MEDICAL SERVICE IN THE 

WAR AGAINST JAPAN
END OF A BUSY DAY
UNITED STATES ARMY IN WORLD WAR II

The Technical Services

THE MEDICAL DEPARTMENT:

MEDICAL SERVICE IN THE

WAR AGAINST JAPAN

by

Mary Ellen Condon-Rall

and

Albert E. Cowdrey

CENTER OF MILITARY HISTORY

UNITED STATES ARMY

WASHINGTON, D.C., 1998
Library of Congress Cataloging-in-Publication Data

Condon-Rall, Mary Ellen, 1938–

The Medical Department : medical service in the war against Japan

/ by Mary Ellen Condon-Rall and Albert E. Cowdrey.

p. cm. — (United States Army in World War II. The technical

services) (CMH pub ; 10–24)

Includes bibliographical references and index.

1. World War, 1939–1945—Medical care—United States.

2. Medicine, Military—United States—History—20th century.

3. United States. Army—Medical care. I. Cowdrey, Albert E.

II. Title. III. Series. IV. Series: United States Army in World

War II. Technical services.

D807.U6C567 1998

940.54‘7573—dc21 98–22644

CIP

First Printing—CMH Pub 10–24

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. 20402
UNITED STATES ARMY IN WORLD WAR II

Advisory Committee

(As of September 1997)

Michael J. Kurtz

National Archives and Records

Administration

U.S. Army Center of Military History

Brig. Gen. John W. Mountcastle, Chief of Military History

v

Joseph T. Glatthaar

University of Houston (Chairman)

Carlo W. D’Este

New Seabury, Mass.

Lt. Gen. Frederick E. Vollrath

Archivist of the Army

Mark A. Stolar

University of Vermont

Maj. Gen. James J. Cravens, Jr.

U.S. Army Training and Doctrine

Command

Carol A. Reardon

Pennsylvania State University

Col. Everett L. Roper, Jr.

U.S. Army War College

Brig. Gen. Fletcher M. Lamkin, Jr.

U.S. Military Academy

Raymond A. Callahan

University of Delaware

Gerhard L. Weinberg

University of North Carolina

Brig. Gen. Joseph R. Inge

U.S. Army Command and General

Staff College

George C. Herring, Jr.

University of Kentucky

Chief Historian

Chief, Histories Division

Editor in Chief

Jeffrey J. Clarke

Col. Clyde L. Jonas

John W. Elsberg

. . . To Those Who Served

Foreword

The Medical Department: Medical Service in the War Against Japan is the third

and concluding volume on the overseas activities of the U.S. Army Medical

Department during World War II. In the Asian-Pacific theaters of operations

Army medical personnel supported troops in a variety of remote disease-ridden environments, burdened by vast distances, diverse climates, and almost

insoluble logistical problems. This study recounts how the Army’s senior

medical officers pooled their talents with the scientific knowledge of the day

to overcome these obstacles and, in the process, realized significant

advances in military medicine. In the course of the long, grueling war

against Japan these dedicated professionals developed new drugs and techniques for preventing and controlling disease, fielded hospitals and units

uniquely equipped to support jungle and island fighting, and perfected

amphibious medical support.

The story of these developments, as well as of the planning and organizing of theater medical services, provides practical lessons for military students and military leaders of all ranks. I urge you to read this history for its

illuminating examples of the finest in combat medical support and organization, principles that remain vital to our military today.

Washington, D.C. JOHN W. MOUNTCASTLE

1 June 1997 Brigadier General, USA

Chief of Military History

ix
The Authors

Mary Ellen Condon-Rall was born in Brooklyn, New York, where she

received her primary and secondary education. She earned her B.A. and

M.A. degrees respectively from Molloy College for Women and Fordham

University, both in the New York area, and her Ph.D. degree from the

University College of the University of London in England. Beginning in

1972, she started her career as a historian with The Historical Unit of the

U.S. Army Medical Department and, in 1976, when The Historical Unit was

absorbed, moved to the U.S. Army Center of Military History. In 1990 Dr.

Condon-Rall was awarded a one-year Secretary of the Army Research and

Study Fellowship. She is the author of Disaster on Green Ramp: The Army’s

Response; a monograph on host nation medical support during the Persian

Gulf war; a chapter on the history of military anesthesia in the Anesthesia

and Perioperative Care of the Combat Casualty volume of The Textbook of Military

Medicine; and a chapter on the U.S. Army and the fight against malaria in

the forthcoming work Science and the Pacific War. She also has contributed

numerous articles on military medicine and naval history in American,

British, and Australian journals.

Albert E. Cowdrey was born in New Orleans, Louisiana, and received his

education from the schools in that city and from Tulane and Johns Hopkins

Universities. He served in the Army as an enlisted man during the years

1957–59. After teaching at Tulane University and at Louisiana State

University, he joined the staff of the U.S. Army Corps of Engineers historical office and, since 1978, that of the U.S. Army Center of Military History,

from where he retired in 1993. His interest in southern history brought him

the American Historical Association’s Herbert Feis Award in 1984, and his

prizewinning history of Army medicine in the Korean war, The Medics’ War,

has been widely adopted as a text in military medical schools. Dr. Cowdrey

is the coauthor of The Medical Department: Medical Service in the European

Theater of Operations and author of Fighting for Life: American Military Medicine

in World War II. He also has published many articles on a variety of historical topics in American, British, Canadian, and international journals.

x
Preface

The Medical Department: Medical Service in the War Against Japan is a comprehensive organizational and operational history of medical support in the

Asian-Pacific theaters in World War II. The narrative begins with medical

prewar planning and ends with the establishment of public health and welfare in occupied Japan. In the context of fierce combat operations waged in

the geographical area extending from Australia to Alaska and from the

Gilbert Islands to Burma, we focused on how the Army Medical Department

coped with the great distances, diverse climates, disease epidemics, grave

logistical problems, and rapidly changing circumstances to maintain the

fighting strength of American troops. Flexible organization, ingenuity, and

the latest scientific advances helped medical personnel to support infantry

combat teams on isolated islands or in dense jungles, to evacuate casualties

over difficult terrain and then by sea or air, to adapt medical support to

amphibious operations, and to prevent and control disease. Cooperation

with the U.S. Navy and with the Allied medical services, especially in the

Southwest Pacific, also is covered.

Work on a volume dealing with the medical service in the war against

Japan began shortly after the end of World War II in The Historical Unit of

the Office of the Surgeon General. Over the years this unit collected original

documents, interviewed participants, and produced research note cards and

various historical drafts, from which we benefited. Although we found the

lengthy manuscripts of Warren W. Daboll and Donald Mitchell to be invaluable, our volume represents largely new research in primary and secondary

sources, as well as a fresh approach, theme, and organization to the subject.

For background, we drew upon the clinical volumes published by the Office

of the Surgeon General to gain insights into the medical story and also the

relevant volumes of the United States Army in World War II series, as well as

numerous subsequent scholarship, to understand the combat story.

Special acknowledgements must be made to many individuals for their

unstinting support. Members of the review panel—Dr. Jeffrey J. Clarke, Dr.

Edward J. Drea, Dr. Stanley L. Falk, Robert J. T. Joy, M.D., and Joanne M.

Brignolo—provided perceptive comments and suggestions that gave final

form to our volume. Dr. Joy, in addition, and Col. Charles J. Simpson were

always there to counsel, encourage, and give generously of their expertise

while we were working, and Lt. Col. James Carafano offered his much

appreciated help and encouragement during the final stages of production. 

We are deeply grateful to the more than fifty campaign participants who

were interviewed; they shared pivotal insights that added a personal dimenxi
sion to the unfolding of the story. Our sincere appreciation also is given to

Jan Herman, the U.S. Navy’s Bureau of Medicine and Surgery historian, and

Sylvan Katz for lending us relevant photographs that visually enhanced our

text. 

Meriting special recognition are the archivists who assisted us during our

research. We extend our gratitude to George Chalou, Fred W. Pernell,

Richard L. Boylan, and Victoria Washington of the National Archives and

Records Administration, Washington, D.C., and Richard Sommers of the

U.S. Army Military History Institute, Carlisle Barracks, Pennsylvania, for

contributing their time, knowledge, and skill. Present and former colleagues at the Center of Military History—Hannah M. Zeidlik, Charles

Ellsworth, Geraldine H. Harcarik, Carol I. Anderson, James B. Knight, Mary

J. Sawyer, John B. Wilson, Donna C. Everett, and Stephen E. Everett—also

were unfailing in their efforts to help us find materials.

Other key contributors at the Center are deserving of praise. Arthur S.

Hardyman and Sherry L. Dowdy used their cartographic skills to design the

maps; Beth F. MacKenzie, who also helped with the map compilations, and

John Birmingham, their desktop publishing talents to create camera-ready

copy and artwork; W. Scott Janes, his penetrating eyes to proofread the text;

Roger Wright, his craft as a photographer to reproduce a number of illustrations; and Susan Carroll, her meticulousness to develop the useful index,

bringing to light thoughtful queries in the process.

Finally, we are indebted to our hard-working editor, Joanne M. Brignolo,

whose literary skills, attention to detail, and technical proficiency contributed immeasurably to the smooth flow of the narrative and the accuracy of the citations. Her uncommon efficiency, unwavering support, and

unflagging enthusiasm helped us to navigate the turbid waters of the book

publication process.

For any errors of fact or interpretation remaining in the volume, we

alone are responsible.

Washington, D.C. Mary Ellen Condon-Rall

1 June 1997 Albert E. Cowdrey

xii
Contents

Page

PROLOGUE: THE DRIFT TOWARD WAR . . . . . . . . . . . . . . . . . . . . . . 3

Plans and Preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

The Approaching Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Chapter

I. A MEDICAL CALAMITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Japan Attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Philippines Prepare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

The Ordeal Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

The Jungle Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

The End Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

The Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Corregidor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

II. A NEW KIND OF WAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Endemic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Problems of Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

The Australian Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

The Base Sections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Hospitalization and Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

III. ARMY MEDICINE IN NAVY THEATERS . . . . . . . . . . . . . . . . . . . 82

The Hawaiian Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Care of the Troops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

The South Pacific Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Medical Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Medical Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Preparing for War . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

IV. JUNGLE WARFARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Guadalcanal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Invasion and Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

xiii
Chapter Page

Medical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Disease and Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Papua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

The Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Medical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

The Ravages of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

V. ALASKA: THE PYRRHIC VICTORY . . . . . . . . . . . . . . . . . . . . . . . 149

The Medical Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

The Enemy Attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Regaining Attu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

The Balance Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Regaining Kiska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

VI. AMPHIBIOUS ADVANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

CARTWHEEL Opens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

New Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Medical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

Bougainville . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Medical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

New Britain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

CARTWHEEL Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

The Road to Hollandia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

The Driniumor Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

On to Wakde and Sarmi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

On to Biak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

Conquest of the Vogelkop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

VII. THE FORTIFIED ISLANDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Winning the Gilberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

The Marshalls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Medical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Eniwetok . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Operation FORAGER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Saipan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

The Medical Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Tinian and Guam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

VIII. GROWTH OF THE MEDICAL SYSTEM . . . . . . . . . . . . . . . . . . . 251

SWPA: Unity Replaces Conflict . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

The Bases Advance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

xiv
Chapter Page

Persistent Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264

Supply and Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

The Central and South Pacific Areas . . . . . . . . . . . . . . . . . . . . . . . 270

The Medical Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

IX. THE CHINA-BURMA-INDIA CHALLENGE . . . . . . . . . . . . . . . . 286

The Burma Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

Preparing To Counterpunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

Northern Burma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

Medicine and Marauders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

The Central Burma Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

The Chinese Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314

X. LARGE-UNIT WAR: THE PHILIPPINES . . . . . . . . . . . . . . . . . . . 319

Leyte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

The Landings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

Luzon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331

Manila . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334

Manila Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340

The Mountain Campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342

Fighting in the North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

The Reconquest Completed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348

The Impact of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

XI. BEHIND THE LINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

The Guerrillas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

Prisoners of War . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

Cabanatuan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

Bilibid and Santo Tomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

Prisoners Outside the Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . 377

XII. LARGE-UNIT WAR: OKINAWA . . . . . . . . . . . . . . . . . . . . . . . . . . 384

Foretastes: Angaur, Peleliu, Iwo . . . . . . . . . . . . . . . . . . . . . . . . . . . 384

Planning the Attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

The Battle Opens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390

The Tempo Quickens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

The Medical Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396

Stress and Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

Victims of War . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408

Reviewing the Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

xv
Chapter Page

XIII. THE LAST ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412

Organizational Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412

USAFPAC Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414

USAFWESPAC Prepares . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

The Sixth Army . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424

The Rear Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

The Occupation Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426

Medical War Crimes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431

The Japanese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433

Nuclear Warfare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436

EPILOGUE—THE MEDICAL SERVICE IN RETROSPECT . . . . . . . . . 441

BIBLIOGRAPHICAL NOTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445

LIST OF ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

Tables

No.

1. The Chain of Evacuation, 1943–1945 . . . . . . . . . . . . . . . . . . . . . . . . 78

2. Malaria Admission Rate for Allied Units, Guadalcanal, 1943 . . . . . 126

3. Malaria Incidence in U.S. Army Forces, SWPA, 1942–1945 . . . . . . . 140

4. 5307th Composite Unit (Provisional)Casualty Profile, 4 June1945 . . 310

Charts

1. Organization of the Office of the Chief Surgeon, USASOS, SWPA,

January 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

2. Typical Joint Malaria and Insect Control Island Organization . . . . 105

3. Scrub Typhus Admission Rate for U.S. Army Forces, New Guinea, 

July–September 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

4. Organization of the Office of the Chief Surgeon, USAFICPA, 

December 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

5. Organization of the Medical Service, CPBC, August 1944 . . . . . . . 275

6. Diarrhea and Dysentery Incidence in U.S. Army Forces, CBI, 

1943–1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

xvi
Maps

No. Page

1. Hospitals on Oahu, December 1941–January 1942 . . . . . . . . . . . . . 12

2. Hospitals on Bataan, December 1941–January 1942 . . . . . . . . . . . . 29

3. Asian-Pacific Theaters of Operations, 1942–1945 . . . . . . . . . . . . . . 52

4. Australian Base Sections, September 1942 . . . . . . . . . . . . . . . . . . . . 62

5. Army Hospital Support, Guadalcanal, 

November 1942–January 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

6. Hospitals on Papua, November 1942–January 1943 . . . . . . . . . . . . . 144

7. Hospitals in Alaska, May 1942 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

8. Army Medical Support, Operation Cartwheel, 

June 1943–May 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

9. Army Medical Support, Operation Forager, 

June–September 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

10. New Guinea Bases, December 1944 . . . . . . . . . . . . . . . . . . . . . . . . . 262

11. CBI Fixed Hospitals and Depots, December 1943 . . . . . . . . . . . . . . 304

12. Sixth Army Medical Support, Leyte, 26 October 1944 . . . . . . . . . . . 324

13. Sixth Army Medical Support, Luzon, 13 January 1945 . . . . . . . . . . 335

14. Prison Camp Areas in Japan, August–September 1945 . . . . . . . . . . 379

15. Hospitals on Okinawa, April 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . 399

16. Philippine Bases, June 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419

Illustrations

Evacuation Under Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Paperback Cover

End of a Busy Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frontispiece

Brig. Gen. Edgar King, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Pearl Harbor Casualties Receiving Care Aboard the USS Solace . . . . . . 17

U.S. Naval Mobile Base Hospital No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Col. Wibb E. Cooper, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Col. Harold W. Glattley, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Philippine Scout Being Treated at General Hospital No. 1 . . . . . . . . . . 32

Gas Gangrene Ward at General Hospital No. 2 . . . . . . . . . . . . . . . . . . . 34

Army Nurses on Corregidor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Maj. Gen. George W. Rice, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Brig. Gen. Percy J. Carroll, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Dispensary and Ambulance in the Australian Bush . . . . . . . . . . . . . . . . 65

Army Nurse Wearing the New Field Uniform . . . . . . . . . . . . . . . . . . . . . 67

Main Ward of a Prefabricated Station Hospital . . . . . . . . . . . . . . . . . . . 72

Portable Hospital on the Move . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Portable Hospital Bivouac Area and Surgical Tent . . . . . . . . . . . . . . . . . 74

The Maetsuycker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

xvii
Page

Col. Andrew W. Smith, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Zone-of-Interior Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Facilities of the 18th and 39th General Hospitals . . . . . . . . . . . . . . . . . 99

Brig. Gen. Earl Maxwell, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Island Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Field Hospital on Aitutaki . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Stockades for Neuropsychiatric Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Litter-bearers Negotiating a Steep Slope . . . . . . . . . . . . . . . . . . . . . . . . . 119

Moving Casualties Under Guard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Taking Quinine Tablets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

The Jeep Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Papuan Natives Spraying Malarious Areas . . . . . . . . . . . . . . . . . . . . . . . . 139

Awaiting Evacuation by Papuan Litter-bearers . . . . . . . . . . . . . . . . . . . . 142

Buna Casualty Arriving at the 171st Station Hospital . . . . . . . . . . . . . . . 146

Unit Dispensary at Nome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Hospital Dog Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Winter View of Attu Hospital Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

Morphine Syrettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Litter-bearers Hauling a Casualty Over the Attu Tundra . . . . . . . . . . . . 165

Offshore Evacuation of the Seriously Wounded . . . . . . . . . . . . . . . . . . . 167

General Area Occupied by a Medical Battalion on Kiska . . . . . . . . . . . 173

Medics Administering Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Clearing Company, 37th Division, at Work . . . . . . . . . . . . . . . . . . . . . . . 187

Unloading Casualties at a Collecting Station . . . . . . . . . . . . . . . . . . . . . 194

Loading Casualties on a Tank Lighter . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

29th Evacuation Hospital Following the Air Attack . . . . . . . . . . . . . . . . 197

Brig. Gen. Guy B. Denit, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Evacuation by Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Native Litter-bearers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

11th Portable Surgical Hospital Medics Taking Care of Casualties . . . . 211

Shuttling Litter Casualties to a Clearing Station . . . . . . . . . . . . . . . . . . . 224

Tarawa Casualties on Their Way to Offshore Medical Care . . . . . . . . . . 226

Litter-bearers Removing a Kwajalein Casualty From the Front Line . . 230

Hospital Ship Fitted With Hanging Cots . . . . . . . . . . . . . . . . . . . . . . . . . 231

Wounded Native Children on Saipan . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Unloading Supplies on a Saipan Beach . . . . . . . . . . . . . . . . . . . . . . . . . 244

Aid Station Medics Caring for 77th Division Troops on Guam . . . . . . . 247

Prefabricated Buildings in New Guinea . . . . . . . . . . . . . . . . . . . . . . . . . 257

The USS Comfort Arrives at Hollandia . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Port Dispensary Tent on Biak Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

New Concrete Floor in a Station Hospital Ward . . . . . . . . . . . . . . . . . . 261

Typhus Commission Entomologist Gathering Mites . . . . . . . . . . . . . . . 266

Shed for Medical Supplies at Oro Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Brig. Gen. John M. Willis, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274

xviii
Page

USAFPOA Headquarters, Fort Shafter . . . . . . . . . . . . . . . . . . . . . . . . . . 277

147th General Hospital Upper Respiratory Ward . . . . . . . . . . . . . . . . . 279

Brig. Gen. Robert P. Williams, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

Dr. Gordon S. Seagrave and Capt. John H. Grindlay . . . . . . . . . . . . . . . 289

Col. John M. Tamraz, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

Anti-malaria Efforts in India’s Assam Province . . . . . . . . . . . . . . . . . . . . 293

Evacuating Chinese Casualties on a C–47 . . . . . . . . . . . . . . . . . . . . . . . . 303

Seagrave Hospital Field and Camp Areas in Myitkyina . . . . . . . . . . . . . 308

Col. George E. Armstrong, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Medics Administering Plasma to a Y-Force Casualty . . . . . . . . . . . . . . . . 316

Frontline Surgery on a Chinese Casualty . . . . . . . . . . . . . . . . . . . . . . . . 317

36th Evacuation Hospital at Palo, Leyte . . . . . . . . . . . . . . . . . . . . . . . . . 321

Shell-torn Church at Dulag, Leyte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331

Unloading a Casualty at the 7th Evacuation Hospital, Villasis, Luzon . . . 332

Transporting Casualties Across Manila’s Pasig River . . . . . . . . . . . . . . . 337

Ward of the 49th General Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339

Manila Bay Casualties Disembarking From an LST at Corregidor . . . . 341

Litter-bearers Evacuating Wounded From the Luzon Hills . . . . . . . . . . 344

Igorot Women Litter-bearers in the Mountains of Northern Luzon . . . 346

Pulling a Mindanao Litter Casualty Across a Deep Ravine . . . . . . . . . . 350

Guerrillas and an Infantryman Carrying a Casualty . . . . . . . . . . . . . . . . 355

American Prisoners Under Japanese Guard Sorting Equipment . . . . . 364

Prisoners on the Death March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366

American Prisoners at Camp O’Donnell . . . . . . . . . . . . . . . . . . . . . . . . . 368

Old Bilibid Hospital Ward After Liberation . . . . . . . . . . . . . . . . . . . . . . 375

81st Division Casualties in a Jeep Ambulance . . . . . . . . . . . . . . . . . . . . . 386

Feeding a Severely Burned Seaman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392

Litter-bearers Traversing Okinawa’s Difficult Terrain . . . . . . . . . . . . . . 397

Administering Whole Blood and Ether . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Malaria Control Efforts on Okinawa . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

Tank Used for Frontline Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407

Flight Nurse Accompanying Okinawan Casualties . . . . . . . . . . . . . . . . . 408

Col. Maurice C. Pincoffs, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420

Navy Transport Evacuating Casualties to the States . . . . . . . . . . . . . . . . 423

Liberated Allied Prisoners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429

Liberated Prisoner Enjoying a Full Meal and Attentive Care . . . . . . . . 430

Brig. Gen. Crawford F. Sams, MC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433

Inoculating Against Typhoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

Illustrations courtesy of the following sources: pp. 17 and 18, Bureau of

Medicine and Surgery Archives, Department of the Navy; pp. 20, 110 (bottom), and 204, U.S. Army Center of Military History; pp. 32, 42, 364, 366,

403 (bottom), and 429, U.S. Army Military History Institute; pp. 48, 94, 201,

xix
274, 277, 287, 292, 313, 420, 433, and 435, Office of the Surgeon General,

Department of the Army; p. 102, Armed Forces Institute of Pathology; and

p. 346, Mr. Sylvan Katz. All other illustrations are from the National Archives

and Records Administration.

The works of Franklin Boggs (1914–) depicted on p. ii—End of a Busy Day,

1944, oil on canvas, 331

⁄4” x 263⁄8”—and on the paperback cover—Evacuation

Under Fire, 1944, oil on canvas, 311

⁄4” x 371⁄4”—are from the Army Art

Collection.

xx
MEDICAL SERVICE 

IN THE WAR AGAINST JAPAN

Every combat theater of World War II

had its own unique medical history, but

nowhere did disease pose a greater

threat to American soldiers and to military operations than in the bitter war

against Japan. The nation faced the dual

challenges of fighting and supporting its

troops in primitive, largely tropical,

environments, burdened by grave logistical problems. Fortunately, military surgeons and medical units were able to

make available to American commanders a wealth of scientific knowledge

that had developed over previous centuries, and especially over the preceding

seventy years. 

The late nineteenth century had seen

the ancient learned profession of medicine transformed into a laboratory science by the germ theory of disease.

Soon after, the Army Medical

Department became an exponent of the

new science and, through the work of

Walter Reed and many others, a leader

in the study of tropical ills. Through preventive medicine, the department revolutionized the health care of the

American Army over the next forty

years. During this period, as the Army

reorganized and professionalized, the

Medical Department kept pace, establishing a variety of specialized units to

support the troops in the field; general

hospitals to carry out complex definitive

care of the seriously ill and injured; and

laboratories to advance the growth of

military medicine.

Simultaneously, the American medical profession at large matured, improving its methods of educating new doctors and creating a research establishment that began to rival those of

Europe. World War I brought the

United States government into the

large-scale sponsorship of scientific

research. Both private foundations and

the government promoted public

health campaigns that created a cadre

of trained workers. The battlefield

taught its own lessons. From World War

I came many advances, including the

use of blood transfusion to combat

wound shock, the development of techniques to alleviate combat exhaustion,

the use of debridement as a standard

surgical technique, the open reduction

of fractures with internal and external

fixation, and improved treatment of

neurosurgical injuries. A number of

early twentieth century medical

advances had direct applications to military medicine, among them the discovery of the first drugs to fight syphilis, the

creation of synthetic antimalarials to

supplement the natural drug quinine,

the discovery and eventual mass producPROLOGUE

The Drift Toward War
tion of penicillin, and the rapid development during the 1930s of the sulfa

drugs to fight infection. American medicine was sufficiently mature to absorb

and, in some cases, improve upon discoveries made overseas.

The Army Medical Department, however, did not keep up with the developments of the interwar years. Suffering

the same neglect as the rest of the

nation’s military establishment after

World War I, the medics lost the leading

position they had attained earlier. On

the other hand, the 1920s and 1930s saw

medical officers more fully integrated

into the Army; many attended Army

schools in other branches, and a few

even studied at the prestigious

Command and General Staff School at

Fort Leavenworth, Kansas, where the

nation’s future military leaders met one

another. The Army started its own

Medical Field Service School at Carlisle

Barracks, Pennsylvania, to train its officers in the practical requirements of

military medicine. The tradition of scientific medicine flourished in military

laboratories and general hospitals, especially in studies of trauma and militarily

significant diseases.

With the opening of World War II,

medical officers of the Regular Army

became the administrators and leaders

of the Medical Department as the Army

expanded from a force of a quarter-million to a mass of more than eight million men and women. Most hands-on

medicine became the province of

reserve officers and civilian physicians,

who received wartime commissions in

the Army of the United States (AUS).

Between the two groups—the regulars

who knew the Army, and the AUS officers who had experienced (and in some

cases had led) the sweeping changes in

civilian medicine—relations were sometimes testy, sometimes mutually respectful. Ultimately, both groups would contribute in essential ways to the wartime

successes of American medicine.

Plans and Preparations

Army studies in tropical medicine

originally grew out of the SpanishAmerican War of 1898–99, which made

the United States a power with overseas

possessions to defend and administer.

The “splendid little war,”1 as U.S.

Ambassador to Great Britain John M.

Hay called it, also conferred upon the

nation many Pacific islands, including

the Philippines and Guam. The building of a powerful fleet followed, as well

as the establishment of naval bases that

had to be defended by Army garrisons.

World War I complicated the situation, enabling the Japanese Empire to

strengthen its position by acquiring former German possessions. Hence, the

U.S. Army was obliged to consider the

possibility of war between the two

expanding empires, Japan and the

United States, and to prepare plans

accordingly. The war plans were colorcoded; those dealing with Japan were

ORANGE. In the event of war in the

Pacific the ORANGE plans called for the

U.S. Pacific Fleet, based first on the West

Coast and later at Pearl Harbor, to isolate and harass Japan through offensive

sea and air operations. The defense of

the Philippines depended on the ability

of the Pacific Fleet to sortie westward to

relieve the archipelago, where the small

1

As quoted in Graham A. Cosmas, An Army for

Empire: The United States Army in the Spanish-American

War (Columbia: University of Missouri Press, 1971), p.

245.

4 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
THE DRIFT TOWARD WAR 5

U.S. Asiatic Fleet was based. U.S. Army

forces in the Philippines were assigned a

limited defensive role. If war came,

ground troops would move to the jungles of Bataan, a mountainous peninsula west of Manila, to assist in holding the

entrance to Manila Bay as an anchorage

for the U.S. fleet once it had fought its

way across the Pacific. From the beginning, many knowledgeable American

leaders found the ORANGE plans quite

unrealistic.2

Nevertheless, to accord with ORANGE

strategy, subordinate commands and

their respective medical organizations

developed their own contingency

plans. The Philippine Department’s

Office of the Chief Surgeon had as its

basic missions the conservation of manpower, the preservation of the health

of the command, and the care of the

sick and wounded. In the event of war

the office would call up its medical

reservists in the islands and seek

recruits to supplement Regular Army

personnel. Hospitals would be expanded, supplies collected, and excess

equipment and supplies shipped to

Mariveles on the Bataan Peninsula. If

retreat to Bataan was ordered, the

Medical Supply Depot in Manila would

move to Corregidor, one of the fortified islands guarding the mouth of

Manila Bay, and Sternberg General

Hospital in Manila would move with all

personnel and equipment to establish

a 500-bed hospital at Mariveles.

Patients would be evacuated from the

capital by boat. 

Since the peninsula was known to be

highly malarial, personnel serving there

were to take quinine, use mosquito nets

at night, and cover exposed skin with

mosquito repellent. Medics would survey the hospital area at Mariveles and

spray standing water with oil to destroy

mosquito breeding grounds. Disease

control would depend to a great extent

on supplies evacuated from Manila and

on the release of medical personnel

from other duties.3

Like the overall war plan, the medical plan was unrealistic. The

Philippine medical community of the

prewar period found malaria control

on Bataan to be economically impractical, on account of the prevalence both

of the microscopic parasites that cause

the disease and the mosquito vectors

that spread it. To break the well-known

life cycle of the malaria parasite on

such a large scale seemed an insurmountable task, and was not attempted. With only limited resources at their

command, medical authorities might

well have found it impossible to do

more. At the beginning of World War II

“the U.S. Army had not developed the

mechanics and procedures for controlling malaria among large bodies of

troops in highly endemic areas.” The

specialized units that would materialize

during wartime did not yet exist, and

thus medical planners fell back upon

2

Louis Morton, Strategy and Command: The First Two

Years, United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History,

Department of the Army, 1962), pp. 21–25, 33, 43;

Stanley L. Falk, “Douglas MacArthur and the War

Against Japan,” in William M. Leary, ed., We Shall

Return: MacArthur’s Commanders and the Defeat of Japan,

1942–1945 (Lexington, Ky.: University Press of

Kentucky, 1988), pp. 3–5. See also Joint Army and Navy

Basic War Plans Orange, 1924, pp. 1–2, file JB 325,

Record Group (RG) 225, and 1939, pp. 2, 8, file AG

223, RG 407, National Archives and Records

Administration (NARA), Washington, D.C. 

