Contents

CHAPTER V

The Aleutians¹ 

    In February 1941, the Territory of Alaska, in which a United States Army garrison had been maintained for some 75 years, was designated as the Alaska Defense Command. The first surgeon of the command was appointed the following December.         

    The conditions under which troops originally served in this area in no way resembled combat conditions. The weather, on occasion, was extremely cold, but the barracks to which the men returned were warm and comfortable, and their food was always excellent.
     
    The clothing which was used by troops in Alaska was patterned after that worn by the Eskimos and was made of furs, which could easily be provided in sufficient amounts for a limited number of soldiers. Both clothing and equipment were slightly revised in 1928, but otherwise the issue remained unchanged until 1940. In 1935, however, when the aggressive policies of Japan began to indicate the possibility of war and when developments in airpower made it clear that Alaska was highly vulnerable to air attack, clothing for cold weather became a subject for scientific research, and many new and improved items were available by the time of the Aleutians campaign in 1943 (fig.18).

      Throughout the war, occasional cases of frostbite occurred among United States troops stationed in Alaska, and some cases of immersion foot also occurred in this area in fliers forced down at sea. On the whole, however, cold injury was of no great consequence because the troops were well fed, they had superior equipment and used it correctly, and they were trained in techniques of prevention of cold trauma, especially frostbite. On one occasion, 17 of 21 men engaged in a practice maneuver over the Valdez Glacier were frostbitten, and on another similar maneuver, near Nome, 126 men, 23.6 percent of the total strength, were also frostbitten. In both instances the explanation was not only highly unfavorable weather conditions but also neglect of the precautions essential under such conditions. Elsewhere in the command, the number of cases was small because line officers and medical officers alike were very much aware of the necessity for such measures.
       
    The situation in the Aleutians was very different from that in Alaska. Because of the location of these islands, far out in the Bering Sea, the dry cold of the Alaska Peninsula is replaced by wet cold. Most of the task force which invaded Attu had not been trained in the prevention of cold injuries. They had to subsist on combat rations instead of hot, regular meals. Many items of
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¹ Unless otherwise indicated, all material in this chapter was secured from McNeil, Gordon H.: History of the Medical Department in Alaska in World War II, pp. 401-477. [Official record.]

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FIGURE 18.- Properly equipped and clothed soldier advancing in snow, in scout position,  Aleutian Islands.

their clothing were unsatisfactory. The background of these difficulties and deficiencies was, of course, that the men were engaged in combat and not in the peacetime garrison duties in which the troops in Alaska had been engaged up to the outbreak of the war and in which, for all practical purposes, they continued to be engaged throughout the rest of the war.

THE ATTU CAMPAIGN

    Attu and Kiska, where the first cold injuries were sustained by United States troops under combat conditions in World War II, were occupied by the Japanese, without opposition, in 1942. Attu was retaken by Allied (chiefly American) forces in May and June 1943, and Kiska was retaken, without opposition, by forces of approximately the same components in August of the same year.
       
    The force which invaded Attu, consisting of about 15,300 men, required 22 days to take the island. It sustained a total of 3,829 casualties from all causes (table 2). Cold injuries, which numbered 1,200 up to 1 June, exceeded the number of casualties caused by wounds (1,148) and accounted for more than 31 percent of all casualties from all causes. After 1 June, only scattered cases occurred. Seven patients with cold injuries were admitted to the shore hospital on 12 May, 146 were admitted on 16 May, and 191 were admitted on 17 May.

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TABLE 2.- Battle casualties and admissions for disease and nonbattle injury, Allied troops on Attu, 11 May through 1 June 1943

     The invasion began 11 May. The theater policy was to evacuate to the Zone of Interior all patients who, it was thought, would require more than 21 days of hospital care, and by 1 June, 241 casualties from cold injury had left the island. By the same time, 691 had been returned to duty. Although this fact might suggest that many of these cold injuries were of mild degree, generalizations would not be warranted. Of 93 patients with trenchfoot treated at the 183d Station Hospital, Fort Richardson, Alaska, for instance, 14 were discharged to duty as cured and the other 79 were discharged as improved, but a considerable number of these men were unable to continue their duties and were subsequently returned to the hospital for further treatment^,.² Recurrence, or perhaps recrudescence, of their original injuries also explained many of the casualties from trenchfoot (luring the later Kiska operation (p. 99). Furthermore, during the winter of 1943-44, men who had been discharged as cured after the Attu experience began to appear with complaints of various subjective symptoms as well as with such objective signs as redness, cyanosis, and excessive perspiration.
       
