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Chapter XIX



Eighth U.S. Army

Frank J. McGowan, M.D.


    The surgical treatment in the Eighth U.S. Army area of soldiers wounded in combat was carried out in portable surgical hospitals, evacuation hospitals, and field hospitals. The surgical training of men in the evacuation hospitals was, in general, good. There were, however, marked differences in individual abilities among these surgeons. The surgical abilities of the staff of the field hospital were, on the other hand, of a definitely lower quality, and, in the author's experience, the field hospital did not function at all well. It is a matter of record that the actual frontline surgery was, for the most part, performed by clearing companies reinforced by portable surgical hospitals with accompanying surgical teams. This was certainly the case in the Battle of Leyte, the Battle of Zig Zag Pass on Luzon, the operations on Bataan, the retaking of Corregidor, and the lower Visayan operations, which were conducted wholly by the Eighth U.S. Army and involved 51 amphibious landings on two dozen islands.

    The Eighth U.S. Army took over the battle for Leyte (p.477) on 26 December 1944 at a the when the Leyte campaign was declared strategically closed. The subsequent mopping-up operation, which was handled by the Eighth U.S. Army, accounted for 26,000 dead Japanese.

    At the time when the Battle of Leyte was being fought in the region of Carigara and the Ormoc Corridor, the forward care of the wounded was done entirely by portable surgical hospitals and clearing companies. The 58th and the 36th Evacuation Hospitals were some 15 to 20 miles in the rear. Evacuation to these hospitals was extremely difficult because of the condition of what were called roads, the constant rains, one-way bridges, and the movement of supplies in the opposite direction.

    In the XI Corps landing in the region of Subic Bay, which was quickly followed by the Battle of Zig Zag Pass, the situation was again practically the same. There were two portable surgical hospitals up forward some 2 or 3 miles behind the lines. After 5 to 7 days, the 36th Evacuation Hospital was established some 15 miles to the rear. There was, of course, no transportation after darkness, so here again the brunt of the primary surgical treatment of all types of war wounds was carried on by the portable surgical hospitals and a separate clearing company reinforced by surgical teams.


FIGURE 96. - Col. Frank J. MGowan, MC, Consultant in Surgery. Eighth U.S. Army.

    When Corregidor was retaken, the medical support furnished during the first week consisted of the organic regimental medical detachment which had jumped with the parachutists, plus one portable surgical hospital which made the subsequent amphibious landing on the beach. The day after this landing, the commanding officer of the portable surgical hospital was evacuated because of epidemic hepatitis. These two medical units were consolidated on the "Top of the Rock" and, in the days to follow, were strengthened by the addition of several surgeons. This same procedure was rather typical of the actual situation in regard to the mechanism of handling the wounded during the remainder of the Visayan operations, which ended with the fall of Davao City in Mindanao.

    These small units, therefore, in the experience of Col. Frank J. McGowan, MC, Consultant in Surgery, Eighth U.S. Army, (fig.96) bore the brunt of the surgical treatment of the wounded soldier. They were manned by young men with little surgical experience, and the presence of a well-trained surgeon in these units was the exception rather than the rule. The majority of well-qualified men, and by that is meant men who had attained or were qualified for the rating of the American Board of Surgery, were to be found in the general hospitals and in the evacuation hospitals.


    Evacuation hospitals were designed to function early. However, in many instances, due to difficulties in terrain, overwhelming difficulties in transportation, and the rapid movement of tactical units, they were never in a position to receive cases until late in an operation (fig.97). This was especially true during the Battle of Zig Zag Pass.

    Many incidents contributed to failure in otherwise well-laid plans. For example, on Cebu Island, Japanese mines on the beachhead delayed the early establishment of an evacuation hospital, although its personnel were used. Casualties were high, and hospitalization facilities, consisting of a division clearing company plus personnel from the 58th Evacuation. Hospital, were swamped with patients. Again, within a very short time after the landing on Mindanao at Polloc Harbor, the combat troops advanced so far over difficult terrain that they outstripped the two evacuation hospitals by some 75 to 100 miles. In the southern Philippines campaign for Mindanao, one portable surgical hospital en route to the Davao area was ambushed by the enemy, its equipment was destroyed. and the commanding officer was seriously bayoneted.

