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Chapter IX

Contents

CHAPTER IX

The Pacific Ocean Areas

Although Army troops in the Pacific were eventually organized within a single Pacific theater, from 1942 to August 1944 separate theater organizational structures prevailed in three main areas: the Central, South, and Southwest Pacific Areas (map 7). 1 In these three regions the land areas, small in proportion to the ocean surface, were strung out over great distances, with long stretches of water between. This feature had far-reaching effects upon command structure, as well as military tactics. In the absence of continuous land masses, the communications zones developed for the three areas did not follow the orthodox pattern laid down for theaters of operations. The fact that land masses were small, with poor facilities for overland transport, and separated by long stretches of water, led to the burgeoning of many small commands with staff medical sections and to considerable decentralization in the supervision of medical service. The Pacific islands varied greatly in climate, types of endemic disease, and sanitary conditions. They presented Army doctors with many problems of local scope.

The strategic Pacific areas that were to prevail throughout most of the war were established in March 1942. In the Southwest Pacific Area, Gen. Douglas MacArthur was in supreme command. In the other two major Pacific regions, the Central and South Pacific Areas, Army forces were subordinate to a higher Navy command headed by Adm. Chester W. Nimitz. In addition to his Navy assignment as Commander-in-Chief, U.S. Pacific Fleet, Admiral Nimitz was made Commander-in-Chief, Pacific Ocean Areas. The Commanding General, Hawaiian Department (and his successor, the Commanding General, U.S. Army Forces, Central Pacific Area) was made directly subordinate to Admiral Nimitz. Over the Commanding General, U.S. Army Forces, South Pacific Area, Admiral Nimitz exercised command through a deputy naval commander. Through the extension of the principle of single control and responsibility downward, the Navy controlled various subordinate Army headquarters and units in the Central and South Pacific Areas (Pacific Ocean Areas, as these two were jointly termed), while the Army exercised highest jurisdiction over Navy headquarters and units in the Southwest Pacific Area. Although Army medical service was fully organized within the various Army commands in the three areas, the fact of final naval authority in the Central and South Pacific Area indirectly affected medical planning for combat, as well as the actual operations of field medical service in these areas.

    1 The North Pacific Area is omitted from this discussion. Except for air units in the Aleutians assigned to the Navy-controlled North Pacific Force, Army units in that area belonged to the Alaskan Defense Command, which in terms of its organization and administration resembles a Zone of Interior rather than an oversea command.


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Map 7.- U.S. Army commands in the Pacific Ocean Areas, February 1943


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CENTRAL PACIFIC AREA

Hawaiian Department

When Pearl Harbor was attacked on 7 December 1941, the surgeon's office of the Hawaiian Department, located at Fort Shafter on the island of Oahu, was composed of 10 officers (including 4 of the Regular Army), 8 enlisted men, and 15 civilians. In addition, certain medical, dental, and veterinary officers assigned to hospitals on Oahu were considered part of the department surgeon's staff. On the day of the attack, the office of the department surgeon, Col. (later Brig. Gen.) Edgar King, MC (fig. 84), was divided, together with the other technical services, into forward and rear echelons. Colonel King was made directly responsible to the commanding general of the department (Lt. Gen. Delos C. Emmons, after 17 December), who maintained his forward echelon headquarters underground in Aliamanu Crater. Forward echelon performed the functions of a theater of operations headquarters; rear echelon of those of a communications zone. The Hawaiian Department was placed under martial law, and as the commanding general held the additional responsibility of military governor (with headquarters


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at Iolani Palace, Honolulu), Colonel King became responsible for the health of civilians, as well as for that of Army troops, in Hawaii.

During the early days of confusion after the Pearl Harbor attack, Medical Department units of the 24th and 25th Infantry Divisions and Army and civilian doctors and dentists pitched in to perform whatever service was most needed. As on the mainland of the United States, but under even greater compulsion, Army Medical Department officers and governmental and private agencies handling medical work cooperated closely. The Japanese attack had made clear this community of civilian and military interest. The uncertainty as to the wisest allocation of medical personnel, supplies, and facilities as between military and civilian agencies and other questions of jurisdiction which repeatedly cropped up on the mainland in 1942 made little appearance in Hawaii. The stringencies of martial law, the longer working hours of the population, the threatened shortages of supplies, and the frequent movements of the military and of civilian workers in and out of the outlying islands as well as Oahu called for all medical assets that the Army could muster in Hawaii. The Army was given leading responsibility for civilian health.

Throughout 1941, Medical Department officers had made plans for immediate medical care of civilians in the event of an assault on the islands. During 1941, emergency aid stations had been set up in Honolulu, civilians trained in first aid, and surgical teams of civilian doctors and ambulance corps organized. Schools had been selected for conversion to hospitals, military and civilian, should the need arise. As Japanese planes struck at Oahu, all these units- aid stations, surgical teams, and converted hospitals- went into action, some of them within minutes after the attack.

Medical Department officers had also made long-range plans, with the support of local agencies, for coping with preventive medicine problems in the event of an attack. During the prewar period the health record of Army troops stationed in the islands, where few tropical diseases were endemic, had been excellent. Plans centered around preparations to cope with the possible need for emergency hospitalization on a large scale, the increase of health hazards under wartime living conditions, and the threat of introduction of diseases from other areas.

One of the most important measures taken had been the establishment of a blood plasma bank for the protection of civilians. Originally set up at the instance of the department surgeon, it became the first to operate under the jurisdiction of the United States under wartime conditions. The Honolulu Chamber of Commerce, the American Red Cross, the University of Hawaii, certain commercial organizations, and a few local hospitals had contributed technical equipment, trained personnel, or moral support. Although the supply of plasma, built up since June 1941, was exhausted within some hours after the Pearl Harbor attack, it was promptly replenished through already established channels.


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The Army's prewar industrial medical program in Hawaii was derived from studies made by the Territorial Board of Health (counterpart of a State health department on the mainland) with the aid of U.S. Public Health Service funds, to detect industrial poisons and determine conditions of heat, ventilation, and lighting in industrial plants. In September 1942, the Medical Department assumed joint responsibility with the Territorial Board of Health for industrial hygiene in the islands.

With the Pearl Harbor attack the destruction of insects on planes flown into the islands became a responsibility of the Medical Department. During 1941 the U.S. Public Health Service, then responsible for putting quarantine regulations into effect, had obtained the cooperation of the Army in enforcing the regulations on Army planes. By October it had become clear that the increasing number of flights and the exigencies of military secrecy might. interfere with notifying civil authorities of the arrival of military planes. The Hawaiian Sugar Planters' Association, concerned over the possible introduction of crop-destroying or disease-bearing insects, had contributed the services of its entomologists stationed on Canton and Midway Islands in identifying insects on planes landing there en route to Hawaii. After the Territory was put under martial law, the Army assumed full responsibility for disinfestation of its incoming aircraft, and the Surgeon, Hickam Field, Was designated Air Quarantine Officer to make inspections. In May 1942, the department surgeon assigned a medical officer on his staff to supervise the program, and in June the senior medical officer of each airfield in the department was made quarantine officer for the inspection of aircraft. 2

Plans had been made in the prewar period to cope with a contingency which never developed- the deliberate contamination of food or water supplies by Japanese living in the islands. Fear had developed that the Japanese would undertake some form of chemical or bacteriological warfare in the event of an outbreak of hostilities. Nearly all dairies, food processing plants, and water supply systems employed people of Japanese descent. On the day of the Pearl Harbor attack the commanding general of the department made the department surgeon his adviser on all problems connected with the possible contamination, deliberate or accidental, of food and water. In his capacity as staff surgeon for the military governor, he issued a series of general orders designed to control the sale of poisons, medicinal spirits, narcotics, and incendiary chemicals. An officer in his medical section obtained inventories of medical

    2 (1) Office of the Surgeon, Headquarters, U.S. Army Forces in the Middle Pacific: History of Preventive Medicine. [Official record.] (2) Whitehill, Buell: Administrative History of Medical Activities in the Middle Pacific. [Official record.] (3) Office of the Surgeon, Headquarters, U.S. Army Forces in the Middle Pacific: History of Surgery, Section III, Clinical Subjects. [Official record.] (4) History of U.S. Army Forces, Middle Pacific and Predecessor Commands, During World War II, 7 December 1941-2 September 1945. [Official record, Office of the Chief of Military History.] (5) Annual Report, Surgeon, Hawaiian Department, 1942. (6) Annual Report, Surgeon, 24th Infantry Division, 1941. (7) Annual Report, Surgeon, 25th Infantry Division, 1941. (8) Memorandum, Brig. Gen. Edgar King, for Col. Joseph H. McNinch, MC, 31. May 1950, subject: Supplemental Data in Reply to Letter of 2 May 1950.


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stocks from dealers and passed upon the sale of all drugs under special restriction. The sanitary inspection of military installations, water systems, and local plants engaged in processing foods or bottling drinks was intensified.