    Only 6 of the 93 cold injuries treated at the 183d Station Hospital were graded as third degree and only 1 as fourth degree. Nonetheless, in these 93 cases alone, a total of 5,827 days was lost from duty. The potential seriousness of this condition from the standpoint of military manpower is evident from these figures, which do not take into account the expenditure of medical care, including hospital bed space, and the tax on military transportation caused by these injuries.
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² Annual Report, 183d Station Hospital, 1943.

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Tactical Situation, Environment, and Weather

    D-day on Attu was originally set for 7 May, the plan being that the troops should sail from Cold Bay on 4 May. Because of bad weather, the invasion had to be postponed to 11 May. The landing was unopposed, the enemy having withdrawn from the beaches to occupy the high central ridges. From these vantage points, they could descend to within the fog line, which was at times within 500 feet of sea level, where they could see without being seen and could effectively pin down attacking units in waterlogged foxholes in the boggy tundra.
        
    As a result of the dense fogs, the landings began later than had been planned, and the second wave of troops was not landed until almost 8 hours after the first.³ The operational plan, which was to take the island in 38 hours, thus proved completely unrealistic. Later, it was agreed that the task force would have done well if, within this time and without meeting any opposition at all, the troops had merely walked over the ground which they were scheduled to take.
     
    Opposition from small-arms fire and mortars was encountered within 1,000 yards of the beach, and the initial main line of resistance from Massacre Bay was about 2,000 yards. For 6 days, there was practically no forward move-

FIGURE 19.- Tractor and trailer mired down near the beach, Massacre Bay, Attu 19 May 1943.
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³ Orr, R. D.: Report on Attu Operations May 11-June 16, 1943, dated 30 July 1943.

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ment of American positions. The artillery never left the beaches because the guns could not be pulled over the tundra, and firing was at maximum ranges throughout the battle (fig.19). The Japanese launched a desperation (banzai) attack on 29 May against American infantry positions and so exhausted their own fighting strength that by 2 June all organized resistance was at an end.
       
    Both terrain and weather served to make the conquest of Attu an extremely difficult operation. Attu and Kiska are islands far out on the Aleutian chain, in the Bering Sea, about due north of Midway. The terrain on both is rugged and mountainous. The elevations are not particularly high, but when bad weather is added the conditions are comparable to those in altitudes twice as high in milder climates. On Attu, where peaks and ridges rise to 3,000 feet above sea level, the heavy winter snowfall remains on some of the higher points throughout the summer. There is an almost complete absence of natural shelter. The ground cover is boggy tundra, without trees (fig.20).
     
    The air on Attu is continuously cold, even on the occasional sunny days. There are long months of wind, fog, rain, snow, sleet, and mud. A man walking along a road on an ordinary day may suddenly, even when the sun is shining, be struck by a terrific gust of wind, which blows sand, snow, and rain in his face, all at the same time. An observer from the Office of the Quarter-

FIGURE 20.- Landing beach in Holtz Bay area, Attu, seen from top of ridge separating Holtz Bay and Chichagof Bay. The steep, jagged crags, knifelike ridges, and boggy tundra greatly impeded the movement of the troops and made any extensive use of mechanized equipment entirely impractical.

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master General,⁴ who had spent February, March, and April on other Aleutian Islands, commented on the weather of the region as follows:

    * * * one needs a pretty strong imagination to get the full flavor of it (even if you have previously heard of it). In one day I have seen it cold and snappy in the early morning with light snow on the ground, followed by warm, Springlike sunny weather, followed by a blizzard of very small hail-like snow, followed by sun, followed by rain, etc. The mud is often more than knee deep, and generally is of a very slushy type * * *. More often than not a biting wind whips the rain, snow and sand (where there is any) about all day and all night.

    During the campaign, the weather, for the Aleutian Islands, was reasonably good.⁵ Light rain is known to have fallen on 4 days between 22 and 27 May, from 4 to 12 hours at a time, and light snow fell on 23 May, for 12 hours. During the same period, the wind velocity ranged from 20 to 36 miles an hour most of the time. On 3 of the days between 22 and 27 May, there was fog for 8 hours at a time. Reports submitted by a vessel and weather station in the vicinity show that, between 11 and 27 May, the temperature averaged between 25º and 30º F. (-3.9º and -1.1º C.) in the valleys (1,000 feet) and between 33º and 37º F. (0.5º and 2.8º C.) at sea level. On the highest ridges, where there was considerable combat, the average temperature was 24º F. (-4.4º C.) and the minimum 10º F. (-12.2º C.). The men were constantly exposed to cold and dampness, often for several days at a time without relief. The foxholes were always filled with water, and the troops, of necessity, remained in them for hours at a time. There is evidence that many of the troops found the cold, damp, wet weather harder to endure than the enemy fire.