    The lives of wounded soldiers were saved in forward medical units and not in the rear hospitals. Wounded soldiers rarely arrived in rear hospitals until from 7 to 10 days after the time of injury, a demonstration of their ability to survive and travel. Proper treatment, if afforded early, saved many lives, minimized complications, and shortened future care. These remarks are made with particular reference to the SWPA. (Southwest Pacific Area) with its isolated islands, its great difficulties in transportation, and an average medical strength which was always below authorized strengths. This deficiency in personnel was further complicated by the theater policy of separating nurses from their units before moving into combat zones. In the European theater, nurses accompanied their units on the Normandy invasion. The policy of separating the nurses seriously affected those units which had trained with their complement of nurses, especially as the enlisted personnel replacements, supposedly on a basis of two enlisted men to one nurse, were never supplied in that ratio and were, in most instances, badly lacking in training. The consultant could never understand why army nurses were not allowed to join their units on D+3 or D+4 or just as quickly as there was local security. The casualty load was heavy, and the nurses would have contributed greatly to the increased efficiency of all surgical units. As it worked out, they were shuttled about in the rear areas, and those complements of nurses that finally caught up with their units did so at a time when the casualty load was low and the unit was on the verge of becoming inactive (fig.98).

    The Eighth U.S. Army conducted the Visayan operations which Gen. Douglas MacArthur called "a model of what a light, but aggressive command can accomplish in rapid exploitation." This campaign called for task forces up to the size of an army corps (X Corps, Mindanao). each of which had to


FIGURE 97. - The 30th Evacuation Hospital at Parang, Mindanao. Philippine Islands. A and B. External views of hospital area. 21 April 1945. Dust from main supply route covered patients and facilities.


FIGURE 97. - Continued. C. Mosquitoproofed operating pavilion.

be supplied with adequate surgical support (fig. 99). The Eighth U.S. Army surgical consultant covered as many of these task forces as he could in order to maintain a high quality of professional work in the care of the wounded. This high quality of surgical work was attained by augmenting existing personnel with suitable additions of trained individuals from the less active to the more active combat areas and by anticipating as far as possible, with the advice of the corps or division surgeons, the problems of supply and evacuation. These multiple military operations, occurring often at or about the same time, posed many problems since there never was aim adequate supply of medical units. It was a case of simply having to do with what was available.

    Combining medical units, dividing units, and adding surgical teams became the standard procedure. An excellent evacuation hospital, the 168th, was sent in on the Palawan invasion. Meeting with comparatively few casualties, this hospital was used as a surgical pool, and the majority of its surgical personnel were dispatched by plane to other areas such as Mindanao and Davao where the casualties were heavy.

    The author, drawing upon his experience as surgical consultant to the Eighth U.S. Army, would like to state that there were never enough properly trained surgeons available in the forward areas. He would therefore suggest that, in active hostilities, more qualified surgeons capable of field service be assigned to forward medical units.


FIGURE 98.- Maj. Margaret D. Craighill, MC. adviser to The Surgeon General on women's health and welfare, arrives at Parang, Mindanao, with Col. George W. Rice, MC, surgeon, Eighth U.S. Army, to investigate the use of female Army personnel in the X Corps. At left is Colonel McGowan.


    The terrain, for the most part, was extremely difficult. This was particularly so in the Battle of Leyte where conditions were frankly in describable. Contributory to this were the poor roads, torrential rains, one-way bridges, and so forth.

    The climate, in general, was extremely hot. It was imperative of course, that all drinking water be chemically treated. On Leyte, particularly, it was impossible to carry out any foot hygiene among the troops fighting in the mountain passes.