In June 1942, Secretary Stimson became alarmed over the possible use of bacteriological warfare by the Japanese in the Hawaiian Islands when he received a letter of warning from a doctor in Honolulu. The writer declared that large numbers of Japanese. in the islands were loyal to the Japanese Empire. He advocated adoption of the following measures to prevent spread of bacterial disease: The registration of bacteriological laboratories and bacteriologists and the internment of all laboratory workers of known Axis sympathies, the eradication of mosquitoes and, more especially, of rats because of the danger of plague; and the immunization of all inhabitants against yellow fever and cholera.

At Secretary Stimson's request for recommendations, Surgeon General Magee advised the appointment of an officer to tackle the problem. He advocated supervision and inspection of civilian bacteriologists and laboratories, cooperation with health authorities in protecting the civilian population of the islands against infectious disease through vaccination, and finally, cooperation with authorities engaged in the protection of agriculture and animal husbandry. The officer in charge, in General Magee's opinion, should have an assistant trained in laboratory science and preventive medicine. He should be on the staff of the Chemical Warfare Officer, Hawaiian Department, and should report to the Secretary of War, through the commanding general of the department, on any biological warfare undertaken by the enemy and on measures taken to counteract it. 3

The reaction of the Secretary of War and The Surgeon General to the Honolulu letter revealed the ignorance of current operations which sometimes prevailed at high levels as a result of the necessity for keeping certain programs secret to all but a few people. It also reflects the fear, then prevalent in all quarters, of subversive action by Hawaiian inhabitants of Japanese descent. Although The Surgeon General seems to have been aware of a general prewar program for counteracting biological warf are in Hawaii and the Secretary had taken the initiative in establishing this program on the homefront, neither seems to have been informed of the latest development in Hawaii. The Hawaiian Department Surgeon had been put in charge of antibiological warfare activities at the outbreak of hostilities. Later an Army medical officer was designated antibiological warfare officer for each of the task forces which invaded the westward islands, and officers of the Veterinary and Sanitary Corps were given similar assignments on the various islands. All worked closely

    3 (1) Memorandum, W. B. Herter, M.D., Honolulu, T.H., for the Secretary of War, 12 June 1942, subject: The Next Attack Upon Oahu- Bullets or Bacteria. (2) Memorandum, Harvey Bundy, Special Assistant to Secretary of War, for The Surgeon General, 26 June 1942; and reply by Brig.. Gen. Larry B. McAfee and Col. James S. Simmons, MC, same date. (3) See footnote 2(2), p. 378.


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with the medical inspector of the department surgeon's office, with the chemical warfare officer, and with the Territorial Health Department. 4

With the expansion of military camps throughout the Territory of Hawaii and of camps for civilian employees of the Army, the work of the medical inspector of the department surgeon's office increased. The large preventive medicine program of the Territory, for which responsibilities were somewhat scattered in 1942, finally centered in his hands. Work which had formerly been limited to the inspection of fixed Army installations gradually grew into a large program of many phases: Determination of the adequacy of food and water supplies, waste disposal, mosquito and rat control, venereal disease control, immunization of Army troops and of civilians in the Territory against a variety of diseases, the three programs mentioned above (occupational health, foreign quarantine measures, and the antibiological warfare program), and many general sanitary measures.

Before December 1941, the department surgeon had had no dental officer assigned directly to his office. In accordance with the prewar custom of assign-ing responsibilities to the chief of dental service at the major installation in a corps area or department, the chief of dental service at Tripler General Hospital had acted as dental adviser to the department surgeon. In early 1942, he was formally assigned to the position in the department surgeon's office. The commanding officer of the veterinary general hospital at Fort Armstrong, Oahu, served in a similar capacity in veterinary matters. Besides supervising the usual inspection of meat and dairy food and the quarantine and treatment of animals and work in antibiological warfare, he gave technical aid to the military governor on the storage and handling of foods for civilian consumption. Not until March 1943 was a staff nurse appointed to the department surgeon's office.

The Pearl Harbor attack also led to the development of the standard laboratory planned by the Surgeon General's Office for corps areas and departments. Creation of a departmental laboratory in Hawaii had been long delayed because of some uncertainty in the Surgeon General's Office as to its necessity, possibly because the prewar health status of Army troops in Hawaii had always been high. With the outbreak of war, the role it could play in the prevention of epidemic disease was acknowledged; the Hawaiian Department Laboratory was established in January 1942. 5

In spite of the advent of war and the inclusion of the Hawaiian Islands in one of the strategic Pacific areas- the Central Pacific Area- in March 1942, the Army command in the islands was not organized after the fashion of a theater of operations; throughout 1942 it continued to be known as the Hawaiian Department. Early in 1942 some nearby island groups- the so-called Line Islands, Midway, Christmas, Baker, and Canton Islands- and a few others

    4 [Whitehill, B. (?)]: Rough copy of History of Anti-Bacteriological Warfare, 7 December 1941-2 September 1945.
    5 See footnote 2 (2), p. 378.


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occupied by American troops or jointly by British and American troops were added to the territory included in the department; station hospitals and branch medical depots were located on these islands. Additional veterinary and sanitary service also became necessary when Christmas and Canton Islands were stocked with chickens and cattle to supply food for troops.

When service commands were organized in March 1942 for the islands of the Hawaiian group- the Hawaii, Maui, Molokai-Lanai, and Kauai Service Commands- a surgeon was assigned to each. The surgeons' offices of the service commands and the station hospitals on the islands served a variety of components: the service command itself ; divisional and air force elements; elements of the Territorial Guard, the Women's Air Raid Defense Service, and the Air Raid Warning Service; U.S. Engineering Department employees; and some Coast Guard personnel.

The introduction of a Services of Supply into the Hawaiian Department in October 1952 did not greatly change the situation. Although it was a distinct command, it was staffed by members of Headquarters, Hawaiian Department. Colonel King, who had held since the attack on Pearl Harbor a dual position as surgeon of the Hawaiian Department and as the responsible medical official for the military government, was made additionally Surgeon, Services of Supply. The Services of Supply (renamed Hawaiian Department Service Forces in April 1943) was merely an intermediate command between the already established area commands- here called "service commands" in Zone of Interior terminology rather than base sections- and the departmental setup. Within the Services of Supply command, Colonel King's office was made subordinate to a Supply Service Division headed by the Assistant Chief of Staff, G-4, Hawaiian Department. 6

Before 7 December 1941, the Hawaiian Air Force, which suffered several hundred casualties when the Japanese attacked Oahu, had had several dispensaries for the use of its troops, including one of 60 beds which was actually the station hospital for Hickam Field. Lt. Col. (later Col.) A. W. Smith, MC (fig 85), the senior flight surgeon, became surgeon of the Seventh Air Force, as the Hawaiian Air Force was renamed in March 1942. Flight surgeons were needed to staff the nine airbases in the islands (including Midway, Christmas, and Canton) which the air force opened during the succeeding year; the air force surgeon obtained permission from the Commanding General, Army Air Forces, to train locally medical officers obtained through the cooperation of the Surgeon, Hawaiian Department. The Seventh Air Force surgeon's office also conducted the training of medical officers as aviation medical examiners who would administer physical examinations for Hawaiian applicants seeking aviation training on the mainland. 7

    6 See footnote 2 (4), p. 378.
    7 Consolidated Medical History of the Seventh Air Force from its Activation to 1 June 1946. [Official record.]


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At the end of 1942, the Army Medical Department in Hawaii was engaged in caring for the health of Army troops on the Hawaiian Islands (Oahu, Hawaii, Maui, Molokai, Lanai, and Kauai) and on Christmas, Fanning, and Canton Islands. It was also carrying out policies which the Office of the Military Governor had established for the protection of civilian health- quarantine regulations and other measures for control of communicable diseases, regulatory measures for control of laboratories engaged in bacteriological work, and regulations concerning the sale and use of civilian medical supplies. During the year of martial law, civilian hospitals had been under Army control, and some Army doctors and nurses had been assigned to them. The fixed hospitals of prewar days on Oahu- Tripler General near Fort Shafter in Honolulu and the station hospitals at Schofield Barracks and Hickam Field- had been augmented by several station hospitals. Many aid stations had been built, some partially or completely underground. Dental clinics had been set up in areas not served by other fixed medical installations, and dental trailers served troops in still more remote areas. A main supply depot located at Fort Shafter and a number of branch depots furnished medical supplies for Army troops in the Central Pacific Area. 8

During 1943, as the fear of further enemy attack on Hawaii lessened, the responsibilities of the Office of the Military Governor for civilian health were

    8 (1) See footnote 2 (4) and (5), p. 378. (2) Memorandum, Brig. Gen. Edgar King, for Editor, History of the Medical Department, 22 Mar. 1950.