Medical Care and Evacuation
       
    Planning for Attu called for medical care to be provided through aidmen, battalion aid stations, collecting platoons, clearing stations, field hospitals, shore-party medical sections, and the Navy medical service aboard ship. Revisions were inevitably made. The first principle of treatment of cold injuries is that the casualties should not be permitted to walk, even if they feel able to do so. Many of the injuries sustained on Attu were so severe that the men were scarcely able to walk, but, because of the difficulties of evacuation, many of them had to walk; some of them crawled. The wheeled litters which had been brought ashore were useless, and evacuation had to be by hand carry, because of the precipitous slopes of the mountainous terrain in which most of the'fighting occurred. Aid which was but a few miles away in direct line was often hours away by litter carry. Casualties often had to be taken down cliffs by ropes, pulleys, and improvised elevators.
       
    The task force surgeon, utilizing elements of the 14th Field Hospital and personnel from an antiaircraft artillery unit and a shore-party medical section, improvised and set up a small convalescent-type hospital on the west side of
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⁴ Letter, 1st Lt. Robert D. Orr, to the Quartermaster General, attention: Col. Georges F. Doriot, 17 Apr. 1943.
⁵ See footnote 2, p. 85.

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Massacre Bay on 16 May (fig. 21). Patients who had sustained moderately severe exposure were treated here after they had been evacuated from field hospitals. Evacuation from the island was by boat and plane to Adak and thence to Fort Mears, Fort Greely, and Fort Richardson. Most of the severely wounded casualties were evacuated by ship or were flown directly to the Zone of Interior. The air evacuation planned from Attu to Fort Richardson did not prove practical, but special flights were arranged from the 183d Station Hospital to Barnes General Hospital, Vancouver, Wash.


FIGURE 21.- Field hospital on Attu. It was set up and in operation the day after the landing.

Clothing and Footgear

    When the invasion of Attu was being planned and organized, cold-weather specialists from the Special Forces Section, Office of the Quartermaster General, were sent to the Alaska Defense Command for observation and for advisory purposes. They recommended that special types of footgear and clothing be selected for the invasion, but their advice was not accepted. The items used were chosen without sufficient consideration of the special environmental conditions certain to be encountered, as well as without due evaluation of the newly developed cold-weather equipment. The sole responsibility for the high incidence of casualties from cold injury cannot, of course, be placed upon a single erroneous decision, but later analyses indicated that failure to use the

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special Arctic equipment which was available was probably the explanation of many cases.
       
    Clothing.- There were numerous adverse comments on some of the clothing supplied for the invasion, although, as just noted, the selection had been a deliberate command decision, and more efficient types had been available. Specific comments were as follows: ⁶
     
    The issue olive-drab woolen trousers did not provide the protection which kersey-lined trousers would have provided. The issue trousers had been waterproofed, but, under the conditions of combat and terrain, the material was not sufficiently durable to remain impervious to moisture for more than a few days.
      
     The Arctic field jacket did not furnish the protection against wind and rain which the lightweight reversible ski parka would have provided. In addition, the field jacket had no hood.
     
    Sweaters were not permitted, though experience in Alaska had shown them to be a real necessity in extreme cold.
       
    The parka overcoat was not originally intended to be part of the equipment, but a certain number had been picked up at the rendezvous point when the task force first encountered the severity of the Aleutian weather. The supply, however, was not sufficient. Furthermore, while this overcoat furnished excellent protection for men who could remain relatively immobile, it was not satisfactory for active combat.
   
    The troops were not permitted to wear their rainsuits ashore, and therefore, since their clothing was not water repellent, many of them were drenched immediately. The rainsuits were in rucksacks, which usually did not reach the men in the frontlines until several days after the initial landings.
      