3

Surg, Phil Dept, First Phase Plan Orange, 1933, pp.

2–5, and Plan Orange, 1936, p. 1, file AG 170, RG 407,

NARA.
the techniques they knew and the manpower that was available.4

As military adviser to the Philippine

government, Maj. Gen. Douglas

MacArthur refused to accept the

inevitability of defeat that he, like many

others, saw as inherent in the ORANGE

plans. Defense of the Philippines rested

with the peacetime garrison of 10,000

men, plus the Philippine Army, which

MacArthur had been building and training since 1936.5 Although the Philippine

Army was deficient in personnel, equipment, and supplies, MacArthur

expressed confidence in its ability to

defend the islands. He believed that the

addition of B–17 bombers would enable

him to crush the enemy on the beaches,

rather than withdraw his troops to

Bataan. His optimism influenced many

in Washington and led to a new formulation in RAINBOW 5, one of the war

plans that superseded ORANGE. RAINBOW

5 changed and expanded the Army’s

role in the Philippines, from protecting

the Manila Bay entrance to defending

the coasts. Medical preparations

changed accordingly, as the Office of

the Chief Surgeon centralized people

and supplies around Manila. The danger of the new arrangement was that if

American and Philippine forces were

defeated on the beaches and had to

withdraw to Bataan, medical personnel

would have a difficult time evacuating

medical supplies to the peninsula.6

The Approaching Crisis

Meanwhile, the drift toward war was

rapid. President Franklin D. Roosevelt

proclaimed a state of national emergency in September 1939; in August

1940, after the fall of France, Congress

summoned the National Guard into federal service and ordered the call-up of

the reserves. The following month

brought the nation’s first peacetime

draft. 

Maj. Gen. James C. Magee, the surgeon general, began first to plan and

then to mobilize the Army Medical

Department for war. Throughout the

United States and its possessions the

number of medical officers increased

(though it never reached the levels prescribed in the existing tables of organization). Within the Office of the

Surgeon General, a separate Preventive

Medicine Division was set up to meet the

needs of the public health of the Army.

Contacts proliferated between Army

medical officers and the other armed

services, the quasi-official National

Research Council, the International 4

Quotation from Thomas A. Hart and William A.

Hardenbergh, “The Southwest Pacific Area” in Ebbe

Curtis Hoff, ed., Communicable Diseases: Malaria, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), p. 513. See also Paul F.

Russell, Malaria: An Account of Its Cause, Cure and

Prevention (Manila: Bureau of Printing, 1931), p. 37. 5

MacArthur became military adviser to the

Philippine government on 18 September 1935, less

than two weeks before completing his service as Army

chief of staff (21 November 1930–1 October 1935) with

the rank of temporary general. Thereafter, he resumed

his permanent rank of major general. The following

year, on 19 June, MacArthur was appointed field marshal of the Philippine Army.

6

Falk, “Douglas MacArthur,” in Leary, ed., We Shall

Return,” p. 3; Maurice Matloff and Edwin M. Snell,

Strategic Planning for Coalition Warfare, 1941–1942,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1953), p. 45; Ray S. Cline, Washington

Command Post: The Operations Division, United States

Army in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1951), pp. 55–59; Mark Skinner Watson, Chief of Staff:

Prewar Plans and Preparations, United States Army in

World War II (Washington, D.C.: Historical Division,

United States Army, 1950), pp. 103–04.

6 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
THE DRIFT TOWARD WAR 7

Health Division of the Rockefeller

Foundation, and the Public Health

Service. New medical units were organized to supplement the four regiments

then in existence. In addition to divisional medical units, seventy-six nondivisional units were activated, including

numbered general, station, evacuation,

and surgical hospitals, supply depots,

and laboratories. More skilled women

entered the Army Nurse Corps; enlisted

men received training as medical technicians; and the ranks of the allied professions—pharmacists, oculists, medical

administrators, entomologists, and sanitary engineers, among others—were

filled, as civilians donned the uniform

and reserve officers reported for active

duty. Major maneuvers gave new soldiers, including many officers and men

of the Medical Department, their first

taste of life in the field under simulated

wartime conditions.7

The United States spent the last

months of peacetime feverishly making

preparations that had been too long

delayed. While some Americans clung to

pacifism or isolationism, others believed

that the only questions remaining to be

answered were when and where the blow

would fall. Then plans would encounter

reality, and wartime casualties would put

the nation and its military medical services to the test of fire.

Interior, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1956). See War

Department, [Annual] Report of the Surgeon General, U.S.

Army, to the Secretary of War, 1940 (Washington, D.C.:

Government Printing Office, 1941), pp. 172–93; idem,

[Annual] Report of the Surgeon General, U.S. Army, to the

Secretary of War, 1941 (Washington, D.C.: Government

Printing Office, 1941), pp. 141–42 and 153–54. See also

Blanche B. Armfield, Organization and Administration in

World War II, Medical Department, United States Army

in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), pp.

1–68; and, in the same series, Robert J. Parks, Medical

Training in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army, 1971),

pp. 13–41, and John H. McMinn and Max Levin,

Personnel in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army, 1963),

pp. 111–66.

7

The process of medical mobilization is treated in

detail in Clarence McKittrick Smith, The Medical

Department: Hospitalization and Evacuation, Zone of

Nowhere was the imminence of war

and the need for increased medical

resources more strongly felt than in the

nation’s major Pacific bastion, the

Hawaiian Islands. Especially after May

1940, when Pearl Harbor became the

home of the U.S. Pacific Fleet, troops,

supplies, and equipment flowed into

Oahu, the most heavily settled of the

islands. Here the mission of the Army’s

Hawaiian Department was to cooperate

fully in defending the Navy’s largest

overseas base. 

For many years the principal Army

unit had been the Hawaiian Division,

headquartered at Schofield Barracks

some 10 miles from Pearl Harbor. In

October 1941 the old four-regiment

unit was reorganized into two three-regiment (“triangular”) divisions and several nondivisional units. By December

Army forces—including the two understrength infantry divisions, four complete coast artillery regiments, four antiaircraft regiments, one company of light

tanks, and supporting service troops—

numbered 43,000, then the largest contingent stationed outside the continental United States. The air component,

the Hawaiian Air Force, reached a total

of 754 officers and 6,706 enlisted men,

organized tactically into the 18th

Bombardment Wing, with headquarters

at Hickam Field, and the 14th Pursuit

Wing, with headquarters at Wheeler

Field.1

Upon Col. Edgar King, MC, chief surgeon of the Hawaiian Department, fell

the responsibility for meeting the growing medical needs of the Army and—in

the event of an emergency—those of a

dependent civilian population as well. A

somewhat intimidating Regular Army

officer, King benefited from thirty-four

years of experience as a military surgeon

in the Philippines, China, the Canal

Zone, and the United States. During

1940 and 1941 he acquired more medical personnel, enlarged hospital facilities, and planned future construction.

The chief surgeon also started an intensive training program, and guided the

revision of old emergency medical plans

and the formulation of new ones. In

these endeavors he was assisted by a

comparatively small staff of 9 officers

and 8 enlisted men, plus leading memCHAPTER I

A Medical Calamity

1

Joint Army and Navy Basic War Plan Orange, 1938,

p. 5, file JB 325, Record Group (RG) 225, National

Archives and Records Administration (NARA),

Washington, D.C.; Wesley Frank Craven and James Lea

Cate, eds., The Army Air Forces in World War II, 7 vols.

(Chicago: University of Chicago Press, 1948–58), 1:170;

Mark Skinner Watson, Chief of Staff: Prewar Plans and

Preparations, United States Army in World War II

(Washington, D.C.: Historical Division, United States

Army, 1950), p. 474.
bers of the Hawaiian medical profession. Demands for medical preparedness were heard throughout the United

States, and were encouraged and given

direction by the American Medical

Association. Civilian liaison formed the

principal duty of one Medical Corps

officer on King’s staff, highlighting the

importance that the department surgeon attached to cooperation with the

local community.2

Yet the medical establishment lagged

behind the growing needs of mobilization, to say nothing of war. Colonel King

requested more doctors, nurses, and

enlisted men for the Hawaiian

Department at monthly intervals during

1941. In December he asked for 80 medical officers, 100 nurses, and 600 enlisted men. The replies he received indicated that all the reinforcements would be

sent, but by the close of the year they

still had not arrived. The strength of the

medical contingent in Hawaii totaled

1,931—288 officers, 195 nurses, 1,414

enlisted men in the medical and dental

services, 25 enlisted men in the veterinary service, and 9 warrant officers.

Since the Army forces, including the air

complement, numbered 2,588 officers

and 53,853 enlisted men, the ratio of

medical personnel to total Army

strength was 3.5 percent below authorized levels. In many cases, the workload

outran medical capability; the shortage

of nurses was particularly acute, obliging

King to employ civilians in both professional and nonprofessional capacities.3

Problems of military reorganization

added to the stresses caused by growth.

2

See CSurg, Haw Dept, Annual Rpt, 1940, pp. 1,

9–10, file 319.1–2, Historical Unit Medical Detachment

(HUMEDS), RG 112, NARA. See also King’s brief testimony before the Army Pearl Harbor Board in United

States Congress, Hearings Before the Joint Committee on the

Investigation of the Pearl Harbor Attack, 79th Cong., 1st

Sess. (Washington, D.C.: Government Printing Office,

1946), pp. 1403–09 (hereafter cited as Pearl Harbor

Attack Hearings); Mary Ellen Condon-Rall, “The U.S.

Army Medical Department and the Attack on Pearl

Harbor,” Journal of Military History 53 (Jan 89): 65–78;

Committee on Medical Preparedness, “An Appeal for

Service,” Journal of the American Medical Association 114

(29 Jun 40): 2556.

3

CSurg, Haw Dept, Annual Rpt, 1941, p. 13, file

319.1–2, HUMEDS, RG 112, NARA; “History of Office

of the Surgeon, United States Army Forces, Middle

Pacific and Predecessor Commands, 7 December

1941–2 September 1945,” sec. 1, “Hawaiian

Department,” ch. 1, pp. 2, 7, Ms 8–5.6 AA 30/1, files of

the U.S. Army Center of Military History (CMH),

Washington, D.C. (hereafter cited as “History of

OofSurg, USAFMIDPAC”). See also John H. McMinn

and Max Levin, Personnel in World War II, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963) p. 58; Strength of the

Army, December 1941.

10 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

BRIG. GEN. EDGAR KING, MC

(Rank as of 25 October 1942)
Triangularization of the Hawaiian

Division brought immediate change to

the 11th Medical Regiment, which for

years had provided complete service to

its parent unit. Under the old arrangement regimental medical personnel had

manned the station hospital at Schofield

Barracks, operated dispensaries, and

formed medical detachments for duty

with troops in the field. In October most

were reassigned to the 24th and 25th

Medical Battalions, serving the newly

activated 24th and 25th Infantry

Divisions. At the same time, the 350-bed

Schofield Station Hospital became an

independent unit, offering some services previously performed by the 11th

Medical Regiment.4

Simultaneously, the whole Army hospital system—comprising both Schofield

Station Hospital, which served local and

ordinary needs, and Tripler General

Hospital, which served general and special needs, on Oahu; a smaller facility at

the Kilauea Military Camp on Hawaii;

and dispensaries scattered about the various military stations on the islands—

underwent change and expansion. In

1940 Colonel King ordered temporary

wards set up in barracks and on hospital

porches, or lanais. A new station hospital

was constructed at Hickam Field, which

added 32 beds and a reserve of 28 more

during 1941 (see Map 1). By December

the number of beds on Oahu, including

emergency beds, totaled over 1,449,

more than double the prewar total of

650. With this increase went changes

designed to improve the ability of the

hospitals to function rapidly in the event

of war, including measures for treating

gas casualties. Lt. Col. Andrew W. Smith,

MC, the surgeon on the staff of the

Hawaiian Air Force commander, Maj.

Gen. Frederick L. Martin, coordinated

his work with King’s office. As each new

air installation went into operation in the

Hawaiian Islands, it received an air surgeon trained in flight-related medicine.5

The medical supply system grew also,

as Colonel King established a branch

depot at Schofield Barracks to supplement the major supply center at Tripler

General Hospital. Stocks of many critical items, particularly sulfa drugs, were

dispersed to Army hospitals on Oahu

and the outlying islands, for protection

against air attack. Civilians aided the

buildup. By December 1941 the depots

had collected over 58,000 surgical dressings made by the Hawaiian chapter of

the American Red Cross. Civilian

depots, at King’s request, increased

their own stocks, adding to the islands’

overall preparedness.6

In addition to expanding medical

facilities and depots, Colonel King

revised outdated emergency medical

5

CSurg, Haw Dept, Annual Rpt, 1940, p. 9, file

319.1–2, HUMEDS, RG 112, NARA; Rpt, Maj. Charles

Gill, n.d., sub: Hospital Facilities for the Civilian and

Military Personnel of Oahu, Hawaii, Encl to General

Report on Hospital Development on Oahu, in “History

of OofSurg, USAFMIDPAC,” sec. 1, ch. 3, an. 8, pp. 2, 4,

Ms 8–5.6 AA 30/1, CMH. See also Stetson Conn, Rose

C. Engelman, Byron Fairchild, Guarding the United States

and Its Outposts, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1964), p. 159. 6

Charles M. Wiltse, Medical Supply in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1968), pp. 393, 395; CSurg,

Haw Dept, Annual Rpt, 1941, p. 12, file 319.1–2,

HUMEDS, RG 112, NARA.

4

Blanche B. Armfield, Organization and Administration

in World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), p.

64; Watson, Chief of Staff, p. 158. See also Schofield

Barracks Sta Hosp Annual Rpt, 1939, pp. 1, 4; 24th Inf

Div Annual Rpt, 1941, p. 2; 25th Inf Div Annual Rpt,

1941, p. 2. All in file 319.1–2, HUMEDS, RG 112,

NARA. 

A MEDICAL CALAMITY 11
plans and created new ones. The key

existing document was the medical

annex to Emergency Plan WHITE, a civil

disturbance plan aimed at controlling

riots. The plan outlined a standard evacuation procedure, specified the military

hospitals to which the north and south

sectors of Oahu would send casualties,

authorized Army medical officers to use

civilian hospitals, and made military personnel responsible for rendering first aid

to civilian casualties. Tripler General

Hospital would receive severely wounded

from the Honolulu area, while Schofield

Station Hospital would treat casualties

from Schofield Barracks. Honolulu area

military and civilians suffering only from

minor wounds would use dispensaries

either at Tripler or at Forts De Russey,

Kamehameha, and Armstrong.7

In 1940 King’s office devised a new

medical plan that in essence restated

Plan WHITE, with some important additions. The Army Medical Department

became responsible for the treatment of

civilians on the island of Oahu under disaster conditions. Much more than first

aid was now involved. Casualties must be

collected, given emergency treatment,

evacuated, and hospitalized. In order to

make the plan workable, King had to

7

“History of OofSurg, USAFMIDPAC,” sec. 1, ch. 3, p.

7, and ch. 4, p. 1, Ms 8–5.6 AA 30/1, CMH.

12 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

PACIFIC

OCEAN

PACIFIC

OCEAN

Kaneohe Bay

Naval Air 

Station

Bellows

Field

Fort

De Russey

Honolulu

Fort

Shafter

Fort Kamehameha Hickam

Field

Schofield

Barracks

Wheeler

Field

Haleiwea Field

Fort Armstrong

Schofield Station Hospital

Hickam Station Hospital

Tripler General Hospital

U.S. Naval Hospital, Pearl Harbor

U.S. Naval Mobile Base Hospital No. 2

Provisional General Hospital Nos. 1, 2, and 3

Provisional General Hospital No. 4

HOSPITALS ON OAHU

December 1941–January 1942

Miles

0 10

Airfield

MAP 1
rely on the participation of the civilian

medical and dental professions. The

Honolulu Medical Society gave prompt

cooperation; it established a preparedness committee, headed by Dr. Harry L.

Arnold, Sr., to help the Army devise and

carry out the contingency proposals.

The planning called for military control

of all hospitalization, for establishment

of first aid stations throughout Oahu,

and for supplementary care of military

personnel by civilian doctors. Maj. Elmer

D. Gay, civilian liaison officer on King’s

staff, established contact with the Red

Cross and similar agencies and organized medical teams of civilians to work

in the hospitals under the supervision of

military medical personnel.8

Civilian hospitals and public and private buildings, like civilian doctors and

nurses, were needed. During 1941

Colonel King placed a civilian physician,

Dr. Nils P. Larsen, in charge of civilian

hospital expansion and evacuation. Maj.

Robert Faus, on King’s staff, headed

plans and training. Faus and Gay prepared sixteen civilian hospitals—including Queens, Children’s, St. Francis, and

others—to care for convalescing

patients evacuated from other medical

facilities in event of an attack. During

the summer and autumn of 1941 Gay

surveyed other buildings that could be

utilized. For the most part, he selected

schools because they were fire resistant,

easily adaptable, and located at some

distance yet not too far from military

installations. He formulated a scheme

for the speedy conversion of Farrington

High School, Kamehameha School for

Boys, and St. Louis College; worked out

detailed plans; and designated medical

equipment for emergency use. When

the crisis came, the Office of the Chief

Surgeon was in the process of occupying

one school and had all necessary plans

ready for the others.9

By November Colonel King had established twenty civilian aid stations, complete with the necessary trained personnel and supplies. The stockpiling of medical supplies had made good progress.

Major Faus had obtained twelve trucks

from business firms and modified them

to carry litters. With the cooperation of

the Honolulu Medical Society, the chief

surgeon had organized civilian nurses to

move into Army hospitals as soon as their

services were called for. Civilian training

in first aid was under way, and the

women of Schofield Barracks were studying first aid. Maj. Charles C. Gill, MC,

assigned to Schofield Barracks, helped to

pioneer an Army ambulance corps for

women. Supplementing such efforts, Dr.

Forrest J. Pinkerton, a civilian acting as

liaison between the Red Cross and other

public health agencies, organized a plasma bank, responding to the American

Medical Association Preparedness

Committee recommendations to the

medical profession. In so far as the limitations of supplies and manpower

allowed, Hawaii was ready to meet the

great medical emergency that lay

ahead.10

8

Ibid., ch. 1, p. 5, Ms 8–5.6 AA 30/1, CMH;

Testimony of Maj. Gen. Walter C. Short, in Pearl Harbor

Attack Hearings, pp. 173, 182.

9

“History of OofSurg, USAFMIDPAC,” sec. 1, ch. 3,

pp. 3–4, Ms 8–5.6 AA 30/1, CMH; Memo, Col Edgar

King to Ed., History of the Medical Department, U.S.

Army in World War II, 22 Mar 50, sub: Supplemental

Data on the Work of the Medical Department in the

Hawaiian Department, Later U.S. Army Forces in the

Pacific, then the Central Pacific Area, p. 6, file 000.71,

HUMEDS, RG 112, NARA. 10“History of OofSurg, USAFMIDPAC,” sec. 1, ch. 3,

pp. 1–4, an. 1, pp. 1–3, and an. 8, p. 3, Ms 8–5.6 AA

30/1, CMH.

A MEDICAL CALAMITY 13
Japan Attacks

On 26 November 1941 a Japanese

strike force sailed for Hawaii. At 0600 on

7 December the aircraft carriers moved

into position 200 miles north of Oahu,

and within minutes some of Japan’s best

pilots took off from the flight decks,

dropping the first bombs at 0755 on a

slowly awakening Pearl Harbor. In addition to the ships at anchor on Battleship

Row, their targets were Hickam,

Wheeler, and Bellows airfields, and

Kaneohe Bay Naval Air Station on

Oahu’s north shore. Army planes parked

wing to wing at Hickam and Wheeler

Fields were easy marks for bombs and

machine gun fire, as the Japanese raid

marked a spectacular tactical success.

Among the ruins 2,327 American officers and enlisted men lay dead, of whom

2,000 belonged to the Navy, 98 to the

Marines, and 229 to the Army. Some 70

civilians perished. Another 1,143,

among them 459 soldiers, were wounded. The Army’s greatest losses were at

Hickam Field, adjacent to Pearl Harbor,

and Wheeler Field, next to Schofield

Barracks.11

Though stunned, Army and Navy

authorities quickly put into effect their

planned emergency measures. Hickam

Station Hospital functioned primarily as

a casualty clearing station, rendering

only first aid before evacuating the

wounded to Tripler by all available

means. An Army nurse at the station hospital remembered: “We didn’t even get to

stage them, all we could do was give M. S.

[morphine sulphate] and send them to

Tripler.” Medical personnel used ambulances from the post, reserve ambulances

from Schofield Barracks, and trucks from

the Hickam motor pool. The first casualty arrived at Tripler ten minutes after the

raid began, and several hundred wounded, mainly from badly damaged Hickam

Field, were admitted soon after the

attack. A Japanese bomb had made a

direct hit on a mess hall where more than

300 young aviators were having breakfast.

“Their wounds were even worse than

those of the burned,” another nurse

reported. “Some of them were too terrible to describe. They were mortal

wounds by the side of which the loss of an

arm or leg was nothing. Some had their

chests or stomachs blown away.”12

Blast, bomb fragments, machine gun

bullets, and such secondary missiles as

pieces of macadam, stone, brick, and

mortar had caused the injuries.

Tourniquets were in short supply and the

staff had to improvise, using belts, cords

for gas masks and pistol holsters, and

muslin strips. Army wives made dressings.

The first problem confronting workers in

the receiving wards was to select the cases

in greatest need of immediate surgical

attention. Casualties were examined and

sorted. Head injuries, sucking chest

wounds, abdominal perforations, and

shattered limbs that required amputation

went to the operating tables first. All

patients were given sulfanilamide against

infection, morphine to alleviate pain,

11Ibid., p. 6, Ms 8–5.6 AA 30/1, CMH; Louis Morton,

The Fall of the Philippines, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1953), pp.

78–79; Samuel Eliot Morison, The Two-Ocean War: A

Short History of the United States Navy in the Second World

War (Boston: Little, Brown and Co., 1963), pp. 56–59.

On the Pearl Harbor attack, see also Gordon W.

Prange, At Dawn We Slept: The Untold Story of Pearl Harbor

(New York: McGraw-Hill Book Co., 1981). 

12First quotation from Blake Clark, The Fight at Pearl

Harbor (Washington, D.C.: Infantry Journal Press,

1943), p. 78 (see also pp. 79, 82); remaining quotations

from “Letters from Readers,” American Journal of

Nursing 42 (Apr 42): 425–26.

14 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
plasma and warmth to forestall shock.

Such a large number of casualties had

been brought to Tripler by the time the

raid was over that they were placed on litters on the floors, in the halls, and in the

corridors. Chaplains comforted the

wounded and attended the dying.

Powerful emotion as well as morphine

acted as an anesthetic, and many seemed

unaware of their pain.13

As a result of Colonel King’s preparations, an admirable military staff supplemented by civilians was on hand to care

for the Army’s casualties. Notable was

the contribution of a reserve officer, Dr.

John J. Moorhead, a prominent New

York surgeon who, on invitation of the

Honolulu Medical Society, had arrived a

few days before to give a course of lectures on traumatic surgery. When word

came that surgeons were needed at

Tripler, Moorhead joined the effort, taking over the operating rooms at the

request of Col. Alvin C. Miller, MC, the

hospital commander. Moorhead briefly

instructed the surgical teams on the

methods he wanted to be used, and the

civilian-military medical force started

work with a “fine spirit of cooperation.”14

Surgery was carried out in three operating rooms by nine teams, four of Army

surgeons, the other five of civilians

recruited and organized during the past

year. The surgeons shared instruments,

sterilizing and shifting them from table

to table. When not performing an operation, they relieved each other on the

wards doing pre- and postoperative treatment. Both traditional methods of military surgery and recent discoveries in

chemotherapy contributed to the success

in handling severe wounds. The early

morning attack caught many victims with

bowels full, increasing fecal contamination of abdominal wounds, and recently

eaten breakfasts added the further danger of undigested food. Hence, surgeons,

after suturing perforations, packed the

peritoneal cavity with crystalline sulfanilamide, preventing much infection that

would otherwise have been inevitable.

The same antibacterial agent plus sulfathiazole helped to prevent infection in

the amputees. But delayed closure of

wounds was also a factor, for wounds prematurely sutured sometimes became

infected despite the wonder drugs. Stores

of plasma from civilian sources were critical in preventing shock and making successful surgery possible. Though dozens

of the injured died of their wounds in the

first twenty-four hours after the raid,

there were no deaths after the first week.

The low mortality rate after the first day

resulted from skilled surgery and the use

of sulfa drugs to prevent infection.15

13Hickam Field Sta Hosp Annual Rpt, 1941, p. 1, file

319.1–2; Ltr, Charles Gill to his father, 10 Dec 41, sub:

Account of Attack on Hawaii, p. 4, file 319.1; I. S.

Ravdin and Perrin H. Long, “The Treatment of Army

Casualties in Hawaii,” pp. 1–4, and “The Problems of

the Hickam Station Hospital, the Tripler General

Hospital, and the Schofield Station Hospital,” pp. 3–5,

file 314.7–2 (Wounds and Casualties) Hawaii. All in

HUMEDS, RG 112, NARA. 14Quotation from Ravdin and Long, “Problems,” p. 5,

file 314.7–2 (Wounds and Casualties) Hawaii,

HUMEDS, RG 112, NARA. See idem, “The Treatment

of Army Casualties in Hawaii,” Army Medical Bulletin 61

(Apr 42): 1–8; idem, “Some Observations on the

Casualties at Pearl Harbor,” U.S. Navy Medical Bulletin 40

(Apr 42): 355–58; John J. Moorhead, “Surgical

Experience at Pearl Harbor,” Journal of the American

Medical Association 118 (28 Feb 42): 712–14. See also

Walter Lord, Day of Infamy (New York: Henry Holt and

Co., 1957), p. 194. 15Ltr, Gill to his father, 10 Dec 41, p. 4, file 319.1;

Ravdin and Long, “Problems,” intro and pp. 5, 7, file

314.7–2 (Wounds and Casualties) Hawaii; Tripler Gen

Hosp Annual Rpt, 1941, p. 19, file 319.1–2. All in

HUMEDS, RG 112, NARA. See also Clark, Fight at Pearl

Harbor, pp. 78–79, 82; John J. Moorhead, Clinical

Traumatic Surgery (Philadelphia: W. B. Saunders Co.,

1945), pp. 702–25.

A MEDICAL CALAMITY 15
16 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

Heavy use depleted the plasma and

blood banks, but a radio appeal for volunteer donors brought five hundred people to the doors of Queens Hospital in

the first half hour. Fifteen doctors and

trained technicians worked at twelve

tables drawing blood, but could not take

it as fast as it was offered. Some donors

stood in line for seven hours; many did

not know what plasma was, but knew they

were helping. The entire crew and a

number of passengers of a Dutch ship, in

port for only a few hours, also gave blood.

For days following the attack, hundreds

of donors were to come from all over the

island as a result of daily radio and newspaper appeals. The power of the events at

Pearl Harbor to unify Americans was evident from the beginning.16

Lifesaving work also went on at

Schofield Station Hospital, where 118

soldiers suffering from machine gun

wounds, fragmentation wounds, and

burns received treatment. The most seriously injured came from Wheeler Field,

where a Japanese bomb penetrated a

hangar that had been converted into a

dispensary and exploded, collapsing the

sides of the building. The wounded,

including two nurses, were taken outside, placed in rows on blankets and

given first aid before being evacuated to

Schofield. Four major surgical teams

worked until the last serious case was

cared for, while minor surgical teams

labored on the less seriously injured. In

keeping with emergency plans, dentists

assisted the surgeons and performed various hospital duties. Twenty-seven casualties were dead on arrival, nine more died

in the first twenty-four hours, and two

final victims in the days following the

raid. Many more would have lost their

lives but for the speed and thoroughness

with which their wounds were treated.17

Navy casualties received emergency

treatment at aid stations in the dock

area or at a temporary dispensary set up

in the Navy Yard officers club. For further care, military and civilian ambulances and other vehicles moved the

wounded to the U.S. Naval Hospital,

Pearl Harbor; the USS Solace, a hospital

ship that was providentially in the harbor; and the U.S. Naval Mobile Base

Hospital No. 2. Many sailors acquired

flash burns from exploding bombs or

torpedoes while rushing to battle stations in a state of undress. Blazing fuel

oil roasted men who fell, jumped, or

were thrown overboard by explosions.

When time permitted, medics used a

tincture of green soap with water to

remove oil. More often, time permitted

only scant cleaning before applying tannic acid or gentian violet, sometimes

mixed with sulfa powder, to the burned

areas over oil. Treatment for compound

fractures and for shrapnel and machine

gun bullet wounds followed the traditional pattern of debridement, sulfa

therapy to prevent infection, and

surgery. Again, plasma from civilian

sources saved many lives.18

16Clark, Fight at Pearl Harbor, pp. 85, 87. See also

Honolulu Advertiser and Honolulu Star Bulletin, 8–15 Dec

41.

17Schofield Barracks Sta Hosp Annual Rpt, 1941, pp.