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gradually returned to the public health authorities which had handled them before the war. Beginning about March 1943, the control of communicable diseases and the regulation of sale of medical supplies and poisons were returned to civil authorities. Army supervision of laboratories was relinquished a few months later. Colonel King's office continued to cooperate closely with such civil authorities as the Territorial Board of Health and the Office of Civilian Defense in efforts to maintain civilian health. A few epidemics, including a poliomyelitis outbreak and an epidemic of dengue fever in 1943, were brought under control through the combined efforts of military and civilian authorities. 9

Central Pacific Area Command: August 1943-Mid-1944

A major reorganization took place in August 1943 when the U.S. Army Forces in the Central Pacific Area was established, with headquarters at Fort Shafter, under the command of Lt. Gen. Robert C. Richardson, Jr. This change marked the revamping of Army organization for the offensive warfare in the Central Pacific Area which resulted in the taking of the Gilbert, Marshall, and Marianas Islands. The Army's Hawaiian Department had been subordinate to Admiral Nimitz' Pacific Ocean Areas command since the spring of 1942, but the concept of the Central Pacific as an important area, of combat operations had applied primarily to Navy activities there. Although he continued to hold the nominal post of Hawaiian Department Surgeon, General King became surgeon on the special staff of General Richardson. His medical section operated until mid-1944 as the chief medical office of U.S. Army Forces in the Central Pacific- that is, in the role of a theater medical section. Headquarters, U.S. Army Forces in the Central Pacific Area, now had the chief .responsibility as a training agency for Army forces mounting from the Hawaiian Islands, as the logistic agency for supporting forward operations and as the administrative agency for all Army forces in the Central Pacific Area. 10

The Hawaiian Department Service Forces (as the Hawaiian Services of Supply had been renamed) was abolished at the time of this reorganization, but an Army Port and Service Command, set up on Sand Island, took over certain of its functions applicable to the ports and subports of the Hawaiian Department. The port of Honolulu underwent intensive development in preparation for the capture of the westward bases. The Army Port and Service Command enforced quarantine regulations applicable to personnel entering or leaving ports and furnished medical service on transports and harbor craft operated by the command. Up to the end of 1944, medical responsibilities increased as the command received several important additional tasks: The training and use of port companies, operation of the Waimanalo Amphibious

    9 (1) See footnote 2 (1), (2), (4), and (5), p. 378.
    10 (1) See footnote 2(4), p. 378. (2) Memorandum, Brig. Gen. Edgar King, for Col. J. H. McNinch, MC, 9 Aug. 1950, subject: Additional Data for History.


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Training Area and the Central Pacific Casual Depot, and the command of the prisoner-of-war camps.

At the end of 1944- a date by which the war had moved far away from Hawaii- Medical Department personnel assigned to the Army Port and Service Command included 38 medical officers, 14 dental officers, 4 Medical Administrative Corps officers, 1 Veterinary Corps officer, 243 enlisted men, and 1 civilian. Its Medical Division at headquarters contained, besides the surgeon, an assistant surgeon and medical inspector, a port surgeon, and a port veterinarian and administrative officer. Veterinary personnel of the division supervised the loading and discharge of the Army's perishable foods aboard ships and inspected ship refrigeration. The division provided medical attention at dispensaries maintained at the various posts for Army and civilian personnel and those at prisoner-of-war compounds. Individuals served by the dispensaries totaled about 37,000 by the end of 1944; about 7,000 were prisoners of war, largely Italians. The division also received and evacuated casualties by transports, provided quarantine information, made medical and sanitary inspection of Army transports, supervised medical service on ships assigned to the port of Honolulu, and provided medical supplies to Army transports stopping at the port. 11

Soon after Army reorganization under the Central Pacific Area command, Medical Department officers were given some responsibility in coordinating medical plans for support of Army combat units with those of Navy medical officers for support of their forces during the amphibious operations westward. Admiral Nimitz, who as Commander in Chief, Pacific Ocean Areas, had had a joint Army-Navy command (in addition to his naval command of the U.S. Pacific Fleet) since early 1942, was now to conduct joint combat operations. A staff of Navy and Army officers was established for him in his capacity as Commander in Chief , Pacific Ocean Areas, in September 1943; it drew up the plans for Army-Navy assaults on the Gilberts, Marshalls, and Marianas. Within its Logistics Division was created in October a medical section, initially composed of a Navy medical officer (the former Fleet Medical Officer) and an Army medical officer who had previously worked in General King's office. A number of Navy medical officers were added, but the section never contained more than two Army medical officers, a second one being assigned in January 1944. When first established, the joint medical section was mainly concerned with the campaign of November 1943 in the Gilbert Islands (Tarawa and Makin atolls), making plans for evacuation, hospitalization, preventive measures, and the care of civilians. Later it drew up medical plans for the campaign of January-March 1944 in the Marshall Islands (Kwajalein and Eniwetok atolls) and that of June-August 1944 in the Marianas (Guam, Tinian, and Saipan). Continuing duties were the preparation of directives on medical and sanitary problems and the allocation of Army and Navy facili-

    11 Annual Report of Medical Activities, Army Port and Service Command, Hawaiian Department, 1944.


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ties for hospitalizing patients on the captured islands and for evacuating patients to fixed hospitals at the rear bases. Medical officers on the joint staff also had duties with the Joint Intelligence Center, Pacific Ocean Areas; their work in medical intelligence was of a type normally performed by an Army medical officer assigned to G-2 of a general staff. 12

The Office of the Surgeon, Central Pacific Area, worked in close liaison with the two Army medical officers participating in the high-level planning on Admiral Nimitz' staff; it prepared in its turn the more detailed medical phases of plans for the Army combat units participating in the westward offensive. The Operations and Training Section of General King's office took on increased importance; it conducted several training programs aimed at support of the island campaigns. Basic medical training was given to men of the divisions staging on Oahu; technical training was given to medical technicians in the hospitals on Oahu; medical officers and nurses were instructed in work under field conditions. At a Medical Department training camp established in January 1944 at Koko Head, intensive training was given to Medical Department units and special instruction to tactical units in the best methods of survival in tropical jungle. Some of the surgeon's staff observed rehearsals and maneuvers in amphibious and jungle warfare. The movement of troops from the salubrious Hawaiian Islands into areas of endemic tropical disease called for additional immunizations of troops and special equipment and trained personnel to combat insect vectors of disease.

General King's medical section had to provide medical support for the six divisions (the 6th, 7th, 24th, 40th, 77th, and 96th) which were sent to other islands during 1943 and 1944 after staging in the Central Pacific Area; all but the 24th received medical units and equipment especially designed to support amphibious operations. The office worked out plans for the Medical Department units which came to be standard support for the reinforced division (about 20,000 men) typically used in the island assaults in the Central Pacific Area: a field hospital, two portable surgical hospitals, and a malaria control and a malaria survey unit. Another standard development which emerged from its planning was the addition of equipment to the divisional clearing company which enabled it to operate as a 250-400-bed hospital on small islands where mobility was not so imperative as on large land masses.

Staff medical sections and fixed hospital units (station and general) were furnished to the Army garrison forces which accompanied task forces and became the Army administrative organizations on the westward islands after combat had ceased. Supply officers in General King's medical section worked out special procedures for providing medical supplies to the remoter islands

    12 See footnote 2,(2), p. 378. Since this medical section was under control of the Navy and naval medical officers assigned to it greatly outnumbered Army Medical Department personnel, an appraisal of its work is not in order here. However, an opinion expressed in the document cited, to the effect that the medical section on Admiral Nimitz' joint staff could have been more efficient "had Naval Medical Officers been trained or experienced in staff and logistics principles and procedures to the extent that those of the Army had been" is of some significance in this connection.


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directly from the mainland; the ordinary lines of communications did not prevail in this area and the bypassing of islands produced more rapid delivery. 13

In addition to General King and his deputy, Col. Kermit H. Gates, MC (fig. 86), former surgeon of the 24th Infantry Division, the theater medical section at the end of 1943 included 27 Medical Department officers, 3 warrant officers, and 121 enlisted men. Before mid-1944 specialists in medicine, surgery, orthopedic surgery, and laboratory work in several general hospitals had been given the additional assignment of consultants in those fields in General King's office. At that date, General King's medical section served as the highest medical office in the Central Pacific Area, supervising directly (without the interposition of a Services of Supply) the work of the surgeons' offices of the following commands: XXIV Corps and various divisions, the service commands on the outlying Hawaiian Islands, the army garrison forces on the westward islands, the Army Port and Service Command in Hawaii, and the Seventh Air Force. In June 1944, the total Army strength in the Central Pacific Area was approximately 296,000 men. 14

Late in 1943, when the westward offensive began, units of the Seventh Air Force, which until that time had been chiefly occupied with defense and training, were scattered over a number of islands; total air force strength in November 1943 was about 25,000. The Seventh Air Force maintained dispensaries at airfields, but as a result of close cooperation between the Surgeon, U.S. Army Forces in the Central Pacific Area, and medical officers of the air force, these dispensaries did not tend to develop into hospitals as did those operated by the air forces in. some other areas. The Seventh Air Force surgeon, Colonel Smith, although favorably disposed in theory to the operation of separate hospitals by the air forces overseas, pointed out several f actors which argued against it so far as the Central Pacific Area was concerned: the small proportion of air force patients in the total number of hospitalized troops, the convenient location of the fixed hospitals maintained by the Hawaiian Department Service Forces, and the sympathetic consideration given by the Pacific Area surgeon to air force medical problems.

