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Headquarters, Third Portable Surgical Hospital, A.P.O. 704

HEADQUARTERS
THIRD PORTABLE SURGICAL HOSPITAL
A. P. O. 704

[no date]

SUBJECT: HISTORICAL REPORT

TO: COMMANDING GENERAL, ALAMO FORCE, APO 712 (Thru channels)

1.    The TORNADO TASK FORCE was organized on April 17, 1944. The Third Portable Surgical Hospital was immediately assigned. Our mission was two-fold: To supply hospitalization, including major surgical procedures, from D-day until a higher echelon hospital should come in and set up. Then we would perform our second function; i.e. that of a station hospital.

2.    This unit is composed of four officers and thirty-three enlisted men. Two of the officers are surgeons, one a general surgeon, the other a surgeon particularly trained in orthopedic work. Two are medical officers, one trained in tropical disease, the other trained in general medicine. They are:

William L. Garlick    Major    
Paul A. Fernbach    Captain        
James R. Karns    Captain        
Stephen E. Muller    Captain        

3.    Just previous to the official date of organization we met, for the first time, the problem of mobile loading for travel on a LST. It was obvious that in making a D-day landing all equipment required for immediate use be landed from LSTs to the beach and driven to the area of activity. In our particular function, everything necessary to setup a hospital in which adequate surgical and medical care, housing with reasonable comfort, and good feeding for patients and our own enlisted and officers,  had to be carried. Bulk loading of necessary


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equipment seemed too uncertain to be practicable. Before the heavy equipment could be transferred by hand to vehicles which had been ashore end returned, many things could occur. The LST might have to leave the beach for tactical reasons. They make a practice of pulling off at dusk whether it has been possible to unload or not. Accidents might occur, such as the elevator falling when heavily loaded with a truck, blocking the bulk loaded tank deck and slowing up the process of moving material. A second trip to the ship keeps a number of men tied up when the time is most urgent to clear an area and set up a camp to receive patients. We decided to load bare essentials and leave other surplus equipment and “comforts” in a rear echelon to be shipped later. The disadvantage here was that two guards and drivers were required to remain behind and every single man is important in the haste of that first D-day set up.

4.    It was not until after the Aitape landing that we arranged a better plan. On this, our first amphibious landing, we found we had cut ourselves to the least possible material to function with only one vehicle, whereas many trucks on the LSTs were loaded only partially or carried much nonessential excess equipment. We determined to alter our method, turn in all equipment that could not be mobile loaded thus getting rid of the problems of bulk loading and rear echelons and land on D-day functional and unencumbered by surplus baggage and loss of men, with all the material that we would expect to use for that campaign. To do this it was necessary to borrow the space on two 2 ½  ton trucks which, with our two 3/4 tons, a jeep, and trailer supplied very adequate equipment on D-day and subsequently Lt. Colonel Rowlings of the 27th Engr. Regt. has, in the two subsequent campaigns supplied us with heavy trucks. I hope he will continue to do so. It is advantageous to him also as he has two extra


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trucks to work with on D-day which he would otherwise not have as they would not be carried empty. We hope in the future to get our T/E vehicles changed because a 3/4 ton truck is of small capacity and required almost as much space in mobile loading as a 2 ½ ton truck.

5.    On April 9, 1944, we boarded an LST, one of a fleet of nine, and proceeded to “Red” beach near Lae. The LSTs were loaded as they would be on a future D-day. The fleet arrived, beached at 6:30 AM and proceeded immediately to unload and reproduce the tactical plan for the coming invasion for a depth of 1500 yards. All vehicles were unloaded and driven to their appropriate area. We proceeded to an area in close proximity to Task Force Headquarters and set up a small hospital unit functionable for surgery within twenty minutes. The entire task force ate 10 in 1 rations for the noon meal and returned to the LSTs and reloaded by 3:30 PM. The operation as a whole was a reasonable success in that it ironed out and clearly defined the problems of landing from LSTs, organizing on a heavily crowded beach, and proceeding to, and setting up in a prearranged area. We departed from “Red” Beach and arrived back at Finschhafen on 10 April, 1944. There we disembarked to await the actual invasion.