    On 24 November 1944, Colonel McGowan saw approximately 100 eases of immersion foot at the 58th Evacuation Hospital. These men had been in their foxholes for 2 or 3 weeks and were utterly exhausted. On the same day, he saw between 50 and 100 similar cases at the 36th Evacuation hospital. Indeed, it was even difficult to supply these combat troops with rations and ammunition. Evacuation in the early days of the Leyte campaign was a frightful problem. Colonel McGowan saw one group of 50 wounded (Ormoc Corridor) who had been 3 days in transit with no food.


FIGURE 99. - On the morning of Task Force V-5's landing on Green Beach, Parang, Mindanoa, Colonel McGowan confers with Col. C. McC. Downs, MC, Surgeon. X Corps.

    The author landed on Corregidor on 18 March (the initial landing had been on the 16th ) with about 100 pints of blood--some fresh blood from the 36th Evacuation Hospital and some old blood from a hospital ship in Subic Bay. He found the 1st Portable Surgical Hospital on the beach, and that afternoon, when the top of the Rock was first reached, he found scores of fractures, the majority of which were compound. The 503d Parachute Regiment had jumped 2,100 men of whom 182 had been injured. The third wave of jumpers had been machinegunned by the Japanese. These were the rough figures given at the regimental command post at that time. The fractures found had resulted from the jump.

    Colonel McGowan organized a surgical setup consisting of the 1st Portable Surgical hospital and the 503d Regiment's medical detachment and began to operate. At about 2300, water ran out and plaster could not be used.

    During that night, the first of the tunnel explosions occurred with many casualties. There was much firefighting about the building. Here, one of the difficulties due to terrain was the lack of water as the Rock was to be supplied by a water boat which had not come in. Ambulance evacuation down to the beach was under small arms fire, and one convoy was turned back.

    It was interesting to note that none of the cases of compound fracture of the femur, untreated for 45 hours, went into shock when debrided and immo-


bilized and that no bad effects were noted from the use of the outdated blood obtained from the hospital ship.

    The line of evacuation from Corregidor was as follows: From the top of the Rock by ambulance to the beach; from the beach by LCM (landing craft, mechanized) and LST (landing ship, tank) to Subic Bay; by ambulance from the bay to the 36th Evacuation Hospital. There were eventually on Corregidor one large operating room with three tables, a plaster room, a recovery ward, and a good surgical team.


    The methods of evacuation ranged all the way from native litter bearers to Ducks (single-engine, general-purpose amphibian airplanes), ambulances, watercraft, and air evacuation planes--L-5B's which could accommodate one litter or one sitting patient and C-47's. There were all manners and combinations of these.

    Evacuation of casualties by C-47's implied the necessity for a condition of security for the most part. Evacuation by L-5B's, while tedious because of the limited carrying capacity and range of the planes, was of extreme value in Colonel McGowan's experience because it could be carried out when there was no security and was lifesaving in many situations where evacuation by road was impossible. For instance, during the Battle of Zig Zag Pass, the 64th Portable Surgical Hospital found itself entirely cut off in the Dinalupihan area. The staff had been operating for days on all types of war injuries, had about run out of supplies, was crowded with postoperative cases, and was running short of food. Colonel McGowan took a surgeon from the 36th Evacuation Hospital and three L-B's from the airstrip at San Marcelino, Luzon, landed near the hospital, and set up an evacuation scheme whereby, in 48 hours, it was possible to remove all of the wounded.

    The maintenance of close contact between the hospitalization and evacuation sections in the army surgeon's office was necessary in order to avoid the dangerous piling up of wounded soldiers in forward areas. Evacuation of the wounded from the frontlines by light aircraft was frequently resorted to by the Eighth U.S. Army during the Visayan operations and was responsible for the saving of many lives. Evacuation by C-47 or C-46 hospital plane of postoperative patients from small islands with limited medical facilities to larger bases on neighboring islands kept the forward zone in a fluid state and prevented the accumulation of postoperative cases where their care would seriously hamper the already overtaxed personnel (fig.100). Considerable credit must be given to the sergeant pilots who flew the light aircraft. Had more planes been available at the time, much more effective work could have been accomplished in the care of the wounded.