2, 16, 24; Department of the Navy, Bureau of Medicine

and Surgery, “The United States Navy Medical

Department at War, 1941–1945,” 1:20, files of Bureau of

Medicine and Surgery Archives (BMSA), Washington,

D.C.; Felix Sutton, We Were There at Pearl Harbor (New

York: Grosset and Dunlap, 1957), p. 66. 18“Navy Medical Department at War,” 1:2–4, 11–15,

19, 22–23, 64, BMSA; Charles M. Oman, Doctors Aweigh

(Garden City, N.Y.: Doubleday, Doran and Co., 1943),

pp. 5–6, 9–11; George A. Eckert and James W. Mader,

“The Solace in Action,” U.S. Navy Medical Bulletin 40

(Jul 42): 552–57; Ravdin and Long, “Some

Observations,” pp. 353–56.
Besides the soldiers and sailors,

eighty-eight civilians had been injured.

Most were treated at civilian hospitals.

The City Emergency Hospital took care

of the majority; Children’s Hospital

admitted eleven youngsters with burns,

shell fragments, or bullet wounds; and a

hospital run by and for Japanese

Americans was taken over by the Army,

admitting four civilians with shrapnel

wounds. The other Honolulu hospitals

received no civilian casualties but maintained vacant beds on reserve. In rural

areas of Oahu, hospitals or emergency

medical centers set up in plantation

houses cared for a few attack victims.

Naval casualties from the Kaneohe Bay

Naval Air Station went mainly to the

Kaneohe Territorial Hospital.19

After the immediate emergency had

passed, steps were taken to correct the

inadequacies that the catastrophe had

revealed and also to prepare for another

attack. On the afternoon of 7 December

the islands passed under martial law and

Lt. Gen. Walter C. Short, commander of

the Hawaiian Department, became military governor. The Office of the Chief

Surgeon now took over civilian structures

to house four temporary hospitals under

military control. Provisional General

A MEDICAL CALAMITY 17

19“History of OofSurg, USAFMIDPAC,” sec. 1, ch. 3,

pp. 7–9, Ms 8–5.6 AA 30/1, CMH.

PEARL HARBOR CASUALTIES RECEIVING CARE ABOARD THE USS SOLACE
Hospital No. 1, with a capacity of 595

beds, opened at the Kamehameha

School for Boys on the seventh; twelve

days later all of the wounded children at

Tripler were transferred to this new hospital, which was also designated to

receive civilian outpatients in the event

that Honolulu had to be evacuated. St.

Louis College, in the Kaimuki district of

Honolulu, began operating as

Provisional General Hospital No. 2 on 8

December. On the thirteenth the

Japanese Hospital was converted into No.

3, and served primarily as an isolation

hospital for the Army, with a section

reserved for Japanese-American civilians.

The Kaneohe Territorial Hospital

became Provisional General Hospital No.

4 on 10 January 1942, specializing in the

treatment of nervous and mental diseases

(see Map 1). Seven military hospitals were

set up on the other islands. Civilian hospitals expanded as well, and within five

months after the onset of war the

Hawaiian medical facilities were considered ample, at least for the time being.20

Medical supply kept up with the

quickening pace. Since 7 December the

main Hawaiian supply center on Oahu

had functioned twenty-four hours a day.

Colonel King planned and, during 1942,

set up branch depots on the islands of

Maui, Kauai, and Hawaii to supply the

service commands of those districts. On

Oahu he also authorized the construction of five additional warehouses at the

Schofield Barracks branch depot and

the completion of a warehouse at Fort

Ruger, which was ready for use by the

middle of February. The chief surgeon’s

20Ibid., pp. 10–11, Ms 8–5.6 AA 30/1, CMH. On 17

December 1941 Lt. Gen. Delos C. Emmons succeeded

General Short as military governor.

18 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

U.S. NAVAL MOBILE BASE HOSPITAL NO. 2, where 110 casualties were treated
office ordered stocks, particularly sulfa

drugs, to be further dispersed in the various hospitals of the Hawaiian

Department to lessen the possibility that

all might be destroyed in the event of

another attack. In April the 5th Medical

Supply Depot, under the command of

Lt. Col. James P. Gill, MC, arrived in

Hawaii from the United States. Less than

three months later the Oahu supply center was deactivated, and all personnel

and equipment were transferred to the

5th. But the immense job of building a

logistical base for the campaigns that lay

ahead had, as yet, hardly begun.21

The baptism by fire was over for the

doctors, nurses, and corpsmen, as well

as for the civilian colleagues who had

worked beside them during the crisis on

Oahu. Though few would have believed

it at the time, they were comparatively

lucky, for the enemy did not return and

no invasion fleet appeared to threaten

the Hawaiian Islands. Not so fortunate

were other Americans 2,000 miles to the

west. In the Philippines one of the great

tragedies of American military history—

in many respects a medical calamity as

well—had begun to overwhelm both

military and civilians alike.

The Philippines Prepare

As of 26 July 1941 defense of the

Commonwealth of the Philippines had

been entrusted to a new Army command, the United States Army Forces in

the Far East (USAFFE), under General

MacArthur, who was promoted to lieutenant general the next day. USAFFE

consisted of the Philippine Department,

which before July had been the highest

Army headquarters in the Far East, and

the Philippine Commonwealth forces

designated for service with the U.S. military. Its principal army was Maj. Gen.

Jonathan M. Wainwright’s Philippine

Division, with three infantry and two

field artillery regiments; the coast

artillery units garrisoning the Harbor

Defenses of Manila and Subic Bays; and

a miscellany of others, including the 4th

Marines, the 26th Cavalry of the

Philippine Scouts (PS), and three additional regiments of field artillery.

Philippine natives served both as professional soldiers—for example, enlisted

men in Wainwright’s 45th and 57th

Infantry (PS) and other U.S. Army

units—and as militiamen in the illtrained and ill-equipped Philippine

Army, a citizen-soldier force that

President Franklin D. Roosevelt had

called into the service of the United

States. The strength of USAFFE, to

include the air complement but not the

Philippine Army, was 22,532 officers and

enlisted men.22

The Philippine Department’s Office of

the Chief Surgeon, under Col. Adam E.

Schlanser, MC, initiated medical mobilization planning in the winter of

1940–41. When Schlanser left the islands

in September 1941, his successor, Col.

Wibb E. Cooper, MC, took up the task,

performing the dual functions of Chief

Surgeon, USAFFE (although informally,

as the position was never established officially until early 1943), and Surgeon,

Philippine Department. Like his predecessor, he relied greatly upon the

Philippine Division’s 12th Medical

21Ibid., ch. 1, p. 8, Ms 8–5.6 AA 30/1, CMH; Wiltse,

Medical Supply, p. 395.

22Morton, Fall of Philippines, pp. 21, 23; Mary Ellen

Condon-Rall, “U.S. Army Medical Preparations and the

Outbreak of War: The Philippines, 1941–6 May 1942,”

Journal of Military History 56 (Jan 92): 35–56.

A MEDICAL CALAMITY 19
Regiment, a unit formed of Philippine

Scouts under Maj. Harold W. Glattley,

MC. A midwesterner and graduate of the

University of Iowa’s School of Medicine,

Glattley served for fourteen years at Army

hospitals in the United States and overseas before taking up his position with

the Philippine Scouts. He witnessed the

growth of the 12th Medical Regiment

from only 200 before 1941 to 22 officers

and 399 enlisted men by 31 July.23

This small force of Philippine natives

and American officers participated in

the maneuvers of the Philippine

Division; trained cadres for newly created medical detachments and provided

them key noncommissioned officers;

and taught the militiamen of the

Philippine Army the rudiments of field

medicine, medical supply, and hospitalization. In August 1941, as the Philippine

Division began the process of triangularization, the 12th Medical Regiment was

reorganized locally as the 12th Medical

Battalion,24 with a headquarters section,

three collecting companies, and one

clearing company. A collecting company

23Wibb E. Cooper, “Medical Department Activities in

the Philippines From 1941 to 6 May 1942, and

Including Medical Activities in Japanese Prisoner of

War Camps,” pp. 5, 20–22, file 314.7, HUMEDS, RG

112, NARA.

24While the 12th Medical Regiment may have been

reorganized locally in 1941 as the 12th Medical

Battalion, War Department directives for the action

were not published until the spring of 1946. The unit’s

official designation until April 1946 was 12th Medical

Regiment, which is used in this volume.

20 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

COL. HAROLD W. GLATTLEY, MC

(Rank as of 7 April 1942)

COL. WIBB E. COOPER, MC
and a platoon of the clearing company

were attached to each of the three new

regimental combat teams.25

Medical service for the Air Force,

USAFFE, which before 4 August 1941

had been called the Philippine Air

Force, was provided by a detachment at

Nichols Field and another at Clark

Field. Clark held the headquarters of

the senior flight surgeon, Lt. Col.

William J. Kennard, MC, who was a graduate of the Army’s School of Aviation

Medicine at Randolph Field, Texas, and

had just turned thirty-five. On 16

November the Air Force, USAFFE, was

reorganized as the Far East Air Force,

with Maj. Gen. Lewis H. Brereton as

commanding general. At the same time,

when the subordinate Far East Air

Service Command was activated under

the leadership of Col. Lawrence

Churchill, Colonel Kennard, who routinely coordinated all medical activities

with Cooper’s office, additionally

became the Air Service Command surgeon. The Far East Air Force had its own

dispensaries, but used the fixed Army

hospitals and supply depots.26

For administrative and training purposes the Philippine Army’s ten reserve

divisions had been divided into three

task forces, one for northern Luzon, a

second for southern Luzon, and a third

for the Visayan Islands and Mindanao.

Colonel Cooper assigned a medical officer to each force headquarters as its surgeon. He further tried to allocate a medical instructor to the headquarters of

each Philippine Army division. When

manpower proved insufficient (the

Office of the Chief Surgeon had authority to recruit enlisted men but not officers), local physicians and nurses were

commissioned in the Philippine Army

and inducted into the service of the

United States.

On the southern islands, the Visayas

and Mindanao, medical detachments

were aided by local hospitals, which furnished care on a contract basis. There

were a number of such hospitals—military, civilian government, missionary,

industrial, and privately owned. The surgeon coordinated and supervised the

arrangements of the Red Cross for the

evacuation and treatment of civilian

casualties in the event of air raids, and

his arrangements later proved workable

when combat began.27

As in Hawaii, the problem of providing enough hospital beds preoccupied

medical planners during the prewar

buildup. Before 1941 the Army’s medical facilities in the Philippine Islands

consisted of Sternberg General Hospital

and Forts John Hay, William McKinley,

and Stotsenburg Station Hospitals on

Luzon; Fort Mills Station Hospital on

Corregidor; and Fort Brent Station

Hospital on Mindanao. Three of the station hospitals as well as Sternberg had a

dental clinic, and Sternberg also had a

laboratory (including a veterinary section) and a dispensary service. In 1940

these installations served approximately

30,000 American and Philippine personnel, about one-fourth of whom were

dependents.28

25Cooper, “Medical Department Activities,” pp.

20–22, file 314.7, HUMEDS, RG 112, NARA. On collecting and clearing companies, see Table 1. 26William J. Kennard, “Observations on Bataan,” 22

Aug 42, pp. 2–3, attached to idem, “History—Medical

Department,” same date, file 000.71 (Interviews–SWPA),

HUMEDS, RG 112, NARA.

27Cooper, “Medical Department Activities,” pp.

92–95, file 314.7, HUMEDS, RG 112, NARA. 28CSurg, Phil Dept, Annual Rpt, 1940, p. 1, file

319.1–2, HUMEDS, RG 112, NARA.

A MEDICAL CALAMITY 21
After planners adopted RAINBOW 5 in

November 1941, looking to the defense

of Manila rather than the withdrawal of

forces to Bataan, the Office of the Chief

Surgeon began preparations to develop

a hospital center and supply system

around Sternberg General Hospital.

Located in the capital, the hospital

buildings were much as they had been

under the Spaniards—structures of hollow tile and stucco, standing near the

Pasig River—but the site had grown

noisy and congested with the city’s

growth. Colonel Cooper expanded

Sternberg from 450 to 800 beds and,

paralleling methods used in Hawaii,

selected a number of buildings for conversion into hospital annexes in the

event of war. Since the War Department

expected Manila to be the target of

enemy air attacks, plans also called for

the relocation of the now enlarged

Medical Supply Depot in Manila to a

place outside the city. Schemes were put

on paper to construct subdepots at

Tarlac, Los Banos, and Cebu, but the

subdepots had not materialized when

war broke out. Perhaps fortunately, the

change in plans came too late to permit

such a wide dispersion of supplies.

Outside the capital, the old hospital

building at Fort William McKinley, just

south of Manila, was reconditioned and

transformed into a 250-bed station hospital. Although the medical and surgical

staffs were adequate, the hospital lacked

up-to-date equipment. At Fort

Stotsenburg, near Clark Field, the 350-

bed station hospital was fairly well

equipped, and a 750-bed addition was

under construction when hostilities

started.29

Both Bataan and Corregidor received

some attention. In late 1941 Colonel

Cooper guided the alteration and renovation of existing buildings at

Corregidor’s Fort Mills, and planned to

use Malinta Tunnel, actually an underground complex, as hospital space in

the event of war. No permanent hospital

stood on Bataan, but during the autumn

equipment for one general hospital of

1,000 beds was stored in a warehouse at

Limay on the peninsula.30

A few weeks before Pearl Harbor,

equipment for two general hospitals and

five station hospitals arrived in the

Philippines. Their fortuitous appearance resulted from timely requisitions

made upon Surgeon General Magee by

Colonel Schlanser in support of the

Army’s new and broader defense role.

Other supplies remained tantalizingly

out of reach. When hostilities began,

equipment for ninety regimental dispensaries either was being prepared for

shipment or was already en route to the

Philippine Islands. The same was true of

new medical chests and other gear for

the units of the Philippine Division,

which took the field with 1917-type medical chests. Medical units of the

Philippine Army had practically complete but obsolete equipment, and

almost no reserve stocks, leaving them

entirely dependent on the Medical

Supply Depot for replacement of all

items. Similarly, they depended on civilian vehicles for evacuation, having only

about a quarter of their authorized

transportation. 

29Cooper, “Medical Department Activities,” p. 47, file

314.7, and Sternberg Gen Hosp Annual Rpt, 1940, pp.

1–2, file 319.1–2, HUMEDS, RG 112, NARA; Wiltse,

Medical Supply, pp. 399–400. See also Manila Hosp Ctr

GO 1, 12 Dec 41, The Historical Unit (THU) Note

Cards, Historians files, HUMEDS, RG 112, NARA. 30Cooper, “Medical Department Activities,” p. 47, file

314.7, HUMEDS, RG 112, NARA.

22 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
By 8 December 1941 (7 December in

the United States and Hawaii), the

strength of the medical contingent in

the Philippines stood at 1,536, including

247 medical officers (some arrived with

other USAFFE reinforcements), 717

enlisted men, and 572 Philippine

Scouts. Medical personnel were about 5

percent of the total U.S. Army garrison,

which itself was 2 percent below table-oforganization levels. Upon these few soldiers and their civilian colleagues would

fall a formidable burden. Despite all

efforts, in the Philippines as in Hawaii

and at home, the buildup to meet the

oncoming storm had scarcely begun.31

The Ordeal Begins

On the same day the Japanese

attacked Pearl Harbor, their naval and

air forces struck the American territories

of Guam, Wake, and the Philippines. A

few days after the initial assault, on 11

December, Guam surrendered to a

Japanese invasion force. By the twentythird Wake Island also had capitulated,

cutting a line of communications

between Hawaii and the Philippines and

leaving the United States without a central Pacific base west of Midway. The

Philippines’ only hope for defense lay

with USAFFE’s ground and air forces

and with the U.S. Asiatic Fleet.

But the enemy’s early morning air

attacks severely damaged U.S. defensive

capabilities in the Philippines.

Destruction was widespread. Strikes on 8

December destroyed nearly all the

planes and killed many personnel at

Clark Field north of Manila and at Iba

Field to the west. On the following day

the Japanese attacked Nichols Field

near Manila before dawn, wrecking

planes and ground installations. On the

tenth they hit Del Carmen Field near

Clark and the Nichols and Nielson

Fields near Manila. On the same day

enemy bombers flying at 20,000 feet, out

of range of American antiaircraft guns,

struck the Cavite Naval Base on the

southern shore of Manila Bay, scoring

direct hits on the power plant, dispensary, repair shop, warehouses, barracks,

and radio station, and setting the entire

yard ablaze. On the twelfth and thirteenth Japanese aircraft in force again

assaulted targets throughout Luzon.

When these raids ended, American air

power in the Philippines had been virtually demolished. Admiral Thomas C.

Hart, commander in chief of the Asiatic

Fleet, had no recourse but to evacuate

his warships, isolating the Philippines

and leaving them open to attack.32

Meanwhile, the medics labored over

the first waves of wounded. On 8

December 300–350 casualties from

Clark Field were admitted to the nearby

Fort Stotsenburg Station Hospital. Most

suffered from shrapnel and a few from

burns and bullet wounds incurred in the

strafing. In a small room at the hospital,

surgical teams worked at three operating tables, treating the more seriously

injured. Most burn cases were handled

in the first aid room. As in Hawaii, the

use of sulfanilamide in great quantities

resulted in very little infection and quick

31Ibid., pp. 5, 7, 22–23, file 314.7; Radiogram, AGO

to CG, USAFFE, Manila, 20 Aug 41, sub: [Shipment of

Medical Supplies], and 1st End, AGO to TSG, 1 Dec 41,

sub: Priority for Complete Original Equipment for

Army and Corps Medical Units, THU Note Cards,

Historians files. All in HUMEDS, RG 112, NARA.

32Morton, Fall of Philippines, pp. 84–87; Samuel Eliot

Morison, History of United States Naval Operations in

World War II, 15 vols. (Boston: Little, Brown and Co.,

1947–62), 3:168–74.

A MEDICAL CALAMITY 23
healing of even the deepest wounds.

Stotsenburg was a small hospital, however, and the casualties were too numerous for its staff. As a result, patients were

evacuated by train to Sternberg General

Hospital in Manila. Soon casualties from

Iba Field, who were almost as numerous,

were entering Sternberg as well.33

When war broke out, Nichols Field,

about 5 miles south of Manila, was in the

midst of a construction program that

included new barracks, quarters,

hangars, and runways. On 8 December

Lt. Col. Charles H. Moorhouse, MC,

flight surgeon at the field, prepared for

the emergency by establishing four aid

stations at key points. Late in the afternoon the first air raid casualties with

minor wounds arrived. Before dawn,

casualties mounted as seven Japanese

bombers attacked Nichols Field itself,

destroying one hangar, killing 3 men,

and wounding 15, one of whom died

later. In the operating room at adjacent

Fort McKinley’s station hospital, other

Nichols casualties awaited surgery. They

lay in unnerving silence, as a result of

either morphine, shock, or simple relief

at finding themselves alive, while medics

rinsed their wounds and “steady-handed

anesthetists drove long, glistening needles” into their naked backs.34

On 9 December Colonel Moorhouse

moved into the new barracks area and

set up a field dispensary. That afternoon, the enemy raided the field again,

killing 18 and wounding 30, many seriously. The temporary dispensary and

much equipment was strafed and one

ambulance almost destroyed. The surgeon then moved onto a road between

Nichols and McKinley, working in the

open until the field was evacuated. For

about two weeks, enemy aircraft bombarded Nichols Field almost daily,

killing 50 and wounding 150.35

Almost immediately after the attack,

Colonel Cooper put the Manila

Hospital Center into operation.

Composed of Sternberg General

Hospital plus eight annexes in colleges,

universities, dormitories, barracks, and

the Jai Alai Building, the center formed

the focal point of medical activity. Total

planned bed capacity exceeded 4,600.

But in the opening days Sternberg

admitted most of the attack victims,

beginning in the early morning hours

of 9 December. As raids increased in

severity during the following days,

wounded poured in from Iba Field,

Clark Field, Fort Stotsenburg, Nichols

Field, Cavite Naval Base, Manila, and

later from the Luzon fronts. The surgical teams that Cooper had organized on

the first day of hostilities were kept busy.

During some peak periods all surgeons,

nurses, and corpsmen worked for two

days without rest, and even at other

33Ltr, 1st Lt Willa L. Hook, CNurse, Base Sec 3, to Col

Percy J. Carroll, CSurg, USASOS, SWPA, 5 Feb 43, sub:

History of Medical Department Activities in the

Philippines Campaign, p. 1, file 000.71

(Interviews–Philippines); Catherine L. Nau, “History of

the War, Philippines, 1941–1945,” p. 40, file 314.7. Both

in HUMEDS, RG 112, NARA. Nau, an American Red

Cross volunteer, was assigned to Sternberg’s Social

Service Department as a field director. 34Quotation in Alfred A. Weinstein, Barbed-Wire

Surgeon (New York: Macmillan Co., 1948), p. 2.

Weinstein was later assistant chief of surgical service in

General Hospital No. 1 on Bataan; his memoir, though

it resembles a “docudrama” in some respects, is filled

with useful observation and commentary on his combat

and prison experiences. See also Ltr, Lt Col Charles H.

Moorhouse to SG, U.S. Army, 20 Jan 43, sub: Medical

Service in the Philippines, December 8, 1941 to March

10, 1942, pp. 1–3, file 000.71, HUMEDS, RG 112,

NARA. 35Ltr, Moorhouse to SG, U.S. Army, 20 Jan 43, pp.

1–3, file 000.71; Nau, “History of War,” p. 4, file 314.7.

Both in HUMEDS, RG 112, NARA.

24 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
times many slept at the hospital in order

to be available when needed. The casualties suffered from injuries that included severe complicated fractures, burns,

and brain wounds. Tressa Cates, a civilian nurse, was stunned by the carnage:

. . . soon our wards, receiving rooms,

operating rooms, as well as the large hospital yard, were filled with the wounded and

the dying.

American and Filipino men, both civilian

and military, were lying everywhere on the

well-kept lawn. Many of them were charred

and burned beyond recognition. Blood as

crimson as the hibiscus flowers which

bloomed in profusion in the yard was scattered everywhere.36

Since the Philippine Army headquarters was located across the street,

Sternberg General Hospital observed

blackout regulations every night. Staff

members dug slit trenches on the

grounds for the protection of their

patients and themselves. Adding to

their burden was an ever-increasing

number of victims of traffic accidents,

resulting from the blackout in Manila

and elsewhere.37

The city was a scene of mass confusion. On 10 December Japanese forces

landed on Luzon, and two weeks later

the main enemy force came ashore, winning quick successes against the defenders. By the end of the month the

invaders were closing in on the doomed

capital. With no protection against the

bombings, casualties mounted. Traffic

was congested and the population

demoralized. Some people indulged in

wild orgies of drinking; others became

hysterical. Hospital activities were disorganized and in a state of turmoil.

Medical personnel treated casualties

amid wailing sirens, bursting flares, and

rifle fire from nervous troops who shot

at any unusual light or sound. False

reports spread of parachute invasions,

gas attacks, and spy infiltrations.38

On 13 December Fort William

McKinley Station Hospital closed down

as a result of constant bombardment

from enemy aircraft, and much of its

staff was integrated with Sternberg’s.

Similarly, personnel from Fort

Stotsenburg Station Hospital transferred to Sternberg on the twentyfourth. Using these reserves, the Manila

Hospital Center treated about 2,000 military and civilian patients during the

first three weeks of the war, including

154 casualties transferred from the U.S.

Naval Hospital, Canacao, at Cavite, 7

miles down the coast from Manila.39

As Manila’s fall became imminent,

MacArthur, who on 18 December was

promoted to the AUS rank of general,

declared the capital an open city and

ordered the withdrawal of American and

Philippine troops to Bataan. With his

medical plans now gutted (there was no

need for a medical center in the capital

when a campaign would have to be

waged on Bataan), Colonel Cooper

began to evacuate medical facilities and

36Quotation from Tressa R. Cates, The Drainpipe Diary

(New York: Vantage Books, 1957), p. 19. See also

Cooper, “Medical Department Activities,” pp. 48–49,

file 314.7, HUMEDS, RG 112, NARA. 37Cooper, “Medical Department Activities,” pp.

48–49, 84, file 314.7, HUMEDS, RG112, NARA. 

38W. H. Waterous, “Reminiscences of Dr. W. H.

Waterous Pertinent to World War II in the Philippines,”

p. 17; James O. Gillespie, “Recollections of the Pacific

War and Japanese Prisoner of War Camps, 1941–1945,”

p. 8. Both in file 314.7–2, HUMEDS, RG 112, NARA. 39Cooper, “Medical Department Activities,” pp.

48–50, file 314.7, HUMEDS, RG 112, NARA. Records

on all casualties during the first weeks of the war in the

Philippines were brief as a result of the tremendous volume of work and shortage of personnel. Also, most

medical records were lost when the boat on which they

were being shipped was bombed.

A MEDICAL CALAMITY 25
personnel, including patients capable of

traveling, to the peninsula. On the afternoon of the twenty-third the staff and

patients of the Manila Hospital Center

joined the caravan of military vans, civilian vehicles, and fleeing refugees crowding the one road leading through the city

of San Fernando and south into Bataan.

Lt. Col. James W. Duckworth, MC, formerly the executive officer at Sternberg,

established General Hospital No. 1 at

Limay, following General MacArthur’s

verbal orders. Working under intermittent air attack, Maj. Peter Kempf, MC,

the medical supply officer at Sternberg,

moved supplies and equipment from the

various annexes in Manila and from Fort

McKinley Station Hospital to Corregidor

by barge and to the Bataan Peninsula by

truck. Despite all efforts, critical supplies

were lost to air attack or abandoned in

the withdrawal.40

After leaving Manila on Christmas

Eve, Colonel Cooper set up the main

section of his office on Corregidor with

the rest of the USAFFE staff. He established a subdivision of his office ashore

at General Hospital No. 1. On Christmas

Day most of the medical personnel

remaining in Manila went by boat to

Bataan to help Maj. William D. North,

MC, organize General Hospital No. 2 at

a previously selected site along the Real

River near Cabcaben. Here Army engineers worked to clear away bamboo

thickets and jungle, while supply personnel opened a medical depot on the

Mariveles road. Vessels carrying evacuees docked at the towns of Lamao and

Cabcaben, usually in the early morning,

and on several occasions during air

raids. On 29 December the remaining

Army nurses left Manila, and by New

Year’s Eve the last patients as well had

departed on boats and barges.41

As the Corregidor hospitals became

overcrowded, General MacArthur on 28

December decided to evacuate the worst

cases. At his order, Col. Percy J. Carroll,

MC, commanding officer of Sternberg

General Hospital, selected 224 patients

to accompany him to Australia on the

Mactan, an interisland steamer chartered by the Red Cross in the

Philippines to serve as a hospital ship.

The doctor also took two Army nurses,

Lt. Floramund A. Fellmeth and Lt.

Florence MacDonald, and a number of

Filipino doctors and nurses serving with

the U.S. Army. Protected by Red Cross

markings, the ship docked at Sydney,

Australia, after a harrowing journey, and

the patients found refuge in an

Australian Army hospital. Yet some who

were hopelessly crippled had been left

behind, a burden to themselves and to

the medical staff during the battles that

followed and in prison thereafter.42 40James O. Gillespie, “Malaria and the Defense of

Bataan,” in Ebbe Curtis Hoff, ed., Communicable Diseases:

Malaria, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1963), pp. 500–501.

See also idem, “Recollections,” p. 8, file 314.7–2;

Cooper, “Medical Department Activities,” pp. 78–79, file

314.7, and James W. Duckworth, “The Official History of

General Hospital Number One, United States Army

Forces in the Far East, at Camp Limay, Bataan, Little

Baguio, Bataan, and Camp O’Donnell, Tarlac,

Philippine Islands, From December 23, 1941 to June 30,

1943,” p. 1, file 319.1–2 (General Hospital 1) Philippine

Islands. All in HUMEDS, RG 112, NARA.

41Duckworth, “History of General Hospital Number

One,”, p. 1, file 319.1–2 (General Hospital 1)

Philippine Islands; Cooper, “Medical Department

Activities,” pp. 2, 8, 53, file 314.7; Kennard,

“Observations on Bataan,” 22 Aug 42, pp. 1–2, attached

to idem, “History—Medical Department,” same date,

file 000.71 (Interviews–SWPA). All in HUMEDS, RG

112, NARA. 42Cooper, “Medical Department Activities,” p. 53, file

314.7; Kennard, “Observations on Bataan,” 22 Aug 42,

p. 1, attached to idem, “History—Medical Department,”

Continued

26 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
The Jungle Environment

Bataan was ideally suited for a defensive campaign. Jungle-clothed and

mountainous, the peninsula juts from

the mainland of Luzon in a southerly

direction between Subic Bay and Manila

Bay. Corregidor and several smaller fortified islands protected the entrance to

Manila Bay. Approximately 25 miles

wide at its broadest part, Bataan is cut by

many streams and steep ravines. In 1941

the peninsula had two roads, one of

which was barely adequate for motor

transport in dry weather. Elsewhere the

tropical jungle was almost impossible to

penetrate, except by a network of narrow trails.

By masterful delaying actions,

MacArthur’s forces prevented the

Japanese from cutting off any significant

number of defenders. By 7 January 1942

American and Philippine troops had

completed their withdrawal. The

Japanese followed, and soon controlled

both the base of the peninsula and its

water approaches. Henceforward, the

defenders had to be self-sufficient. This

fact had enormous repercussions for

medical personnel, who were responsible for the care and treatment of approximately 80,000 soldiers and 26,000 civilians. Supplies of food and medicine were

totally inadequate for so many. Both soldiers and refugees had abandoned extra

clothing and equipment during the

retreat, and now faced the chilly nights

and steamy days without protection from

heat, cold, or mosquitoes.43

The topography that favored the

defense meant also that the evacuation

of wounded would be slow and arduous,

and at times virtually impossible. Despite

its lushness, the jungle yielded little food

to the defenders, while its diseases, especially malaria, took a fearful toll.44

At 1500 on 9 January the battle for

Bataan opened as elements of the

Japanese 14th Army, commanded by Lt.