6.    From April 10th to April 18th we reorganized our supplies, repacked our equipment and generally prepared ourselves for reloading. April 18th the entire task force reloaded, left Finschhafen, and proceeded around Manus Island, in the Admiralties, on the date of April 21st. Life aboard the LSTs was not difficult for the officers as they were well quartered with the navy and received three full meals a day. This was not true for the enlisted men as they had to sleep on the muddy upper deck without cover in among the vehicles, with poor washing facilities, over crowded latrine facilities, poorly prepared rations


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which were served twice a day and insufficiently heated mess gear water. On LST 452 the officers of the unit handled the morning sick call in the pharmacy after the navy had finished its sick parade. No serious illnesses or accidents occurred while enroute.

7.    On April 22nd the Aitape landing was made with the aid of naval gun fire and aerial bombardment ox tremendous volume. The LSTs followed the infantry landing craft and beached about forty-five minutes after their initial landing. Very few casualties occurred in the landing and these were immediately evacuated to the LSTs on which there were surgical teams. This regime was followed throughout the day until the LSTs pulled off the beach at dusk. We duplicated the plan exactly as planned at “Red” Beach--proceeding by vehicle and on foot. We proceeded to a designated area near headquarters and set up a functioning hospital. The Clearing Co of the 135th Med. Regt., commanded by Captain Neeb, set up immediately adjacent to our area. We received our first casualty about 3 PM. He was a Japanese POW named Fukatsu Sudamu. He had a penetrating wound of the left chest with “fracture” of the diaphragm. An open thoracotomy was performed under pentothal-ether anesthesia. From that time on casualties continued to arrive for about thirty-six hours. The hospital did surgery all through the night in a blacked out CP tent for an operating room. The action moved to the Tadji plantation and inland to the air strips. On D plus 2 we received orders through the task force surgeon to move our hospital to the end of the first air strip because of the crowded condition of the beach head and by 5 PM of that day we were again functioning as a surgical team and receiving casualties. We remained fourteen days, suffering no casualties among our own men, although the guards reported foraging Japs in the area back of the


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kitchens two nights in succession. Nightly for four nights they were air alerts but no bombs were dropped in our immediate vicinity. One liberty ship received two direct hits in hold 5 and 4 but was not sunk. Twenty-two men were killed and four badly burned patients were brought into the hospital. This was indeed a strange night. During the blackout an order was issued to all Medical Officers to report to the Shore Party CP to give first aid to the patients from the bombed vessel. Leaving the hospital covered, some of us proceeded through the jungle completely blacked out to the shore road where a constant stream of vehicles carrying medical personnel, all hurrying to the CP, was met. The confusion about this area is impossible to describe as no lights were allowed. Nothing could be done it seemed in that total blackout. As if by spontaneous consent all officers returned to their units, and in short order the casualties began to arrive.

8.    The majority of our work in the area at the end of the air strip consisted of fractures, dislocations, and other injuries caused on the air field. Every day at least one P40 cracked up on the air strip, and the casualties from these accidents were immediately placed in our laps. Air evacuation was established about this time and as soon as practicable all of our casualties were evacuated. On the 14th operating day we were ordered to close our hospital and bivouac near task force headquarters. Here we set up our camp modified chiefly for rest and re-equipment and to enjoy the relaxation of the beach. we did no work but prepared for further assignment. During this period the rations were exceptional fresh eggs and meat being received daily. It was possible to go to the movies every night. The 54th Evacuation Hospital had arrived and set up


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their entire outfit and were carrying the burden of patients in the area.

9.    Our enjoyable vacation on the beach at Aitape ended May i4, 1944 when we again boarded a LST and set out on one or the most dangerous and exciting missions to date. We relaxed into the apathy and boredom of living on deck uncomfortably exposed to the weather for four days. Nothing of importance occurred. This time we were entirely mobile loaded and the vehicles waterproofed. Our equipment was in good shape, well packed and we were carrying the barest minimum necessary to function as a hospital. We had no bulk-loaded equipment and left no rear echelon.

