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Headquarters, Third Portable Surgical Hospital, U.S.A.S.O.S., A.P.O. 705, 1 July 1943

Table of Contents

HEADQUARTERS
THIRD PORTABLE SURGICAL HOSPITAL
U .S. A. S. O. S.

A.P.O. 705
1 July, 1943

SUBJECT: Quarterly Report of History of Medical Activities of the 3rd Portable Hospital, for the period of Jan. 1, 1943 to Mar. 31, 1943.

TO: Chief Surgeon, USASOS, APO 501, (THRU Surgeon, Base Section #2, APO 922).

1.    New Years Eve and Day was as any other for the personnel of the 3rd Portable Surgical Hospital. I am not sure that many were aware that it was any different than any of the preceding days and nights or the ones that followed. We were very busy. Day and night was marked only by taking the next surgical case from an open air fly to the steaming-hot blacked out tent and back again when morning came. Meals were never served in mass. Every one ate when he could. For the first fourteen days the Officers slept for an hour or two in the early or late morning, and then shortly, the stream of seriously wounded men arrived by stretcher bearers. As for the enlisted men, I am not sure whether they ever slept or ate. Everyone knew and did his job without direction. Even the two or three men who always contrived to lay down on the job, were so moved by the terribly wounded and sick that they went to work. The situation was exactly what one went to war for.

2.    Between January 1, and 14, we had two hundred and thirty-nine (239) patients admitted, and one hundred and thirty (130) were medical cases with fever. We had brought with us a microscope and a few stains and were able to make positive diagnosis. The majority of these fevers were Malaria, well over one hundred. One well trained enlisted man, a Greek from Egypt who had been two years in medical school in Europe and only three years in the States, and Captains Muller and Karns, took care of the laboratory diagnosis and treatment on these masses of fever. When ever one tent was filled we threw up another until we had five pyramidal, two small wall and two flys full of patients, then we had no more tents and the rest were unfortunate and slept out in the open on extra stretchers and the ground. We had to be careful in walking at night to keep from stopping on some fever riddens middle. All of these got wet with the torrential rains which came nearly every night, but they didn't seem to mind. They were sent down the trail -  walking - as quickly as possible after being fed and started on their therapy of quinine. Stretcher bearers could not carry any of these out; they were too busy carrying the seriously wounded.


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3.    One fever case was particularly interesting. Most of the Malaria's  were either Plasmodium Vivax or Falciparum. This man came in with a fever of 105 degrees and maintained it. He had Vivax in his blood stream, but also had enlarged, tender cervical, axillary and inguinal glands. In four days, his temperature had varied only to go to 106, terminating in his death. He had had a continuous diarrhoea and was totally unable to eat. He was given 3000 cc. I.V. 10 percent Glucose in Saline daily and intramuscular quinine, but with little response. We did an autopsy. His spleen was larger than his liver and extended down to his Iliac crest. The peculiar thing was that all lymphatic tissue, especially the deep mesenteric and dediastinal glands were greatly enlarged. We regretted not being able to preserve pathological specimens of the case. It was Captain Muller's impression that he had Scrub Typhus.

4.    A few of the medical cases were diarrhoea, asthma, shell shock and simply exhaustion. Any cases, that with short care might be able to return to combat, we treated and sent in again because it seemed important. Often the results were poor, for lying in that camp so close to the Japanese, with bullet holes appearing in the tents and the noise of fighting and the bloody parade of wounded men passing the tents, served only to accentuate their illnesses. They were evacuated as quickly as possible.

5.    We never kept a shell shocked case, even overnight. It was catching. A shell shocked patient among the severely wounded, after a little while of crying with each burst of fire or having a convulsion when the twenty-five pound shells began to go overhead, would have the whole tent apprehensive and upset. We sent them down the trail during the day and at night when it was necessary to send one of our men to guide them. The dangers of keeping those noisy patients were greater than sending them along a trail lined with fox-hole-bound men bristling with guns which, at the slightest noise in the dark, would spray the horizon with bullets. No lights were allowed, but we did not lose a man.

6.    One hundred and nine cases in those fifteen days were seriously wounded men. Because of being about three hundred yards from the Japs, we kept only those men who, because of shock, bleeding, or the serious nature of their wounds could not possibly be carried back the two and a half miles to the 5th Portable Hospital. They were either bullet wounds or shrapnel wounds. We had no burns. They fall into the following groups:

    Head    15
    Neck    5
    Chest    16
    Abdomen    14
    Extremity        57

None of these wounds were superficial. All head cases kept had penetrating wounds, at least to the dura mater; chest wounds were those with through-and-through injuries which caused either pulmonary hemorrhage or were complicated wounds of the lung, diaphragm and liver. The abdominal wounds kept were those that penetrated the peritoneum. The extremities kept were those which were in profound shock with either great blood loss or compound fracture or required immediate amputation.