     Since rucksacks were entirely too bulky to be carried ashore by the troops, the operational plan was that they would be brought forward by nightfall of the first day of the invasion. The men would thus have sleeping bags, rainsuits, and other equipment, to supplement the small amount which they had carried ashore with them in the canvas field bags attached to their belts. The delays in landing and the difficulties of terrain and weather made the implementation of this plan completely impossible. Once supplies could be landed, ammunition and food had to be brought forward before clothing. As a matter of fact, few men in the frontlines ever received their rucksacks.
     
    Whenever it was possible, sleeping bags were removed from the rucksacks on the shore and were sent forward as conditions permitted. Few troops, however, received them before the fourth or fifth day, and until that time the men had no protection during sleep, when sleep was possible, except from the shelter halves which they had carried ashore in their field bags. Had the sleeping bags been received earlier, it is highly probable that some cases of trench-foot could have been prevented. One unit which obtained its bags on the second and third days and could hold on to them throughout the campaign experienced almost no cold injuries.
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⁶ See footnote 3, p. 86.

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    After the invasion,⁷ it was suggested that the Arctic sleeping bag which had been used, and which was too bulky to be carried on the person, should be replaced by a model small enough to be carried into combat, with the same lining as the Arctic bag and with a waterproof outer covering. During his periods of rest, it was reasoned, the soldier equipped with this bag could rest in it with his boots and socks off and could dry his socks inside the bag by body heat. The Quartermaster General's Office,⁸ replying to the criticism n of the sleeping bag used during the Attu campaign, stated that the bag had been badly chosen. The model selected should have been either the inner lining of the Arctic bag or the mountain sleeping bag, both of which could be used with a water-repellent case. It was also pointed out that tests had shown that a fully waterproof covering for a sleeping bag was not practical, since condensation of moisture from the body within the bag would set up conditions favorable in themselves for the development of trenchfoot.
         
    Footgear.- The shoepac recommended by the observers from the Quartermaster General's Office had a number of admitted defects, including lack of an arch support, but it was relatively waterproof, because of its rubber sole, and it kept the feet warm. The blucher boot for which it was passed over was a model which reached to about 4 inches below the knee (fig.22). This boot had a number of disadvantages. It did not keep the feet warm. It was not waterproof, even when dubbing was regularly applied to it. It (lid not wear well; some soles were worn through in 4 to 6 weeks. Once it became wet, it could not be thoroughly dried under conditions of combat. The leather tended to contract, and the tight fit, combined with tight lacing, resulted in embarrassment of the circulation to the feet. Most of the fittings were originally too snug, since no attention had been paid to the plan that the boot be worn over two pairs of socks, one of them woolen. Finally, the steel support in the heel was not carried high enough, so that the boot broke against the Achilles' tendon and a severe traumatic tenosynovitis was sometimes added to the disability caused by cold. A possible explanation of this particular complaint was that many of the troops had been issued their boots on shipboard and had no opportunity to break them in before they were landed on the Attu shore.
       
    The only troops equipped with shoepacs for the invasion of Attu were men who had had long service in Alaska. This type of footgear was therefore not universally tested in combat in the Aleutians (fig.23).
          
    Japanese clothing and footgear.- There is no evidence that the Japanese on Attu sustained cold injuries to anything like the degree that the Americans sustained them. The Japanese were favored by their occupation of higher ground, it is true, and were less often immobilized. On the other hand, they were more suitably clothed, and they seem to have had better footgear. They
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⁷ Memorandum, Maj. Gen. LeRoy Lutes, Director of Operations, Army Service Forces, for Quartermaster General, Army Service Forces, attention: Storage and Distribution Division, 3 Oct. 1943, subject: Report of Operations on Attu.
⁸ Memorandum, Research and Development Branch, Military Planning Division, to Operations Branch, Military Planning Division, 13 Oct. 1943, subject: Report of Operations on Attu.

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FIGURE 22.- Combat-type boots supplied to infantrymen on Kiska after occupation. Staff sergeant supervises fitting, while private at right boxes ammunition.

wore hobnailed, fur-lined rubber boots, which extended to just below the knee. A rolled legging, applied outside the boot just below the top, kept most moisture out of the boot, even if the wearer stepped. into water above boot-top level. Some American troops, in spite of the risk of being shot by their own comrades, equipped themselves with Japanese caps, hoods, and boots as they became available.

Training and Discipline
     
    The task force which recaptured Attu consisted chiefly of units of the 7th Infantry Division, plus a battalion from the 4th Infantry Division, which had had 2 years of service previously in Alaska. The units which bore the brunt of the fighting had been trained as a motorized infantry division at Fort Ord, Calif., and in the Mojave Desert, and then had undergone amphibious training on the California coast. Nothing in their previous training and experience fitted these troops for the climate and terrain which they were to encounter on Attu.
        