The general and station hospitals run by the Hawaiian Department Service Forces on the islands of Oahu and Hawaii took care of air force, as well as ground force, patients, although the station hospital at Hickam Field was operated by the air force with Medical Department personnel assigned by the theater surgeon. As in other air forces, a few veterinarians inspected foods when they were received at airbases from the theater command and when they were issued to air force units. One medical supply platoon (aviation) drew

    13 (1) See footnotes 2(2) and 2(8), p. 378. (2) Interview, Col. Kermit H. Gates, MC, 17 July 1945. (3) History of the Medical Service, Central Pacific Base Command, vol. VIII. [Official record, Office of the Chief of Military History.] (4) Annual Report, Medical Section, Headquarters, U.S. Army Forces, Pacific Ocean Areas, 1944. (5) Quarterly Reports, Medical Department Activities, XXIV Corps, 2d, 3d, 4th Quarters, 1944.
    14 See footnotes 2 (2) and 2 (4), p. 378.


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medical supplies from the Fifth Medical Supply Depot and furnished them to the units of the Seventh Air Force by truck or to outlying bases by air. For its laboratory service the Seventh Air Force depended upon the regular theater laboratory service. 15

Until the summer of 1943 only two or three divisions were stationed in the Central Pacific Area at any one time; as divisions arrived from the United States, others moved westward to participate in the island campaigns directed by the Navy. In April 1944, XXIV Corps was activated, and a corps surgeon's office coordinated the medical work of the divisions assigned to it. During the summer several additional Medical Department officers and enlisted men were temporarily assigned to the office to aid with intensive planning for Medical Department personnel and supplies to support the invasion of Yap Island in the Palaus by XXIV Corps, then scheduled for the fall. 16

The Pacific Wing of the Air Transport Command bad its headquarters in the Central Pacific Area- at Hickam Field, Honolulu- and for many months, in advance of the organization of all Army forces in the Pacific into a

    15 (1) See footnote 7, p. 381. (2) Medical Report, Seventh Air Force, 26 Nov. 1943. (3) Interview, Maj. Everett B. Miller, VC, 27 June 1951. (4) Letter, Col. A. W. Smith, to Acting Air Surgeon, 5 Apr. 1944.
    16 Annual Report, Medical Department Activities, XXIV Corps, 1944.


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single theater of operations, it conducted Pacific-wide air evacuation. The wing surgeon and nine other medical officers arrived in Honolulu soon after the wing was established early in 1943. By April, they had established dispensaries at several locations along the Pacific routes of the Air Transport Command: Hickam Field, Amberley Field near Brisbane, Christmas Island in the Line Islands, Canton Island in the Phoenix Islands, Nandi Airport on Viti Levu in the Fijis, and Plaines des Gaiacs in New Caledonia. These installations served, as did other Air Transport Command dispensaries, personnel en route by air. During 1943 the Pacific Wing evacuated thousands of patients from forward areas to fixed hospitals in rearward Pacific bases, especially Hawaii, and to the United States. Because of the great distances, a relatively large proportion of evacuees in the Pacific were transported by plane. 17

SOUTH PACIFIC AREA

The creation of the Army command which administered medical service for Army troops throughout the South Pacific Area (map 7) took place in mid-1942. During the early months of the year, Army troops, as well as Marine and Navy units, had moved into the islands of the southern Pacific; the chief Army elements were the Americal Division in New Caledonia and the 37th Division in the Fijis, smaller troop elements being scattered over a number of other islands and atolls. Until the end of the year, with the exception of the work of a few station and general hospitals, medical service was largely furnished by the units that had come in with troops. At times during the early island campaigns a single unit, such as an evacuation hospital, had rendered the medical care commonly afforded by hospital units of both the combat and the communications zones, performing the standard functions of a collecting company, clearing company, general hospital, and so forth, since it was the only Medical Department unit within hundreds of miles. 18

Areawide Direction of Medical Service

The U.S. Army Forces in the South Pacific Area was established in July 1942, with headquarters in Auckland, New Zealand, until November when they were moved to Nouméa, New Caledonia. Commanded by Maj. Gen. (later Lt. Gen.) Millard F. Harmon, it was directly subordinate to the Commander of the South Pacific Area (Vice Adm. Robert L. Ghormley, later Vice Adm. William F. Halsey), who was in turn responsible to the Commander in Chief, Pacific Ocean Areas, Admiral Nimitz. Col. (later Brig. Gen.) Earl Maxwell, MC (fig. 87), became staff surgeon of the U.S. Army Forces in the South Pacific Area, and when the Services of Supply, South Pacific Area, was created

    17 (1) History of the Medical Department, Air Transport Command, May 1941-December 1944. [Official record.] (2) See footnote 2 (2), p. 378.
    18 Letter, Col. Earl Maxwell, MC, Surgeon, U.S. Army Forces in South Pacific Area, to The Surgeon General, 7 Dec. 1942.


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late in the year he was additionally made surgeon of that command. In his staff position with General Harmon, an air force officer, at Headquarters, U.S. Army Forces in the South Pacific Area, Colonel Maxwell was termed Air Surgeon, as he was the senior flight surgeon in the area. At the same time he served as assistant surgeon on Admiral Halsey's staff, second only to the Navy staff surgeon.

Colonel Maxwell's office prepared plans for medical units and supplies to support Army combat troops invading the South Pacific islands. Although the Navy surgeon on Admiral Halsey's staff had the higher responsibility for making medical plans for forward movements and the Navy the final authority in the South Pacific campaigns, in some cases- plans for medical support of the Bougainville operation, for example- Colonel Maxwell was given the major responsibility, for he had a larger staff than the Navy surgeon. As in the Central Pacific Area, many changes were made in the composition of units and equipment to fit the needs of medical service in jungle and amphibious warfare on small islands.

When Colonel Maxwell became surgeon of the newly formed Services of Supply in November 1942, his office personnel were transferred to the head-


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quarters of that organization, but after late March 1943 some were assigned to theater and some to Services of Supply headquarters. Officers who worked in the fields of operations and planning were assigned to the U.S. Army Forces in the South Pacific Area, while those handling medical supply, personnel, hospitalization, food inspection, and statistics were Services of Supply personnel. Assignments were essentially nominal, however, for the two groups occupied the same quarters in Nouméa. Often an officer performed the same work after a theoretical transfer to the other headquarters. The medical section remained under this dual arrangement throughout the life of the South Pacific Area command- that is, until August 1944; it never moved with General Harmon's headquarters to forward areas. The use of one surgeon and of complementary rather than duplicate assignments for two static headquarters effected a substantial savings in medical personnel. Colonel Maxwell favored a small, simple organization at this top level, believing that too large all organization would be unwieldy. He recognized the need for a good deal of decentralization in a region in which the land areas were so widely dispersed as in the South Pacific.

Not until the closing days of the New Georgia campaign were vacancies for a surgical consultant and a medical consultant allotted to the medical section of U.S. Army Forces in the South Pacific Area. In mid-1943, Colonel Maxwell obtained the release of a medical officer from the 39th General Hospital, an affiliated unit from Yale University stationed in New Zealand, and of another from the 19th General Hospital [sic - 18th General Hospital], an affiliated unit from The Johns Hopkins University stationed in the Fijis, for duty with his office as surgical consultant and medical consultant, respectively. Later in the year a neuro-psychiatric consultant and an orthopedic consultant were added to his staff. 19

Since it became standard policy to decentralize responsibility to local commands, each island tended to become medically independent. Because of the absence of sizable metropolitan areas on some islands and the inaccessibility of the larger towns to troops on others, venereal disease was a minor problem on many islands. Wherever preventive measures were necessary, the medical officers of the Army area command handled the problem in conjunction with local authorities. The work of the theater surgeon's office was thus greatly restricted.

Problems of general sanitation were also tackled on a, local basis. In New Caledonia, when several thousand American troops crowded the island, sanitary problems increased; the dumping of additional garbage and the opening of new bistros and restaurants called for additional sanitary inspections.

    19 (1) See footnotes 2(2), p. 378, and 18, p. 388. (2) Memorandum, Brig. Gen. Fred W. Rankin, for The Surgeon General, 2 Nov. 1943, subject: Remarks on Recent Trip Accompanying Senatorial Party. (3) Report of Observations of Medical Service in SWPA and SPA, 12 July 1943, by Brig. Gen. C. C. Hillman. (4) Annual Report, Medical Department Activities, South Pacific Area, 1943. (5) Interviews, Brig. Gen. Earl Maxwell, 11 and 12 May 1950. (6) Memorandum, Lt. Gen. M. F. Harmon, for Assistant Chief of Staff, Operations Division, War Department, 6 June 1944, subject: The Army in the South Pacific. (7) Letter, Brig. Gen. Earl Maxwell, to Col. J. H. McNinch, MC, 8 Mar. 1950.