    From the experience with these and other situations where aircraft were used in the evacuation of battle casualties, the author was strongly of the


opinion that air evacuation of the wounded should be under the control of the army surgeon or his representative, and not a function of G-4 (logistics (supply)). In several situations, where aircraft of both types were set up for evacuation of the wounded by G-4, there was the temptation to use these aircraft for the transport of nonmedical freight., a practice which interfered with the schedule set up for evacuating patients.


    In general, the medical and surgical supply situation was adequate. At times, when there were temporary failures of supply, those failures were due to circumstances beyond anyone's control.

    The author would like particularly to compliment the Army and the Navy authorities on their whole blood program. The blood began to arrive on Leyte in November 1944. It was well packaged with 16 units of whole blood to a container in which were 17 pounds of cracked ice. The accompanying tubing was reaction proof. With the advent of these units, transfusion of whole blood became as simple to administer as plasma had been, and more and more whole blood was used. Up to this time, the surgeons had been prone to use plasma rather than whole blood because plasma had been much easier to administer and its value had been too enthusiastically stressed (fig. 101). To a large extent, they were using a makeshift type of tubing and methods which led to frequent clotting, reactions, and other unfavorable results. Throughout the entire Leyte campaign and subsequent to it, Lt. Col. Frank Glenn, MC, Consultant in Surgery, Sixth U.S. Army, amid Colonel McGowan insisted upon the use of whole blood whenever possible.


    Portable surgical hospitals were originally set up for jungle warfare where larger units could not operate (fig.102). Their chief weaknesses, which were obvious toward the close of the campaign in the SWPA, were:

    1. The mediocre abilities of the professional personnel--to which generalization there were some outstanding exceptions--and the many replacements resulting from rotation.
    2. The lack of equipment which seemed adequate on paper but was woefully lacking when it is realized that these small units practically bore the brunt of frontline definitive surgery. They had no generator, no electrical illumination, no refrigeration, no suction apparatuses, and no resuscitation equipment.
    3. In the press of work, they were not set up to function independently. Consequently, as often as Colonel McGowan could, he insured that they were attached to separate clearing companies and reinforced with surgical teams.


FIGURE 100. - (See opposite page for legends.)


FIGURE 100. - Evacuation by C-47 aircraft from Malabang airstrip, Mindanao. A. First load of patients to be evacuated from Malabang arrive at planeside on 28 April 1945. B. View of litter patient being loaded into C-47. C. Interior of loaded C-47.


    In the SWPA. there were none of the. auxiliary surgical groups which proved of such great value in the European theater. Col. William B. Parsons, MC, organized a series of surgical teams to be taken from rear echelon units and put at the disposal of army medical units for the purpose of augmenting these units when in combat. These surgical teams consisted of two surgeons and six enlisted men. After Colonel Parsons left, the SWPA, Col. I. Ridgeway Timble MC, carried on this excellent scheme.

    In this consultant's experience with these teams in Subic Bay, Corregidor, Bataan, and the Leyte campaign, he occasionally encountered a team of two well-trained surgeons and six well-trained enlisted men. Too often, the rear echelon units busied themselves with convalescent patients, and, unaware of the demanding situations of the combat zone, sent their less trained medical officers and enlisted men to the front.


    In general, the plan for an amphibious assault was to have one or more LST's, especially equipped as hospital ships, support the landing until the beach was secure and the evacuation hospital was established. Each LST then


FIGURE 101 . - Administration of plasma to patient during litter carry. Mindanao.

acted as all evacuation hospital ship (fig. 103). These LST's received patients during daylight hours, pulled offshore at dusk, and remained at sea during the night. They had U.S. Navy surgical teams. These teams consisted rarely of well-trained surgeons. Colonel McGowan would advise augmenting the staffs of these LST hospitals with well-trained surgeons from the Army to do the surgery on these ships. An ophthalmologist and a neurosurgeon were required in the surgical team. On Luzon, in the XI Corps action (Zig Zag Pass, Bataan, Corregidor), there was no trained ophthalmic surgeon. Fortunately, Colonel McGowan located a U.S. Navy medical officer trained in ophthalmology who served as a consultant. In the author's opinion, close cooperation between the Medical Corps of the Army and the Navy in amphibious warfare was vital. Only thoroughly trained personnel should be entrusted with the receiving and disposition of casualties.

