, enduring even through the summer malaria season.44
By May 1945, the Services of Supply of the theater was abolished. Its area commands were placed directly under U.S. Army Forces, India-Burma Theater; their surgeons were under the direction of the theater surgeon. Thereafter, the theater medical section declined markedly.
The small medical section at the forward echelon of the China-Burma- India theater in Chungking, which became the medical section of the new China theater headquarters, was headed by Col. George E. Armstrong, MC, who became theater surgeon. In early December 1944, Colonel Armstrong's office moved to K'un-ming, where the rear echelon of China theater headquarters was located. It remained there until this headquarters was dissolved in July 1945. By the end of 1944, the office contained five Medical Department officers and five enlisted men. Besides the normal tasks of a theater surgeon's office, it had to maintain close liaison with the office of the surgeon of the India- Burma theater in New Delhi. Medical supplies and personnel from the United States came by way of the India-Burma theater, and the New Delhi office was a link in the chain of evacuation of patients from China to the Zone of Interior. The New Delhi office also arranged for prolonged hospitalization of U.S. Army patients sent from China theater to hospitals in India. On its own side of the mountains, Colonel Armstrong's office cooperated closely with the Chinese Army medical administration in efforts to promote the health of Chinese troops with various Chinese medical authorities (particularly the National Health Administration) in the prevention of diseases among civilians, and with foreign philanthropic organizations giving medical aid to the, Chinese.
Very shortly after becoming theater surgeon, Colonel Armstrong joined with Colonel Gentry, the Fourteenth Air Force surgeon, and with the Surgeon, Y-Force Operations Staff, in insistent demands for nurses for the China theater. General Stilwell's opposition no longer stood in the way. By March 1945, 62 American nurses were in China, the majority serving with the 95th Station Hospital in K'un-ming.
44 (1) See footnotes 3 (1) and (4), p. 507 ; and 4 (1), p. 511. (2) Memorandum, Col. Robert P. Williams, MC, for The Surgeon General, 5 Oct. 1945, subject: Medical Service in India-Burma.
A Services of Supply was established at K'un-ming for the China theater; it had five base sections, which by June 1945 had boundaries tallying with similar area commands of the Chinese Army's Services of Supply. The medical section at Services of Supply headquarters, headed by a separate surgeon, had a relatively large staff; at its height early in the summer of 1945, it contained 19 Medical Department officers, including the theater malariologist and the theater medical supply officer, and 22 enlisted men. Since it was located in the same city, K'un-ming, as the theater surgeon's office, the two staffs worked closely together. A medical officer and a veterinary officer were assigned in a liaison capacity with the Chinese Services of Supply.
The surgeon for each of the five base sections was concerned with medical and sanitary service for troops within his base section; district surgeons had the same responsibility for the districts into which the base sections were subdivided. In each base section was a general depot which contained a medical section to handle medical supply. The Services of Supply controlled the small amount of fixed hospitalization necessary for U.S. Army personnel in the theater- a general hospital, two station hospitals, and several field hospitals and dispensaries.
After the rout of the Z-Force in southeastern China in the fall of 1944, the Chinese undertook the retraining of a volunteer army of 100,000 men to stem the Japanese advance. Colonel Armstrong worked closely with the Director General of the Chinese Army Medical Services (Gen. Hsu Hsi Lin) in 1945 in creating a fresh medical training program. A system of "emergency medical service schools" which the Chinese had devised in the late thirties had been overshadowed by the training centers for Y- and Z-Forces. The director of the chief emergency medical service training school at Kweiyang, Gen. Robert Ko-Sheng Lim (later Director of the Chinese Army Medical Administration), had studied at the Medical Field Service School at Carlisle Barracks, Pa., in the fall of 1944. This school was selected as the prototype for expanding the Chinese system of emergency medical service training schools.
The Chinese Training and Combat Command, created in November 1944, was the American command concerned with training the newly planned Chinese divisions. Its staff was formed by merging the "operations staffs" of Y- and Z-Forces; the former surgeon of Y-Force operations staff, Lt. Col. Eugene J. Stanton, MC, became its surgeon. This command, termed merely Chinese Combat Command after January 1945, paralleled, as did the Services of Supply, its counterpart Chinese command. Six subordinate commands corresponded to Chinese Army groups. The Medical Department followed the same pattern, with a surgeon at general headquarters and a surgeon for each subordinate command. The theater surgeon assigned another former Y-Force operations staff surgeon who spoke fluent Chinese as liaison officer to the office of the Chinese Surgeon General to advise on medical matters, including training. A somewhat more effective job of medical training was possible than in the days of the
China-Burma-India theater, for Chinese doctors had been drafted into the army, for the first time during World War II, in October 1944.