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These tasks could be handled only through liaison with the local French Government. Army and Navy medical officers and French medical officials therefore established a Joint Sanitation Board. This organization- a coordinating rather than an operating one- served to prevent duplication of effort and disagreement on Army, Navy, and French policies with respect to maintaining a satisfactory water supply, standards of sanitation in barbershops, restaurants, and other establishments frequented by troops, as well as on prevention of venereal disease. 20

The isolation of units and installations on the scattered islands hampered the pooling of their resources. The central dental clinic, effectively used in some areas to pool the specialized training of dental officers and special dental supplies and equipment that separate installations had in insufficient quantity, could not be effectively established in the South Pacific Area. Here the distances between camps on separate islands were too great. The hospitals had to furnish prosthetic equipment, which was not provided to tactical units; and small units without dental personnel were attached to specific hospitals for dental care. By the spring of 1944, when enough trained enlisted personnel became available, prosthetic teams were formed; they were attached to the various hospital and division dental clinics to furnish dentures to troops receiving rehabilitation after periods of combat. 21

One of the most difficult problems encountered by Colonel Maxwell's office was the establishment and supervision of a, satisfactory system of inspecting foods for Army troops. The usual system prevailed among local commands on the various islands, where foods were inspected when they were received at island ports and at various stages of distribution and preparation for troop consumption. At these stages the task was complicated chiefly by the necessity for many transshipments from island to island (making further inspections necessary) to adjust to changing troop strength. A more serious problem arose in connection with inspection of foods at the point of origin, mainly New Zealand. From mid-1942 to the close of 1945, millions of pounds of dairy products and fresh vegetables and fruits, as well as canned foods, were bought monthly in New Zealand by the Joint Purchasing Board in Wellington (established June 1942 and immediately responsible to the Commander, Service Squadron, South Pacific Force) for consumption by Army, Navy, and Marine Corps troops on the scattered islands. In the early period, the Board maintained a policy not in accord with the thinking of U.S. Army veterinarians assigned to Colonel Maxwell's office in New Caledonia. Partly out of reliance upon the sound reputation of New Zealand food exports in prewar years and the country's strong protective legislation, the Purchasing Board in Wellington was inclined to rely upon the New Zealand Government's

    20 (1) Annual Report, Headquarters, Service Command, New Caledonia, 1943. (2) King, Arthur G.: Medical History of New Caledonia Service Command. [Official record.] (3) Letter, Col. Arthur G. King, to Director, Historical Unit, Office of The Surgeon General, 21 Aug. 1955.
    21 (1) See footnote 2(2), p. 378. (2) Dental History, South Pacific Area.[Official record.]


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standards and its system of inspection. Army veterinarians of the U.S. Army Forces in the South Pacific, on the other hand, noted the lack of enforcement under wartime conditions, of New Zealand legislation relating to food products, partly as a result of the shortage of qualified New Zealand inspectors; they warned of the danger that persons interested in the sale of food products would bring pressure to lower standards. They insisted upon the need for a sound system of food inspection by Army veterinarians at slaughterhouses and processing and packing plants.

Some struggle between the two points of view continued throughout the war. In July 1943, an Army veterinarian was assigned to the Joint Purchasing Board. This agency created a Food Inspection Division to supervise the inspection of food and food processing plants to insure that products bought were processed from suitable raw materials and packed under sanitary conditions. By dint of continued pressure, bolstered by an inspection of the situation in New Zealand by General Maxwell's veterinarian, the Army succeeded early in 1944 in assigning 13 veterinarians to the Board. They were placed in charge of food inspection in. the various areas of New Zealand and supervised the inspection of foods processed at plants and items in storage; they checked also on the sanitary conditions of ships loading foods for shipment at the New Zealand ports. Two laboratories maintained in New Zealand by the Food Inspection Division made examinations of canned, frozen, and dehydrated products and tested dairy and water supplies from processing plants and ships.

As in the case of other protective measures involving relations with local governments- as well as with the Navy command- large-scale inspection of local food products by Army veterinarians was difficult to achieve to the satisfaction of all concerned. Nevertheless, in spite of some dissatisfaction with the amount of support afforded to the program by the Navy command in control of the Joint Purchasing Board, as well as with the number of Army veterinarians assigned to the Board, the special system had been founded. During the last year of the war the scope of its work and the results were considered generally satisfactory by the Army veterinarians of the South Pacific Area command, as well as by those assigned to the work with the Joint Purchasing Board. 22

Control of Malaria and Other Insectborne Diseases

The prevention of tropical, diseases, chiefly malaria, was the challenge that demanded, and received, centralized control in the South Pacific Area. The most serious diseases in the islands were insectborne- mainly malaria, dengue fever, filariasis, and scrub typhus. In 1942 malaria rates rose to epidemic proportions on Efate in the New Hebrides Islands and on Guadalcanal in the

    22 (1) Annual Report, Veterinary Service, Headquarters, U.S. Joint Purchasing Board, 1945, and inclosures. (2) History of the South Pacific Base Command. [Official record, Office of the Chief of Military History.] (3) See footnote 2(2), p. 378. (4) Annual Report, Veterinary Service, Headquarters, U.S. Army Forces, Mid-Pacific, 1945.


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Solomons, where American troops with insufficient antimalaria supplies (chiefly the Americal Division and the 1st and 2d Marine Divisions) were in close proximity to infected enemy troops, as well as malarious natives. Colonel Maxwell noted in November 1942 that malaria was "the most serious disease present." The exigencies of the military situation and the typical belief of commanding officers that malaria control was of secondary importance, or that it was not possible to cope with the disease during the combat period, made a purely local system of control unsatisfactory. The statement of one officer that "we are out here to fight Japs and to hell with mosquitoes" succinctly expressed the attitude of many line officers. 23

An organization at a high level appeared to be the solution for control of a disease prevalent in most of the islands and responsible for the loss of many hours of work and combat. The South Pacific Malaria and Insect Control Organization24 was set up in November 1942, almost concurrently with the establishment of the Headquarters, U.S. Army Forces in the South Pacific Area. Its primary task was the control of malaria among Army troops (including the Thirteenth Air Force), the Navy (including Marine Corps personnel), and the New Zealand forces. The organization developed by the Surgeon General's Office for control of malaria overseas was somewhat modified to fit the complex command structure, but most of its features prevailed, although the resources of the Army and Navy were pooled and the Navy had final authority. A Navy medical officer, attached to the staff of the Commander, South Pacific Area, headed the organization; Lt. Col. Paul A. Harper, MC, acted as Army liaison officer and held the highest Army position in it. Army Medical Department officers and Army malaria control and survey units were added from January 1943 on; since the Army had more personnel available than the Navy, it performed the greater portion of the work.

By the end of 1943, 49 Army Medical Department officers, including malariologists, sanitary engineers, entomologists, and parasitologists, and 264 enlisted men were working on malaria control. The headquarters of the organization was first located at Efate, then at Espiritu Santo after April 1943, and finally moved to the headquarters of the Commander, South Pacific Area, on New Caledonia in February 1944. With the addition of about a dozen malarious islands to the command, the South Pacific Malaria and Insect Control Organization eventually directed a large network of Navy, Army, Marine, and Allied personnel in antimalaria work among a troop population of more than 200,000. Later, it had responsibilities for control of other epidemic diseases as well, including two other mosquitoborne diseases-

    23 (1) Memorandum, Surgeon, U.S. Forces In the South Pacific Area, for The Surgeon General, 4 Nov. 1942, subject: Preliminary Sanitary Survey of CACTUS (Guadalcanal). (2), Harper, Lt. Col. Paul A., Butler, Comdr. Fred A., Lisausky, Capt. Ephraim T., and Speck, Maj. Carlos D.: Malaria and Epidemic Control in the South Pacific Area, 1942-44. [Official record.]
    24 This title appears to have been used loosely to apply sometimes to the total network of personnel engaged in control and sometimes to the top directing personnel only. Other titles used were "South Pacific Malaria and Epidemic Control Organization" and "Malaria Control Board."


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filariasis, which appeared in epidemic form on several of the eastern bases in 1943, and dengue fever which reached epidemic proportions on New Caledonia early in 1943- as well as the miteborne scrub typhus. The mosquito was unquestionably the outstanding disease vector in the South Pacific islands; by about the middle of 1944, more than 750 personnel trained in entomology, engineering, and malariology and about 4,000 laborers were engaged in mosquito control.

Army malariologists went to the South Pacific Area as casual officers, were originally assigned to the Services of Supply and then reassigned to the various bases and to divisions. Six malariologists became senior base malariologists at headquarters; six more became division malariologists. A malariologist was also appointed for General Maxwell's office. As in other malarious areas, Army survey units and control units performed the fieldwork. As of 1 June 1944, 17 malaria survey units and 20 malaria control units were in the South Pacific Area.