Gen. Masaharu Homma, began their

attack with a concentrated barrage.

Strong resistance by American and

Philippine forces surprised the enemy,

whose advance was also hindered by difficult terrain and inadequate maps. But

after a week of fighting, the American

line began to give way to heavy Japanese

pressure. Litter-bearers carrying the

wounded led the retreat along the narrow beaches of the South China Sea.

Guns, trucks, and equipment that could

not be moved were destroyed. By the

evening of the twenty-fifth the line had

been evacuated. Daily counterattacks

failed to halt the enemy’s advance. On

the morning of the twenty-sixth the last

troops of the Philippine Division to be

withdrawn took positions along a new

line paralleling the Pilar-Bagac road.

Losses on both sides had been heavy.

General Hospital No. 1 at Limay treated

more than 1,200 battle casualties, all

requiring major surgery.45

same date, file 000.71 (Interviews–SWPA); Waterous,

“Reminiscences,” p. 18, file 314.7–2. All in HUMEDS,

RG 112, NARA. See also Interv, Mary Ellen Condon-Rall

with Percy J. Carroll, 26 Sep 80, CMH; Philip A. Kalisch

and Beatrice J. Kalisch, “Nurses Under Fire: The World

War II Experiences of Nurses on Bataan and

Corregidor,” Nursing Research 25, no. 6 (Nov–Dec 76):

411. The Japanese government was notified of the ship’s

mission through Swiss channels. See Msg, Forster,

Philippine Red Cross, to Chairman, American Red

Cross, 28 Dec 41, and other Mactan materials, THU

Note Cards, Historians files, HUMEDS, RG 112, NARA.

43Morton, Fall of Philippines, p. 405. 44Ibid.; Gillespie, “Recollections,” p. 13, file 314.7–2,

HUMEDS, RG 112, NARA. 45Morton, Fall of Philippines, pp. 265–95; Duckworth,

“History of General Hospital Number One,” p. 2, file

319.1–2 (General Hospital 1) Philippine Islands,

HUMEDS, RG 112, NARA.

A MEDICAL CALAMITY 27
Frontline medical support varied

widely. The recently organized

Philippine Army medics were poorly

equipped, short of blankets, litters, and

surgical equipment. Lacking both

materiel and training, they were slow in

moving the wounded to hospitals. By

contrast, Lt. Col. Harold W. Glattley’s

12th Medical Regiment (PS) functioned

admirably, rarely losing equipment,

improvising when necessary, and moving its patients to the general hospitals

well within the eight- to ten-hour period

that doctors considered essential. “It is

doubtful,” declared Colonel Cooper, “if

any unit of similar size [421 men in all]

had ever contributed so much to the

medical service of a major campaign.”46

The objectives of medics with seriously wounded patients were the general

hospitals at Limay and Cabcaben. At

Limay—the village itself was “a collection

of tiny bamboo shacks mounted on high

stilts”—they found a complex of thirtyeight single-story tin- or nipa-roofed

buildings in a spacious quadrangle dotted with lofty mango trees. In addition to

the wards and an operating pavilion,

Limay provided buildings for the hospital headquarters, officers quarters, a

ward for minor surgery, a dental clinic, a

laboratory, and a pharmacy. A huge

sheet-iron warehouse fronting the beach

bulged with salvaged medical supplies.47

Standing close to the front line, the

Limay facility was in actual practice more

a surgical than a general hospital.

Blankets blacked out doors and windows. In the operating pavilion the seven

tables were occupied at all times, while

more patients lay on litters awaiting their

turns. During intense fighting, casualties

averaged 80 to 200 daily. Surgery

reached its peak on 16 January, the day

after the Japanese penetrated the line,

when surgeons performed 187 major

operations in twenty-four hours. During

the last week of the month, when the

enemy was overrunning the defense line

and the American and Philippine forces

were withdrawing to the Pilar-Bagac

road, General Hospital No. 1 moved

from its quarters to open sheds at Little

Baguio, a onetime Army engineer camp

on the southeast corner of Bataan, about

5 miles from General Hospital No. 2

near Cabcaben (Map 2).48

The result of improvisation, the

Cabcaben hospital was primitive by comparison with Limay and even with Little

Baguio. Army engineers had built the

facility from scratch in a dense jungle on

the edge of a stream leading to Manila

Bay, clearing away lush vegetation and

bamboo and cutting a drive from the

coast road. By 5 January the basic facilities for a tented hospital existed at

Cabcaben, and the first operation was

46Cooper, “Medical Department Activities,” pp. 20

(quotation), 22–23, file 314.7, HUMEDS, RG 112,

NARA. Glattley was promoted to lieutenant colonel on

19 December 1941. 47Quotation from Weinstein, Barbed-Wire Surgeon, p. 10.

See also Cooper, “Medical Department Activities,” p. 54,

file 314.7; Kennard, “Observations on Bataan,” 22 Aug

42, p. 4, attached to idem, “History—Medical

Department,” same date, file 000.71 (Interviews–SWPA);

Duckworth, “History of General Hospital Number One,”

p. 2, file 319.1–2 (General Hospital 1) Philippine Islands.

All in HUMEDS, RG 112, NARA.

48Cooper, “Medical Department Activities,” p. 54, file

314.7; Kennard, “Observations on Bataan,” 22 Aug 42,

p. 4, attached to idem, “History—Medical Department,”

same date, file 000.71 (Interviews–SWPA); Duckworth,

“History of General Hospital Number One,” p. 2, file

319.1–2 (General Hospital 1) Philippine Islands. All in

HUMEDS, RG 112, NARA. Hospital No. 1 was bombed

on 30 March and again on 7 April; the Japanese high

command apologized for the first attack. See Msg,

Wainwright to CG, USAFFE, Melbourne, 31 Mar 42,

THU Note Cards, Historians files, HUMEDS, RG 112,

NARA. The nickname Little Baguio was ironic, referring

to a resort in the cool hills of northern Luzon.

28 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
MAP 2

Mauban

Bagac

Abucay

Mariveles

Cabcaben

Lamao

Limay

Orion

Pilar

Balanga

Mabatang

Corregidor I

MT BATAAN

MT SAMAT

MT NATIB

Little Baguio

MANILA

BAY

SOUTH

CHINA

SEA

Caibobo Pt

Anyasan Pt

Quinauan Pt

Longoskawayan Pt

XXX

XXX

XXX

I PHILIPPINE

CORPS

II PHILIPPINE

CORPS

SERVICE COMMAND AREA

General

Hospital No. 1

(23 Dec)

General

Hospital No. 2

Philippine Army

General Hospital

General

Hospital No. 1

(25 Jan)

0 7

Miles

HOSPITALS ON BATAAN

December 1941–January 1942

Airfield

XXX Corps Boundary
successfully performed that day. The site

possessed good water, offered concealment by tall trees, and lay close to the

Medical Supply Depot. But its disadvantages were equally marked. The hospital

was scourged by malaria and, as the campaign neared its end, ran short of beds,

blankets, bandages, mosquito nets, and

other necessities.49

During the second week of January

General Hospital No. 2 began to expand

and improve. At maximum development the facility sprawled for about

1,500 yards along the south bank of the

Real River, and its personnel numbered

some 67 officers, 83 nurses, 250 enlisted

men, and 200 civilians. Hospital boundaries were marked by three red crosses,

each 40 x 60 feet, placed at the points of

an equilateral triangle 1 mile from apex

to base. The crosses were plainly visible

from the air, and the enemy, despite a

reputation for ruthlessness, respected

them, for no bombs fell within the

points. But since the hospital stood a

mile or so from the village and airfield

at Cabcaben and 4 miles from the

Bataan Airfield, all enemy objectives,

the staff witnessed numerous bombings.

Such sights became more common as

the front contracted.50

During the course of the struggle the

role of General Hospital Nos. 1 and 2

changed. Early in the campaign, evacuation had conformed to standard practice, with collecting companies operating ambulance service forward to the

various battalion aid stations and backward to division clearing stations.

Soldiers with minor wounds received

first- and second-echelon treatment at

such stations before returning to the

front. As the enemy advanced, however,

ambulance drivers moved patients

directly to the two hospitals. The latter

served increasingly as field or surgical

hospitals as well, and provided a

melange of second-, third-, and fourthechelon care.

The Philippine Army surgeon set up a

general hospital on the

Cabcaben–Mariveles road, not far from

army headquarters, to treat Philippine

casualties in the rear areas. Since materials were limited, tents with wooden

floors became wards, a small surgical

pavilion, and a first aid dressing room.

Bamboo platforms supplemented the

limited number of iron beds and cots.

Staffed by Philippine Army doctors, dentists, and corpsmen, the hospital handled both medical cases and minor

wounds, the patient census seldom rising

above 100 until late in the campaign.51

The End Approaches

From 23 January to 17 February the

American positions on Bataan were

under strong attack along the west coast

(the Battle of the Points) and at two

places along the reserve battle line (the

Pocket Fights). During those battles the

three battalions of the 45th Infantry

(PS) were fighting on two widely separated fronts. Two battalions entered

combat at Anyasan Point and the adjoining sector Quinauan Point, and the

third battalion fought along the Tuol

River near the reserve battle line. The

49Cooper, “Medical Department Activities,” p. 54, file

314.7, HUMEDS, RG 112, NARA. 50Ibid., pp. 68–70, file 314.7; Ltr, Gen Hosp No. 2 to

Surg, Phil Dept, thru CG, Phil Dept, 3 Feb 42, sub:

Sanitary Report for Month of January 1942, THU Note

Cards, Historians files. Both in HUMEDS, RG 112,

NARA.

51Cooper, “Medical Department Activities,” pp.

76–77, file 314.7, HUMEDS, RG 112, NARA.

30 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
collecting company’s ambulance sections had to cover substantial distances

over narrow twisting trails carved out of

the jungle by Army engineers. One

ambulance section worked out of a collecting station located on the main west

road, about 3 miles north of Quinauan

and Anyasan Points, evacuating casualties from those two sectors. Only the

seriously wounded could be brought

back to the general hospitals. The other

ambulance section operated forward

from the collecting station, a distance of

some 12–15 miles, moving towards the

regimental and battalion aid stations

around the Tuol River. This ambulance

section carried a full load of patients

back to the collecting station and

returned to the front for more casualties. By the middle of February, when

the fighting ceased, the collecting stations resembled large field hospitals,

with many patients suffering from

minor wounds, malaria, and dysentery. 

However, the danger on the west

coast was over, at least for a time. Worn

out, having sustained heavy losses both

in battle and from malaria, the enemy

withdrew and awaited reinforcements.

Both sides remained dug in along the

Orion–Mount Samat–Bagac position, in

an apparent stalemate. The reality of the

situation was quite different, for the

attackers could replenish supplies and

replace exhausted fighters, while the

defenders could not. During the lull the

Japanese grew stronger, but hunger and

disease took their toll among the

American and Philippine troops.52

Meanwhile, major changes came to

the Allied force. On 12 March General

MacArthur left Corregidor for Australia,

assuring General Wainwright of his

determination to “come back as soon as

I can with as much as I can.” Prior to his

departure, because he planned to control operations in the Philippines from

his office in Australia, MacArthur abolished USAFFE’s advance command and

created a new entity, the Luzon Force,

comprising the troops on Bataan and

those still holding out in the mountains

of Luzon, with General Wainwright as

commander. Then, late on the night of

the twentieth, the War Department

appointed Wainwright commander of

the United States Forces in the

Philippines (USFIP), and he left Bataan

for Corregidor. Command of the Luzon

Force passed to Maj. Gen. Edward P.

King, Jr.53

The medics, too, reorganized. On

Corregidor Colonel Cooper became

Chief Surgeon, USFIP, and appointed

Colonel Glattley on Bataan to be the

Luzon Force surgeon. Cooper also

made some changes in the hospital commands. Lt. Col. James O. Gillespie, MC,

replaced Lt. Col. William D. North as

commander of General Hospital No. 2.

Col. Carlton L. Vanderboget, MC,

briefly took command of General

mucous lining of the bowels. See, e.g., Ltr, Surg, thru

CO, Provisional Regt (Air Corps), to CG, Phil Dept, 1

Apr 42, sub: Monthly Sanitary Report, THU Note

Cards, Historians files, HUMEDS, RG 112, NARA. 53As quoted in Morton, Fall of Philippines, p. 361 (see

also pp. 363–64). “With the establishment of

Headquarters, United States Forces in the Philippines

[on Corregidor on 21 March 1942], and General

Headquarters, Southwest Pacific Area (GHQ SWPA)

[in Australia on 18 April 1942], USAFFE ceased to be

an active command.” See Order of Battle of the United

States Ground Forces in World War II: Pacific Theater of

Operations (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1959), p. 34. 

A MEDICAL CALAMITY 31

52Morton, Fall of Philippines, pp., 290, 305, 316, 324,

350–52, 356; Cooper, “Medical Department Activities,”

pp. 41–43, file 314.7, HUMEDS, RG 112, NARA. Both

bacillary and amebic dysentery were noted on Bataan;

however, some doctors believed that most cases resulted from multiple vitamin deficiencies, which affect the
Hospital No. 1 when Colonel

Duckworth left that facility to establish a

convalescent hospital at Iloilo on Panay.

But when the Japanese sank the interisland steamer on which Duckworth was

to travel, the chief surgeon shelved the

plan for the convalescent hospital and

Duckworth resumed his command of

Hospital No. 1. Colonel Vanderboget

then became medical inspector at the

service command headquarters.54

At the hospitals, patient care was

marked increasingly by expedients as

supplies fell. Little Baguio, though

much smaller than the Limay complex,

did possess water and electricity in its

eleven buildings, former engineer

garages, and machine shops. High

above sea level and shaded by towering

hardwoods, the hospital was free of

malaria. The wards were housed in two

large open sheds with no floors and tin

roofs; one sheltered prisoners of war.

Most patients were brought in at night

to protect them from bombing and

shelling by enemy error because of the

hospital’s proximity to the ordnance

and quartermaster supply points. Lt.

Juanita Redmond described how “the

54Gillespie, “Recollections,” p. 20, file 314.7–2,

HUMEDS, RG 112, NARA.

32 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

PHILIPPINE SCOUT BEING TREATED AT GENERAL HOSPITAL NO. 1
litter bearers would come in a procession from surgery, and I would turn my

flashlight to guide them to the unoccupied beds.” The patient’s record was

made from a field tag attached to his

clothing at the first aid station. Then the

corpsmen undressed him, and the nurse

“made him as comfortable as [she]

could.”55

At first Little Baguio functioned primarily as a surgical hospital, transferring patients to Cabcaben as necessary.

However, as the number of casualties

increased, the hospital grew. Filipino

workmen from the surrounding countryside built bamboo shelters and

double- and even triple-decked beds of

the same material. Eventually, even

these additions were not enough, and

hospital personnel were forced to

spread out onto the strip of ground

between the two tin-roofed sheds,

where they cleared a patch of ground

for new accommodations.56

Meanwhile, Hospital No. 2 started to

receive a larger number of surgical

cases as the pace of fighting picked up.

Additional surgical tents were set up as

rapidly as possible. Colonel North

developed and directed a 200-bed

receiving ward, lighted for night work

and equipped to perform minor

surgery. Most casualties resulted from

shell fragments or machine gun fire,

and sulfa drugs were available to help

prevent infection. Inadequate debridement, packing wounds too tightly, and

omission of delayed primary closure,

however, encouraged gas gangrene,

which resulted in many amputations

and the needless loss of lives. A morgue

was set up near the receiving ward, and

a graves registration unit attended to all

burial details, as well as maintained

records.57

To accommodate the increasing numbers of casualties, Army engineers built

many additional facilities in March

1942, including more operating theaters

and receiving wards, some under canvas.

As surrender neared during April, however, the hospital census soared from

3,256 to 7,000. Medics set up wards in

the jungle without any cover, except

shelter halves attached to individual cots

or beds, or sheets tied to the limbs of

trees. A nurse serving on Bataan

observed: “When we found a nice shady

spot we made that into a ward or a place

for an operating room.”58

The most alarming factor in the situation of the 80,000 troops on Bataan continued to be the inadequate food supply.

Control of the air and sea by the

Japanese allowed them to blockade the

defenders with increasing effectiveness.

Enemy patrols made smuggling across

Manila Bay difficult. An enemy cruiser, a

minelayer, and eight destroyers isolated

the whole region from the supplies available in the southern islands of the

Philippines. Attempts by General

MacArthur to introduce supplies from

Australia met with little success. As early

as 5 January the soldier’s daily ration

had been cut in half. From that time

55Juanita Redmond, I Served on Bataan (Philadelphia:

J. B. Lippincott Co., 1943), pp. 46–47. 56Ibid.

A MEDICAL CALAMITY 33

57Ibid., p. 56; Cooper, “Medical Department

Activities,” p. 66, file 314.7, and Kennard, “Observations

on Bataan,” 22 Aug 42, pp. 3–4, attached to idem,

“History—Medical Department,” same date, file 000.71

(Interviews–SWPA), HUMEDS, RG 112, NARA. 58Quotation from Interv, 2d Lts Juanita Redmond

and Eunice C. Hatchitt, ANC, 6 Jul 42, sub: Their

Experiences During the Siege of Bataan and

Corregidor, p. 2, file 000.71. See also James O.

Gillespie, “History of General Hospital Number 2,” p.

12, file 314.7–2. Both in HUMEDS, RG 112, NARA.
through February the daily issue averaged less than 30 ounces, as compared

to the peacetime garrison ration of 71

ounces for the American Army and 64

for the Philippine Army. Colonel

Cooper estimated that the soldiers

received about 2,000 calories a day in

January, about 1,500 in February, and

only about 1,000 in March. Yet they

needed about 4,000 to fight in the harsh

landscape of mountains and jungles.59

By April the ration had been reduced

to 17 ounces a day, of which only 1.2

ounces was meat, most often canned

corned beef. Rice took the place of

wheat; about half was white, its husk

removed by milling, and in consequence it lacked the thiamine that

would have prevented beriberi. Even

brown rice had lost much nutritive

value, for it was mildewed and moist.

Scurvy and pellagra, caused respectively

by deficiencies of vitamin C and niacin,

also appeared. The soldiers used up

their fat reserves and then began to lose

muscle, ultimately suffering from weakness and from night blindness, due to a

lack of vitamin A. The want of protein

was particularly debilitating for the

younger soldiers, their deteriorating

condition further aggravated by diarrhea and dysentery; the latter ailments

were especially widespread among the

Philippine troops, who were inade- 59Morton, Fall of Philippines, pp. 367–68.

34 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

GAS GANGRENE WARD AT GENERAL HOSPITAL NO. 2
quately trained in basic military hygiene.

By March, weight loss of twenty to thirty

pounds per man was common.60

The soldiers’ meals, which hardly

deserved the name, were served twice a

day, breakfast at 0800 and dinner

between 1630 and 1700. The airmen

had their rations drawn from the same

quartermaster depot. No one, not even

the quartermaster officers themselves,

ate any better than anyone else. A soldier described his dinner the day after

he went on one-third rations as “one

slice of bread, one slice [of] corn beef,

cup of tea, rice and that my friend is

what we now call a good chow.” On 28

March General Wainwright cabled

Washington: “Our most pressing need is

subsistence as only a suff[icient] quantity remains on hand in Bataan to feed

the troops there until Apr[il] 15 at

about 1/3 ration. . . .” He added, “We

are now slaughtering all available

carabao [water buffalo] and surplus

horses, and will be forced to slaughter

pack mules within the next week or ten

days. When this supply of meat is

exhausted, the chief component of the

ration will no longer be available.”61

The diet of the patients in the hospitals was more ample than that of the

troops in the field, for General

MacArthur ordered that they receive

full rations, and on occasion they

enjoyed one and a half rations. But quality was poor, and by the end of the campaign the sick and wounded subsisted

basically on rice and carabao meat.

During the early part of the siege flour,

coffee, tea, oatmeal, canned goods, and

vegetables were available in limited

amounts. Milk and pineapple juice were

given to the seriously ill, especially after

a quantity was received in February. By

April, however, the qualitative inadequacy of the ration had begun to result in

impaired healing. As meat became more

and more difficult to obtain, rice

formed the sole or chief component of

the patient’s diet, as it did the soldier’s.

Noted a doctor: “It was quite a sight to

see . . . those who should have received

adequate soft and liquid diet trying to

eat a gob of sticky, gummy, half-cooked

rice.”62

The Veterinary Corps tried to alleviate the food shortage by killing native

pigs and carabao. The killing of animals

for food went on from early January

until the time of the surrender. In all,

over 2,800 carabao and approximately

600 other animals were slaughtered and

distributed to the Army. Foraging was

another way the soldiers tried to supplement their food. Frontline units on

their own initiative secured and slaughtered animals, helping to sustain themselves for a few additional weeks.

60Ibid. See also Ltr, Moorhouse to SG, U.S. Army, 20

Jan 43, p.5, file 000.71, and Kennard, “Observations on

Bataan,” 22 Aug 42, p. 6, attached to idem, “History—

Medical Department,” same date, file 000.71

(Interviews–SWPA), HUMEDS, RG 112, NARA. 61First quotation from James H. and William H.

Belote, Corregidor: The Saga of a Fortress (New York:

Harper and Row, 1967), p. 102; remaining quotations

from Msg, Wainwright to AG, WD, Washington, for Gen

Marshall, 28 Mar 42, THU Note Cards, Historians file,

HUMEDS, RG 112, NARA. See also Msg, MacArthur to

CG, Svc Cmd Sector, 5 Jan 42, [sub: Reduction of

Subsistence to Half Rations], THU Note Cards,

Historians files, and Cooper, “Medical Department

Activities,” pp. 35, 44–45, file 314.7, HUMEDS, RG 112,

NARA; Redmond, I Served on Bataan, p. 37. On blockade, see Memo, G–4, USAFFE, to CofS, USAFFE, thru

G–2 and G–3, 21 Mar 42, sub: CG, USAFFE, Radiogram,

THU Note Cards, HUMEDS, RG 112, NARA.

62As quoted in Morton, Fall of Philippines, p. 368. See

also Ltr, CG, USAFFE, to CG, Harbor Defense of Manila

and Subic Bays, and CG, Phil Dept, 10 Feb 42, sub: Issue

of Rations, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA. The hospital staff ate the

same ration as troops in the field.

A MEDICAL CALAMITY 35
Eventually, all available animals were

slaughtered for human consumption.

Particularly painful to General

Wainwright, a cavalry officer, was the

necessity for the men of the 26th Cavalry

(PS) to shoot and eat the bony horses

that once had “served so gallantly.” To

add to the difficulties of obtaining provisions, the limited amount of food available on the peninsula was slow in getting to the troops because the supply

vehicles often broke down on the mountain trails. Indicative of the growing

shortage was the fact that casualties frequently arrived at the hospitals, not

complaining of their wounds but rather

requesting food.63

The second most needed item was

quinine. Before 1941 civilian health

authorities had failed in their efforts to

carry out an effective malaria control

program on Bataan, where some 400

square miles of marsh, rice paddy, thick

jungle, and many streams defeated their

efforts to kill mosquitoes. When the war

began, the military authorities were

equally unable to impose control measures of any significance. Instead, they

relied almost entirely on quinine prophylaxis, which suppressed the symptoms of malaria without curing it. Many

soldiers occupied native villages, or barrios; sanitary conditions were poor, and

the heavy population of refugee civilians

formed a reservoir of infection, from

which malaria spread rapidly to the

troops. The mosquito chiefly responsible for spreading the disease bred in the

streams of the foothills, where much of

the fighting occurred.

Inevitably, when the supply of quinine became depleted, malaria quickly

attained a devastating incidence. There

was never enough of the drug to protect so large an army for a three-month

siege. At the outbreak of war approximately 4.5 million five-grain (.325-

gram) tablets of quinine sulfate were

available in the Medical Supply Depot.

This whole quantity would have been

sufficient only for thirty days’ prophylaxis, on the basis of ten grains (.650

grams) of quinine per man per day. As

early as 26 January the dosage had to

be reduced to five grains a day.

Ultimately, the supply was so limited

that prophylaxis was discontinued, and

the small quantity of quinine that

remained was reserved for hospital

treatment only—no more than eight

grains to any individual case, however

severe. Only the timely arrival of 1 million tablets from a medical depot on

Cebu ensured that no hospital patients

were denied treatment before the surrender. As a result, the death rate from

malaria was low.64

Debilitation of the troops on the line

was another matter, for the spread of the

disease among the fighting forces could

not be curtailed. Insect repellents

63Quotation from Jonathan M. Wainwright, General

Wainwright’s Story: The Account of Four Years of

Humiliating Defeat, Surrender, and Captivity (Garden City,

N.Y.: Doubleday, 1946), p. 53. See also Cooper,

“Medical Department Activities,” p. 99, file 314.7,

HUMEDS, RG 112, NARA; Morton, Fall of Philippines, p.

369; Redmond, I Served on Bataan, p. 47.

64Paul F. Russell, Malaria: An Account of Its Cause, Cure

and Prevention (Manila: Bureau of Printing, 1931), p. 37;

Gillespie, “Malaria,” in Hoff, ed., Communicable Diseases:

Malaria, p. 503; Kennard, “Observations on Bataan,” 22

Aug 42, p. 14, attached to idem, “History—Medical

Department,” same date, file 000.71 (Interviews–SWPA),

and Interv, Redmond and Hatchitt, 6 Jul 42, p. 4, file

000.71, HUMEDS, RG 112, NARA. The chief carrier

(vector) of malaria was Anopheles minimis flaviostris. Small

amounts of the new synthetic antimalarial Atabrine were

received on Bataan, but too little to make a difference.

On the quinine shipment, see Msg, Wainwright to AG,

WD, Washington, for Gen Marshall, 28 Mar 42, THU

Note Cards, Historians files, RG 112, HUMEDS, NARA.

36 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
proved useless; the Philippine Army soldier was not provided with a mosquito

bar and net, and many of the American

soldiers had discarded theirs as an

inconvenience when they retreated to

Bataan. By March some units in the

front line had malaria rates as high as 80

percent; on one day, the eighth, General

Hospital No. 2 had 350 cases under

treatment and on the next received 260

new ones. Medical officers explored the

possibility of manufacturing quinine

from cinchona bark. In early March Lt.

Col. Arthur F. Fischer—a military intelligence officer and onetime director of

forestry for the Philippine government

who had introduced cinchona into the

islands—was dispatched from Bataan to

Mindanao to supervise the harvesting of

the bark. The venture never promised

to do more than alleviate the problem

and, as matters turned out, Fischer was

still on the southern island at the time of

the final surrender.65

By the beginning of March the enormous increase in the number of patients

with malaria, dysentery, and wounds, all

complicated by malnutrition, had so

overfilled the hospitals that retention of

most casualties in the division areas

became the rule. The shortage of motor

fuel and the inaccessibility of forward

units were contributing factors, making

it necessary by the end of the month to

retain at battalion and regimental aid

stations even those with major injuries

and illnesses. Eventually, thousands of

such noneffectives strained every facility

in the forward areas.66

Aid stations, normally without any

holding capacity at all, attempted to treat

200–300 casualties, while clearing and

collecting companies each held 600–900,

in violation of standard practice. As long

as the front remained stable, the lush

tropical flora offered them unlimited

cover and protection. But with so many

helpless troops near the front, any movement along the battle line compelled

immediate and massive evacuation.

Being “within easy artillery range” when

the enemy’s final push came, the wounded and the medics who served them

found no safety in the jungle without the

immunity of the Red Cross emblem.67

The Fall 

Like the defenders, the enemy had suffered severely from malaria, dysentery,

and deficiency diseases. In February the

surgeon of the Japanese 14th Army estimated that 10,000–12,000 soldiers were

ill, and enemy forces were depleted further when the early rapid victories in the

Philippines resulted in major troop withdrawals for the Netherlands East Indies

invasion. Reinforcements arrived only

after successes in French Indochina,

Singapore, and Malaya freed troops and

aircraft for the Philippines. By April

General Homma was ready to try again.68

65Rpt, Lt Col J. O. Gillespie, CO, Gen Hosp No. 2, to

Surg, Phil Dept, 10 Mar 42, sub: Malaria Control, and

Ltr, Lt Col A. F. Fischer, Svc Cmd, Luzon Force, to

ACofS, Svc Cmd, Luzon Force, 18 Mar 42, sub: Source

of Supply of Quinine for the Philippines, THU Note

Cards, Historians files, HUMEDS, RG 112, NARA. See

also Gillespie, “Malaria,” in Hoff, ed., Communicable

Diseases: Malaria, pp. 506–07.

66Cooper, “Medical Department Activities,” pp.

32–34, file 314.7, HUMEDS, RG 112, NARA. 67Quotation from Cooper, “Medical Department

Activities,” p. 26. See also Gillespie, “Malaria,” in Hoff,

ed., Communicable Diseases: Malaria, p. 507. 68Gillespie, “Malaria,” in Hoff, ed., Communicable

Diseases: Malaria, p. 510. See also Historical Section, G–2,

Far East Command, “14th Army Operations,” Japanese

Studies in World War II, 1:230–31, bound as Japanese

Monograph No. 1, “Philippine Operations Record, Phase

1, 6 November 1941–June 1942,” Ms 8–5.1 AC 1, CMH.