10.    On the morning of the 17th of May we sat off the beach at Toem to the right of Wakde Island and witnessed the tremendous aerial and naval bombardment and shelling. No enemy aircraft appeared. Large fires were started on the mainland and on the island. Huge trees and debris were thrown into the air by tremendous explosions. The infantry went ashore as if into a uninhabited world. The LSTs beached uneventfully and we proceeded off and collected ourselves to move down to a previously designated area opposite Wakde and just above Toem Village.

11.    The area was excellent, covered with palm trees evenly spaced, with very little underbrush, a level sandy floor, and a good beach of black sand. We set up wit in the space of two hours and were receiving patients at night fall The Red Cross flags were placed on the road at our rear and on the beach for patients were being brought in by LCMs . About 100 yards below us on the edge of Toem Village, a collecting company was set up. Next to them was the Headquarters of the 163 Infantry Regiment and their perimeter of defense. Just


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back of us were combat engineer troops and less then 50 yards away two 105mm guns which were firing constantly during the first night on the island.

12.    On D plus 1 the second phase of the battle began, the invasion of Wakde Island. LCMs carried the infantry first to a small island just off Wakde which was taken during an aerial bombardment on the main island. The whole show was clearly visible from our excellent vantage point on the mainland out we were unable to watch for long. As rapidly as the LCMs pulled up to the beach and emptied, through field glasses, the wounded could be seen being placed back on them. They pulled on and headed for the Red Cross flag, beached as near as possible in a low tide and stretcher bearers carried the patients through the surf and into the hospital area. Within about two hours there were about seventy patients more or less seriously wounded filling the admitting fly, and the ground about and between the tents and the beach. Four were dead on arrival and were segregated on the beach. About eighteen were in serious shock and required immediate surgery. The picture of so many wet, dirty, bloody, terribly wounded soldiers lying in all manner of attitudes is impossible to describe. For a moment it seemed there were more things to be done here in a moment than could be done in a week. We organized into teams, Captain Karns and four technicians gave plasma and shock therapy. Captain Muller gave anesthesia and Captain Fernbach and I began doing the most pressing cases as rapidly as possible,  running two surgical teams. We worked continuously for forty-eight hours before any sleep could be gotten and then continued for the next four days with only an hour or two of sleep out of twenty-four and time out for meals. Casualties were coming in a gradually diminishing stream.


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13.    As soon as patients were in shape to travel: i.e., had clean wounds without infection about them or well opened draining wounds with no danger of blockage, free of shock and in such shape that they would not require expert attention for 24 or 36 hours, they were evacuated: at first by LST and later were carried to Wakde Island by LCM and evacuated by air. We followed the rule or keeping belly wounds for at least eight days or until they were having normal bowel movements and were free of the danger of peritonitis, and of keeping fractured femurs until the danger of thrombosis and embolism was past, always having them well splinted or in plaster. We had  to modify these rules because of the tactical situation.

14.    The eighth day, the stream of casualties was coming from the direction of Sarmi across the Tor River. It required several hours to travel by truck and LCMs across the river and often the ambulances was fired upon by the enemy. The 54th Evacuation Hospital was functioning and taking the great volume of patients from the clearing companies and us. We were forced to evacuate our most seriously ill patients to them and even that short distance was a severe strain on their reserve strength. The routine of treatment, particularly with penicillin was broken giving bad results. The patients arrived in reasonably fair shape with more or less normal temperatures and it was the opinion of the new hospital that penicillin need not be continued. Some of them had had doses for two to four days and, we feel that as a preventure in peritonitis where it is a certainty, the patient should receive at least 500, 000 to 700,000 units over the period of a week. I feel the results in these cases showed that necessity. Within four more days each had had a gradually increasing higher temperature, developed abdominal tenderness and rigidity, nausea and vomiting and all the