An organization was set up at each island base; the area entomologist, engineer, and others of the staff at headquarters kept in touch with the work on each island through frequent visits. A senior base malariologist (either an Army or a Navy officer) was responsible on each island, originally through a commanding officer of the island service command, to the island commander, and later directly to the island commander, for developing a program applicable to all forces (Army, Navy, Marine, and Allied) on the island. The senior base (or island) malariologist estimated the assistant malariologists and survey and control units needed and requisitioned them from the area malariologist. Theoretically, the island malariologist, one survey unit, and one control unit formed the organization for malaria control at a base, but a larger island, such as Guadalcanal, had an assistant island malariologist and one or more survey and control units for each of several districts. On most islands a mixed Army and Navy organization was used.

The responsibilities of the island malariologist were of broad scope: The initiation of malaria surveys, the preparation of directives for protective measures to be enforced by unit commanders among troops, and measures taken in collaboration with colonial authorities or native chiefs to reduce the threats of transmission of malaria from natives to troops. In order to prevent transmission from infected natives, camps were located at some distance from native villages, or if necessary, the villages were moved. Another task of the island malariologist was the inspection of departing ships and planes for the presence of mosquitoes; some areas- New Zealand, New Caledonia, Fiji, and Samoa- were nonmalarious, and disinfestation of ships and planes was undertaken to prevent transmission of malaria vectors to uninfested islands. The island malariologist- as well as the island entomologist, the parasitologist, and the engineer- also had the job of training troop personnel assigned to malaria control work.


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The malaria survey unit made geographic surveys of areas within the base for actual and potential breeding grounds of mosquitoes, maintained records on the mosquito population, and surveyed malaria parasites among troops, natives, white civilians, and Japanese prisoners. The control unit eliminated mosquitoes by draining and applying larvicides and insecticides to areas designated by the survey unit. Army Engineer troop units and Navy construction battalions provided additional skilled or semiskilled labor. To perform the unskilled, and some semiskilled, work, troop antimalaria details and Army medical sanitary companies (consisting of two platoons, each made up of two drainage teams, two oiling teams, and two spraying teams), as well as natives, were used.

The malaria control carried out in Army tactical units was done exclusively by personnel of the Army Medical Department; that is, the programs of the Army and Navy were separate at this level. Unit commanders had direct responsibility for initiating and enforcing the antimalaria measures in Army units. An antimalaria detail, consisting of a noncommissioned officer and enlisted men in numbers proportionate to the, size of the unit (company, battery, squadron, or other unit), maintained mosquito control by oiling, spraying, and draining on campsites and in the surrounding area for a distance of 1 mile. Battalion and regimental surgeons were designated malaria control officers for their respective units and given responsibility for training the antimalaria details. For the Army division the control group consisted of a malariologist, responsible to the division Surgeon, and one malaria survey and one malaria control unit. Whenever the division went into a new combat area, its antimalaria group carried out control work until the base organization was in working order; thereafter the antimalaria work of the division was closely integrated with that of the base. Antimalaria personnel assigned to a base usually had the more stable duties, of course, while the division malariologist sometimes had to create temporary teams for spraying and to shift them about as the tactical situation changed. 25

Obviously no set Pattern prevailed either for the various bases or for Army units. The number of units and their assignments varied with the terrain and climate of the island bases and were modified within the base or the Army unit in accordance with change of season, shifts in the tactical situation, and so forth. During periods of combat or movements of units, emphasis shifted from environmental control of malaria to the mass taking of Atabrine (quinacrine hydrochloride), then the drug of choice for suppression of malaria. But the establishment of broad uniform policies, standard assignments of per-

    25 (1) See footnotes 2(2), p. 378; 19(3), 19(4), and 19(5), p. 390; 20(2), p. 391; and 23(2), p. 393. (2) Report No. 35, Air Evaluation Board, Southwest Pacific Area: Medical Support of Air Warfare in the South and Southwest Pacific, 7 December 1941-15 August 1945. (3) Memorandum, Chief, Professional Services, to Chief Surgeon, USAFIA, 6 Oct. 1943, subject: Malaria Control. (4) Annual Report, Malaria and Epidemic Control, Guadalcanal Island Command, 1944. (5) Annual Report, Medical Department Activities, South Pacific Base Command, 1944. (6) See also Medical Department, United States Army. Preventive Medicine in World War II. Volume VI, Communicable Diseases: Malaria. [In press.]


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sonnel, and routine procedures helped to prevent interruptions in control whenever troops moved from one island to another.

A steady decline in malaria rates took place in the South Pacific Area, beginning in mid-1943 and continuing in 1944 and 1945, interrupted only by sporadic rises whenever troops went on maneuvers or entered uncontrolled areas. The low rates on Bougainville, potentially an area of high malaria incidence, and on other islands occupied in 1943 and 1944, proved the value of control work begun on the day of occupation. The draining, leveling, or, filling in of extensive mosquito breeding areas, clearing of underbrush, spraying water surfaces and buildings with DDT, better identification of malaria- carrying mosquitoes through improved laboratory work, more thorough training of troops and wider publicity of the need for control- all these undertakings of the organization for malaria control contributed to the decline of malaria. The regular dosage of troops with Atabrine in order to build up immunity in advance was relied on to prevent the incidence of the disease in mosquito- infested areas during the early days of combat before the mosquito population could be destroyed. Commanding officers, impressed by the loss of man-days resulting from the incidence of malaria on Efate and Guadalcanal, enforced more strictly the Atabrine regimen on the eve of later campaigns.26

One noteworthy feature of the South Pacific Malaria and Insect Control Organization was that from its inception its head, a Navy doctor, was placed at the highest level of command in the South Pacific Area; a similar position for the island or base malariologist was early established. The principle of centralized control over malariologists and control and survey units was steadfastly maintained. Most observers found that the organization in the South Pacific worked more smoothly than that in the Southwest Pacific Area, where the question of the proper structure and placement of the malaria control organization was bandied about for some time and where control over the effective employment of units was lost through their assignment. to various commands. While some problems arose in the South Pacific Area wherever local command relationships were not well defined, Army and Navy forces attained a high degree of cooperation in their joint program in the South Pacific. Ready exchange of supplies, facilities, and technical knowledge seems to have taken place. Administrators made the following appraisal: "The efficiency and economy of this joint use of personnel and equipment is a stimulating chapter in combined service organization." Colonel Harper stated: "It is worthy of emphasis that the South Pacific Malaria. and Insect Control Organization was based on a combination of centralized control over assignment of personnel and over matters of policy which could reasonably be areawide in application and of decentralized responsibility for day to day operations at each base." 27

    26 See footnotes 19 (4), p. 390 ; and 22 (2), p. 392.
    27 (1) See footnote 23(2), p. 393. (2) Letter, Paul Harper, M.D., to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. Army Medical Service, 25 July 1955.


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The Ground Combat Forces and the South Pacific Islands U.S. Army tactical troops sent to the South Pacific Area from early 1942 to the spring of 1944 (when plans were made for redeployment of troops in the South Pacific to the Southwest Pacific) consisted of six divisions (the 25th, 37th, 40th, 43d, 93d, and Americal Divisions) and the Thirteenth Air Force. During combat, the divisions usually functioned under XIV Corps. The latter's headquarters on Guadalcanal included a medical section which by March 1943 was acting as the medical section for a provisional island command for Guadalcanal as well as the medical section of the corps. From July to about November 1943, it functioned in the same dual capacity on New Georgia. In the winter of 1943-44, the, office of XIV Corps surgeon, then consisting of three Medical Department officers, was on Bougainville. In June 1944, when XIV Corps took over control of New Georgia, Treasury, and Green Islands in the northern Solomons, as well as Bougainville, and of Emirau in the Bismarck Archipelago, four more officers were added to the medical section. As in most corps medical sections, officers were of the Medical or Medical Administrative Corps, the task of the corps medical section being largely that of coordinating the medical work of the divisions operating under the corps. On 15 June 1944, XIV Corps was transferred to the Southwest Pacific Area. command, having entered islands within the latter's boundary lines. 28

With the progress of combat, "island commands" were established on islands of strategic importance on which troops were concentrated in considerable strength; each was composed of all tactical troops on the island- Army, Army Air Forces, Navy, and Marines. Island commands were finally established on the seven following South Pacific islands or island groups: New Caledonia, Fiji, Efate, and Espiritu Santo in the New Hebrides; Guadalcanal and New Georgia in the Solomons; and the Russell Islands. In addition, the Army maintained for varying periods of time garrison forces at the following locations: Auckland, New Zealand; Upola, and Wallis Island in the Samoan Islands; Tongatabu in the Tonga Islands; Bora, Bora in the Society Islands; Aitutaki and Tongareva in the Cook Islands; Treasury Islands, Bougainville, and Green Islands in the Solomons; and Emirau Island in the Bismarck Archipelago. While troop strength varied greatly, most of these forces, except on Bougainville, were small. In January 1944 nearly 36,000 Army troops were on Bougainville, approximately the same number as were on Guadalcanal and on New Caledonia. By early August 1944 (when the South Pacific Area command was abolished), only four island commands still existed- New Caledonia,

    28 (1) Annual Report, Medical Department Activities, Headquarters, XIV Corps, 1943. (2) Quarterly Reports, Medical Department Activities, Headquarters, XIV Corps, 1st, 2d, and 3d quarters, 1944. (3) Letter, Col. Maurice C. Pincoffs, MC, to Brig. Gen. Guy B. Denit, 10 July 1944. (4) Annual Report, Surgeon, Service Command, Guadalcanal, 1943. (5) History of U.S. Army Forces in the South Pacific Area During World War II, 30 March 1942-1 August 1944. [Official record, Office of the Chief of Military History.]