    On many landings, the LST's were storage places for units of whole blood. The stored, refrigerated blood should have been packed by plan, with a medical officer responsible for its care, screening, and distribution. Too often, blood was distributed haphazardly throughout a convoy and was difficult to locate (fig.104). The handling of whole blood was much more efficient when a responsible person was in charge.


FIGURE 102. - Operating scene, 23d Portable Surgical hospital.


    The treatment of war wounds has been well covered elsewhere as a result of the extensive data which came out of the war theaters. The author, however, would like to stress some of the following observations with respect to the treatment of regional injuries--observations based on his experience as the surgical consultant, Eighth U.S. Army.

    Abdominal injuries. - There must be routine use of gastric drainage with adequate supportive therapy through the liberal use of blood and plasma. Wire sutures should be employed to close the abdominal wall in serious cases. There should be more frequent use of transverse and oblique incisions.

    Chest injuries. - The earlier diagnosis of massive hemothorax must be urged. Open thoracotomy should be resorted to as soon as it is indicated and, in general, sooner than it was done. More intelligent use of morphine is required. The surgeon has to distinguish between the restlessness due to the lack of oxygen and real pain.

    Wounds and injuries of the femur. - Thorough but not too radical debridement must be practiced and must be followed by the application of a double-leg spica plaster. Medical officers should appreciate the fact that


FIGURE 103. - Casualties debark from an LST hospital ship at Corregidor Island in March 1945.

a limb-saving debridement is a challenge to the good surgeon and more difficult to perform than a guillotine amputation.


    In the event of any future war, it will be necessary to place well-qualified surgeons in forward medical units in order to improve the care of casualties. Well-qualified surgeons may be temporarily attached to hospitals actively engaged in the support of combat operations. This attachment could be handled as it was in the European theater by the employment of auxiliary surgical groups. Various specialists should be assigned to the forward areas, and the general surgeons in these areas should be capable of performing major surgical operations.

    Newly arrived medical officers should be attached for training and orientation to active general hospitals at an early date. The newly arrived should also be attached to more forward units for proper orientation and experience in actual combat, but the combat zone is not the place to train surgeons in the. fundamental principles of war surgery.


FIGURE 104. - The 99th Evacuation Hospital, combat loaded on top deck of LST at Morotai before the V-5 operations in the southern Philippines campaign.

    The foregoing implies machinery for rotating medical personnel between army and communications zone units. Flexibility in handling personnel should be the constant aim of army and communications zone authorities. Surgeons from the rear echelons rapidly changed their ideas concerning proper surgical management of battle wounds after having participated in frontline surgery. The Eighth U.S. Army surgical consultant resorted to this practice of rotating surgeons, but, in retrospect. it should have been done more frequently.

    Early during Colonel McGowan's tour of duty in the SWPA and shortly after he reached Leyte, the following notes were written:

    1. Army medical units in the SWPA had not been appraised professionally. This was particularly true of units just arriving from the United States or from another theater.
    2. There was no professional supervision by the corps or division surgeons of the work being done.
    3. Surgical consultants were asked with practically no authority to correct or supervise work. This situation was corrected later, and the author can report personally that his own endeavors in this respect met with the fullest cooperation on the part of Col. (later Brig. Gen.) George W. Rice, MC, Surgeon, Eighth U.S. Army. Many of the medical units assigned to armies had


undergone long training in the Zone of Interior and many inspections as to equipment, ability to set up in the field, et cetera. However, to the best of the author's knowledge, none of these units had had an evaluation of their ability to perform good surgery.

    The author would strongly recommend that, in the future, under circumstances similar to those which existed in the Eighth U.S. Army during World War II, surgical consultants be regularly assigned to each army corps, and, as frequently as becomes necessary, a consultant be assigned to each division in combat.