    Specifically, these troops had not been trained to care for their feet. They did not understand that they must remove their boots at frequent, regular intervals, change their socks, and dry their insoles. Some of them did, not remove their boots for 5 days or even longer, after the landing. When they

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FIGURE 23.- Shoepacs worn during occupation of Kiska. The soldier is treating them according to the method used by experienced Alaskan sourdoughs.

finally took them off, they could not replace them because their feet had swelled. Many soldiers threw away their wet socks without making any endeavor to dry them. Often, when the terrain made going hard, the men discarded their cold-weather clothing. Many of them, when they received their sleeping bags, made little or no effort to keep them dry.
       
    Preventive measures are not easy to accomplish under the conditions in which these soldiers worked and fought, and the total accomplishment of such measures was obviously impossible. The underlying fault, however, was that none of the troops had been taught that every effort must be made to accomplish them, in spite of adverse circumstances. There is no doubt that the effort would have paid dividends in the prevention of trenchfoot.
     
    Some of the troops trained at Fort Ord were brought from California by surface water transport and could change their shoes and socks regularly up until the time they entered combat.⁹ Others, who were brought up by submarine, could not change their footgear during the journey because of cramped quarters and the constant alert status which had to be maintained. The advance troops, who were landed in rubber boats, were instructed to discard all of their equipment as soon as they made contact with the enemy. Their feet and legs became soaked as they landed, and, because additional boots and socks were lacking as the result of this order, they remained wet, even when
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⁹ Lesser, A.: Report on Immersion Foot Casualties from the Battle of Attu. Ann. Surg. 121: 257-271, March 1944.

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occasional opportunities would have permitted a change of footgear. The men spent most of their time in foxholes filled with icy water and cold slush, usually in cramped, inactive positions, with little food, and without any real physical rest or sleep during their whole stay on Attu. They had not been taught such simple precautions as moving their feet in their shoes or exercising their legs, and they therefore did not employ even the limited prophylactic activity which is possible under almost any conditions.

    The differences between training and lack of training were immediately obvious.¹⁰ A provisional battalion, consisting of the 7th Reconnaissance Troop and the 7th Scout Company, had a particularly hazardous mission, for which special clothing was requisitioned and supplied. These men were completely untrained for fighting in cold weather, and, by order of higher authorities, none of the special equipment just mentioned was issued except pistol covers. At the end of 5 days, 30 of these 350 men had been killed or wounded in action and only 40 of the remaining 320 were still able to walk.
     
    In contrast, one of the battalions which spearheaded the attack had battle casualties as high as any unit engaged in the operation, but it had only eight casualties who required evacuation because of trenchfoot. The men in this battalion had been well taught. They had foot-care drills and were paired off in what they themselves termed the "buddy" system, whereby foot-conscious soldiers worked on each other's feet. Attempts were made to supply lubricants for their boots and ointment for their feet at least once daily, with the realization that the virtue of the application to the feet was in the massage and not in the agent used with it. Whenever possible, provision was made to relieve all the men, especially the outposts, for a few hours each day. During this interval of relief, the men removed and dried their shoes, changed their socks, and rested in their relatively dry sleeping bags.
       
    Generally speaking, the severity of a cold injury was directly proportionate to the length of time during which the footgear was not changed.¹¹ Fifteen of twenty-five patients observed. at McCaw General Hospital, Walla Walla, Wash., who had been taken to Attu by surface water transport, went from 3 to 6 days in combat on the island without change of footgear. All had rather mild degrees of trenchfoot. The other 10 men, taken to Attu by submarine, averaged an additional 10 days in combat without change of footgear, and all had severe injuries with gangrene.
     
    Another illustration of the value of training is seen in the experience of a detachment of 30 men of the Alaskan Scouts, the combat intelligence platoon of G-2, Alaska Defense Command.¹² These men were trained for the climate and terrain. They were properly acclimated. They knew what to expect and how to take care of themselves. They fought through the entire Attu campaign under the most unfavorable possible environmental conditions, and they were still serving as a reconnaissance patrol long after the last organized Japanese
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¹⁰ See footnote 3, p. 86
^1I See footnote 9, p. 93.
¹² See footnote 3, p. 86.

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resistance had ended. Their casualties consisted of 1 man killed in action, 2 wounded in action, and 1 with a slight cold injury.