A MEDICAL CALAMITY 37
On 3 April the enemy renewed the

offensive with a heavy attack against the

left wing of the II Philippine Corps, in

an attempt to gain Mount Samat. The

attack developed quickly, with the result

that three clearing stations crowded

with casualties were in danger of being

overrun by the enemy. Under supervision of the 12th Medical Regiment (PS),

a general evacuation took place over

three nights, beginning with that of 2–3

April. Convoys of buses evacuated the II

Corps front, giving priority to stations

nearest the fighting. Colonel Cooper

wrote that “total chaos” reigned in the

forward areas. “Roads were congested

beyond description. In one instance a

convoy was caught directly between

enemy and friendly fire.” A similar evacuation followed in the I Philippine

Corps sector. In all, more than 7,000

patients were transported to rear areas

during the period 2–7 April.69

The burden of receiving and caring

for these casualties fell mainly on the personnel of General Hospital No. 2, whose

patient census rose from 2,700 to 6,000

within six days. Most of the new invalids

suffered from malaria, dysentery, malnutrition, and exhaustion. Hundreds of

walking wounded staggered into General

Hospital No. 1 as well. The morning of 7

April found 1,840 patients on the premises, while 400–450 waited for admission.

But after the Little Baguio facility was

twice severely bombed because of its

proximity to the ordnance and quartermaster supply points, bed patients were

transferred to Hospital No. 2. Despite the

expansion, neither hospital received any

new staff.70

“Already,” said General King, “our

hospital, which is filled to capacity and

directly in the line of hostile approach,

is within range of enemy light artillery.

We have no further means of organized

resistance.” Hospital No. 2 would clearly be overrun the next day. Under cover

of darkness, most of the seventy-eight

American nurses and all medical personnel not absolutely required to tend

the 12,000 sick and wounded crossed

the channel to Corregidor. Corpsmen

remained to care for the patients,

whose welfare was commended to a

small group of Japanese infantry at

1700 on 9 April 1942, just two hours

after the Luzon Force was ordered to

surrender.71

Three months of starvation diet, air

and artillery bombardment, and disease

had taken their toll. General King himself recalled: “When I went through the

Japanese lines on 9 April 1942 to surrender the Luzon Force and got my first

close view of the Japanese troops, I was

surprised by the alert expressions on

their faces and the vigor of their actions.

I had grown so accustomed to lackluster

eyes and lackadaisical movements.” By

March the combat efficiency of the

troops had fallen by more than 75 percent as a result of malaria, intestinal

infections, and malnutrition, and on 1

April Colonel Cooper had written that

the combat efficiency of the troops “was

rapidly approaching the zero point.”

This physical deterioration had become

a determining factor in the military situation. As General Wainwright stated in

his cable to General MacArthur after the

69Cooper, “Medical Department Activities,” p. 36, file

314.7, HUMEDS, RG 112, NARA. 70Ibid., pp. 37, 56, file 314.7, HUMEDS, RG 112,

NARA.

71As quoted in Morton, Fall of Philippines, p. 458. See

also Cooper, “Medical Department Activities,” pp. 37,

76–77, file 314.7; Interv, Redmond and Hatchitt, 6 Jul

42, pp. 3–4, file 000.71. Both in HUMEDS, RG 112,

NARA.

38 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
surrender of Bataan, “Physical exhaustion and sickness due to a long period of

insufficient food is the real cause of this

terrible disaster.” In turn, Japanese control of the sea and air was fundamental

to the failure of supply. The medical disaster had resulted from the logistical

failure, and physical depletion had rendered the defenders incapable of further resistance.72

Corregidor

One act remained. Corregidor,

largest and most important of the fortified islands in Manila Bay, lay between

the Bataan Peninsula and Cavite

Province on the mainland of Luzon.

Shaped like a tadpole, the island since

the days of the Spaniards had been the

center of the bay’s defense. During the

first few weeks after the outbreak of war,

preparations had included the completion of Corregidor’s extensive tunnel

system. Work was still under way when,

on 29 December 1941, the first enemy

bombs fell. These attacks forced the

USAFFE headquarters and the 200-bed

Fort Mills Station Hospital to move

underground, into Malinta Tunnel. A

period of relative quiet followed in early

months of 1942, while the Japanese

expended their efforts in subduing

Bataan. After Bataan’s surrender on 9

April, they set up batteries there, and

from about the tenth up through the

final assault on 5 May, intense and regular bombing of Corregidor became the

rule.73

Before the war, medical service on

Corregidor had centered around the

Fort Mills Station Hospital. To meet the

demands of the increased garrison after

8 December, the surgeon of Harbor

Defenses assumed supervisory control

over all medical personnel on the fortified islands, in addition to his duties as

commander of the Fort Mills Station

Hospital. For medical purposes

Corregidor was divided into zones, each

of which received a detachment of two

medical officers, plus noncommissioned

officers and enlisted men. The zone surgeon cared for all troops within his area,

provided for sanitation, and ensured

that casualties were retrieved and evacuated to the Malinta Tunnel—a difficult

and dangerous task for those who performed it.74

On 30 December 1941 the Malinta

Tunnel facility began to function as a

general hospital. Since it was equipped

with an operating theater, all surgery for

the fortified islands was performed

here, and casualties from the other

islands were ferried in at night for treatment. Malinta provided a bombproof

shelter for the USAFFE headquarters;

the Philippine government; the hospital, now of 1,000 beds; a massive storehouse; powerplants; and machinery.

From a main east-west passage, 1,400

feet long and 30 feet wide, branched

twenty-five tunnels, each about 400 feet

long, at regular intervals. Laterals in

72First quotation from Edward P. King, “Recollections

of the Defense Battles in Bataan,” copy (n.d. but

signed) in James O. Gillespie Notebook, Historians

files, HUMEDS, RG 112, NARA; remaining quotations

from Morton, Fall of Philippines, pp. 404 and 463. See

also Cooper, “Medical Department Activities,” p. 79, file

314.7, HUMEDS, RG 112, NARA. It was sadly ironic

that three shipments of medical supplies—mainly quinine, sulfonamides, and vitamin preparations—arrived

from the south, two by plane and one by submarine,

after the capitulation of Bataan.

73Cooper, “Medical Department Activities,” p. 82, file

314.7, HUMEDS, RG 112, NARA; Morton, Fall of

Philippines, pp. 479–97. 74Cooper, “Medical Department Activities,” pp. 81,

83, file 314.7, HUMEDS, RG 112, NARA.

A MEDICAL CALAMITY 39
turn spread from the branches. All had

reinforced concrete walls, floors, and

overhead arches, and a ventilating system. Double-track electric car lines ran

along the main passage.75

The Malinta hospital had its own

entrance north of Malinta Hill, and the

wards were in concrete-lined laterals off

the main tunnel. At the beginning of the

siege there were eleven wards, the beds

placed close together and alternated

head and foot. After the second month

military authorities opened two more

large tunnels and lined the main hospital

tunnel with beds. Doctors, nurses, and

enlisted men were assigned to each ward,

as they would be in a general hospital.

Equipment was better than on Bataan.

Lieutenant Redmond, evacuated from

Bataan to the island fortress, marveled at

the well-equipped surgical division compared to the crudities of Limay and

Cabcaben; she “couldn’t get over the

wonder of white enameled tables beside

each bed. They seemed almost indecently luxurious.” Other comforts included

an auxiliary lighting plant, neon lighting

fixtures, flush toilets, showers, and running water. Yet living a mole-like existence underground also had certain discomforts, as Redmond soon realized:

“The roar of shells and bombs was not so

muffled as I had thought at first, but

echoed and reverberated through the laterals; and the lack of real ventilation was

hard on everyone, for even the elaborate

system of fans did not keep the air from

getting very stuffy and hot.”76

When the Japanese stepped up the

bombing and shelling of Corregidor in

April, they quickly spread devastation

over the island’s surface. Grass fires

blazed everywhere. Beach defense guns

were destroyed, and buildings were

demolished on Malinta Hill. On the

twenty-second an air raid leveled an

aboveground medical depot at Fort Mills

housing noncritical supplies that had not

been stored in Malinta Tunnel because of

lack of space. Fortunately, many drugs

stowed away in bottles and tins and

placed in covered trenches were not lost

in the raid. The shelling of Corregidor

never stopped, and life in the tunnel

soon became almost unbearable, with

oppressive air, heat, dust, flies and other

vermin, and the smell of the hospital and

human bodies everywhere.77

By the middle of April the reserve

supply of water on which the Malinta

hospital drew had dwindled considerably. Showers were shut off. Quarrels

flared among the crowded men and

women. Yet Maude R. Williams, a hospital assistant who had escaped from

Bataan to Corregidor, observed how

those in the tunnel coped, finding

solace in simple joys: 

Under the deepening shadow of death

life on Corregidor took on a faster, more

intense tempo. The smallest and most simple pleasures became sought after and treasured as they became increasingly rare and

dangerous—an uninterrupted cigarette, a

cold shower, a stolen biscuit, a good night’s

sleep in the open air. 

There was a heightened feeling that life

was to be lived from day to day, without illusions of ultimate victory. Many sought forgetfulness in gambling. There was no way to

spend the accumulated pay that bulged in

their pockets and they rattled the dice or

played endless bridge, rummy and poker.78

75Morton, Fall of Philippines, p. 474. 76Redmond, I Served on Bataan, p. 134.

40 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

77Ibid.

78Maude R. Williams in Leon M. Guerrero, “The Last

Days of Corregidor,” Philippine Review, May 43, as quoted in Morton, Fall of Philippines, p. 542. See also Belote,

Corregidor, p. 140.
Casualties were mainly among those

on beach defense duty, or at gun positions, though no one aboveground was

safe. Coast artillerymen evacuated their

own wounded to the Malinta hospital,

while the 4th Marines took theirs to the

Navy’s lateral under the south side of

Malinta Hill. Though the task of bringing

Corregidor’s sick and wounded to the

hospital was a difficult and hazardous

one, evacuation was usually fast and efficient, and in most instances a casualty

reached the operating table less than an

hour after being wounded. Good evidence of speedy evacuation was the fact

that no cases of gas gangrene were

recorded. When the island was under

heavy bombardment, wounded could not

be carried into the tunnel, and medics

rendered only emergency treatment.79

As the bombing increased and casualties mounted, Williams wrote in her

diary: “Every day it seemed that the line

of stretchers grew longer. The narrow

hospital corridors were crammed with

the wounded, the sick, and the dying; the

convalescents were hurried out to make

room for fresh casualties.” To treat the

increasing number of patients, the hospital expanded into three more laterals.

The staff utilized every inch of space, lining the walls with beds. Redmond noticed

that luxuries disappeared one by one:

“Double-decked and triple-decked beds

in the hospital; civilian refugees sleeping

in packed rows on the tunnel floors; two

meals a day, again, and scanty rations . . .

dreadful, familiar and unmistakable signs

that the end was drawing near.”80

Despite such conditions, as well as the

hopelessness of the situation, the health

of the Corregidor garrison remained

relatively good. Life there was not comparable to Bataan, though the troops

suffered from respiratory diseases

induced by confinement in the damp

dust-laden tunnels. Bataan survivors

brought malaria with them, and shell

holes increased fly and mosquito breeding grounds, but no epidemics broke

out. A basic reason was careful sanitary

inspection by medical officers.

Medicines, too, were readily available,

for a stock had been built up before the

war adequate to care for 5,700 troops

for six months. Food, though monotonous, was enough to carry the soldiers

through June on half rations. By then

some vitamin-deficiency diseases had

begun to appear—the first one noted

was beriberi. Yet only a small fraction of

the personnel showed evidence of suffering from any type of vitamin deficiency, for canned goods gave small but balanced meals.81

Surprisingly, few psychiatric cases

were recorded. The consensus of

Colonel Cooper and his fellow medical

officers was that the situation on

Corregidor, like that on Bataan, discouraged breakdowns because the island

offered no escape from reality. Although

official medical records fail to list combat fatigue as a problem on Corregidor,

some of the garrison may have been

affected, especially antiaircraft artillery

79Cooper, “Medical Department Activities,” pp. 79,

81–82, file 314.7, HUMEDS, RG 112, NARA; Morton,

Fall of Philippines, pp. 536–40. 80Williams in Guerrero, “Last Days of Corregidor,” as

quoted in Morton, Fall of Philippines, p. 544; final quotation from Redmond, I Served on Bataan, p. 134.

81Memo, Lt Col J. O. Gillespie to Gen Marshall, 26

Jan 42, sub: Medical Supplies, THU Note Cards,

Historians files, and Cooper, “Medical Department

Activities,” pp. 81, 83, file 314.7, HUMEDS, RG 112,

NARA; Morton, Fall of Philippines, p. 535; Belote,

Corregidor, pp. 132, 142–43. The relative affluence of

Corregidor caused much resentment on Bataan prior

to its fall.

A MEDICAL CALAMITY 41
crews when air attacks were at their most

intense. Early in the war, however, the

condition often passed unrecognized by

doctors and unreported by the soldiers

themselves, whose sense of manliness

forbade them to show fear. Survivors

tended to agree that their morale had

not weakened until the final days, when

even the greatest optimists realized that

no help was coming.82

Corregidor fell to enemy encirclement and assault, not to hunger or

disease. By 5 May the Japanese had

taken all the fortified islands of Manila

Bay except Corregidor, and their

artillery fire had laid waste its entire

north side. On that day landings began.

Though casualties were heavy, the

Japanese were able to establish a beachhead. Some troops advanced across the

island to the southern shore; others

moved westward toward Malinta Hill,

the main objective of the landing. By

0130 on the sixth that force had established a north-south line across the

island, with artillery and tanks already

coming ashore. American coast and

antiaircraft artillerymen left their guns

to fight as infantry. However, the

Japanese soon were able to infiltrate the

American lines and also to set up their

light artillery and use it with devastating

42 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

82For a recent discussion of combat stress in war, see

Roger J. Spiller, “Shell Shock,” American Heritage 41

(May–Jun 90): 75–87.

ARMY NURSES ON CORREGIDOR just after their capture
effect. American casualties were heavy—

600 to 800 killed and about 1,000

wounded. Since the few litter-bearers

were among the casualties, the wounded

remained in the front line. Medical personnel at the ruined Fort Mills supply

depot were captured that day. At 1000

hours General Wainwright, concluding

that nothing was to be gained by further

resistance, decided to surrender. During

the remainder of the day the defenders

destroyed all weapons, and at midnight

firing ceased.83

The surrender of the southern islands

that followed brought the campaign to

an end, though small groups of

Americans refused to surrender and

soon joined Filipinos in resisting the

Japanese occupation.84 For most, however, prison camps and a new ordeal of suffering lay ahead. The medical lessons of

the campaign centered on the extraordinary attrition imposed on both sides by

the conditions of jungle fighting and on

the overriding importance of seaborne

supply to maintain even small forces in

island warfare. Difficult logistics, attrition

resulting from disease, and the normal

problems of combat medical support all

interacted. With their Pacific fleet shattered and their most advanced garrison

lost, Americans faced up to a new and

most difficult kind of war, one in which

an army could be shattered as much by

the environment as by the enemy.

83Morton, Fall of Philippines, pp. 552–61. 

84See Chapter XI for the story of the resistance movement in the Philippines.

A MEDICAL CALAMITY 43
The war against Japan was fought in

an area that covers roughly one-third of

the Earth’s surface, from Burma to

Hawaii and from Alaska to Australia.

While fighting on mainland Asia

involved Chinese, British, and American

forces,1 the decisive struggles took place

on the islands of the Pacific. 

The vast ocean is dotted with landmasses large and small. Marking its

northern and western boundaries are

the large archipelagoes of the Aleutians,

the Kuriles, the home islands of Japan,

the Ryukyus, and the Philippines. The

Moluccas, the northern coast of New

Guinea, the continent of Australia, and

the two large islands of New Zealand

form the southwestern boundaries of

the disputed region. The central and

South Pacific contain three main groups

of islands: Micronesia (Mariana,

Caroline, Marshall, and Gilbert Islands);

Melanesia (Solomon Islands, Bismarck

Archipelago, New Hebrides, New

Caledonia, Fiji, and the intervening

islands); and Polynesia (Hawaiian,

Samoa, Tonga, and Marquesas Islands

and other groups). 

Distances are great: 7,750 miles of

ocean separate San Francisco from

Sydney, Australia; some 1,600 miles

divide Fiji from Auckland, New Zealand;

and more than 900 miles separate New

Caledonia, then a major Allied base,

from Guadalcanal. In 1942, outside

Australia and New Zealand, port facilities were primitive at best. Unloading

was slow; storage was difficult because of

the damp climate and tropical heat; and

wounded and sick evacuees endured

long and difficult journeys. In this island

world medical supplies like everything

else moved only by sea or air, and the

conditions that developed on Bataan

demonstrated the consequences when

supplies failed. 

The cold windswept Aleutians, the

jungle-clad islands of Melanesia, and the

palm-fringed atolls of Micronesia all

played host to American soldiers.

Despite varied climates and landforms,

however, some factors are fairly constant

throughout the Pacific. Rainfall is heavy,

especially during the summer, with

about 60 inches a year compared to 32

inches for the Atlantic. North of the

equator most rain falls from June

through October, south of it from

November to April. On the coral

atolls—small low-lying islands, seldom

rising more than 20 feet above sea

level—seasonal rains combine with

warm temperatures to nourish coconut

1

See Chapter 9 on operations in the China-BurmaIndia theater.

CHAPTER II

A New Kind of War
palms, low-growing brush, and, in the

marshy areas, luxuriant jungle growth.

On the volcanic islands—often large

complex landmasses with steep cliffs

and wooded plateaus—the climate gives

rise to dense jungle, rain forest, and

high tropical grass. The Aleutians are as

wet, and often bitter cold as well.

In wartime each environment

brought its own characteristic medical

consequences, from frostbite to jungle

rot. Even in the tropical regions, geography and the accidents of settlement

and trade made great differences in disease patterns. Some islands were ravaged by malaria, while others were free

of it. Coral islands rarely have freshwater

catchments for mosquitoes to breed; on

the other hand, volcanic islands, with

their numerous streams, grasslands, and

nonporous black soil, are rich in such

areas. While the Army fought in all

Pacific environments, its efforts for the

first two years of the war were concentrated in the steaming disease-ridden

jungles of Melanesia.2

Endemic Diseases

Some of the ills faced by Army men

and women were familiar communicable diseases, under control in civilian

life in the United States but newly dangerous under combat conditions.

Others were exotics unfamiliar to most

American doctors, spread by vectors little studied by entomologists. Unlike prewar Western colonizers, Americans

could not transplant and maintain the

traditional methods of public health in

the midst of war. Military discipline, new

drugs like Atabrine, and new insecticides had to take up the slack. Among

the commonest diseases were those

spread by poor water supplies and inadequate waste disposal, especially the various forms of dysentery. The incidence

of venereal disease and yaws depended

to a great extent upon the health of the

civilian population and the opportunities for fraternization. Sexual contacts

between soldiers and civilians were common, especially in communities made

destitute by war and in those, such as Fiji

and Aitutaki, where local mores encouraged promiscuity. Yaws, related to

syphilis but spread by nonvenereal contact, was a hazard in rural areas.

Unwashed skin, high humidity, and contact with infected natives led to bacterial

and fungal infections. Schistosomiasis—

infection with a blood fluke commonly

found in the tropics—could only be

avoided by keeping troops, their clothing, equipment, and even their vehicles

out of infected water, a difficult precaution to take in combat. Hookworm disease could result from contact with

infected earth. None of these diseases

were normally fatal, but all could put

soldiers out of action as effectively as if

they had been combat casualties.

2

Unless otherwise indicated, section on distance, climate, and terrain based upon Fairfield Osborn, ed.,

The Pacific World: Its Vast Distances, Its Lands and the Life

Upon Them, and Its Peoples (New York: W. W. Norton and

Co., 1944), pp. 21–42; Buell Whitehill, “Administrative

History of Medical Activities in the Middle Pacific,”

block 1, pp. 1–12, and block 18b, pp. 1–5, file 314.7,

Historical Unit Medical Detachment (HUMEDS),

Record Group (RG) 112, National Archives and

Records Administration (NARA), Washington, D.C.;

Paul A. Harper et al., “New Hebrides, Solomon Islands,

Saint Matthias Group, and Ryukyu Islands,” in Ebbe

Curtis Hoff, ed., Communicable Diseases: Malaria, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 409–14; CSurg,

USAFISPA, Annual Rpt, 1942, pp. 1–8, file 319.1–2,

HUMEDS, RG 112, NARA; Paul F. Russell,

“Epidemiology of Malaria in the Philippines,” American

Journal of Public Health 26 (Jan 36): 1–7. 

A NEW KIND OF WAR 45
Arthropod-borne diseases were common and sometimes fatal. Spread by two

species of Aedes mosquito, dengue

(breakbone fever) occurs in practically

all areas of the Pacific and on mainland

Asia. Another Aedes mosquito transmits

filariasis, caused by a parasitic worm that

is endemic to Okinawa and islands of

the central and South Pacific. Sandfly

fever, a short-term febrile malady transmitted by the bite of one or more

species of the genus Phlebotomus,

appears sporadically in China, Burma,

and India. Chiggers, the larvae of trombiculid mites, spread the febrile infection scrub typhus throughout the Pacific

and Asia. A rodent flea transmits murine

typhus, which was common in Hawaii,

the Philippines, Japan, and Korea.

Louse-borne epidemic typhus, though

more prevalent in Europe than in the

Pacific, appeared occasionally in Japan

and Korea. Rodent fleas also carried

plague in China, Burma, and India. 

Many species of the Anopheles mosquito transmit malaria, the most important

and militarily significant disease in the

Pacific. Where climate and rainfall are

constant, as on the northern coast of

New Guinea, the Bismarck Archipelago,

the Solomon Islands, and the New

Hebrides, malaria existed throughout

the year. Pronounced wet and dry seasons, such as typify the southeast coast of

New Guinea and the northwest coast of

Guadalcanal, caused malaria to become

seasonal, appearing twice a year

between the extreme wet and dry

months, usually the most feasible time

for military operations. In many places

heavy rainfall produced wet grasslands

laced with flowing streams that provided

breeding areas for anopheline mosquitoes, complicating malaria control. The

region of the China-Burma-India theater contains fifty species of anopheline

mosquitoes, of which eleven are known

vectors; the Philippines record thirtytwo species and four vectors. In part, the

insect is widespread because different

species have distinct breeding habits.

Some anophelines prefer to breed in

rice paddies, others in slow-running

streams, in springs with grassy margins,

in coastal lagoons, in irrigation ditches,

in wells, or in the shallows of swamps

and lakes. Some favor clear water, others

brackish; some sunlight, and others

shade. Some breed in water as transient

as rain-filled footprints, hoofprints of

animals, or ruts left by vehicles. 

In the tropical areas of Burma and

India, malaria vectors are especially

prevalent where the great river systems

flow into wet lowlands—for example,

Burma’s Irrawaddy River valley or

India’s great Hindustan Plain. On

malarious South Pacific islands the mosquito breeds in native clearings, along

inland streams, in coastal swamps and

lagoons created by poor drainage, or

where sandbars block the flow of

streams running down from the hills to

the sea. On Guadalcanal the drainage

courses of five rivers transect a broad

alluvial plain on the north central coast

at intervals of about 3 miles.

Meandering between the rivers, sluggish

streams terminate in coastal swamps and

lagoons, creating mosquito breeding

reservoirs. During combat and the occupation that followed, Allied and enemy

forces created new water catchments in

shell and bomb craters, in foxholes, and

in abandoned bomb shelters and gun

positions. 

The cause of malaria is the plasmodium, a parasitic protozoan that attacks

the red blood cells and liver, and reproduces itself both in its human host and

46 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
in the mosquito that carries it from one

victim to another. Different species of

Plasmodium cause different kinds of

malaria, of which the commonest in the

Pacific were vivax, or benign, and falciparum, or malignant. Malignant malaria

could kill, while the effects of the socalled benign form included bouts of

chills and fever, physical debility, and

frequent relapses. To prevent epidemics, command responsibility was as

important as the techniques of preventive medicine and suppressive therapy.

But line officers were often slow to

relearn the importance of malaria to

military operations.3

Problems of Leadership

Early in 1942 Australia emerged as

the great Allied base, playing a role in

the Pacific war like that of Great Britain

in the European fighting. Even before

American forces in the Philippines left

Manila, Secretary of War Henry L.

Stimson and Chief of Staff General

George C. Marshall had decided to use

the southern continent as a base to supply General MacArthur and provide him

air support. Although Britain and

America agreed in December 1941 to

concentrate their forces against

Germany first, the deteriorating situation in the Pacific dictated the diversion

of some forces, and the War

Department took steps to send nine air

groups there. Meanwhile, a convoy

guarded by the light cruiser USS

Pensacola, bound for Manila when war

broke out, had already been diverted to

Australia. Aboard the transport USS

Republic were a miscellany of troops that

included air combat, field artillery, and

service personnel, as well as a number of

officers, among whom were six doctors.

At sea, organization of the forces on this

and other ships into a command began

under Brig. Gen. Julian F. Barnes, who

chose a staff of eighteen officers, including a surgeon, Maj. George S. Littell,

MC. Barnes announced that his new

headquarters in Australia would be

known as the United States Forces in

Australia (USFIA).4

Rapid changes of command ensued.

Arriving at Brisbane on 22 December,

the same day as Barnes, Brig. Gen.

Henry B. Clagett relieved Barnes, pending the end-of-month arrival of the

newly appointed USFIA commander,

Maj. Gen. (later Lt. Gen.) George H.

Brett of the Army Air Forces (AAF).

Shortly after New Year’s Day, 1942,

Brett’s headquarters relocated from a

local hotel in Brisbane to Melbourne.

3

Whitehill, “Medical Activities in Middle Pacific,”

block 1, pp. 1–14, 55, 56, block 14, pp. 6–8, and block

18a, pp. 4–5, file 314.7, HUMEDS, RG 112, NARA. See

also Earl Baldwin McKinley, ed., A Geography of Disease

(Washington, D.C.: George Washington University

Press, 1935); George MacDonald, The Epidemiology and

Control of Malaria (London: Oxford University Press,

1957), pp. 95–97; James Stevens Simmons, Global

Epidemiology: A Geography of Disease and Sanitation (New

York: J. B. Lippincott Co., 1944). For up-to-date information on the diseases cited, see Kurt J. Isselbacher et

al., eds., Harrison’s Principles of Internal Medicine, 12th ed.

(New York: McGraw-Hill Book Co., 1991).

4

Account drawn primarily from OofSurg, USAFIA,

Diary, 10, 12, 21, 27–30 Dec 41, file 314.81, Daily Diary,

10 Dec 41–31 Jul 42, HUMEDS, RG 112, NARA. See

also Maurice Matloff and Edwin M. Snell, Strategic

Planning for Coalition Warfare, 1941–1942, United States

Army in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1953), pp. 87–88; Louis Morton, Strategy and Command:

The First Two Years, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1962), pp. 151–52;

and Blanche B. Armfield, Organization and

Administration in World War II, Medical Department,

United States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1963), pp. 410–11.

A NEW KIND OF WAR 47
On 5 January the USFIA was redesignated the United States Army Forces in

Australia (USAFIA). In order to provide

a logistical system to support the coming

troop buildup, General Brett established four territorial commands—Base

Section 1 at Darwin, 2 at Townsville, 3 at

Brisbane, and 4 at Melbourne. He also

assigned surgeons to each base section

headquarters and dispatched them to

set up offices and organize medical care

for the small number of existing forces

and the greater number to come.

Planning for a system of military hospitals and medical depots began. Littell,

who was promoted to lieutenant colonel

on 30 January, filled the position of

Chief Surgeon, USAFIA, until 1

February, when Col. George W. Rice,

MC, arrived from the United States with

orders from Surgeon General Magee to

serve as theater surgeon. 

A few days earlier, however, Colonel

Carroll had arrived from the Philippines

on the hospital ship Mactan with more

than 200 seriously wounded patients.5

Senior to Rice, Carroll became chief surgeon on 7 February; Littell became

Carroll’s supply officer for a time, and

later his deputy. Rice, after serving as

deputy, became a base section surgeon

following a sharp dispute with Carroll

over medical policy. Rice’s resentment

over being displaced as chief surgeon

may have been a factor in the dispute.6

Almost fifty-one years old, Colonel

Carroll was a long-service Army medical

officer, adept at military medicine but

less successful at headquarters politics.

He had worn the uniform since 1916,

when he joined the punitive expedition

into Mexico as regimental surgeon for

the 24th Infantry. During World War I

he served with the American

Expeditionary Forces in France as assistant commander of a hospital train, and

with a surgical company. During the

1920s and 1930s Carroll held positions

at Army hospitals in the United States,

the Philippines, and at Tientsin, China,

5

On Colonel Carroll’s escape from the Philippines

on the Mactan, see Chapter I. 6

OofSurg, USAFIA, Diary, 2, 5, 7 Feb 42, file 314.81,

Daily Diary, 10 Dec 41–31 Jul 42; Ltr, Col George W.

Rice to Maj Gen James C. Magee, 12 Feb 42, file 201

Correspondence, Col George W. Rice, 1942–1944. Both

in HUMEDS, RG 112, NARA. See also Armfield,

Organization and Administration, pp. 411–12; Morton,

Strategy and Command, p. 168; and Department of the

Army, Reports of General MacArthur, 4 vols. (1950; reprint

ed., Washington, D.C.: Government Printing Office,

1966), 1:21. One other officer—Maj. Jesse T. Harper—

served briefly as chief surgeon during the confused

period before Carroll’s arrival.

48 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MAJ. GEN. GEORGE W. RICE, MC

(Rank as of 8 May 1948)
before returning to the Philippines in

1940 for duty as post surgeon at Fort

Stotsenburg and then as commanding

officer at Sternberg General Hospital.