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signs of peritonitis. I feel that definite routine should be laid down arbitrarily at present in the giving of penicillin in certain type cases which could be followed continuously down the evacuation chain and would give a reasonable basis of study in the evaluation of the drug. We have been using 100,000 units the first day, then 15,000 units every four hours until 400,000 to 700,000 units have been given depending on the case, but we have not always been able to keep the patients until t is is complete. These that we have have been remarkable in their uneventful convalescence. The above cases referred to were these, (1) a penetrating wound of the bladder and small bowel, 48 hours old on admission with a “full-blown” peritonitis on exploration, a belly full of urine, blood and intestinal fluid. The small bowel perforations were resected because about ten inches of bowel were gangrenous and an end-to-end anastomosis, using Stone clamps, was done. The wound of the bladder was freshened up and closed with interrupted suture and a urethral catheter placed in the bladder. He responded well under penicillin. Temperature, pulse and respiration gradually returned to normal. The abdominal wound healed by first intention and catheter was removed from the bladder on the seventh day. No localized masses could be felt in the peritoneum. We have not as yet received follow up cards on him. (2) GSW of the abdomen passing out through the right iliac bone and gluteal muscles with injury to the iliac vessels. An exploratory laporatomy was done. The peritoneum was clear, no bowel or bladder injury. A tremendous haematoma filled the right iliac fossa and was visibly increasing. An extra peritoneal approach was made into the heamatoma along Poupart's lig. Release of the pressure on the haematoma caused a massive hemorrhage. I packed it rather than lose time and blood hunting for the tear in the vessel. The femoral


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artery had good pulsations in it after as well as before packing. No blood was in the urine. An intact right ureter could be seen going into and beneath the haematoma. The wounds were closed. The pack left in place and was removed on the seventh P. O. day without difficulty under Pentathol sodium and a secondary closure done. The patient developed no thrombophlebitis and temperature remained within normal limits under Sulfathiazole. (3) Two cases of one perforation in large bowel and multiple small bowel perforations. Both required small bowel resections and colostomy; i.e., exteriorization of the large penetrated large bowel. Both were evacuated with draining colostomies. (4) One case of large bowel perforation of sigmoid with massive hemorrhage and spilling of feces in the peritoneum, eighteen hours old on admission which died on the fourth P. O. day.

15.    We moved from Toem across the Tor River to set up in the 158 Inf. Regt. perimeter about 400 yards from the Tirfoam River. Each night in this area, which was cut out of heavy cleared jungle under a thick growth of tall fig trees, an infantry perimeter was set up about us by a company that pulled out of the front on the very edge of the river. We were so close, too close, to the fighting that casualties actually fell in our area. The only advantage I can see to being quite so close is that cases of large vessel injury can occasionally be saved by quick surgery, and we had two which made it worth while.

16.    We were situated about a hundred yards off the road and well screened from it. On the third day, we heard a continuous noise and rumble of trucks and marching soldiers but didn't investigate because we were too busy. About three o'clock, a major appeared out of the woods. He was so out of breath he could hardly speak. When he could talk, he said the infantry and guns had made a


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strategic retreat, and moved a thousand yards to our rear, that we were that far outside of the perimeter and must get out within 20 minutes. The area along the Tirfoam was to be shelled by 105 mm. Of course, we couldn't get out in twenty minutes. We had a hospital full of patients and a completely set up camp. However, we moved as never before. The patients went first in any kind of vehicle, 2 ½  ton trucks, 3/4 ton trucks, and all the ambulances which were available on that side of the river. I have never seen men work so fast before. The hospital melted before your eyes. Within two hours we had our patients covered and a lamp started about 400 yards from the Tor River, next to and across the road from the 4.2 mortar company. We had no casualties or serious mishaps. For the first time in our moving life there was no confusion in clearing and setting up camp.

17.    It ruined the morale, this retreat. The next day everyone was lifeless and listless. The infantry soldiers sitting up the perimeter were silent and would rarely look at you. They moved slowly and despondently and without energy. Everyone knew that too few men had been stretched out too far to hold safely such an area but to have to give up the ground over which they had fought, and some died, seemed to knock all of the “fight” out of them.

18.    At this time Col [Earle]  Sandlin took the command of the 158 Inf. Regt. By his manner and freshness and decisive commanding in a few hours the picture was different. He was every where, inspecting the front line protections, checking the mortars and machine guns and visiting the hospital and encouraging the patients. The effect was instantaneous. The troops became a fighting team again full of determination. To me it was one of the miracles of warfare.