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7.    We had nine deaths among this group which were operated on. One head wound died nine hours after operation. The bullet had entered his motor area, bisected his optic nerve and proceeded out of his head at the base of the nose. The patient was a Major [Edmund R.] Schroeder who was in command of the 1st Battalion of the 127th Inf. After the Mission fell, he was struck by a sniper's bullet. He remained conscious long enough to turn his command over and collect his belongings in spite of being blind. To us, he was the greatest hero of that campaign because he always led his men in every undertaking and was very courageous.

8.    Three deaths were of chest wounds which were all similar in that they were all in the right, lower chest, tearing the diaphragm and fragmenting the liver. All of them lived about 48 hours after operations. We tried to repair five of these similar wounds. Two of them lived and were evacuated. In each case a thoracotomy was done, the phrenic nerve clamped, the capsule of the liver closed to stop hemorrhage and the diaphragm sutured. One of these cases required  thoraco-abdominal incision to close the under surface of the liver near the cystic duct. The two cases which lived, are still alive and back on limited duty at this time.

9.    Five deaths were in abdominal wounds. All of them were in patients who had complicated wounds of the stomach and large bowel, or rectum and, bladder, or small bowel and colon. None of the multiple small bowel wounds died after operation and none of the perforations of descending or ascending colon died after closure of the perforations.

10.    One of these deaths was of an American soldier who was lying in a fox hole when an American plane strafed our camp and the grave yard. The Pilot probably could not tell where the American lines ceased and the Jap lines began. The strafing cut the lower end of our camp at meal time putting holes in the kitchen fly and wounding three men. The fifty caliber bullet entered this man's back and eviscerated his stomach and transverse colon. He lived 24 hours after operation.

11.    We did twelve jejunal and ileal resections which were usually closed by end to end anastomosis. The smaller holes were closed by re-enforced purse string sutures. All of these patients, we kept from four to seven days until they were eating a regular diet and having bowel movements.

12.    Two of the abdominal cases required colostomies, one a caecostomy, one a double barreled colostomy in the descending colon and sigmoid after Mikulicz technique. Both recovered.

13.    Our most interesting cases were among the chest and abdominal cases and several of them we kept until they were healed, stitches removed and up and about on their feet.

14.    We received one case in which an “explosive” bullet had entered the right lumbar region and ended in the right kidney. The wound was bleeding profusely on admission and there was gross blood in the urine. A Nephrectomy was done. The kidney was fragmented into four parts hanging together by the pelvis. Sulfanilamide was placed in the wound and it was closed without drainage. He remained with us two weeks, all sutures were removed and the wound healed by primary intention--without infection.


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15.    The extremities consisted of ever conceived wound from serious compound fracture of femur and elbow, to completely severed femoral and popliteal arteries and brachial plexus and other nerve injuries. None of these died. They arrived in our hospital usually not ten to fifteen minutes after injury, bleeding profusely and prior to any serious shock. The quickness in which we got these patients compensated for the dangerously close position to the Jap lines.

16.    We performed one mid-thigh amputation. The remainder we were able to save with debridement, plasma and sulfa drugs. Those cases which were not transported down the evacuation chain, but which remained in our camp usually because of poor general conditions, long enough to have sutures removed, did not have infected wounds. We were interested in noting that those evacuated before healing, nearly all developed infected wounds.

17.    One case of gas gangrene we had, in a man who had laid in the swamp for forty eight hours after being struck by shrapnel about the head and in the heavy muscles of the thigh. He was gently debrided as high as the right button [buttocks?] and around the neck of the femur, putting on sulfanilamide. He remained in our camp two weeks. The crepitation high about his lumbar region disappeared and he recovered sufficiently to be evacuated.

18.    The anesthesia used in every case was that of induction with pentothal sodium followed by open drop either. We preferred this method to spinal anesthesia because (1) of the quickness and ease it could be given, (2) of the profound shock and blood loss (spinal increases bleeding) and (3) of the impossibility of judging the length of time necessary to perform these unusual repairs and the eventual necessity of changing to either when the spinal wore off. There were no anesthetic deaths and no post operative pneumonia.