After escaping to Australia and assuming the position of chief surgeon in early

1942, he planned for an office organization consisting of hospitalization, supply

and finance, personnel, evacuation, sanitation and vital statistics, dentistry, nursing, and veterinary sections. Not until

April, however, was he able to fill all of

the vacant positions.7

One of the first tasks of the nascent

Office of the Chief Surgeon was to procure and ship supplies for the relief of

the Philippines. Colonel Littell, who

continued to serve as medical supply

officer until Maj. Alfonso M. Libasci,

MC, arrived from the United States in

early April, scraped together quinine,

morphine, anesthetics, vitamins, and

other drugs from Australian sources,

depleting that country’s small stocks;

from incoming vessels; and from the

United States. Twelve shipments (ten by

air and two by ship) were smuggled

through the Japanese blockade before

the fall of Bataan on the ninth. By that

time, however, General MacArthur had

arrived in Australia, greeted by enthusiastic crowds. His coming signaled the

true birth of the theater, but also the

creation of divided commands that

shaped the Pacific fighting and the medical role in it for years to come.8

As MacArthur settled in, the AngloAmerican Combined Chiefs of Staff on

24 March assigned the United States

responsibility for the conduct of the war

in the Pacific. Confronted by the need

to satisfy both armed services—no candidate for single commander could be

found who would be acceptable to both

the Army and the Navy—the U.S. Joint

Chiefs of Staff responded by dividing

the region into two commands. On 18

April MacArthur became Supreme

Commander of Allied Forces, General

Headquarters, Southwest Pacific Area

(SWPA), initially located in Melbourne,

which included the Philippine Islands,

Australia, the Netherlands East Indies

except Sumatra, and New Guinea. On 8

May the commander-in-chief of the

Pacific Fleet, Admiral Chester W.

7

CSurg, SWPA, Annual Rpt, 1942, pp. 16–19, file

319.1–2, HUMEDS, RG 112, NARA.

8

Charles M. Wiltse, Medical Supply in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1968), pp. 404–06.

A NEW KIND OF WAR 49

BRIG. GEN. PERCY J. CARROLL, MC

(Rank as of 23 June 1943)
Nimitz, was named commander of the

Pacific Ocean Areas—the vast central

region that stretched from the Bering

Straits to Antarctica, including the

Hawaiian Islands and, in a westward

extension, Japan itself. Nimitz’ command in turn was subdivided into three

sectors: North Pacific Area, Central

Pacific Area, and South Pacific Area (see

Map 3). The Joint Chiefs instructed

MacArthur and Nimitz to contain

Japan’s southward advance, to hold

Australia and key islands of the South

Pacific as bases for future operations,

and to protect their lines of communications with the United States.9

Theater and Army reorganization

soon impacted on the Office of the

Chief Surgeon, USAFIA. On 20 July, following the model established by a War

Department reorganization in March,

USAFIA became a logistical command

called the United States Army Services

of Supply (USASOS). Brett remained in

charge of the air forces in the Southwest

Pacific Area, and MacArthur’s deputy

chief of staff, Brig. Gen. Richard J.

Marshall, took over as the USASOS commander. Though the USASOS was

responsible for hospitalization, medical

supply, and evacuation, Carroll’s role

diminished under the new setup. As

chief surgeon to a services of supply

headquarters rather than to a single

command responsible for the entire

American Army in the Southwest Pacific

Area, he could not impose his recommendations on the ground and air

forces, and thus his position, responsibilities, and authority remained illdefined. Meanwhile, at MacArthur’s

supranational headquarters, Carroll’s

former subordinate, Colonel Rice,

emerged in September as Surgeon,

General Headquarters, SWPA, further

diluting Carroll’s power. The subsequent move of the USASOS to Sydney

and of General Headquarters, SWPA,

back to Brisbane further complicated

relations between the two surgeons. 

Working with only one assistant and

operating through G–4, SWPA, where his

office was located, Rice attempted to

make medical policy for the theater,

influencing General Headquarters to

reject Carroll’s plans when he disagreed

with them. He had no doubt of his proper role: “I am the theater surgeon,” he

subsequently would declare to the surgeon general. Carroll complained bitterly to his commander, General Marshall,

and the two went to General

Headquarters. Here, MacArthur listened

to Carroll and then declared, “The medical department is your baby.” But verbal

support could not undo the organization

charts. Ground and air forces alike continued as independent commands.

Carroll’s contact with MacArthur

remained limited: “I only talked with him

eight or ten times” while in the Southwest

Pacific Area, he later recalled.10

The air surgeon, who headed the

medical section at Brett’s headquarters,

was Lt. Col. Nuel Pazdral, MC. Though

AAF units had their own field dispensaries, they shared hospitalization and

9

Reports of General MacArthur, 1:28–31; D. Clayton

James, The Years of MacArthur, 3 vols. (Boston:

Houghton Mifflin Co., 1970–85), 2:100–19.

10First quotation from Ltr, Col George W. Rice to Maj

Gen Norman T. Kirk, 14 Jul 43, file 201

Correspondence, Col George W. Rice, 1942–1944,

HUMEDS, RG 112, NARA; remaining quotations from

Interv, Mary Ellen Condon-Rall with Percy J. Carroll, 26

Sep 80, pp. 40 and 55, U.S. Army Center of Military

History (CMH), Washington, D.C. See also Reports of

General MacArthur, 1:28–34; James, MacArthur,

2:100–19, 175. On the organization of SWPA, see

Morton, Strategy and Command, pp. 403–11.

50 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
evacuation facilities with the ground

forces and relied on the Army supply system for medical supplies. By the summer

of 1942 most air combat units operated

out of northern Australia; hence,

Colonel Pazdral divided his organization

into northeastern and northwestern districts, each with a flight surgeon, along

territorial lines corresponding to the

existing base sections. On 3 September

air units in Australia and New Guinea

were amalgamated into the Fifth Air

Force—the new name of the Far East Air

Force—under Maj. Gen. George C.

Kenney. Col. Bascom L. Wilson, MC,

now became air surgeon, and Colonel

Pazdral surgeon of the newly activated

Air Service Command. By the end of the

year the Fifth Air Force’s service, fighter,

and bomber commands each had a staff

surgeon. Flight surgeons often shared in

the attitude of stiff-necked independence that typified many airmen, who

saw their method of waging war as the

wave of the future. “They didn’t want us

to have anything to do with their medical

care,” Carroll said. The air surgeon did

not, however, operate any hospitals,

though small infirmaries were established at the scattered bases.11

So matters stood until February 1943.

Then, in order to relieve General

Headquarters, SWPA, and the USASOS

of administrative responsibilities,

MacArthur on the twenty-sixth reestablished Headquarters, United States

Army Forces, Far East (USAFFE), and

named Carroll to be chief surgeon.

USAFFE’s commander was MacArthur

himself, who had taken this means of

bringing most of the American forces in

the Southwest Pacific Area under his

own direct control. Beneath USAFFE

were the USASOS; the recently arrived

Sixth Army;12 and, after July, the Fifth

Air Force. Now Carroll, who was promoted to brigadier general on 23 June,

could hope to obtain directives on medical problems that would be binding on

all American land and air forces in the

theater. However, in September Carroll

returned to the USASOS when the

Office of the Chief Surgeon, like other

special staff sections, was once again put

under the service forces.

As before, no basic regulation defined

the command relationships between

Carroll, Rice, the air surgeon, and the

Sixth Army surgeon, and only limited

practical cooperation developed among

them. No special staff section was established at General Headquarters to recommend theater medical policy that

would be binding on all Allied forces,13

and no new USAFFE surgeon was named

to guide medical affairs for the American

forces. Medical planning for campaigns

was the work of the surgeons of the

11Quotation from Interv, Condon-Rall with Carroll,

26 Sep 80, p. 44, CMH. See also Air Evacuation Board,

SWPA, “The Medical Support of Air Warfare in the

South and Southwest Pacific, 7 December 1941–15

August 1945,” Report No. 35, sec. 1, vol. 1, pt. 1, pp. 11,

13, file 314.7–2 (Army Air Forces—Medical Services)

SPA, SWPA, and Surg, 5th Air Force, Annual Rpt, 1942,

pp. 2–3, file 319.1–2, HUMEDS, RG 112, NARA;

Armfield, Organization and Administration, pp. 415, 436;

Wesley Frank Craven and James Lea Cate, eds., The

Army Air Forces in World War II, 7 vols. (Chicago:

University of Chicago Press, 1948–58), 1:403–26.

12The Sixth Army reached Australia early in 1943. It

served briefly under Allied Land Forces, headed by an

Australian general, and then, as a separate task force,

under USAFFE for the New Britain campaign. 13In March 1943 MacArthur established the

Combined Advisory Committee on Tropical Medicine,

Hygiene, and Sanitation, composed of a group of

American and Australian specialists, to develop preventive medicine plans and policies for the Allied forces.

The committee functioned as an unofficial staff section

until June 1944. The role of the committee is discussed

later in this chapter. 

A NEW KIND OF WAR 51
INDIAN

OCEAN

SOUTH

CHINA

SEA

USSR MANCHURIA

TIBET

CHINA

NEPAL

BHUTAN

INDIA

BURMA

THAILAND

FRENCH

INDOCHINA

NORTH

BORNEO

AUSTRALIA

PA

SARAWAK

MALAYA

NETHERLANDS EAST INDIES

KOREA

I

PALAU IS

FORMOSA

Singapore

LUZON

MINDANAO

BORNEO CELEBES

JAVA

SUMATRA

NEW G

USSR

PHILIPPINES

LEYTE

SOUTHWEST PACIFIC A R

CBI THEATER

(UNTIL 23 OCT 44)

INDIA-BURMA THEATER

(24 OCT 44)

CHINA THEATER

(24 OCT 44)

ASIAN-PACIFIC

THEATERS OF OPERATIONS

1942–1945

0 1600

Miles at the Equator

120° 140°

80° 100° 120°

0°

20°

40°

80° 100°

MAP 3
PACIFIC

 OCEAN

APUA

USSR Attu

A L E U T I A N I S

HAWAIIAN IS

MIDWAY IS

MARSHALL IS

MARIANA IS

Makin

Iwo Jima

Guam

Truk

CAROLINE IS 

BISMARCK

ARCHIPELAGO

SOLOMON IS

Guadalcanal

UINEA

ELLICE IS

GILBERT IS

Tarawa

R E A

CENTRAL PACIFIC AREA

NORTH PACIFIC AREA

SOUTH PACIFIC AREA PACIFIC OCEAN AREAS

180° 160°

40°

20°

0°

160° 180° 160°
Australian-led ground forces and the

Sixth Army. Medical officers in the field

sometimes received redundant or contradictory directives, and nonmedical officers took advantage of the confusion to

run medical activities as they pleased.

Within the theater, sharp criticisms of

Carroll’s medical policies were common.

Except in areas controlled by the field

forces, fixed hospitals in the theater were

unquestionably under his control. Yet the

chief surgeon consistently underestimated SWPA hospitalization requirements,

seeking first fixed beds equal to 9 percent

of the troop strength in 1942, later 11,

and finally 12 percent, while the surgeon

general preferred 15 percent. In a theater beset by disease he followed

pre–World War II practice by failing to

establish a separate preventive medicine

section (Chart 1). He shuffled hospital

commanders about, causing anger and

resentment. An extremely hard worker,

he did not always use his time with discretion. Despite the vast size of the theater, Carroll made few trips to the field;

attempted to run affairs from his own

office; and tended, at least during 1942,

to keep his officers, including himself,

deskbound. He seemed suspicious of the

consultants sent to him by the surgeon

general; a year or more passed before he

used them fully as clinical teachers and as

conduits of information between himself

and medical officers in the field. One

probable effect was to intensify the suspicions of the newly inducted civilian physicians toward Regular Army doctors, for

whom they already possessed little

enough professional respect.14

Carroll’s difficulties apparently

stemmed in part from his own nature

and background, and in part from that

of the theater he served. Organization

in General MacArthur’s theater was seldom clear, and headquarters politics

were complex at best. Carroll’s problems may have been due in some measure to an otherwise admirable lack of

ego and a talent for intrigue, both of

which were needed to define his position when the organization charts

deprived it of formal authority. As the

following will make clear, his contribution to the growth of the medical service

in the Southwest Pacific Area was

nonetheless immense.

The Australian Base

Problems of command soon influenced the relations that developed

between the increasing numbers of U.S.

forces stationed “down under” and their

Australian hosts.15 Troops of the Pensacola

convoy—and those who followed them—

found the Australians friendly, not only

because of the common language and

similar cultural backgrounds but also for

reasons of self-interest. With Australian

forces fighting for the British Empire in

North Africa and elsewhere, the

Americans were the nation’s best guarantee against Japanese attack.

14Memo, Col William L. Wilson to Gen Kirk, 20 Oct

43, sub: [Observations and Facts Obtained During Visit

to SWPA], pp. 3–6, and encl. 1, file 333 (Visit of Col

Wilson to SWPA) 1943; Interv, Col S. Alan Challman, 13

Sep 45, p. 5, file 000.71; Interv, Lt Col Gottlieb L. Orth,

54 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

12 Jun 47, file 000.71. All in HUMEDS, RG 112, NARA.

See also Henry M. Thomas, Jr., “Southwest Pacific Area,”

in W. Paul Havens, Jr., ed., Activities of Medical

Consultants, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1961), pp. 482–84. 15Unless otherwise indicated, section drawn from

Eugene T. Lyons, “Australia and New Zealand,” in Ebbe

Curtis Hoff, ed., Civil Affairs/Military Government Public

Health Activities, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1936), pp.

533–64.
As large as the United States but thinly settled (about 7.5 million population

in 1941), Australia possessed diverse

environments, natural and artificial.

The cities of the eastern coast, including

Melbourne, Sydney, Canberra, and

Brisbane, resembled other urban areas

of the developed world to which, despite

geography, they belonged. Much of the

interior and the land to the west, however, were almost without population,

the scattered settlements resembling

those of the contemporary American

Southwest. Confusing to Americans

were the seasons (those on the Pensacola

convoy left home in late autumn and

arrived in Brisbane as summer began)

and the fact that in Australia the tropics

lay toward the north. 

Distances, too, were reminiscent of

the American West, but Australia’s transport network and industrial base were

less developed. A nation built on the

herding industry, it was far from being

self-sufficient in manufactured goods,

and even in some foodstuffs. In public

health the nation showed variations as

wide as the contemporary United States,

advanced in the cities but primitive in

remote and poor regions. The war and

A NEW KIND OF WAR 55

Dental Supply Nursing Personnel

Veterinary Evacuation Hospitalization Consultants

Veneral Disease

Control

Sanitation and

Medical Records

Deputy Chief Surgeon

Chief Surgeon

CHART 1—ORGANIZATION OF THE OFFICE OF THE CHIEF SURGEON, USASOS, SWPA, 

JANUARY 1943

Source: Adapted from Rpt, CSurg, USASOS, SWPA, 1 Jan 43, sub: Medical Service in Australia, p. 2, file 319.1–2, HUMEDS, RG

112, NARA; Thomas, “Southwest Pacific Area,” in Havens, ed., Activities of Medical Consultants, pp. 477–78.
the tropics both lay close to Australia’s

northern and northeastern shores, and

towns and countryside alike proved

unready to support a vastly increased

population of strangers. 

Clearly, in early 1942 cooperation was

needed among American medical personnel, their Australian military counterparts, and the civil authorities. But the

weakness of the command structure

made such cooperation on a national

level difficult to achieve. Instead, civil

affairs administration tended to shift

downward to the level of the base section, or even of the local camp or airfield. Increasing this tendency toward

local solutions to health problems was

Australia’s political structure, which, like

that of the United States, was federal in

form, with self-government characteristic of not only the six states but also the

local cities, towns, boroughs, and shires

(the last closely resembling American

counties). Base section surgeons, often

working with no more than a few enlisted assistants, opened dispensaries, found

medical supplies, established relationships with local hospitals and public

health officials, and endeavored to survey health conditions over areas of countryside sometimes equal to several large

American states. Fortunately, in April

additional medical, dental, and veterinary officers arrived from the United

States to staff the various base sections,

bringing them up to adequate levels.

Aided by the new arrivals, base section surgeons focused their efforts on

preventive medicine to control communicable diseases, especially malaria and

dengue; to improve waste disposal,

water supply, and the processing of

foodstuffs; and to suppress venereal disease (VD). Malaria resisted local control, for the movement of troops made it

a national public health issue. But such

problems as tuberculosis, in milk cattle,

and venereal disease lay within the

domain of state and territorial governments, and those of waste disposal and

water supply within that of local town

councils. In the absence of a theaterlevel preventive medicine officer, base

section surgeons sought out Australian

military surgeons and formed local committees to investigate health problems

afflicting both armies—the Allied

Services Health Council in Perth, for

example, and the Cooperative Allied

Sanitation Committee in Townsville. In

such groups every unit in the area was

represented, and military police officers

sometimes sat in with the medics.

However, planning by such groups

was not enough in itself to bring about

needed changes, nor was the cooperation of the civil government always

freely given. Sometimes, when wells had

to be dug, marshes drained, cattle

inspected, and anti-VD campaigns

mounted, labor and funds also were

required. Often, poor and remote villages were unable, or unwilling, to make

improvements but were quite amenable

to the Americans doing so, provided

that they paid all costs. The Army engineers were sometimes called upon to

dig drains, or at least to furnish the

equipment. The locals’ reasoning was

that outhouses and shallow wells had

presented no threat to health until the

hordes of American troops arrived.

Even in Rockhampton, a town of 35,000

that served for a time as the I Corps

headquarters, most residents refused to

screen their windows, preferring maximum ventilation, even though Aedes

mosquitoes and the dengue that they

carried were both present in the area.

The corps and the 1st Evacuation

56 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Hospital had to provide mosquito control personnel and undertake a program without local assistance.16

The Medical Department’s Veterinary

Corps played a substantial role in the

American exploitation of Australian

food sources. The early days of World

War II found Army veterinarians somewhat uneasily balanced between their

longstanding duty of caring for animals

and their newer duty of food inspection.

Animals were still important in moving

the Army, especially under the conditions of the Pacific war. Australia was the

main source of horses for two theaters,

the Southwest Pacific Area and the

Navy’s South Pacific Area; during 1942

alone, over 2,500 were shipped to the

South Pacific Area, and all required

examination and care. Veterinary officers—only twenty-five arrived in the

Southwest Pacific Area during the year,

plus nine enlisted men—found inspection of meat and dairy products surprisingly difficult in such a great livestockraising country. The milk supply was

deficient both in quantity and quality,

and milk that could have been rated

Grade A by U.S. standards was unobtainable. Testing of cattle for tuberculosis was spotty and public health supervision of farms and pasteurizing plants

inadequate. Meat produced for export

was carefully examined, but meat for

Australian Army rations—which, in the

beginning, American troops shared—

was often of the poorest quality.17

In attempting to change the practices

of their Australian hosts, veterinary officers employed both leverage and assistance. During 1942 U.S. troops ate their

own field rations or Australian Army

rations, but by early 1943 they consumed food purchased directly from

local sources. As a result, veterinary officers were able either to impose U.S.

standards or, if these were not complied

with, to deny future contracts. A canceled contract, however, produced no

food, and producers normally were anxious to secure future business. Hence,

both sides had strong incentives to compromise on their differences. Assured of

higher standards, veterinary officers

offered producers their assistance in

procuring pasteurizing equipment and

similar essentials. Opposition to change

on the part of the Australians usually

arose not from a reluctance to raise standards but from a shortage of men and

materials in a country whose small population and undeveloped resources

were overcommitted to the war effort.

Venereal disease control was both

national and local. In May 1942, with

most U.S. military personnel still

encamped nearby the ports of entry, the

VD rate reached what proved to be a

highpoint in Australia, 45.8 per 1,000

troops per annum. In these pre-penicillin days the problem was a serious one

for the Army; even uncomplicated cases

of gonorrhea required an average of

thirty days of hospitalization for each

patient. Hence, though the incidence

was not remarkable by comparison with

other early wartime rates among

American forces (the 1940 rate for the

entire Army had been 42.5, before an

anti-VD campaign brought it down), the

rise evoked an effective reaction both

from Americans and Australians. A

16Surg, I Corps, Annual Rpt, 1942, p. 18, file 319.1–2,

HUMEDS, RG 112, NARA. 17CSurg, SWPA, Annual Rpt, 1942, pp. 24–26, file

319.1–2, HUMEDS, RG 112, NARA; Everett B. Miller,

United States Army Veterinary Service in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1961), pp. 312, 318–20, 499.

A NEW KIND OF WAR 57
venereal disease control section was

organized in Carroll’s office in July 1942

under Lt. Col. Ivy A. Pelzman, MC.

Control officers were appointed in every

base section. Support of local public

health officials and local police was, of

course, essential. Some habits appeared

paradoxical; prostitution was legal in

Australia, and yet prudery made candid

discussion of the problem difficult.

Nevertheless, information campaigns

were developed, sometimes using

posters and bulletins printed in the

United States. Prophylactic stations were

set up in cities and towns frequented by

troops, and Americans and Australians

freely used each others’ facilities.

Infected soldiers were required to give

full information about their sexual contacts, and the provost marshal turned

over the information to an Australian

magistrate, who issued an order to the

civil police to take the woman into custody for examination. If infected, she

was held and treated until well.

Efficiency varied from place to place,

but by the end of the war 50–95 percent

of contacts were being traced. The

result of the cooperative endeavor—and

the movement of many men to remote

areas or the fighting front—was a

remarkable fall in the VD rate among

American troops to 4.2 per 1,000 per

annum by November 1944, a 90-percent

decline from mid-1942.18

Malaria was a serious threat to

Australia, not only because of the infected refugees from the East Indies and the

Philippines but also because of the

increasing operations by American and

Australian troops in New Guinea during

late 1942. Even in the early part of the

year a present menace existed, with a

larger one predictably to follow when soldiers returned from the fighting zone for

rest and retraining. Yet custom was strong

and the Australian government showed

little concern until May, when three original—that is, locally acquired—cases

showed up among American troops in

Townsville, a community in the northeastern state of Queensland, and fifty-two

more among civilians in nearby Cairns.

Australian citizens were concerned that

malaria-infected soldiers returning from

Guadalcanal and Papua to hospitals in

Queensland would spread malaria in epidemic proportions throughout the continent. Malaria was fast becoming a political as well as a military problem, one that

civil and military authorities had ample

cause to cooperate in solving.

Col. N. Hamilton Fairley, AMC, a specialist in tropical medicine with the

Australian Army Medical Corps,

presided at a series of meetings called by

alarmed officials in 1942, at which

experts from the military and the states

of Queensland and New South Wales

discussed the problem with representatives of the Army Medical Department.

An informal committee was established

that investigated reports of epidemics,

developed plans, and carried out control measures through a melange of

agencies, military and civilian. Soldiers

of both armies worked to drain mosquito breeding grounds, to resettle the

infected aboriginal population, to treat

cases as they occurred, to evacuate

recurrent cases to nonmalarious areas,

and to ensure that military personnel

18Thomas H. Sternberg, et al., “Venereal Diseases,” in

Ebbe Curtis Hoff, Communicable Diseases Transmitted

Through Contact or by Unknown Means, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

1960), pp. 285–87. On VD in the Army, see also Allan

M. Brandt, No Magic Bullet: A Social History of Venereal

Disease in the United States Since 1880 (New York: Oxford

University Press, 1985), p. 170.

58 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
took suppressive drugs and used mosquito netting.

By October, however, further action

was needed, for the New Guinea fighting caused theater disease rates to

soar. With an epidemic in progress,

Parliament, alarmed by the return of

heavily infected Australian troops,

ordered an investigation. The danger

that mosquitoes would spread malaria

to civilians was acute. In November the

Australian Army’s director of hygiene

proposed that troops returning from

the fighting zone be barred for six

months from Australia north of the

nineteenth parallel until all recurrent

cases had been detected and sent to

hospitals. In December General

Headquarters, SWPA, adopted the recommendation, hoping by a continental

quarantine to prevent the epidemic

from spreading in the troop-staging

areas of tropical Australia, where the climate and the plentiful anophelines

most favored the disease. Despite all

measures, malaria rates were high, by

the end of the year reaching 500 cases

per 1,000 troops per annum in the

Southwest Pacific Area as a whole and

1,500 or more in New Guinea.19

Meanwhile, Colonel Fairley had traveled to Washington and London

between September 1942 and January

1943 to obtain antimalarial supplies

(including drugs, mosquito netting, and

insect spray) that were either not manufactured in Australia or were of poor

quality. Fairley persuaded service and

civilian medical authorities of the imminent dangers of malaria in the

Southwest Pacific and obtained promises of antimalarials from both the United

States and Great Britain. It was during

Fairley’s Washington visit that the Office

of the Surgeon General, which had

been studying the problem of malaria

control in areas where the U.S. Army

was to operate, recommended that

malaria control organizations be

formed in overseas theaters. On 24

October 1942 Surgeon General Magee

invited General MacArthur and other

theater commanders to submit, without

delay, requests for the additional military and sanitary personnel needed to

control malaria.20

After a period of organizing and

training in the United States, the first

malaria survey and control team arrived

in the Southwest Pacific in February

1943. The early months of 1943 also saw

a marked improvement in efforts to

prevent disease of all sorts, including

malaria. In March General MacArthur

set up, under Fairley, the Combined

Advisory Committee on Tropical

Medicine, Hygiene, and Sanitation, a

group of American and Australian specialists with broad authority to develop

plans and policies to be followed by all

Allied forces. MacArthur implemented

most of the committee’s recommendations by directives to the troops. (Before

the committee disbanded in June 1944,

19On disease rates in various theaters, see ASF [Army

Service Forces] Monthly Progress Rpt, 28 Feb 43, sec. 7,

p. 5, The Historical Unit (THU) Note Cards, Historians

files, HUMEDS, RG 112, NARA. The highest disease

rates worldwide continued to be recorded in the North

African theater, which showed 8,516 cases per 1,000

troops per annum in August 1943; see Justin M.

Andrews, “North Africa, Italy, and the Islands of the

Mediterranean,” in Hoff, ed., Communicable Diseases:

Malaria, p. 262. On rates in the Southwest Pacific Area,

see CSurg, SWPA, Annual Rpt, 1942, pp. 1–4, file

319.1–2, HUMEDS, RG 112, NARA.

20Mary Ellen Condon-Rall, “Allied Cooperation in

Malaria Prevention and Control: The World War II

Southwest Pacific Experience,” Journal of the History of

Medicine and Allied Sciences 46 (Oct 91): 496–97. 

A NEW KIND OF WAR 59
MacArthur issued fifteen directives,

fourteen of which dealt with malaria.)

The measures that were adopted

ranged from raising shipping priorities

for antimalarial supplies to the specification of new insecticides for use in the

Southwest Pacific. Committee members

contacted division and base surgeons

and tactical commanders to explain the

directives, which became the basis for

appropriate orders issued by the Allied

armies. Acting on behalf of the committee, the Australian members also maintained contact with civil authorities,

who by this time were thoroughly

aroused to the dangers of malaria and

vigorously protested the presence of

any malarious soldier north of the nineteenth parallel. 

Because of the deficiencies in the

SWPA staff structure, the committee,

with its direct access to MacArthur, gradually assumed the role of a preventive

medicine section for the entire theater.

As such, its relations with Rice tended to

be good and with Carroll less than satisfactory. The fact was plain that by the

decision or whim of the commander-inchief, this ad hoc group exercised powers that were denied to both claimants

to the role of chief surgeon.21

Other diseases were far less serious

than malaria. In April 1942 an outbreak

of jaundice brought 2,400 hospital

admissions and 4 deaths to U.S. soldiers

in Australia. The cause was serum

hepatitis, spread by contaminated yellow fever vaccine—a worldwide phenomenon among American military

personnel at the time. Other problems

included respiratory diseases in the

southern state of Victoria, a cold and

unpleasant place for living in tents during the winter months of July and

August. Yet, overall, and despite the

malaria epidemic, disease rates for

troops in Australia remained generally

comparable to those in the United

States. In terms of mortality, none was

greatly significant; the chief killer was

war, for 67 percent of all deaths of

American soldiers in the theater during

1942 resulted from enemy action.22

All in all, both Americans and

Australians seem to have benefited from

their association in public health during

1942–43. Australia received a strong

stimulus to upgrade food treatment that

had evident advantages for its own army

and people; the United States found a

base among Allies who grasped the

essentials of preventive medicine and

wanted mainly equipment and labor,

which Americans were ready, in many

cases, to supply. By confronting the formidable distances in Australia and by

meeting the challenge of malaria, U.S.

forces gained useful experience, for few

medical problems throughout the

Pacific war were to be as persistent as

these. Finally, despite the difficulties of

the command setup, Colonel Carroll was

able, during 1942, to embark on important changes aimed at adapting the

structure of Army medicine—designed

for conventional warfare on land—to

the kind of warfare that lay ahead.

21Thomas A. Hart and William H. Hardenbergh,

“The Southwest Pacific Area,” in Hoff, ed.,

Communicable Diseases: Malaria, pp. 536–42; CondonRall, “Malaria Prevention and Control,” pp. 499–504.

Apparently, good relations were maintained with Rice

by personally consulting him before the committee

made its decisions on medical policy. The same courtesy could not be extended to Carroll because of the

physical distance of his office in Sydney.

22CSurg, SWPA, Annual Rpt, 1942, pp. 1–6, file

319.1–2, HUMEDS, RG 112, NARA. Eighty percent of

all combat deaths occurred in December, skewing the

proportion for the year as a whole.

60 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
The Base Sections

The number of Allied forces in

Australia grew slowly but steadily. The

increase in medical personnel, however, never kept pace with the total

increase in Army forces, for shipping

priority went first to combat troops.