Physical Status

    Practically all of the men engaged in the Attu operation were young and in good general condition. They were free from such constitutional diseases as arteriosclerosis, cardiorenal disease, and diabetes, which complicate the majority of cases of peripheral vascular disease observed in civilian practice. They had not suffered from dysentery, malaria, and the other debilitating diseases which complicated the management of so many battle and nonbattle injuries in certain other theaters of operations.

    Because these troops went directly into combat from a noncombat status, they had not previously been subjected to prolonged dietary insufficiencies, though they had hot food only infrequently during the period of active fighting. They did not, however, because of lack of training, make use of the concentrated rations with which they had been supplied. Because they had not been taught the importance of eating their rations, whether they liked them or not, and the necessity for eating them to keep up their resistance, they threw away whatever they did not like. Among the provisions, for instance, was fortified dried lemon juice, to provide vitamin C. It was not palatable, and most of the men threw it away. As a result, a few instances of incipient scurvy were observed before the campaign ended. There was apparently no relationship between this minor vitamin deficiency and the cold injuries which occurred, although it was speculated that such a correlation might have developed if the campaign had lasted much longer.

Individual Susceptibility

    Wide variations in individual susceptibility to cold and wet were observed among the men taking part in the Attu operation. If a group of 3 soldiers spent the night in a forward observation post, 2 might return with no complaints, or with minimal complaints, while the third would have numb, mottled, swollen feet. Among 224 patients observed at Letterman General Hospital, San Francisco, Calif., the average duration of exposure was about 6.5 days." One hundred and sixty-five (74 percent), with exposures varying from 3 to 14 days, presented only desquamation of the skin. Thirty-three (15 percent), with exposures varying from 4 to 11 days, had lost toenails, tips of toes, and thick layers of skin. Twenty-three (10 percent), with exposures varying from 4 to 9 days, had lost one or more toes or portions of their feet. Three men who required amputation of both feet had been exposed 4, 6, and 8 days, respectively.
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¹³ Patterson, R. H.: Effect of Prolonged Wet and Cold on the Extremities. Bull. U. S. Army M. Dept. No. 7.5, pp. 62-70, April 1944.

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    One patient at Letterman General Hospital, who had gangrene of both feet up to the level of the metatarsophalangeal junction, was found to have suffered previously in civilian life from frostbite of both feet.

Other Etiologic Factors

    At least two other factors, in addition to those already discussed, played a part in the production of cold injuries on Attu:
       
    1. Many of the men, in their natural desire to get warm as fast as possible, wrapped up their cold feet and exposed them to heat. Most of them had not been warned that this was the worst possible thing they could do.
       
    2. The incidental trauma of walking over rough terrain, on numb feet added to the damage already done by wet, cold, and constriction. It was recognized that walking was harmful, but it has already been pointed out that, as a matter of necessity, patients who could be ambulatory often had to be, since litter carries over tundra and down steep, snow-covered ridges were slow and exhausting work and personnel to move the injured were always in short supply.

THE OCCUPATION OF KISKA

    The operation on Kiska, which began 15 August 1943 and was concluded 31 August 1943, was being planned and organized while Attu was under assault. The task force for this landing consisted of the 87th Mountain Infantry Regiment; the 184th Infantry Regiment, which had been trained at Fort Ord; the 17th Infantry Regiment (minus), which had been transferred from Attu; the 53d Infantry Regiment of the Alaska Defense Command; and the 13th Canadian Infantry Brigade. The last three components joined the force at Adak, just before the landing. The others had been assembled at Adak and Amchitka in the central Aleutians, for several weeks of training.
       
    After these troops were landed, it was found that the enemy had fled before the invasion had occurred, though the fact of their evacuation was determined only after a slow, cautious search of the entire island. There were no true battle casualties, but there were 28 deaths and 50 injuries from accidents and from fire due to mistaken identity.
         
    The terrain was difficult. The land everywhere was cut by fresh-water lakes and streams. Hills and valleys were covered with tundra, which a Royal Canadian Army surgeon ¹⁴ graphically described:
         
    Walking on this growth is like walking on a gigantic spring mattress, into which one's feet sink for a foot or more with each step that is taken * * *. During the warm weather the surface thaws to form a vast bog, or tundra-moor, which is probably unequaled anywhere in those qualities of cohesion and adhesions which make mud the objectionable surface that it is.
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¹⁴ Lane, G. A.: Medical Experience with the 13th Canadian Infantry Brigade at Kiska. J. Canad. M. Service 1.282-288, May 1944.