At the request of the Director General of the Chinese Army Medical Administration (then General Lim), U.S. Army Medical Department officers also aided in reorganizing the Chinese Army Medical Administration. This assistance, requested in May 1945, was not forthcoming until after the Japanese surrender. In September, five officers were assigned to the task for a 6-month period under the direction of Col. Ralph V. Plew, MC. Colonel Plew drew up recommendations for changes in the central office of the Chinese Army medical service, using the Surgeon General's Office in Washington as a model at points where it seemed an improvement over the Chinese setup. Other Medical Department officers aided in establishing a model rehabilitation and reconditioning center at Yunnanyi, delivered lectures on organization and administration of the U.S. Army Medical Department to the training staff of the Chinese Army Medical Administration, supervised the creation of model supply depots and a medical battalion, and aided with the training of medical supply officers at K'un-Ming.45
The loss of Fourteenth Air Force bases in south central China late in 1944 during the Japanese drive to separate east China from west China made for rapid changes in the always mobile medical service of Fourteenth Air Force units. They now had to wing over enemy-held territory in order to carry supplies to the eastern bases and to evacuate patients westward. One flight of a medical air evacuation transport squadron, serving with the Fourteenth Air Force, bore the burden of air evacuation in China.
In May 1945, a Fourteenth Air Force Service Command was organized and was assigned a separate surgeon, while Colonel Gentry remained staff surgeon of the Fourteenth Air Force. Base medical service was then put under the air service command. The various service groups of this command fur-nished medical officers and enlisted personnel to staff the 10-, 20-, and 40-bed dispensaries-some of which were housed in mission hospitals and ancient temples-maintained by four air service centers. Five medical dispensary (aviation) units operated the larger base dispensaries. One such unit, aug-mented by medical officers from other sources, had maintained a station hos-pital of 150-bed capacity at Chengtu to serve the northern air bases for about a year. The Services of Supply, China Theater, furnished regular medical supplies to the Fourteenth Air Force, but in order to get items peculiar to the air forces the medical supply officer at the headquarters of the air force's service command placed a requisition with the appropriate air medical depot of the India-Burma theater.
In June 1945, General Chennault's Fourteenth Air Force had assigned to it a total of 60 medical officers, 12 dental officers, 1 medical administrative officer, 1 veterinary officer, and 162 enlisted men. The surgeons of various
45 (1) See footnote 18, p., 525. (2) History of Services of Supply in the China Theater, 19 Sept. 1945. [Official record.]
tactical units of four wings, which covered about the same territories as the four air service centers, were also available for hospital and other duties. Since personnel of the air force were widely scattered, about 10 dental officers assigned to the air force traveled to various outposts from time to time. Dispersal also led to close cooperation between dental officers of the Fourteenth Air Force and its air service command and those of the Services of Supply. Dental officers treated as many men as possible in the neighborhood of their own stations, regardless of the command to which they or their patients were assigned.
In July 1945, when the Tenth Air Force moved into China from the India-Burma theater- to be built up as a transport air force- the usual higher air force command, Army Air Forces, China Theater, was created. The small medical section at its Chungking headquarters coordinated the medical work of the Tenth and Fourteenth Air Forces with that of the ground forces in the theater. The medical section of the new China Air Service Command (a redesignation of the Fourteenth Air Service Command) was at K'un-ming. A medical supply platoon (aviation) assigned to it issued medical supplies to all air force installations in the China theater, obtaining regular items from Services of Supply Base General Depot No. 1 in K'un-ming and special air forces medical items from the Bengal Air Depot in India. The China Air Service Command was responsible for air evacuation until September, when this task was turned over to the Air Transport Command. The China Air Service Command maintained the dispensaries at the air bases, and undertook to reestablish medical service at bases in southeast China recaptured by American and Chinese forces in the latter half of 1945.
When General Chennault relinquished command of the Fourteenth Air Force in August 1945, his surgeon, Colonel Gentry, also left and was replaced. During the last months of the year many personnel and units, including medical dispensaries (aviation), of the Tenth and Fourteenth Air Forces were moved out of China. In December both air forces were disbanded; only units remained.46
In July 1945, the office of the China theater surgeon at the rear echelon of theater headquarters at K'un-ming reached its zenith. It then included three assistant theater surgeons, a theater veterinarian, a theater dental surgeon, a medical inspector, an executive officer and one assistant, a director of nurses, a venereal disease control officer, a historical recorder, a medical supply officer, and eight enlisted men. In the same month, when the theater rear echelon was dissolved, this office was transferred to theater headquarters at Chungking, but after the collapse of Japanese resistance in August it was temporarily returned to K'un-ming, where it was merged with the medical section at Services of Supply headquarters.
46 (1) Medical History of the Fourteenth Air Force in China, 10 March 1943-10 March 1945. [Official record.] (2) Periodic Report, Medical Department Activities, Fourteenth Air Force, 1 Apr. 1945-30 Nov. 1945, and inclosure. (3) Periodic Reports, Medical Department Activities, Headquarters, Army Air Forces in the China Theater, July 1945-January 1946.