The shortage was made worse by the

unavoidable dispersion of medical personnel into the various base sections, to

small units, and to camps in remote

locations. In the early months of the

war the need for medical personnel was

most apparent in the hospitals and

field units. The pressure eased somewhat with an influx of hospital units in

June 1942, but September brought new

problems when they lost 10 percent of

their personnel for the development of

portable hospital units.23 At the end of

the year the majority of medical units

in the Southwest Pacific Area were still

operating below strength. The shortage

persisted in 1943 despite the fact that

the number of medical personnel

increased approximately 2.5 times during the year.24

The Southwest Pacific Area’s service

command formed the only part of the

growing military establishment where

the chief surgeon’s technical authority

was unquestioned. After July 1942 the

USASOS had a total of seven base sections, territorial commands that covered

the entire Australian continent. Their

boundaries corresponded roughly to

those of the six states, with Queensland,

lying in the far northeast closest to New

Guinea and the battle zone, divided into

two. The base sections provided hospital

care for the troops stationed in them

and for evacuees from the fighting, and

featured a system of medical supply

depots through which materiel received

in the east coast ports reached the field

forces. By late 1942 American troops

had been shifted in great numbers to

the northern areas of Australia. In consequence, the most active logistical commands were Base Section 1, comprehending the Northern Territory and

fragments of two states, and Base

Sections 2 and 3, which divided most of

Queensland (see Map 4).

For Base Section 1 the headquarters

was established at Darwin, the closest

port to the Japanese. The town was

small and undeveloped, and possessed

no railway connections to other

Australian cities. A road and a railway

line ran south to the village of Birdum,

where the tracks ended. Thence, rutted

dirt roads led across some of the most

forbidding parts of the Outback: south,

to Alice Springs, near the geographical

center of the country; and southeast, to

the isolated town of Mount Isa, terminus for a railroad that ran east to the

port of Townsville. The section’s greatest diameter was about 1,000 miles.

Mostly AAF personnel served at airfields strung along the road and rail

corridor, from which pilots attacked

Japanese shipping and supported Allied

operations in New Guinea.

The Japanese were also interested in

Darwin. On the morning of 19 February

23The development of portable hospital units is discussed later in this chapter. 24CSurg, SWPA, Annual Rpt, 1942, pp. 16–19, and

CSurg, USASOS, SWPA, Annual Rpt, 1943, p. 13, file

319.1–2, HUMEDS, RG 112, NARA; Strength of the Army,

1942, 1943. In December 1942 the Army was authorized

6.5 physicians per 1,000 troops in overseas theaters; one

year later the ratio was reduced to slightly less than 6.

The enlisted strength of the Medical Department was

set at 7 percent of total Army strength. See John H.

McMinn and Max Levin, Personnel in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 69–91.

A NEW KIND OF WAR 61
1942 waves of enemy bombers, divebombers, and fighters attacked the town,

sinking the ships at anchor, demolishing

the wharf, and damaging the nearby

Royal Australian Air Force field and

many private homes. A 2,000-pound

bomb hit the American wing of the local

hospital, and Australian military hospitals were strafed and bombed. In the

aftermath the base section command

abandoned Darwin; its small medical

section evacuated American patients to

Australian hospitals in outlying towns.

All was in confusion, for the medical service had “no organization . . . no definite

plan of action” and, as yet, little formal

62 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

WESTERN AUSTRALIA

NORTHERN TERRITORY

SOUTH AUSTRALIA

QUEENSLAND

NEW SOUTH WALES

VICTORIA

TASMANIA

Perth

Darwin

Townsville

Brisbane

Canberra Sydney

Melbourne

Adelaide

Port Moresby

INDIAN 

OCEAN

INDIAN 

OCEAN

CORAL

SEA

Gulf of

Carpentaria

ARAFURA SEA

Advance base headquarters

Section boundary

0

Miles

500

Australian Base Sections

September 1942

Base section headquarters

1 2

3

4

5

6

7

MAP 4
collaboration existed between the two

Allies.25

Base Section 1 headquarters moved

12 miles south to the village of Birdum,

where for a time the medical section

worked on the open porch of the local

hotel. Using available personnel, a field

hospital of forty beds was improvised

nearby an Australian field ambulance.26

The first substantial hospital was the

work of a field unit, the nondivisional

135th Medical Regiment, which dispatched both a clearing company and

an ambulance company from Mount Isa

to care for American troops. The medical convoy rolled for 758 miles over a

rutted road so dusty that the vehicles

kept an interval of 1 mile “to obtain adequate visibility because of the dust,” and

on arrival set to work. The platoons built

Coomalie Creek Hospital from the

ground up, using waterpipe obtained

from Darwin and plumbing fixtures

from “wherever they could be found.”

Showers, latrine buildings, and mess

halls were fabricated of saplings and

bamboo. Fourteen tents held the wards.

The hospital served the 49th Fighter

Group, the 71st Bomber Squadron, base

section personnel, and a melange of

engineer, quartermaster, artillery, and

antiaircraft units.27

The medics at Base Section 1 found

much to do. The airmen suffered an epidemic of dengue, and dysentery was

common, brought on by polluted water.

They had little fresh food, eating

canned leeks, canned beetroot, and

canned cabbage to the point of nausea.

Heat was intense, reaching 140oF. in

summertime; in the dry season the red

dust was deep, turning to gluey mud in

the wet; flies, mosquitoes, and ants

abounded. Local civilians were casual

about public health. Farmers and town

dwellers alike used outhouses and drew

their water from shallow wells, and milk

was commonly unpasteurized. The

refugees infected with malaria exacerbated conditions. Once bitten by

anophelines in the area, the stage was

set for a rapid rise in the disease. 

Exhausted quartermaster drivers, like

their trucks, broke down on the interminable dirt tracks, and small medical

detachments pitched tents at the bores,

or wells, where men and vehicles alike

stopped to take on water. One such

detachment worked in a basin surrounded by rocky hills, sparsely covered

with scrubby eucalyptus trees and dead

spinifax grass. Flies were numerous and

showed “a peculiar affinity for the eyes,

ears, nose, and mouth.” The incessant

wind whipped the dust into small

cyclones the Australians called

“Whirlies.” Amid the blowing dust, the

cleanliness needed for medical procedures was difficult to attain, and tent

ropes and pegs needed constant atten25Quotation from Surg, Base Sec 1, Historical Rpt,

Jan–Sep 42, p. 3 (see also p. 2), attached to Gottlieb L.

Orth and John A. Gallogly, comps., “Medical History of

Base Section No. 1,” file 319.1–2 (Base Section 1)

1942–1944, HUMEDS, RG 112, NARA. Also in the

HUMEDS collection, see Surg, 5th Air Force, Annual

Rpt, 1942, pp. 1–3, file 319.1–2. In April 1942 all civilians were evacuated from Darwin, which became a military reservation. 26The Australian field ambulance was equivalent to

an American aid station. 27Quotations from Surg, 135th Med Regt, Annual

Rpt, pp. 26 and 28 (see also pp. 25, 27, 29), THU Note

Cards, Historians files, HUMEDS, RG 112, NARA. The

base section headquarters moved to the hamlet of

Adelaide River in July; a year later, however, a hospital

of 125 beds, the largest between Mount Isa and Darwin,

still functioned near Birdum. See Surg, Base Sec 1,

Quarterly Rpt, Jan–Mar 43, p. 1, attached to Orth and

Gallogly, comps., “Medical History of Base Section No.

1,” file 319.1–2 (Base Section 1) 1942–1944, HUMEDS,

RG 112, NARA.

A NEW KIND OF WAR 63
tion if the whole camp was not to blow

away. The drivers called the Mount

Isa–Birdum road “The Burma Road of

Australia,” and while they counted no

battle casualties they did suffer an extraordinarily high syphilis rate, presumably

because they spent their paychecks

freely on the prostitutes of Mount Isa, a

raucous mining town of 3,500.28

Evacuation from Base Section 1

depended on regular Qantas flights, on

military aircraft, and on flying boats

that carried casualties from Darwin to

Brisbane. Air ambulances—presumably

light planes, whose use was made necessary by the great distances and the

roughness of the corrugated roads—

brought patients from the hospitals to

airfields or the Darwin harbor, and

alert medics kept an eye out for any

empty space on outgoing aircraft that

might hold a patient. The pace of hospital construction also quickened, as

the Americans brought in a sawmill

and began to turn out lumber, hitherto

unobtainable. Some 3,000–4,000

troops moved in during the spring of

1942; by midyear there were 7,700 plus.

As American hospital units entered

Australia, personnel at the base section

increased. Hospitals often were divided, to serve the scattered camps, the

overnight stations along the supply

routes, and the airfields and other

installations that now dotted the vast

region. Medical supply depots followed

the same trend, dividing and subdividing to reduce the cost in time, wear,

and fuel that travel entailed. Yet as the

end of the year approached, the base

section surgeon noted in his diary that

his office, located in the dispensary

tent, still consisted of one desk and one

table and his staff of one officer and

one enlisted man “who may shortly be

transfered [sic].”29

If this was bush medicine at its most

frontierlike, the two base sections that

shared the state of Queensland grew

more rapidly, received a heavy influx of

casualties from New Guinea, and built

up, before the year was over, an elaborate organization of fixed hospitals to

serve them. In mid-1942 Base Section 2

was responsible for New Guinea casualties as well as for the 17,597 troops stationed within its Australian boundaries,

but in August the Advance Base was

formed at Port Moresby on Papua to

support the forces operating north of

the Torres Strait. Base section hospitals

varied from tiny sections operating in

remote towns to larger establishments

along the main evacuation route. The

12th Station Hospital in Townsville—

which functioned, in fact, as an evacuation hospital—occupied twenty-five private homes, covering a city block in a

residential suburb. The commander

took pride not only in his well-appointed wards but also in his new morgue,

with a refrigerator box, and the graduate embalmer he had located. A dramatic influx of casualties began about 1

December, overworking the medics and

embalmer, and led quickly to further

expansion of the hospital. The end of

1942 found the base section’s medical

28Med Dept Det, 29th QM Truck Regt, Quarterly Rpt,

Oct–Dec 42, p. 1, file 314.81 War Diary, 1 Jul 42–30 Jun

43, HUMEDS, RG 112, NARA.

29Quotation from Surg, Base Sec 1, Confidential

Diary Summary, 23 Dec 42, p. 1, attached to Orth and

Gallogly, comps., “Medical History of Base Section No.

1,” file 319.1–2 (Base Section 1) 1942–1944, HUMEDS,

RG 112, NARA. In the same document and file, see

Surg, Base Sec 1, Med Sit Rpt, 18 Jun 42, p. 2. See also

Rpt, OofSurg, USAFIA, 1 Jun 42, sub: Status of

Evacuation in Australia, file 370.5 Air Evacuation

Reports, SWPA, 1942, HUMEDS, RG 112, NARA.

64 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
establishment large and thriving, with

one general hospital, five station hospitals, a field hospital, and eight portable

hospitals, as well as a medical supply

depot. Hospital personnel served in

locations that ranged from suburban

Townsville to the evocatively named settlement of Kangaroo Dump, where

Dispensary D worked from 7 August

1942 until 22 September 1944.30

Similarly, Base Section 3 grew rapidly

after its formation in January 1942 to

serve 10,973 troops already in the area.

By spring of 1943 it controlled two general hospitals, two evacuation hospitals,

two surgical hospitals, eight portables,

the 3d Medical Laboratory at Brisbane, a

medical supply depot, a total of over

2,500 beds, and nearly 1,800 patients.

Here too, life was fairly comfortable in

the hospitals but much less so for small

detachments in the bush. Near

Rockhampton the 33d Surgical Hospital

suffered through heavy summer rainfall

and flooded latrines. But its personnel

floored the wards to protect patients

from the wet, as well as landscaped the

grounds with fresh plantings, rustic

fences, and arches that gave the area a

pleasant parklike appearance. Dengue,

malaria, and a variety of skin diseases

were the main medical problems, while

hernias, appendectomies, and infected

wounds of various sorts kept the surgeons occupied. The Red Cross showed

movies at the hospital, and weekly

dances were held at the officers club on

Friday evenings. The hospital baseball

team played for the hotly contested

30Surg, Base Sec 2, Historical Rpt, Jan–Dec 42, pp. 7,

12, and Ltr, Surg, Base Sec 2, 18 Apr 42, in Surg, Base

Sec 2, Quarterly Rpt, Apr–Jun 42, pp. 1–2, THU Note

Cards, Historians files, HUMEDS, RG 112, NARA. 

A NEW KIND OF WAR 65

DISPENSARY AND AMBULANCE IN THE AUSTRALIAN BUSH
championship of a league set up by

American units. Afternoon teas marked

the commander’s birthday and officer

promotions. A world away in the bush

was a detachment undergoing intensive

training with a field artillery battalion,

whose camp, pitched in a swamp, turned

to a morass during the heavy rains.31

Dental as well as medical care was

provided to the troops through the base

sections. A dental officer joined the

staff of each base section surgeon and

set up a clinic at the headquarters as

well as a dental laboratory, where the

few available technicians made prostheses. The difficulty of shipping large

items from the United States meant that

cabinets and dental chairs had to be

bought from local manufacturers. Most

of the year was given over to establishing the clinics and doing routine

work—dental surveys of the troops,

examinations, and fillings. Toward the

end of 1942, however, wounds of the

jaws and face appeared among the casualties returning from New Guinea, and

these went to specialists in oral surgery

who worked in the large fixed hospitals.

The familiar SWPA medical pattern of

the skilled few caring for large numbers

of troops spread over a vast area was

especially true of dentists; at the end of

1942 only 187 dental officers, scattered

over Australia and New Guinea, were

providing service to more than 100,000

soldiers, themselves divided among

many units and small posts.32

Army nurses were slow to appear in

the base section hospitals. In 1942 nurses entered Australia in the same piecemeal fashion as other medical personnel. On the Mactan with Colonel

Carroll was Lieutenant Fellmeth, who

became the first chief nurse of the new

USAFIA command. However, on 12

April Capt. M. Jane Clement reported

for duty in Melbourne and succeeded

Fellmeth in the same fashion as Carroll

had taken over from Rice. Meanwhile,

however, substantial numbers of nurses, many of them well trained professionally but ignorant of Army ways and

lacking even uniforms, had begun to

arrive—238 at Melbourne in February;

78 more at Brisbane in early April; and

a few days later another 265 at

Melbourne, accompanying hospitals

that disembarked at the same time.

Twenty-one more, evacuees from the

Philippines, arrived in May, but their

physical condition was such that all save

3 were sent home. In June a dozen hospitals made port with their complements, including more than 500 nurses. Problems in adapting to life in

Australia were many. The women’s

clothing, for example, was clearly inappropriate for the bush or jungle, and

the chief nurse’s office designed new

field uniforms that featured slacks and

culottes.

At first, reluctance on the part of the

chief surgeon to detail women to the

northern camps resulted in hospitals

losing their nurses, who stayed in quarters at Melbourne. The women, unable

to do their jobs, were unhappy and the

hospitals were deprived of essential

workers. But by summer many were

assigned to remote stations, including

the dismal ones at Cloncurry and

Mount Isa. “The flies swarmed like

3133d Surg Hosp Quarterly Rpt, Jan–Mar 43, pp. 1–4,

and Med Dept Det, 148th FA Bn, Quarterly Rpt,

Oct–Dec 42, p. 2, file 314.81 War Diary, 1 Jul 42–30 Jun

43. See also Surg, Base Sec 3, Historical Rpt, Oct–Dec

42, pp. 2–3, file 319.1–2 (Base Section 3) 1942–1943. All

in HUMEDS, RG 112, NARA. 32CSurg, SWPA, Annual Rpt, 1942, pp. 20–21, file

319.1–2, HUMEDS, RG 112, NARA.

66 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
bees,” reported Captain Clements after

an inspection trip, “the dust was ankle

deep, and the ants were innumerable.”

When the New Guinea fighting grew in

intensity, new doubts assailed the Army

Medical Department about sending

female nurses to the embattled primitive island. But in October 1942 the

nurses of the 153d Station Hospital

arrived in Port Moresby, working there

with such success that nurses of other

hospitals followed. Ankle-deep mud

and tropical rains succeeded the arid

Australian bush. But the women proved

more durable than even the chief nurse

had anticipated, bringing scientific care

to the wounded and a boost to morale

as well.33

The base sections were Carroll’s

demesne in the feudal world of the

Southwest Pacific Area. Beginning 1942

as the target of enemy attacks, at least in

the far north, they had found by the

year’s end their true role as parts of a

communications zone that comprehended the entire Australian continent,

but especially its eastern and northeastern coasts. The system provided indisA NEW KIND OF WAR 67

33CSurg, USASOS, SWPA, Annual Rpt, p. 21, file

319.1–2, HUMEDS, RG 112, NARA. Conditions in New

Guinea are treated extensively in Chapter IV.

ARMY NURSE WEARING THE NEW FIELD UNIFORM
pensable support to the operations that

began in New Guinea during

September. The services of the base sections went beyond backup: As will be

seen, their hospitals fathered many of

the units that accompanied the troops

into battle.

Hospitalization and Evacuation

During 1942 an array of Army hospitals sprang into being like an Arabian

Nights city. But more work than magic

went into the achievement. In the early

days, when troop strength was at a minimum, providing hospitalization for the

sick and injured meant dependence on

the Australians—on not only their military but also civilian hospital system. As

early as 15 January the Australian government’s Administrative Planning

Committee agreed to furnish supplies

and hospitalization from either military

or civilian sources for three to four

months, and longer if necessary.

Through the assistance of a joint U.S.-

Australian Hospitals Subcommittee and

the surgeon general of the Australian

Army, Colonel Carroll arranged for the

temporary hospitalization of soldier

patients in Australian military facilities.

Some soldiers were treated in civilian

hospitals, though the chief surgeon preferred to avoid doing so because of the

problems involved in paying private

physicians. In March the USAFIA set up

the Committee on the Adaptation of

Australian Materials and Supplies, of

which Colonel Littell was a member, to

explore ways of “utilizing to the maximum the existing productive capacity of

Australia without sacrificing the health,

comfort or identity of the U.S. Army.”

Americans paid for Australian goods

and services through a lend-lease

arrangement, and the two Allies determined the charges for medical treatment on a reciprocal basis in either of

their hospitals.34

But the chief surgeon wanted to establish U.S. Army hospitals to take care of

American troops wherever it was possible. He anticipated that about 100,000

troops would arrive during 1942, for

whom beds must be provided on a 9-percent basis. In search of the requisite

9,000 beds, he first sought to obtain

existing buildings—schools, resort

hotels, private houses, and civilian hospitals—to be converted into military medical facilities. He soon discovered, however, that the alteration of existing buildings was costly and, for the most part,

unsatisfactory. (The plant of the new

Royal Melbourne Hospital, given outright to the 4th General Hospital by the

Australians, was a much appreciated

exception to the rule.) Carroll came to

prefer construction of the standard

Army fixed hospital. But such work

required time, labor, and materials that

were in short supply. Meanwhile, the

influx of U.S. personnel and equipment

began. Apparently, the first Army hospital to operate in Australia was the 153d

Station Hospital, which arrived at

Brisbane on 9 March and, after receiving

permission to occupy the Queensland

Agricultural High School and College

34Quotation from Memo, Col B. M. Fitch, AG,

USAFIA, to Gen and Spec Staff Secs, USAFIA, 24 Mar

42, sub: Committee on Adaptation of Australian

Materials and Supplies, THU Note Cards, Historians

files, HUMEDS, RG 112, NARA. See also Interv,

Condon-Rall with Carroll, 26 Sep 80, CMH; Alan S.

Milward, War, Economy and Society, 1939–1945 (Berkeley:

University of California Press, 1977), pp. 172, 200, 276,

355; E. Ronald Walker, The Australian Economy in War

and Reconstruction (New York: Oxford University Press,

1947), p. 147; Lyons, “Australia and New Zealand,” in

Hoff, ed., Civil Affairs, pp. 536, 550; and Wiltse, Medical

Supply, p. 403.

68 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
near Gratton, admitted its first patient

on the nineteenth.35

The summer was an anxious time as

the chief surgeon waited for the personnel of twelve more hospitals, all of whom

had sailed from the United States on an

Army transport. “I counted the days,”

Carroll reported to Surgeon General

Magee, “until that ship docked and the

personnel with it.” The doctors, nurses,

and corpsmen who made the trip probably had similar feelings. Leaving the

New York Port of Embarkation in a convoy, the ship was crowded; “quarters can

be adequately described by three words,

standing, sitting, and reclining room,”

wrote a unit historian. The first blackout

at sea, with “weird blue lights, dark corridors, and passing human shadows,”

brought home the reality that a war was

on. Running under Navy protection, the

convoy arrived safely at the Panama

Canal. Blimps hovered over the docks,

the sun was fierce, and the air was

humid. In the Pacific a cruiser and a

destroyer took over the task of guarding

the transports, and for a time the trip

was idyllic, amid “flying fish, the phosphorescent ocean, and the southern

cross.” Then an epidemic of diarrhea

struck. The number of cases reached

four digits, and the voyaging medics

coined such names as the “‘turkey trot’”

and the “‘mess kit blues’” for the malady. Often ill, their drinking water

rationed to two glasses per passenger

each day, their baths cold showers in seawater, they finished the trip as an

uncomfortable, jam-packed, often miserable lot. But they did not encounter

any Japanese submarines or planes, and

docked safely in Melbourne after thirtynine days at sea. The long voyage ended

anticlimactically, as they traveled from

the docks to their first billets in Australia

by electric tram.36

For the chief surgeon the anxiety was

not over. The equipment of the hospitals was on another ship, which broke in

two and sank near Brisbane. “I feel that

my heart is in pretty good shape,” wrote

Carroll, “because when I was called on

the phone and told that the ship with

the equipment of twelve hospitals was

lost I still survived the shock.” But the

equipment was salvaged, and on 1

September the medical service passed

something of a landmark: After that

date more Australian military personnel

were being cared for in U.S. Army hospitals than the reverse.37

Quality proved to be a problem

among some new arrivals, one not easily

solved, for the pressure of an advancing

enemy and the deficiency of personnel

interacted to make retraining difficult.

Among enlisted men, Carroll soon discovered that a minority were of hopelessly poor quality. Thus one small hospital reported that its cook’s “personal

hygiene was filthy” and impossible to

correct; that a man listed as a medical 35Rpt, OofCSurg, USASOS, SWPA, to SG, U.S. Army,

12 Jan 43, sub: Extracts From Report of the Chief

Surgeon, S.O.S., Australia, December 15, 1942, p. 1, file

319 (Medical Service—1942); Interv, Lt Col John A.

Lazzari, 5 Jul 45, file 000.71; 153d Sta Hosp Historical

Rpt, 21 Mar 43, sub: Summary of Diary From Activation

to Present Day, p. 2, file 314.81, War Diary, 1 Jul 42–30

Jun 43. All in HUMEDS, RG 112, NARA. See also Darryl

McIntyre, “Hospitalization Policy for United States

Army Personnel in Australia, 1942–1945,” p. 5, copy in

CMH.

36First quotation from CSurg, USASOS, SWPA,

Semimonthly Rpt, 29 Aug 42, p. 4, THU Note Cards,

Historians files; remaining quotations from 6924V

[28th Surg Hosp] Historical Rpt, 7 Dec 41–30 Sep 42,

pp. 1 and 2, file 314.81 War Diary, 1 Jul 42–30 Jun 43.

Both in HUMEDS, RG 112, NARA. 37CSurg, USASOS, SWPA, Semimonthly Rpt, 29 Aug

42, p. 4, THU Note Cards, Historians files, HUMEDS,

RG 112, NARA.

A NEW KIND OF WAR 69
technician was unable to read a thermometer or remember drug dosages;

and that two or three others were

“unable or unwilling to distinguish

between feces and food.” Those who

were teachable ran afoul of the fact that

during 1942 only one technician’s

school existed in the theater, because

trained personnel could not be spared

from their duties to operate schools or

to teach in them. The medical command was too harried and too poor in

resources to train most of its new personnel, except on the job, or to find any

solution for those who proved unsatisfactory but to transfer them to other

units where, presumably, they would

prove to be equally unsatisfactory.38

The problem of retraining was not

confined to enlisted men. Some medical

officers needing an introduction to

wartime medicine and the diseases of

the Southwest Pacific were fortunate, for

they were able to study chemical warfare

physiology in schools conducted by the

Australian Army and tropical medicine

in Australian universities. Yet few seem to

have received the instruction they needed. Many civilian doctors entering the

Army for the first time were almost wholly unprepared for military medicine,

which—prevention-minded, impersonal,

devoid of anything describable as a doctor-patient relationship—differed from

civilian practice in crucial ways. No systematic effort was mounted to retrain

these professionals, and some reports

suggest that an undercurrent of incomprehension, resentment, and distrust

marred the relations between Regular

Army physicians and volunteers.39

Carroll was more successful in changing the size and equipment of the hospitals to meet the conditions of

Australia. Mobility was a continuing

headache for all elements of the U.S.

Army, including the Medical

Department. A single rail line connected the cities of Australia’s eastern and

southern coasts; it lay close to the ocean,

subject to enemy attack; and track

gauges sometimes changed at state borders, compelling supplies and passengers alike to be unloaded and loaded

again. As already noted, roads were

mostly poor and distances immense.

Early on, the chief surgeon found that

the large mobile hospitals—the 750-bed

evacuation hospital and the 400-bed

field hospital (intended for use as a station hospital)—were unsuitable to warfare either in Australia, if a Japanese

invasion came, or in the islands of the

north, in the event the Allies went over

to the attack. He began to think about

splitting the field hospitals into two and

the “evacs” into three self-sustaining

units. To support the American camps,

many smaller units were preferable to a

few large ones, for the troops were dispersed over a vast crescent—from

Darwin to Adelaide. The smaller unit

that he envisioned must have its equipment reduced to a minimum for movement over the bad roads, especially if

the enemy knocked out the railway, and

be as mobile as possible to support small

concentrations of troops moving 38Quotations from Ltr, Capt A. F. Jonas, CO, 6th Port

Hosp, to CSurg, USASOS, SWPA, 1 Dec 42, sub:

Informal Report of Monthly Activities, bound in

“Histories, Portable Surgical Hospitals in WW II,”

HUMEDS, RG 112, NARA. See also Thomas,

“Southwest Pacific Area,” in Havens, ed., Activities of

Medical Consultants, pp. 482–83.

39CSurg, SWPA, Annual Rpt, 1942, p. 18, file 319.1–2,

HUMEDS, RG 112, NARA; Thomas, “Southwest Pacific

Area,” in Havens, ed., Activities of Medical Consultants,

pp. 482–83.

70 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
through the Australian bush, where,

very often, roads were nonexistent.40

By the end of 1942 twenty-three

American hospitals had arrived in

Australia: four general, thirteen station,

two field, two evacuation, and two surgical. For the most part, general hospitals

were located in the larger cities and station and field hospitals close to training

and operational centers. General hospitals were large fixed installations that

provided comprehensive care for severe

cases from throughout a theater; station

hospitals were intended to serve a single

post; and field hospitals normally were

mobile and accompanied the troops,

although in the Southwest Pacific Area

they often served fixed cantonments

instead. Drawing their professional

staffs from medical schools of major universities in the United States, the general hospitals contained considerable talent. The 4th at Melbourne was staffed by

Western Reserve; the 118th at Sydney by

Johns Hopkins; the 42d at Brisbane by

the University of Maryland; and the

105th at Gatton, 40 miles west of

Brisbane, by Harvard.

In early 1943 Carroll was able to

embark on a major construction program that entailed an increase of 3,500

beds in Sydney and Brisbane, with 2,500

more planned for the future. In July of

that year, with the war moving toward

Queensland, the Australian War Cabinet

approved the construction of an additional 22,000 beds—9,000 for New

Guinea and 13,000 for Queensland. All

of the hospitals followed a standard

Army design featuring the lightest possible frame construction, with exteriors

usually of heavy treated paper or fiber

board, plumbing in separate lavatory

buildings, and stoves rather than a central heating plant for each unit. They

were well suited to conditions in

Australia, where the climate ranged

from temperate in southern areas to

tropical in the north.41

The development of mobile hospitals

was the theater’s chief innovation.

Carroll and his staff worked on three

types: a 100-bed mobile unit mounted

on trucks, a prefabricated demountable

facility, and a 25-bed portable hospital.

The first—oxymoronically termed a

mobile station hospital—was created to

support the Army during a retreat into

the Australian interior, if a Japanese

invasion took place; in the island campaigns that actually followed, the hospital proved of little value, on account of

the lack of roads. The other two, however, greatly improved the mobility of

medical treatment and unquestionably

saved many lives.42

The chief surgeon’s office ordered

from Australian manufacturers hospital

buildings prefabricated of plywood,

masonite, or fibrolite that could be

transported by aircraft. Medical personnel, assisted by engineers, actively

engaged in the construction and disassembly of their own hospitals. (As a

result, in late 1943 Carroll suggested to

the surgeon general, Brig. Gen.

Norman T. Kirk, that medical units dis40CSurg, USASOS, SWPA, Semimonthly Rpt, 27 Jun

42, THU Note Cards, Historians files, HUMEDS, RG

112, NARA.

41CSurg, SWPA, Annual Rpt, 1942, pp. 9–12, file

319.1–2; Interv, Lazzari, 5 Jul 45, file 000.71; Encl 4 to

Rpt, OofCSurg, USASOS, SWPA, to SG, U.S. Army, 12

Jan 43, sub: Extracts From Report of the Chief Surgeon,

S.O.S., Australia, December 15, 1942, file 319 (Medical

Service—1942). All in HUMEDS, RG 112, NARA. 42Encl 4 to CSurg, USASOS, SWPA, Semimonthly

Rpt, 15 Dec 42, file 319.1–2 (Medical Service in

Australia), THU Note Cards, Historians files,

HUMEDS, RG 112, NARA.

A NEW KIND OF WAR 71
patched to forward areas include in

their organization one well-qualified

plumber, one electrician, and at least

two carpenters.) The hospitals consisted wholly of portable huts; floors were

usually of concrete, roofing and wallsheeting of corrugated iron or asbestos

cement. The units came with tools and

instructions for assembly. One type of

building, with an air cooling system

and plumbing, might function either as

a surgical facility, a clinic, or a laboratory; another, less elaborate, housed

wards, storage houses, and offices.