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Fiji, Espiritu Santo, and Guadalcanal Island Commands- the remaining three having been made subbases.29

On 10 islands or island groups a service command (corresponding to a base section in other theaters of operations) was set up to serve all Army troops on the island. (A naval advanced base filled this role for Navy troops.) Between November 1942 and April 1944, the following 10 service commands were established in the order named: New Caledonia, New Zealand, Fiji, Guadalcanal, Espiritu Santo, Efate, Russell Islands, Green Islands, Emirau, and Bougainville. Whereas the island commander- who might be either an Army, a Navy, or a Marine Corps officer- was responsible to the Commanding General, U.S. Army Forces, South Pacific Area (General Harmon), the service commander was responsible (through the Commander, Services of Supply, Forward Area30) to the Commanding General, Services of Supply, South Pacific Area. Oil some islands there existed, for a limited time after tactical troops moved into an island, both an island command surgeon and a service command surgeon, who operated within the channels of their respective commands. Their respective functions roughly resembled those of the surgeon of an army and those of a service command surgeon in the United States, or of an army surgeon and the usual base section surgeon in an oversea, theater. Later the position of island command surgeon was discontinued, and the service command surgeon was then the Army medical officer of chief responsibility on the island. Although he served within the service command setup, he was usually assigned additional duty as island command surgeon or given unofficial recognition in that capacity. A provisional service command which arrived on Guadalcanal early in 1943, for example, had a medical section by May 1943. This section took over the responsibility for the Army's medical program on Guadalcanal from the medical section of the provisional island command (XIV Corps) mentioned above, when the latter left Guadalcanal in mid-1943.

Channels of command were somewhat involved for the service command surgeon. He was responsible to the service commander of the island, who, although on the next echelon below the Commanding General, Services of Supply, South Pacific Area, was responsible to the island commander for local operations. However, both channels for the service command surgeon led back to the individual with single responsibility for the health of Army troops, Colonel Maxwell, for he was not only Surgeon, Services of Supply, South Pacific Area, and surgeon at the next higher, or theater, level, but also assistant surgeon on the staff of the Commander, South Pacific. Thus, Army medical responsibilities were clearly centralized at the top level. Certain complications that arose in medical administration on the South Pacific islands were not due to lack of centralized responsibility within the command structure but to

    29 (1) Annual Report, Medical Department Activities, South Pacific Area, 1942. (2) See footnote 22(2), p. 392. (3) General Order No. 1175, Headquarters, South Pacific Base Command, 3 Aug. 1944. (4) General Order No. 1184, Headquarters, South Pacific Base Command, 19 Aug. 1944.
    30 Under the Navy organization of the South Pacific Area the island commands lay within the forward area, intermediate between combat and rear areas.


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the great distance between islands which prevented effective control from the top level and thrust responsibility downward to the island level where several channels of command, including Navy commands, prevailed.31

The medical administration on the largest of the New Hebrides islands, Espiritu Santo, governed under French-British condominium, illustrates the situation that prevailed on the island bases and the problems that arose. Espiritu Santo was used as a base by air units for attacks on Guadalcanal; by early 1943 the Thirteenth Air Force was based there, as well as some Army ground force, Navy, and Marine Corps elements- the medley of troops characteristic of the South Pacific bases. During 1942 Army medical officers on Espiritu Santo were those assigned to tactical units. A Navy hospital received Army sick, and a French colonial hospital cared for sick or injured natives employed by the U.S. Army. The organization of Army medical service was not of islandwide scope until March 1943, when Lt. Col. Arthur G. King, who had pioneered as surgeon for the service command of the very large base of New Caledonia, organized the medical section for the newly formed Espiritu Santo, Service Command. An evacuation, a station, and a general hospital opened on the island in 1943, and Colonel King's office established a fairly elaborate system of dispensaries for the 17,000 widely scattered Army troops there.

The IV Island Command had tactical control of all Army troops on Espiritu Santo and was responsible to the Commanding General, South Pacific Area. The Espiritu Santo Service Command, though locally responsible to IV Island Command, took orders from the Commanding General, Services of Supply, South Pacific Area, in turn responsible to the Commanding General, South Pacific Area. As no rival surgeon existed at IV Island Command headquarters, Colonel King appears to have been recognized as island command surgeon, as well as service command surgeon. On the other hand, he encountered difficulty in coordinating his work with that of surgeons of various commands on Espiritu Santo. The Surgeon, Thirteenth Air Force, reported directly to the theater surgeon at Headquarters, U.S. Army Forces, South Pacific Area, in spite of the fact that Colonel King, as service command surgeon, had responsibility for hospitalizing Thirteenth Air Force personnel in hospitals on Espiritu Santo and, as island command surgeon, was responsible for issuing sanitation orders to which the Thirteenth Air Force units, along with other military units, were subject. Until the fall of 1943, when a naval advanced base surgeon was appointed, with duties comparable to his own as service command surgeon, Colonel King was obliged to handle problems of sanitation on an individual basis with the various Navy medical officers concerned. Colonel King still had to deal separately with Marine Corps units, and with the two large naval hospitals, as only the service elements of the

    31 (1) See footnotes 2(2), p. 378; 19(5), p. 390; 20(2), p. 391; and 28(3) and (4), p. 397. (2) Scattered quarterly reports of Medical Department activities from various South Pacific islands, including Aitutaki, Tongareva, Upolu, Green Islands, and Viti Levu.


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Navy were under the Naval Advanced Base, while the Marine Corps elements were semi-independent of the Navy.

As might be expected, he experienced his major difficulties in preventive measures which called for consistent policies among troops throughout Espiritu Santo, such as garbage disposal and other general sanitary measures, quarantine regulations, and malaria control. The island commander instructed him to emphasize sanitary measures, which, before the establishment of a service command, had failed signally because of the plurality of tactical units and chains of command. An order of the commander in March 1943 that each unit clean up its own accumulation of garbage, tin cans, and cocoanut waste had led to the threat of armed clashes when units tried to dump garbage on each other's territory. A system of fixed sanitary sectors had also proved ineffective. Colonel King established a central sanitary detail, composed of personnel from Army, Air Force, Navy, and Marine Corps elements on the island, to clean up the entire occupied portion of the island, as well as a central garbage and trash dump. Centralized control by the Medical Department with the backing of the island commander proved to be the answer.

Problems arose with respect to the jurisdiction and responsibility of the port surgeon in Colonel King's office over quarantine and disinfestation measures for incoming ships and planes. Apparently considering Colonel King only an Army service command surgeon, the naval advanced base command was averse to recognizing his port surgeon's authority to inspect Navy- controlled ships and to issue the necessary certificate of health for disembarking personnel, as well as his authority to disinfest Navy-controlled ships and planes. An epidemic of hog cholera among swine on a plantation on an island near Espiritu Santo, supposedly caused by garbage dumped overboard by Navy ships, gave further trouble. In this case not even the naval advanced base command could control the situation effectively, as ships of the Fleet were not responsible to it but directly to the Commander, South Pacific. Not only did the epidemic endanger the supply of meat for troops, but his problem, like some others encountered on Espiritu Santo, could have affected relations of the U.S. Army with the French plantation owners, since the latter paid their native Melanesian workers in hogs. These conflicts with the Navy were eventually solved by various compromises after considerable effort by the service command surgeon to establish specific responsibilities and reconcile conflicting claims.

Although the organization for malaria control seemed a satisfactory one to the malariologists, Colonel King found some defects in the workings of an unorthodox system that singled out a single phase of medical service, albeit an important one, for control through special channels. An early requirement that the malaria control officer (Navy) approve the location of any troop unit was ignored by many Army units. Various directives for malaria control measures, issued by the South Pacific Area command, its Services of Supply, and The Surgeon General sometimes conflicted with the policies of the local


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command. In the spring of 1943, the responsibility for directing the program on Espiritu Santo rested with the Navy malaria control officer. Colonel King considered himself responsible, in his capacity as island command surgeon, for carrying out the program, while the Services of Supply; South Pacific Area, provided the necessary supplies. In late May 1943, however, a Navy order put all malaria control work under the authority of the island malaria control officer, who was responsible to the Commander, South Pacific. This order short circuited the Army chain of command, that is, the Espiritu Santo island command, the U.S. Army Forces in the South Pacific Area, and the Services of Supply, South Pacific Area. Thus the island commander received only information copies of monthly reports, sometimes strongly critical, of work in malaria control among his own troops after the original report had gone to higher headquarters. A directive requiring submission of malaria control reports to the commanding general of the island through the commanding general of the service command straightened out the matter temporarily. However, in August a directive issued by the Navy Bureau of Medicine and Surgery placed the control of all epidemic disease under the malaria control officer; hence re-ports on control of not only malaria but all epidemic diseases were once more sent through Navy channels, the island commanding general and his surgeon receiving only information copies at a later date. The appearance of a War Department circular placing all insect control of any island under the commanding general of the island led to further confusion, but the Army command apparently avoided duplication of Navy work in malaria control. In October 1943, a directive requiring all communications of the malaria control officer to be routed through service command channels brought an end to the controversy.