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    Although the terrain on Kiska, as this description suggests, resembled that on Attu, the general situation was not as difficult, chiefly because of the timing of the invasion. The invasion of Attu occurred in May, when there was snow on most of the hills and snow water running down all of them. During this invasion, there were no dry surface areas until after Japanese installations could be occupied. Level spaces were all marsh, and there was an incredible amount of moisture in and under the tundra on sharp declivities. The invasion of Kiska occurred in August, when there was no snow and when the runoff had largely stopped, except for springs and water courses. Since there was no combat, these could be avoided. Once the troops got away from the landing beaches and the adjacent swamps, they could be on fairly dry ground most of the time. Also, the sun shone for an hour or two daily during most of the period of occupation, and it was therefore possible to dry out in the sun.
       
    Other circumstances were also much more favorable than on Attu. There had been an excellent liaison between the 7th Infantry Division units on Attu and the training authorities at Fort Ord, with the result that the troops who went to Kiska from that area were trained and equipped in the light of the Attu experience. Men physically and mentally unequipped for Army life had been cleared from the unit before it was dispatched to Kiska. The troops who had fought on Attu were acclimated and knew what to expect of weather and terrain. All the men had been given careful instruction for protecting themselves in cold, wet weather, had been trained in foot care, and had been given foot inspections before landing.
  
    Clothing and footgear, although not entirely satisfactory, were a great improvement over what had been selected for the Attu landing.¹⁵ The men went ashore with Alaskan field jackets, parkas, rainsuits, kersey-lined trousers, and tocques to protect the face. Their garments were all water repellent, though in the opinion of some observers only fully waterproofed garments would have been really adequate for the conditions encountered. Shoepacs were used universally. This was a wise decision, though the model employed was not satisfactory in many respects. Most of the men were fitted with such large sizes that their feet had little support. The shoepacs were also cut too low to furnish any protection when troops had to wear them ashore on the beaches, or when much activity in deep mud was required. The shoepacs were also less effective than the low leather boots worn by the Canadian brigade. Nonetheless, they were a great improvement over the blucher boots worn in the Attu invasion.¹⁶
      
    In addition to the general indoctrination already described, troops who participated in the Kiska operation were furnished with a small handbook
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¹⁵ Memorandum, Director of Operations, Army Service Forces, for The Quartermaster General, attention: Military Planning Division, Col. G. F. Doriot, 7 Oct. 1943, subject: Report of Observer on Kiska Operation, Clothing and Equipment.
¹⁶ A medical officer who participated in the occupation of Kiska wrote as follows about footgear: "My personal experience was that the best footwear for me was the regular Army boot over which I wore a standard overshoe (galosh). This assured relative protection from wet terrain and permitted me to open the overshoe and allow the feet to dry as soon as the opportunity presented. Thus, even though my feet tend to perspire readily, I was able to keep them dry most of the time and to allow proper circulation at all times. This combination was arrived at by trial and error, and proved much more satisfactory than the shoepac, combat boot or knee-length rubber boots. Of course, the latter would have been necessary if I had been standing in water of any depth."

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entitled "Soldiers Manual (How To Get Along in the Field)." The foreword to the troops was written by Maj. Gen. Charles H. Corlett, who commanded the task force (ATF9). The suggestions had been collected by General Corlett's staff and had been compiled by Capt. (later Maj.) Roy L. Atteberry, Jr., who, said the introduction, "* * * has had much experience in our future hunting grounds. He knows the score."
       
    The introduction pointed out that the soldier had two major jobs. The first was to do the military job he had been taught to do. The second was to spend the rest of his time keeping himself and his equipment in the best possible condition. It was to help in the second job, said the introduction, that this pamphlet had been prepared.
     
    The pamphlet contained sensible instructions for the care of the feet before and during combat; instructions for the use and care of socks, including the statement that a pair of spare socks was the most valuable piece of extra clothing a soldier could possess; and a description of, and instructions for the use of, shoepacs. It was pointed out that, though the soldiers had probably never worn them before, shoepacs had been selected as the best type of footgear for mud and water; that they had been purposely fitted oversize to take care of extra socks and insoles; and that they should be laced loosely. Instructions were also given for moving the feet, toes, and legs, even in foxholes in combat. Noncommissioned officers were reminded that one of their most important duties was to see that their men took care of their feet.
      