From the date of the surrender, the military activity of the China theater came to be concentrated in the area around Shanghai. Medical tasks included rendering medical aid to the Chinese troops taking over areas occupied by the Japanese in north and east China; giving medical examinations and care to thousands of Allied prisoners of war and internees, largely concentrated in the Shanghai area; disposing of American medical supplies and equipment; and transferring or dissolving Medical Department units. Hence Colonel Armstrong's medical section was relocated in Shanghai. In September, some of the staff went there to establish dispensaries, a field hospital, and prophylactic stations the rest arriving by early October. This group served as the medical staff both for theater headquarters, newly relocated in Shanghai, and for the Shanghai Base Command, until the latter was dissolved in November.
When the theater was dissolved on 1 May 1946, the medical section was transferred to a newly established China Service Command, having undergone possibly more shifts in location and jurisdiction than any other top medical office overseas in a comparable length of time. Colonel Armstrong retained his responsibility as senior surgeon for all U.S. Army troops in China. At Nanking, another medical section served with the Army Advisory Group, where it aided the Director General of the Chinese Army Medical Administration in reorganizing the Chinese Army medical service. This project involved setting up a large military medical center near Shanghai and arranging for a year's medicomilitary training for about 130 Chinese medical officers in the United States. 47
SUMMARY: MEDICAL ADMINISTRATIVE PROBLEMS IN CHINA-BURMA-INDIA
No firm direction of medical service in the China-Burma-India theater was ever achieved by the theater surgeon and his medical section. The split of the theater into two areas, until the fall of 1944, with transport of men and supplies possible only by flight over the Hump, and the scattering of subcommands and bases, made it difficult to distribute Medical Department personnel, supplies, and facilities effectively. These features abetted the characteristic claims of the air forces that they should control medical supplies and facilities for their personnel. They also hampered the achievement of uniformity in policies for the prevention of disease.
The need to deal firsthand with the Chinese Nationalist Government led the theater surgeon to maintain his headquarters, from late 1942 to the spring of 1944, in Chungking far from the Indian bases where most of the Army's medical resources were located. Separation of the theater surgeon from the majority of his staff, coupled with the lack of a fully developed staff and frequent changes in the person of the deputy theater surgeon, made centralized control by the theater surgeon virtually impossible. Colonel Williams conceived of his re-
47 (1) See footnotes 18, p. 525; and 45(2), p. 548. (2) Medical History of the China Theater for April 1946. Office of the Surgeon, Headquarters, China Service Command, 1 May 1946. (3) Letter, Col. George E. Armstrong, MC, to The Surgeon General, 2 May 1946.
sponsibility as one of assisting Chinese authorities to develop an adequate medical service for their troops which were under American control and of supervising and inspecting the U.S. Army medical service throughout the theater, especially the medical service being furnished to the American and Chinese troops in combat. In filling what he considered to be a necessary role, he undertook duties quite different from those of a theater surgeon whose responsibilities were limited to U.S. Army troops and who maintained centralized control by means of a large and specialized office staff.
The China-Burma-India theater had insufficient Medical Department officers trained and experienced in administrative work. It was particularly ill supplied with men qualified to staff the medical sections of the top commands, serve as surgeons of base, intermediate, and advance sections, and fill posts in the field of medical supply. The record also shows a dearth of personnel for preventive medicine duties and of Veterinary Corps personnel.
The fact that the theater had as its chief raison d'être the training and support of troops of an Ally, the Nationalist Government of China, meant that the character of work to be done by the Medical Department- and the personnel and units needed- differed markedly from those in other theaters. American troops for whom the Medical Department was responsible were largely air force and service troops. The dearth of U.S. Army ground troops lessened the need for tactical Medical Department units-such as medical battalions and other units employed in the chain of evacuation at the front. On the other hand, the usual resources of the Services of Supply-hospitals, laboratories, supply depots, and so forth-were needed in numbers sufficient not only to give service to U.S. troops present but also to serve Chinese patients of the X-Force. Moreover, Chinese medical service in the combat zones had to be supported wherever it was deficient. Poor liaison between the War Department and the theater command led to a misunderstanding in the War Department as to the number of Chinese for whose hospitalization the U.S. Army was responsible and as to the actual numbers being cared for in the U.S. Army hospitals.
The decline of disease rates, especially of malaria, and the diarrheal diseases, in the India-Burma theater during the early months of its existence as compared with the rates prevailing in the days of the China-Burma-India theater testifies to the direct bearing of good and sufficient medical supplies, facilities, and trained personnel upon the quality of medical service. In the opinion of a chief of the Preventive Medicine Division in the office of the, Surgeon, India- Burma theater, and later surgeon of that theater, no adequate preventive medicine organization ever existed in the days of the China-Burma-India theater. Colonel Williams expressed what he considered to be the principal lesson to be derived from the Medical Department's experience in the China- Burma-India theater: "Good public health is, within limits, a purchasable commodity and the results obtained will be proportionate to the numbers and quality of the personnel employed and the amount of material that is expended."48
48 See footnote 4 (1), p. 511.