A proposal to prevent contact of troops with the malaria-ridden Tonkinese laborers working for French planters on Espiritu Santo was also bandied about in various commands. After failure to move the Tonkinese or to get French doctors to treat them early in 1943, the malaria control officer proposed in August their forcible removal to a central village from which they could be transported daily to the plantations. The island commander approved this move without consulting the surgeon, but when the commanding general of the service command protested, the scheme was dropped. In October the Commander, South Pacific, ordered the removal of all Tonkinese and other natives from. the military area on Espiritu Santo without any consultation with a newly appointed island commander. The following day the order was rescinded. A few days later the island commander directed the surgeon to treat the Tonkinese on the plantations, and treatment was given with the cooperation of the French planters. Colonel King noted that this satisfactory solution was brought about only through centralizing authority in the new island commander who was able to deal realistically and tactfully with the sensitive French.

Colonel King found his lack of control over the assignments of medical personnel another stumbling block to efficient medical service. Like many


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another island command surgeon (and many base section and theater surgeons), he noted his need of a pool of medically trained personnel to replace officers to be sent home for rest and recuperation and to fill certain medical jobs which had developed in the areas outside official allotments and tables of organization. When he tried to use the personnel of hospital ship platoons, stranded for lengthy periods in the theater, for this purpose, he found that command channels interfered with transfer of medical personnel from one command to another. He developed a plan to effect more efficient use of medical personnel on the island by transferring them to the positions for which they were best fitted after classifying them according to specialized training, experience, and proficiency. This undertaking bogged down because of the unwillingness of commands to surrender personnel and the many paper transactions necessary to effect reassignments. His efforts to transfer a pathologist, then surgeon of an antiaircraft battalion, and a highly qualified orthopedic surgeon, who was a ship's hospital platoon officer, to hospitals where their specialized skills were urgently needed, were defeated in spite of complicated paper transactions.

In summing up his experiences, Colonel King made a plea for a medical service with more direct control by medical officers and less hampered by chains of command. In his opinion "the complex and cumbersome" command relationships on Espiritu Santo and throughout the South Pacific Area had put difficulties in the way of administering medical service there. His insistence in his report that "optimal cooperation between the Army, Navy, and Air Force, even to the point of loss of identity, was sorely needed" is significant in view of the trend towards unification of the three military arms that took place in the postwar period.32

Thirteenth Air Force

The Thirteenth Air Force built up in the South Pacific from and after early 1942. Its nucleus was air units dispatched to South Pacific islands from Hawaii, which were temporarily supplied by their remote parent organization, the Seventh Air Force. An island air command, with a flight surgeon on its special staff, was created on each of several islands, and in December administrative control of all air units oil the South Pacific islands became the responsibility of Headquarters, U.S. Army Forces in the South Pacific Area. In January 1943 Headquarters, Thirteenth Air Force, was called into being, with Lt. Col. (later Col.) Frederick J. Frese, MC (fig. 88), as its surgeon, based on Espiritu Santo; Colonel Frese had previously been assistant to Colonel Maxwell, who was serving in the dual capacity of Surgeon and Air Surgeon, U.S. Army Forces in the South Pacific Area. Like Colonel Maxwell himself, Colonel Frese had been trained as a flight surgeon.

    32 (1) King, Arthur G.: Medical History of Espiritu Santo (New Hebrides) Service Command, 12 March 1943-15 May 1944. [Official record.] (2) Annual Report of Medical Activities on Espiritu Santo, 1944.(3) Diary, Lt. Col. Arthur G. King, MC, 12 Mar. 1943-21 Nov. 1944.


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As units of the Thirteenth Air Force were scattered over the South Pacific islands and were operating against the Solomons in close conjunction with air elements of the Navy, Marines, and the New Zealand forces, centralized direction of medical service throughout the air force from headquarters was out of the question. Late in 1943, duties of staff surgeons were unorthodox. One officer of the headquarters medical section was on detached service with the combined Army-Navy-Marine, headquarters for all aircraft on the Solomon Islands, and another was acting as flight surgeon in the rest area at Auckland. The Surgeon of XIII Air Service Command was also serving at Auckland, while his assistant was handling the neuropsychiatric duties for the whole air force. At that date the bomber command was the only one of the air commands which had a well-developed medical section functioning as planned.

The geographic and tactical situation weakened arguments for control of separate hospitals by the air force, as well as efforts at centralized supervision of medical service for air force troops. The Thirteenth Air Force surgeon agreed with the Air Surgeon's Office in Washington that oversea air forces should operate separate hospitals for their personnel, but Colonel Maxwell noted that the short stay of the air force units on small islands made control of hospitals by the Thirteenth Air Force in that area impracticable. Hospitals assigned to the air force would have been subject to frequent moves to conform to the rapid changes of station of air force units; they would have had to be


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put under tentage and would have lacked various facilities. Sending in one hospital, under the Services of Supply, for both ground and air troops to a relatively permanent location had resulted in better construction, running water, screening, and other advantages. In the Thirteenth Air Force the majority of tactical as well as service groups established small infirmaries, many as well equipped as small station hospitals except for such specialized items as operating equipment. These treated many cases of malaria and dengue. After the transfer of Thirteenth Air Force to the Southwest Pacific Area command, a few 25-bed portable surgical hospitals were attached to it; the group infirmaries were then abandoned. An informal agreement by Colonel Frese and Colonel King on Espiritu Santo to ignore the rules for distribution of patients on an area basis and concentrate all Thirteenth Air Force patients in only one of the three hospitals on the island, with free participation by flight surgeons in their treatment, solved the problem in that area to the satisfaction of the Thirteenth Air Force surgeon.33

The organization which directed air evacuation within the South Pacific Area- the area where large-scale evacuation by air occurred earliest in World War II-was an interservice, command, which reflected both the advantages and the problems inherent in joint Army-Navy direction of a medical activity. From the fall of 1942 to the spring of 1943, no special organization existed to evacuate casualties by air from the overcrowded facilities on Guadalcanal to base hospitals on New Caledonia. During the late months of 1942, unarmed and unescorted planes of the Marines and troop carrier planes of the Thirteenth Air Force which carried supplies to troops on Guadalcanal evacuated patients on their return flights to their bases, with Marine Corps hospital corpsmen assigned to each plane to care for patients en route. Late in November, the South Pacific Combat Air Transport Command was formally organized, under direction of the Marine Corps, to carry supplies; its returning planes took care of intratheater air evacuation. Planes and medical personnel of the Thirteenth Air Force were used, along with those of the Navy and Marine Corps, by the combined command. After the 801st Medical Air Evacuation Transport Squadron arrived early in 1943 and was assigned for duty with the medical section of the combined command at Tontouta on New Caledonia, Army Air Forces medical personnel constituted three-fourths of the personnel available to accompany patients in flight.

Personnel of the squadron (later based on Espiritu Santo) were individually assigned and reassigned by the South Pacific Combat Air Transport Command (directly by the Navy flight surgeon who headed its medical section) rather than by an Army Air Forces command as in other areas. In a, report on the effectiveness of medical support given air force elements in the Pacific theater, the Air Evacuation Board criticized the tendency of the Navy and Marine Corps to establish policies on air evacuation without consultation with

    33 Letter, Col. Arthur G. King, MC, USA (Ret.), to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. Army Medical Service, 21 Aug. 1955.


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the Thirteenth Air Force and a tendency to assign patients to the care of Navy corpsmen during flight in preference to putting them in the hands of the more highly trained flight nurses of the Army Air Forces. Nevertheless the operations of the Army evacuation unit under this system were highly successful. By the close of 1943, 62 members had flown more than 18,700 hours, nearly all in combat zones, evacuating thousands of Army, Air Force, and Navy patients over the lengthy routes from the Solomons.34

    34 (1) Medical Report, Thirteenth Air Force, 11 December 1943. (2) See footnotes 19(5), p. 390; 25(5), p. 395; and 28(5), p. 397. (3) War Critique Study, XIII Air Force Service Command. (4) Special Order No. 1, Headquarters, Island Air Command, 17 Oct. 1942. (5) General Order No. 407, Headquarters, U.S. Army Forces in the South Pacific Area, 19 March 1944. (6) Annual Report, 801st Medical Air Evacuation Transport Squadron, 1943. (7) Link, Mae Mills, and Coleman, Hubert A.: Medical Support of the Army Air Forces in World War II. Washington: U.S. Government Printing Office, 1955, pp. 773-774.

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