    Other sections of the pamphlet dealt with the proper use and care of clothing and other cold-weather equipment; with the importance of eating the rations that had been provided, heating them when possible, and saving what was left; with the importance of drinking tea, for which teabags could be used; and with the means of keeping foxholes dry. Two cartoons showed what happened to soldiers who left their equipment behind and suffered from the cold as a result.

Incidence of Cold Injury ¹⁷

    The approximately 28,450 troops who participated in the occupation of Kiska suffered a total of 130 cold injuries. In spite of the training given them before landing, some of these casualties admitted that they had failed to follow instructions given them and did not remove their shoepacs and socks for several days at a time.        

    The footgear used seemed to influence the incidence. The Canadian brigade, whose footgear was thought to be better than that worn by American troops, sustained only 1 trenchfoot casualty in their strength of 5,326 men. Their rate of 2 per 10,000 for the 15-day period of the operation was far lower than the comparable American rate of 55.6 per 10,000, according to the report submitted by the surgeon of the task force at the conclusion of the operation.
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¹⁷ Letter, Col. L. R. Moore, MC, Surgeon, Headquarters, Alaskan Department, to The Surgeon General, 4 Dec. 1943, subject: Medical Service, Occupation of Kiska, Alaska.

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    It is doubtful that the somewhat better weather in which the Canadians landed accounted for this considerable difference.
         
    The use of lanolin for massage of the feet seemed of doubtful value. The 87th Mountain Infantry Regiment, which used it before disembarking, suffered 7 casualties from trenchfoot in a strength of 5,517 men. The 184th Infantry Regiment, with a strength of 5,999 men, did not use it and had 15 casualties from trenchfoot. This is not a significant difference.
       
    The high incidence of cold injury in the 17th Infantry Regiment, which had 76 cases in a strength of 3,906 men, was thought to be related to their previous exposure on Attu. The environmental and other circumstances under under which they operated were no worse than those of any of the other troops, and it seemed logical to explain at least some of their injuries on the basis of pathologic changes present as the result of the earlier experience. A number of men in this regiment were evacuated and were classified as casualties due to cold because it was feared that their condition might be more serious than it seemed superficially.

SUMMARY

    On Attu, the tactical and environmental hazard, improperly chosen equipment, and lack of individual and unit training in the proper use of equipment and in preventive measures against cold and exposure combined to set a pattern which was to be repeated, in varying degrees, during the remainder of the war. Within the next few months, trenchfoot occurred during the occupation of Kiska, but to a lesser degree. Within 6 months, there was a major epidemic of trenchfoot in Italy. Within the next 18 months, there was an even more explosive outbreak in Europe, on the Western Front.         

    While the actual number of cases of cold injury was small in the Attu operation, the incidence was high. Twelve hundred cold injuries occurred in 22 days, in a force of 15,300 men, which is an incidence rate for the period of about 80 per thousand. Expressed as an annual rate, this is 1,300 cases per thousand. An almost equal number of wounded-in-action cases occurred. The ratio of cold injuries to wounded-in-action cases was approximately 1:1, as compared with 1:5 in Italy in 1943-44 and about 1:4 in the European theater in the winter of 1944-45.

    On Kiska, the troops were exposed to cold injury only for the short time required to establish that the enemy had withdrawn. Circumstances were favorable. Because the enemy had fled, there was no combat activity. The operation was started 3 months later than the Attu invasion, so that the weather was less severe. Equipment and footgear were better than what had been provided on Attu. Many of the men had fought on Attu and had learned by experience how to take care of themselves in cold, wet weather. The other troops had been specifically trained to care for their feet.

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    Yet, in spite of the brevity of their exposure and other favorable circumstances, the 28,450 troops who participated in the landing on Kiska sustained 130 cold injuries. What the incidence might have been if the enemy force, estimated at 10,000 men, had not abandoned the island before the allied troops arrived is a matter of conjecture. It would probably not have been as high as the incidence in the Attu operation, but it would undoubtedly have been considerably higher than it was in an unopposed landing.
        
    NOTE.- Because the clinical observations in trenchfoot were essentially similar in all theaters, they are discussed elsewhere, under a single heading (p.259) . Treatment is also discussed under a single heading (p.307) . In the Attu campaign, treatment consisted of a variety of methods, depending upon the knowledge and preferences of the individual medical officer. There was no background of experience in cold injury, and no directives concerning its management had yet been issued.