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19.    I did not like our situation. About us on one side was and infantry company, the 4.2 mortar company filled the second. To our left was a swamp and bridge. A collecting company and ourselves filled out the perimeter. From the bridge to the Tor River was ammunition and food supply and another infantry company. The Regt. Headquarters had crossed the river and set up a perimeter about the crossing on the other side. These two perimeters about the river crossing were well isolated. About four miles down the road the big task force perimeter began. There were no defenses in between and the men had to drive through this each day for rations and supplies. They were heavily armed and were frequently fired on by Japanese or stopped by Inf. patrols until the road was considered more or less passable. They had luck, none were injured.

20.    I did not like our situation because each night from nine to twenty men had to man fox-holes strung around the back of the camp, varying from twenty to fifty feet from the tents and complete the perimeter. Only we four doctors, a surgical team of four enlisted men, one ward man and the sickest of patients remained above ground. Each afternoon when the night's casualties had been debrided or casts applied those who could travel were placed in ambulances and sent across the Tor to the 54th Evac. Hospital. Several patients were far too ill to be moved, and had to remain. Actually, this was a very good place for a Portable Hospital although it may not seem so. On our side of the river we were a completely equipped perimeter with heavy artillery, mortars, two infantry companies, rations, gasoline and ammunition dumps and a hospital.

21.    The first day in this area was quiet. Everyone spent their time


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digging in and getting a well-set system of defenses. That night, however, was a different story. There was one weak spot in our perimeter: the bridge over the swamp which pinched the troops into a dumb-bell shaped fortress. One of the well beaten trails through the jungle coming down the rifer ended near this bridge. The enemy took advantage of this. About 9:00 PM the first night, every thing was quiet. The guards had been established since sun down. The patients were quiet and protected as well as possible. We had sat up talking after dark in a deserted world where nothing appeared to live or move, and then went to bed feeling secure. About twenty minutes later we heard a voice in a clear, decisive, loud, commanding tone give orders in Japanese. He spoke at least two full sentences. Every gun in the area opened up. Ten minutes later when the shooting stopped, there were eleven dead Japs about fifteen feet from the machine gun at the corner of our camp. Several of our tents exhibited holes in them at, about mosquito-bar level. No casualties occurred among ourselves. The rest of the night was spent in sporadic fire every fifteen or twenty minutes which made sleep impossible. The next morning a wounded Jap was found about twenty feet from the ward tents and was “finished off” by one or the collecting company men. Casualties began coming and the day was spent in work, fortunately.

22.    The second night was spent in fox-holes. It is a peculiar sight to see a hospital go under ground and remarkable to me how desperately ill patients survive such treatment. We would have evacuated them if we had not felt that the six miles of travel would have over-taxed their little remaining strength. Only a small battle, this night, with intermittent firing here and there around the perimeter. One man across the road had an attack of acute abdominal pain. His fox-hole companion crawled out to get help and was shot in the neck.


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Two other men jumped out of their hole and dragged him across the road into the hospital. It required about two minutes but he was bleeding out from a wound of the carotid artery and died. Soon after, several more casualties came in, hand grenade wounds both Japanese and American. We went to work in the blacked out surgery, controlling bleeding and debriding, and doing as little as possible. Every fifteen or twenty minutes there was gun fire about the perimeter, but the walls of a tent seemed to give protection and the work went smoothly enough.

23.    The next day a new perimeter was established about four hundred yards in front of us and casualties came in in a continuous stream. A tank came crashing through the woods from the beach area, about two hundred yards to our left, bringing with it gun fire from a Jap “mountain-gun”, situated somewhere toward the Sarmi area. Their aim was poor and no one was hurt, although the terror produced by the sound of the shrapnel passing over head was demoralizing.

24.    It was during this day that we saw a minor rout, 20 or 30 men had gone out on the beach to bathe near one or the 105mm gun positions. Several trucks were parked nearby, all visible from the curving shore of the bay. The Jap artillery began shelling the men, the trucks, and the gun. In a few seconds there were thirty men in all states of dress to nakedness without shoes or arms running through the camp. The gun stopped tiring after five rounds. One truck was hit and several men received small shrapnel wounds but no one was seriously injured. The men got themselves in hand. In a snort while the trucks and  gun moved through our area and disappeared down the road toward the Tor River.