19.    Post-operative treatment consisted of sulfathiazole or sulfanilamide every four hours, position flat until conscious then semi-Fowler's position, which we produced by setting the head of the cot up on boxes. The diet was usually coffee or tea or some broth made from “C” rations when liquid was required, then “C” rations thinned with water when a soft diet was required and of course, “C” rations for a regular diet. It worked out very well. Intra-venous fluids were usually given the first post operative day as required. Most of the patients received the total volume of plasma required either before or during the operation. If stomach drainage was required, we used the Levine [Levin] tube and a three bottle Wagenstein [Wangensteen] apparatus constructed out of handy bottles.

20.    Plasma was not sufficient in several cases. As we were able to obtain sodium citrate, we gave several whole blood transfusions using the empty plasma bottles to collect it in and give it. They worked satisfactorily. We had no transfusion reactions.


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21.    After the Mission fell, the native bearers would come to our camp and it was no longer necessary for the American stretcher carriers to evacuate the patients the two and a half miles to the 5th Portable Hospital. Four natives would carry one patient who was usually left at one of the hospitals on the evacuation chain over night on the way to Dobodura. Evacuation was usually in groups from six to ten stretcher cases and many walking cases. The native police would have charge and accompany the stretcher bearers.

22.    We received eleven Japanese patients and about fifteen Chinese. One Jap required a caecostomy from a 48 hour old wound of his right lower quadrant. He had a fulminating peritonitis and died in four days. The remaining cases were compound fractures and shrapnel wounds requiring debridement and reductions and cast. All of the Japanese had malaria and most of them had worms of one sort or another, usually ascaris. They were a terribly malnourished and debilitated lot. As patients they were uncooperative and surly often refusing food or care. Eight of them were placed in one tent together. At meal times they would eat their food and then vomit usually half a can-full of pin worms. The stronger ones at night would try to kick the weaker ones to death and had to be carefully watched. The Chinese on the other hand were cheerful and happy and hungry. They were enforced labor brought down from the north in the Jap drive and were all very glad to be free of their captors. Most of their wounds were minor shrapnel injuries.

23.    We also had a native practice of Buna, Rigo boys and other coastal tribes. The natives moved into the cocoa nut grove after Buna fell and built a village. Their illnesses were either tuberculous, which was usually in the young teen age group and very severe, or tinea nigra and digestive disturbances. We even gave pediatric advice and set aside a day for a dediatric [sic] clinic.

24.   The enlisted men and officers were in excellent health through out the campaign. There were various cases of fever which lasted until quinine or atabrine was increased beyond the daily dose of one tablet. In two of the men positive malaria smears were made and these were evacuated. One other man was evacuated because of a chronic pleurisy. We attributed the low malaria rate to the regular taking of quinine or atabrine, the use of a mosquito bar, and the fact that our camp was located in a new and clean area which had not been occupied by either the natives or Japanese.

25.    By this time, Officers and Men were exhausted. Fortunately the Mission had fallen and the stream of wounded diminished to a trickle. The action was entirely day patrols going up the beach and swamp from Buna Village toward Swori and Terekena Villages.

26.    About this time, in the last days of January, the 4th Portable Hospital moved about five hundred yards in the front of us, just beyond the grave yard and the pressure of surgical cases diminished. We became a fever hospital, receiving thirty to fifty cases a day, almost entirely malaria. We had seven hundred and fifty fever cases totally by the seventh of February when we closed up and were relieved by a Portable Hospital attached to the 41st Division.


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27.    We moved back to the number four air strip at Dobodura, where we remained for twelve days. The Second Field and the Second Portable at Dobodura overflowed with fever patients. They also did not want to take any more of the 32nd Division cases as the 41st Division was already sending in cases. We opened a hospital for ten of those days. The first day we had fifty-five patients, the second one hundred and twenty-five. Then the transports began to carry them away in large numbers. Many of these patients were Australians. We simply threw up five pyramidal tents in a clearing and were supplied with equipment through the Division Surgeon of the 41st, who was very helpful. When we were evacuated all of the equipment was returned to the 41st Division supply. We did no surgery here.

28.    Four of our enlisted men were left behind at Dobodura to guard our equipment which came over a day after the rest of the men. That night the Japs bombed the strip and dropped about fifty eight personnel bombs on and about the area. None of the men were injured.

29.    On February 25th, we boarded the Henry Dearborn, a liberty ship, and quietly returned to Brisbane in convoy, and after a pleasant and uneventful journey, arrived there on March 1, 1943.

[Signed]
WILLIAM L. GARLICK
Major, M. C.,
Commanding.

SOURCE:  National Archives and Records Administration, Record Group 112, The Army Surgeon General, Entry 54A, 3d Portable Surgical Hospital History, Box 611.