25.    That night at fifteen minutes intervals, the 105mms laid barrages just in front of the perimeter four hundred yards away. The observer brought them within fifty yards of the leading fox-holes without mishap. One short round would have landed in our camp but there were none and that “freight-train” sound going overhead became a consolation for nothing moved or fired while


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it was going on.

26.    The next night was one of the worst so far. The Japs came in close with automatic fire and mortars. It was impossible to work. Tracer bullets were flying all over the area and camp. The burst of mortars were falling all about. That peculiar sound of large shrapnel going through the trees and falling about made it seem that “this is it”. The 4.2 mortars opened up and landed shells about 400 yards away so close that the ground and trees shook and the flash was clearly visible. After a few rounds everything became quiet and we could work again. Enough casualties came in to keep us busy into the next day.

27.     Certain cases justified our position and the necessity of filling out an infantry perimeter with medical troops. Two in particulate illustrated the point. A patrol, led by an officer, Lt. Chisholm, was moving through the swamp about two hundred yards up the road when he stepped on a “bouncing Betty” which had been over looked when the area was cleared of mines after the strategic retreat. His left foot was blown off and his right leg blown off at the knee. The man next to him received a piece of shrapnel in his head, his left shoulder was completely torn up and his left foot blown off. Two others received more or less severe wounds. These patients were in the hospital within ten minutes. The first two were nearly exsanguinated. Lt. Chisholm was given 1800 cc of whole blood before his pulse could be felt after the femoral artery bleeding was controlled. The other boy received the same. Lt. Chisholm was the only bilateral amputation we have ever done. Long anterior and short posterior flaps were made and turned back. No enclosure was done. The vessels were ligated and the nerve injected with alcohol. He received 3000 cc of whole


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blood in 36 hours before he got over his air hunger and shock. Both recovered and were eventually evacuated.

28.    We remained in this camp site twenty-three days. During that time we worked with three different infantry regiments, the 163rd, the 158th and finally the 20th. Each change brought the perimeter back to our camp and there was a recurrence of fighting within our vision. One day the Task Force Surgeon visited our camp. Just as he was driving away, at the corner of the Camp, a soldier in a jeep was shot by a sniper in the head and died as he was brought into the camp. This sort of thing kept up as long as we were here. At no time was it reasonable to relax. Every man's reactions became his only protection.

29.    When the 20th Infantry took over the perimeter we were in mortal danger for a night or two from their fire. They were allowed to practice fire from 1800 to 1830 each evening. The first time all units had been notified except us to get into fox-holes. The firing began. We were fired over, through and about. The men thought a major attack was staged against us. Patients who couldn't move from cots were terrified. However, not one of us were wounded although we did get several casualties from the line companies.

30.    We were not sorry when the 11th Portable Surgical Hospital relieved us. We returned for the first time back to our original area above Toem Village, and found a large city had grown up in that time about us and on Wakde. We remained here in a rest period without patients.

31.    A new Task Force was being formed out of the 158th Inf. Regt. We were assigned to the 6th Division and the 11th Portable Surgical Hospital assigned to the force. Col. Sandlin requested General Patrick to have us


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attached in their place as we bad worked together before and knew what to expect of each other. The request returned from 6th Army Headquarters and we were off on a third Task Force within these three months.

NUMBER OF PATIENTS 17 APRIL TO 22 JUNE 1944

32.    Sanitation was kept consistently good. Immediately a box-latrine was set up in each area and no straddle trenches were used in or about each of the camps. In each camp a well was dug using old gasoline drums for sides and the water obtained used for washing and showers, which also were set up immediately. Drinking water was brought from water points.

33.    Rations were 10 in 1 and at the end of each campaign we received


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rations and some fresh meat and eggs. We carried flour, baking powder and yeast and always had fresh baked bread which was our only luxury.

34.    On June 22, 1944, we were assigned to the CYCLONE TASK FORCE.


Signed
WILLIAM L. GARLICK
MAJOR, M.C.
COMMANDING

SOURCE:  National Archives and Records Administration, Record Group 407, The Adjutant General's Office, World War II  Unit Histories: 3d Portable Surgical Hospital, Box 21733.