Factories in Sydney were producing

American-designed prefabricated units

by the end of 1942. American-manufactured units did not arrive until late

1943.43

Carroll’s third and most creative

attempt to find a mobile facility suitable

for the theater’s vast distances, small

troop concentrations, abundant jungles,

and shortages of medics was the 25-bed

portable hospital. As early as June 1942

work was under way in the chief sur43CSurg, SWPA, Annual Rpt, 1942, p. 13, and CSurg,

USASOS, SWPA, Annual Rpt, 1943, pp. 15, 30–31,

72–76, file 319.1–2, HUMEDS, RG 112, NARA. Carroll

also suggested that medical units dispatched to forward

areas include in their organizational equipment the following items: hammers, saws, nails, corrugated iron

roofing, concrete for floors, screening, pipe and pipe

fittings, and portable power saws, if available.

72 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MAIN WARD OF A PREFABRICATED STATION HOSPITAL
geon’s office to use these hospitals at isolated camps and, if needed, on the

islands. For these units the chief surgeon

anticipated allowing no conveyance at all,

except sturdy wheeled litters to double as

a sort of wheelbarrow on which the staff

could push whatever equipment they

could not carry. The portables would

have no female nurses, and Carroll, while

asking the surgeon general for male

nurses, began to train enlisted men as

practical nurses for use wherever women

could not go. As yet, the chief surgeon

had no idea of using the portables as surgical hospitals; he saw them as very small

station hospitals, for use in supporting

small units in remote locations.

During the summer, as preparations

began for a counterattack against the

Japanese, the portable took more definite form. Now it became a surgical hospital, intended to accompany invasion

forces, to work on the beaches, and later

to move forward with the troops, providing emergency lifesaving treatment to

frontline casualties and stabilizing their

condition for the long trip to the rear.

Carroll scavenged from existing hospitals

in Australia, forcing each to give up personnel and equipment equal to 10 percent of its bed strength. Thus a 250-bed

station hospital became the parent organization of one portable, a 1,000-bed

general hospital of four, and so on. By

early October the chief surgeon’s office

had twenty-seven of the units assembled

and ready to go. In time, portable hospitals proved ideally suited to the combat

team organization and jungle fighting of

the Pacific war; they served the fighting

men well, and in some respects, foreshadowed the postwar organization of

the MASH. But they were not always

effectively used or wanted. As soon as the

units were sent forward, they passed out

of USASOS control, and often were

improperly placed and used by field commanders and their surgeons. In the end,

however, the portables emerged as a triumph of improvisation in a war where

field expedients were the norm.44

44CSurg, SWPA, Annual Rpt, 1942, pp. 17–18, file

319.1–2; OofCSurg, USASOS, SWPA, Diary, 7, 10, 18, 23

Sep 42, file 314.81 Daily Diary, 1 Aug 42–2 Jan 43; CSurg,

USASOS, SWPA, Semimonthly Rpts, 27 Jun 42, and Encl

4, 15 Dec 42, and Info Memo, OofCSurg, USASOS,

SWPA (copy to Base Sec 3 Hosps), THU Note Cards,

Historians files. All in HUMEDS, RG 112, NARA. See

also Interv, Condon-Rall with Carroll, 26 Sep 80, CMH.

In the European theater mobile surgical teams also assisted field hospital platoons. They, too, were another World

War II source for the MASH; however, precursors can be

traced back to World War I. See Albert E. Cowdrey,

“MASH vs M*A*S*H: The Mobile Army Surgical

Hospital,” Medical Heritage 1 (Jan–Feb 85): 4–11.

A NEW KIND OF WAR 73

PORTABLE HOSPITAL ON THE MOVE
PORTABLE HOSPITAL BIVOUAC AREA AND SURGICAL TENT
A NEW KIND OF WAR 75

In building an evacuation system,

the chief surgeon also showed an innovative spirit. Air evacuation was an evident need under Australian conditions

and still more so when serious fighting

began again in New Guinea. Carroll

warned: “We are in a modern War and

should adopt modern methods to meet

the needs.” His preference was for

strict adherence to the letter of the

Hague and Geneva Conventions, not

out of legalism but to protect the

wounded. He wanted dedicated air

ambulances, painted white and marked

with the red cross. But convenience dictated instead that the same planes that

flew supplies to forward outposts

should also bring casualties on return

flights. Six air ambulances that arrived

from the United States in response to

Carroll’s pleas were stripped of their litter brackets and converted into transports, General MacArthur ruling that

“it is not desired to mark, equip and set

aside my air transports for exclusive use

in the evacuation of sick and wounded

at this time.”45

Carroll also hoped for hospital ships,

properly painted and marked as the

Mactan had been, to carry evacuees to

the United States. He pointed to the

action of the Japanese in notifying the

United States that they planned to put

ten such ships into service; he argued

that the enemy intended to use, and thus

would be compelled to respect, the protection of the international accords that

Japan had signed but not ratified. On

the other hand, casualties carried on

unmarked ships or planes would be

entirely helpless in the event of an attack

by plane or submarine, and would probably lose their lives. But worldwide shipping shortages prevented conversion of

transports to hospital ships. Later the

chief surgeon solved his problem by

obtaining hospital ships from the

Australians for use in the immediate

area, and by converting the Dutch liners

Tasman and Maetsuycker into hospital

transports for interbase service only.46

To speed land evacuation, the chief

surgeon borrowed Australian ambulance trains. A train could operate only

in the states with the proper gauge

tracks. Trains built to 3 ́6 ̋ gauge could,

for example, cross from the Northern

Territory into Queensland, but at the

border of New South Wales casualties

had to be reloaded onto another train.

Despite these problems, by the end of

1942 six trains were in service, each

capable of carrying from 48- to 354-

stretcher patients and served by two or

three nurses and a variable complement

of corpsmen. 

By this time the Japanese threat to the

trackage, exposed at many points along

the coastline, had diminished greatly.

Fighting raged in the Solomon Islands

and New Guinea to the north, and in

consequence a definite pattern of evacuation had taken shape. Each base section

maintained a careful record of beds

available and in use in its own hospitals,

and the base section surgeon was respon- 45First quotation from Check Sheet, CSurg, SWPA, to

G–4, SWPA, 10 Oct 42, sub: Airplane Ambulance; second quotation from Ltr, Col B. M. Fitch, AG, for CinC,

SWPA, to Cdr, Allied Air Forces, 4 Nov 42, sub: Air

Ambulances. Both THU Note Cards, Historians files,

HUMEDS, RG 112, NARA. The story of air ambulances

can be followed in detail in file 451.8 Air-Sea

Ambulances, SWPA, Mar 42–Feb 43, HUMEDS, RG

112, NARA.

46CSurg, USASOS, SWPA, Semimonthly Rpt, 29 Aug

42, pp. 1–2, THU Note Cards, Historians files; idem,

Annual Rpt, 1943, p. 5, file 319.1–2. Both in HUMEDS,

RG 112, NARA. See also Stanley L. Falk, “Army Hospital

Ships in World War II,” Military Review 45 (Sep 65):

85–91.
sible for evacuating his own command

under theater guidelines. Less serious

cases remained in the north, ideally, and

more serious ones were sent south, with

the worst injured ending their journeys

in the large general hospitals, especially

the 4th in Melbourne, whose 2,000 beds

made it the biggest as well as the best

equipped and staffed in Australia.

Specialists were concentrated in the few

large rear-area facilities, to make best use

of their talents, while the evacuation of

long-term cases kept beds empty and

ready for use near the fighting zone.

Patients facing a permanent disability or

requiring very long-term care were sent

from the 4th, 42d, 105th, and 118th

General Hospitals to the United States as

shipping became available.47

Evacuation policy in the theater grew

from near-nonexistence in early 1942 to

considerable complexity a year later.

Transport problems in the different

base sections varied so widely and methods of carrying casualties were so casual

and so diverse that the Office of the

Chief Surgeon initially had not established any general policy for evacuation

from one to another. Base Section 1

evacuated solely by air; the northern

part of Base Section 2 sent patients to

Townsville by land-based aircraft or by

seaplanes, or in the small hospital ships

loaned by the Australians. Townsville

hospitals sent casualties they could not

hold to Base Section 3 by the same

methods, or by hospital train. In the

more populous southern Base Sections

4 and 7 a relatively good roadnet and

railway system were available for use.

In February the chief surgeon’s office

adopted a six-month evacuation policy

47Encl 5 to CSurg, USASOS, SWPA, Semimonthly

Rpt, 15 Dec 42, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA.

76 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

THE MAETSUYCKER
for Australia as a whole—that is to say,

patients not expected to return to duty

within 180 days were sent to the United

States. Considering how few beds

Carroll had available, the policy was

practicable because the theater had so

few American troops. But as troop

strength grew, so did the hospital system, and though the continuing deficit

in medical manpower made maintenance of the six-month standard difficult, the chief surgeon clung to it

against the surgeon general’s preference for 120 days in order to conserve

the theater’s fighting strength. For those

who must be sent home, the absence of

large hospital ships meant voyages on

unmarked transports. Space on aircraft

was at a premium, emergency cases and

AAF personnel having priority.

By early 1943 the ad hoc evacuation

policy had matured into a complicated

hierarchy of policies, ranging from 3

days for field units in contact with the

enemy, to 60 days for New Guinea and

for Base Sections 1 and 2, to 120 days for

Base Section 3. A single chain of evacuation now linked the entire theater, from

the north coast of New Guinea to urban

Melbourne and the rest camps of south

Australia. Along the chain, a seriously ill

or wounded soldier might travel nearly

2,000 miles from aid station to general

hospital in Australia and, if his condition warranted, almost 8,000 more to

home (see Table 1).48

Supply

All the problems and make-do accomplishments of the medical service in the

Southwest Pacific theater were mirrored

in the supply system. Like the theater at

large, medical supply for American

troops in Australia began with the

unloading of the ships in the Pensacola

convoy. The early chief surgeons

secured space in a Brisbane warehouse

and, for lack of personnel, put an AAF

dental officer in charge. When the officer was transferred, a staff sergeant temporarily took over. Troops passing

through Brisbane were issued whatever

they needed, and items not available

were provided by the Australian Army’s

Advanced Depot of Medical, Dental,

and Veterinary Supplies. Throughout

1942 trained depot personnel were few

and in heavy demand; for most of the

year only the 3 officers and 42 enlisted

men of the 4th Medical Supply Depot

(later redesignated the 9th Medical

Supply Depot) had to operate the

depots in Sydney and Melbourne. On 1

December the 3d Medical Supply Depot

reached Australia, and its 14 officers

and 227 enlisted men were promptly

subdivided, even individual platoons

being split to provide small sections that

worked in locations from Sydney to New

Guinea.

48Rpts, CSurg, USASOS, SWPA, to CG, USASOS,

SWPA, 12 Nov 42, sub: Evacuation of Sick and

Wounded; idem to AG, [USASOS, SWPA], 6 Feb 43;

and idem to Surg, USAFFE, 17 Mar 43, sub: Evacuation

Policy. All in file 370.5 Air Evacuation Reports, SWPA,

1942, HUMEDS, RG 112, NARA. In World War II the

chain of evacuation comprised five levels, or echelons:

regiment, division, army, communications zone, and

continental U.S. The war against Japan, however, saw

several modifications to the official format described in

the Army’s Mobile Units of the Medical Department, Field

Manual 8–5 (1942). One was the invention of the

portable surgical hospital, a unit that did not arrive in

the European theater until around V–E day. Another

was the general strengthening of the medical service in

lower-echelon tactical units. Officially, a corps surgeon

belonged to a purely tactical headquarters, but in the

Pacific a corps operating separately acquired many of

the logistical functions of a field army. Similarly, battalions and regiments operating separately as combat or

landing teams might be provided with medical units

and assigned duties usually associated with a higher

headquarters.

A NEW KIND OF WAR 77
78 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

Aidman

The aidman, although assigned to the battalion medical section, served with the

line companies and gave first aid to the injured.

Aid Station

The battalion aid station, the first medical installation reached by a casualty

because of its location near the front line, treated shock and provided minor

surgery, dressing for wounds, and relief from pain. The battalion surgeon, aid

station personnel, and company aidmen together formed one of the three battalion sections of the regimental medical detachment. A separate battalion,

however, had its own medical detachment.

Collecting Company/Collecting Station

In World War II the division surgeon commanded the division’s medical battalion. Each of the battalion’s three collecting companies was designed to support

one regiment or regimental combat team. A collecting company evacuated casualties from forward aid stations, and a collecting station, which the company ran,

provided additional first aid, plus oxygen and whole blood, and formed a regimental holding unit for casualties until they could be taken to the rear.

Sometimes a collecting station and a portable surgical hospital worked together,

with the hospital stabilizing the seriously wounded for evacuation.

Clearing Company/Clearing Station

Also part of the medical battalion was the clearing company. The clearing station

that it operated was, in effect, a small forward hospital, providing fairly complex

treatment and informed prognosis, on which further disposition of the casualty

was based. In the Pacific clearing companies often functioned as small field hospitals, because most battles were small and hospital units might be absent from

the task force or remote from the fighting line. Here again, a portable surgical

hospital might work nearby.

Portable Surgical Hospital

With a capacity of 25 beds, this small unit was developed in Australia and later

adapted to provide skilled surgical care in jungle fighting during the Papuan

campaign. Still later, it was attached to task forces to provide early frontline surgical care in amphibious operations. In theory, hospital equipment and supplies

were to be carried on the backs of the thirty-three soldiers and four officers who

formed the unit. The portable might be attached to a regiment, a division, or an

army, depending on circumstances.

Field Hospital

Attached to a division or corps, the 380-bed (later 400-bed) field hospital was

intended to be highly mobile and to concentrate on the early care of casualties.

TABLE 1—THE CHAIN OF EVACUATION, 1943–1945
A NEW KIND OF WAR 79

Field Hospital (Continued)

Located whenever possible within a few miles of the front line, the field hospital

was a highly flexible unit that could be broken down into its component platoons, each of which, if strengthened with surgical teams, might operate as an

independent small hospital.

Medical Group

A headquarters that organized field army medical units—separate medical battalions and field hospitals, in the main—for operational and administrative purposes, a medical group controlled evacuation to the rear of the divisions and all

evacuation of nondivisional units serving under a field army.

Evacuation Hospital (Semimobile)

Larger and more difficult to move than the field hospital, and intended to care

for 250–400 casualties (though some held up to 2,000 when fighting was heavy

and/or evacuation failed), this unit primarily was utilized for the care of the seriously injured or ill designated for evacuation to large hospitals in the rear. There

was also a 750-bed hospital, but it was not semimobile.

Station Hospital

A fixed hospital of 25–900 beds, corresponding to a post hospital in the United

States, provided highly skilled care in medicine and surgery both to casualties

evacuated from the combat zone and to garrison troops stationed in its vicinity.

The great variation in size reflected the fact that a station hospital might serve

anything from a small islet to a major base.

General Hospital

The last stop in the chain of evacuation, this large fixed installation of 500–1,000

beds provided the best available care and specialized treatment for all types and

classes of casualties. The general hospital was authorized to evacuate patients to

the United States for additional care or discharge.

Hospital Center

Indefinitely expandable, the hospital center was a collection of general hospitals

operating under a single headquarters. Component hospitals normally specialized in the care of one or more types of disease or injury.

Convalescent Hospital

This unit was either a station or general hospital devoted to preparing for duty

soldiers who had recovered from illness or wounds but were unready to resume

full duty status. Those who reached a convalescent hospital were already on their

way back to a line or support unit; normally, their next stop would be a replacement depot, outside the medical system.

TABLE 1—THE CHAIN OF EVACUATION, 1943–1945 (CONTINUED)
Meanwhile, the United States—especially the medical depot at Fort Mason,

California, from which Carroll received

most of his supplies—struggled to provide for its forces in Australia over a distance equal to more than one-quarter

the circumference of the Earth. In

quality the materiel that arrived was

excellent, almost without exception,

but quantity was another matter.

Shortages developed early in surgical

and dental instruments, hospital equipment, and biologicals, which the chief

surgeon attempted to make up through

local procurement in Australia. Here,

however, he confronted myriad realities: small population, nascent industries, heavy commitment to the war

effort, and long history of colonial

dependence on imports. Less than 2

percent of the drugs listed in the

United States Pharmacopeia could be

manufactured from raw materials produced in Australia, and the standards

of the British Pharmacopoeia governed

those that were. A few types of surgical

instruments were in limited production

by the year’s end, but manufacture of

heavier hospital gear—mess and laundry equipment, for example—was

impeded by manpower shortages that

filled the workforce with untrained

adolescents and by the almost complete diversion of heavy industry to

munitions. The USASOS obtained

enough from local sources to cover its

shortfalls, but time lags of three

months or more between order and

delivery were common. As Carroll

made plain, he preferred American

goods. He hoped to be able to depend

upon them entirely and repeatedly

argued that medical supplies, most of

which were small in bulk and weight,

imposed comparatively little burden on

the long supply line from the United

States.49

As the year advanced, the supply system developed rapidly. Carroll’s office

worked to educate its American suppliers in the special requirements of the

theater—lightness in weight, portability,

packaging that protected against moisture, unbreakable containers to facilitate airdrops, and elimination of all

heavy medical chests. Carroll recommended using small, mobile water

purification outfits and pointed out that

each hospital assembly needed its own

electricity and steam generating plants,

plus the necessary pipes and fixtures. To

render each hospital independent of

the local water supply became a theater

goal. The chief surgeon preferred plastic utensils to metal and glass, whenever

possible. Allowances of equipment had

to be changed, he argued, on account of

the need to break hospitals up into

smaller units. Generators, X-ray

machines, and microscopes, among

other things, had to be duplicated in

each of the smaller hospital units.

Distribution followed a like course. At

first, medical depots were set up only in

Melbourne and Brisbane, where supplies

were received. But by the end of 1942 the

original installations had become reserve

as well as issuing depots and a system of

branch depots had developed in all base

sections, including the Advance Base at

Port Moresby on Papua. Each depot was

49Encl 2 to CSurg, USASOS, SWPA, Semimonthly

Rpt, 15 Dec 42, and Ltr, Col P. J. Carroll, CSurg,

USASOS, SWPA, to Col. C. D. Buck, Med Supply Off,

Fort Mason, Calif., 29 Aug 42, THU Note Cards,

Historians files. See also CSurg, SWPA, Annual Rpt,

1942, p. 15, file 319.1–2, and OofSurg, Base Sec 3,

Historical Rpt, n.d., sub: Diary of Medical Installations

of Base Section 3, USASOS, SWPA, pp. 7–8, file 314.81,

War Diary, 1 Jul 42–30 Jun 43. All in HUMEDS, RG 112,

NARA.

80 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
controlled by its base section commander

under the technical direction of the chief

surgeon. Automatic resupply items were

distributed to the branch depots without

requisition on a troop strength basis. The

theater aimed to keep a sixty-day supply

on hand everywhere except New Guinea,

where the unpredictable demands of

combat required a ninety-day supply. As

will be seen, the improvised system there

achieved remarkable success in the face

of heavy odds.50

In its hard-pressed first year, the medical service in the Southwest Pacific Area

exhibited both a talent for innovation

and a susceptibility to long-term organizational problems. Throughout many

changes, some common aims were

apparent: to break up large units into

self-contained small ones; to reduce

equipment to a necessary minimum; to

concentrate fixed beds while making

direct-support hospitals as mobile as

possible; and, above all, to make the

most of slender resources that must be

spread over great distances. Since

Carroll bore much criticism for the failings of the medical service, he deserves

also to be recognized for adopting policies in hospitalization and evacuation

that were fundamentally correct and for

developing many useful innovations,

notably the portable hospital. 

If expedients were the hallmark of

the period, surely the basic reason was

that the southern Pacific theaters had

no time for leisurely preparation. The

Allies were compelled simultaneously to

create bases, train forces, and engage

the advancing enemy. Indeed, American

forces in the Navy-run South Pacific theater were struggling to meet a timetable

that was even more demanding.

50OofSurg, Base Sec 3, Historical Rpt, n.d., p. 15, file

314.81, War Diary, 1 Jul 42–30 Jun 43; Encl 2 to CSurg,

USASOS, SWPA, Semimonthly Rpt, 15 Dec 42, THU

Note Cards, Historians files. Both in HUMEDS, RG 112,

NARA.

A NEW KIND OF WAR 81
For six months following the Pearl

Harbor attack, the Hawaiian Islands

were on the defensive, awaiting another

Japanese assault. Rumors of sabotage

and enemy landings spread fear and

unrest. While Army engineers camouflaged vital installations with paint and

nets, defense forces braced themselves

for renewed attack. 

On 17 December 1941 two new commanders, Admiral Nimitz and Lt. Gen.

Delos C. Emmons, replaced those disgraced by the success of the Japanese

raid. Determined to avoid the confusion

over command that had preceded Pearl

Harbor, President Roosevelt compelled

the creation of unified commands in vulnerable areas—under the Army in the

Panama Canal Zone and under the Navy

in Hawaii. On the thirty-first Nimitz

became Commander-in-Chief, Pacific

(CINCPAC), in charge of the Pacific

Fleet and, in the spring of 1942, of the

Pacific Ocean Areas (CINCPOA). As

commander of the subordinate Hawaiian

Department, Emmons provided for the

land defenses of Hawaii and the nearby

islands. Under martial law, he also served

as military governor of the territory.1

Although the fear of invasion and air

raids never completely left Hawaii, the

American naval victory at the Battle of

Midway in June 1942 greatly diminished

the Japanese threat. As American planners began to think of shifting from

defense to offense, the islands where the

war had begun emerged, first as a supply

base for the active theaters of the southern Pacific and then as a springboard

for operations in the central Pacific.

Life there was transformed. Already,

martial law had been instituted, partly to

ensure the speedy enforcement of military orders and partly to control the

large minority of ethnic Japanese. The

national government poured in air,

ground, and naval units, constructing

new installations as it repaired and

expanded old ones. Hundreds of thousands of war workers followed. Buildings

and land were taken over by the armed

forces, barracks were erected with great

speed, and depots were filled with vast

accumulations of war materiel. On some

plantations school children worked in

the canefields, replacing absent men,

while on others barbed-wire fences went

up to protect new cantonments. Tanks

1

Louis Morton, Strategy and Command: The First Two

Years, United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History,

Department of the Army, 1962), pp. 144–45, 232. On

the military government, see Gwenfread E. Allen,

Hawaii’s War Years, 1941–1945 (Honolulu: University of

Hawaii Press, 1950), pp. 166–83.

CHAPTER III

Army Medicine in Navy Theaters
and guns rumbled at all hours through

the streets of Honolulu.

The Hawaiian Base

To protect soldiers and civilians from

disease, to expand the Army hospital system, and to prepare for future offensives—these were the tasks of Colonel

King, the efficient chief surgeon of the

Hawaiian Department who had directed

the prewar preparations and the medical response to Pearl Harbor. A meticulous manager, determined to master

and control as far as possible all the

activities of his office, King was ultimately obliged to loosen his grip on day-today business as the complexity of the

work increased. His basic approach was

to assume that the enemy was capable of

achieving the worst—a surprise attack,

accompanied by a blockade of the

islands—and to attempt to ready the

medical service for it. “In preparation

for war,” he said later, “take nothing for

granted—see everything.”2

Under him, the chief surgeon’s office

grew rapidly to meet the needs of the

expanding Army and the military government. At the time of the attack on

Pearl Harbor King’s staff was small, consisting of nine officers, eight enlisted

men, and fifteen civilians, divided into a

rear and a forward echelon. The rear

echelon, including the bulk of the

administrative section, was located in

the offices of Farrington High School

on Oahu; administration and supply

were apparently its main concerns. The

forward echelon, which was responsible

for operations and training, was situated

in the Aliamanu Crater together with

the commanding general and his staff.

Three consultants were also on the staff

of King’s office, but they were assigned

to hospitals on Oahu.3

In March 1942 service commands

were set up on the other islands of the

Hawaiian archipelago, and a surgeon

was appointed to each. Typical was the

Hawaii Service Command on the largest

island, Hawaii. The command surgeon,

Lt. Col. William A. D. Woolgar, MC, and

his staff provided medical and dental

care for nondivisional units, hospitalization for the 27th Infantry Division, and

management for the hospital construction then under way. His area of control

grew steadily during 1942, as he organized the local hospitals and served as

liaison between them and King.

Ultimately, when the 27th Division left

Hawaii, he took responsibility for the

care of the tactical forces that

remained.4

In October a centralized services of

supply organization came to the

Hawaiian Islands. King was named surgeon of the new command, without

relinquishing his duties as chief surgeon

and as medical adviser to the military

governor. During December the number of officers assigned to his staff doubled. By that time King himself was

2

Quotation from Memo, Col Edgar King to Ed.,

History of the Medical Department, U.S. Army in World

War II, 22 Mar 50, sub: Supplemental Data on the Work

of the Medical Department in the Hawaiian

Department, Later U.S. Army Forces in the Pacific,

then the Central Pacific Area, p. 7, file 000.71. See also

Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 3, pp. 13, 22–23,

file 314.7. Both in Historical Unit Medical Detachment

(HUMEDS), Record Group (RG) 112, National

Archives and Records Administration (NARA),

Washington, D.C.

3

Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 1–2, file 314.7, HUMEDS, RG 112, NARA. 4

Surg, Haw Svc Cmd, Annual Rpt, 1942, p. 1, in

CSurg, Haw Dept, Annual Rpt, 1942, sec. 3, file 319.1–2,

HUMEDS, RG 112, NARA.

ARMY MEDICINE IN NAVY THEATERS 83
already a brigadier general, having been

promoted on 25 October, in recognition

of the many hats he wore and the rapid

growth of the area.5

The special circumstances of

Hawaii—its geography and closeness to

the front lines, its large population of

Japanese descent, and its critical function as the rear base for all Pacific operations—tended to centralize unprecedented authority in King’s hands. Civilmilitary relations remained especially

important. In case of renewed enemy

attack, the Army Medical Department

would again be responsible for the care

of civilian casualties, while civilian doctors would once more play an essential

role in the care of wounded servicemen.

Hence, King assigned a member of his

staff to handle civil affairs liaison, and

plans were laid, in case of need, to place

control of all hospitals, civilian and military alike, under the chief surgeon’s

office; to set up first aid stations

throughout Oahu; and to provide civilian care for military casualties wherever

the military facilities were insufficient.

In essence, King’s civil affairs officer

served as the point of contact between

the chief surgeon’s office and the

Honolulu Medical Society, which had

already provided so much valuable aid

at the time of Pearl Harbor.

Japanese residents of Hawaii—comprising about one-third of the population, some of whom were aliens but

many American citizens—formed a special concern. King employed a Japanese

maid, ignoring rumors that she planned

to poison him. He listened with some

skepticism to old Hawaii hands, who

held emphatic but contradictory views

on the ethnic Japanese, some terming

them completely loyal while others

thought them entirely disloyal. “As is

always the case,” he remarked later, “the

truth lay somewhere between, but

where?” Among the Japanese were many

doctors, dentists, nurses, and medical

technicians; their services were “desperately needed” and hard to refuse. Many

volunteered to aid the war effort, either

in or out of uniform, and those who

were citizens “claimed the right to serve.”

King was not without a touch of cynicism, asking, “What would have been

the attitude of these people as a whole

had the Battle of Midway been lost by

us?” But neither was he prepared to

exclude from all service skilled people

who might be as loyal as they claimed.

For the few whose loyalty seemed capable of proof, he recommended full

acceptance in positions of trust; for the

many who could not positively be shown

to be disloyal, he found positions for

them chiefly in civilian service among

their own people, where they had “no

access to vital spots.” After the war, he

was to pay tribute to the Japanese

Americans who “served gallantly and

gave much. To them my highest

respect.”6

As ever in wartime, venereal disease

(VD) control was an important aspect

of civil-military relations. King’s position gave him unusual opportunities to

control such diseases through both military and civilian channels. Until 1942

5

Blanche B. Armfield, Organization and Administration

in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), p.

381.

6

Quotations from Memo, King to Ed., History of

Medical Department, 22 Mar 50, pp. 4–5, file 000.71,

HUMEDS, RG 112, NARA. See also Armfield,

Organization and Administration, pp. 376–77, and

Whitehill, “Medical Activities in Middle Pacific,” block

3, p. 5, file 314.7, HUMEDS, RG 112, NARA.

84 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
the Hawaiian Department pursued its

customary course in dealing with soldiers—lecturing, giving monthly physical inspections, and reporting contacts

to the military police. The situation in

the islands was unusual for an

American territory in that prostitution

was tolerated; brothels employed physicians, often very able ones, to check

their inmates. The business was lucrative for both the doctors and the often

wealthy and influential owners of the

houses.7

In May, however, General Emmons, as

military governor, directed the

Territorial Board of Health to implement a VD control program throughout

the islands. Both military and civilian

doctors were ordered to report every

case within twenty-four hours of diagnosis. Infected civilians were closely monitored until certified as noninfectious.

King reported that the board of health

was energetic in its follow-ups, resulting

in a large number of infected men and

women being placed under treatment.

Military and civilian police gathered up

streetwalkers for compulsory examination. Propaganda intensified; prophylactic stations were opened in Honolulu

and run day and night. The results of

rigorous centralized control were evident by the year’s end. At a time when

tens of thousands of troops and thousands of construction workers were

arriving in the traditionally easygoing

islands, the VD rate for the command

dropped from 14 per 1,000 troops per

year in 1941 to 9.6 in 1942—“the lowest

rate ever reached in this Department,”

King reported.8

Official fears of biological or chemical warfare intensified sanitary inspections of military posts, civilian food processing plants, and water supply sources.

A false report of water poisoning at

Hickam Field on 7 December 1941 coincided with King’s appointment as adviser to the commanding general on all

matters relating to the contamination of

food and drink. For all Hawaiians, rigorous and thorough preventive medicine

was the result. All residents of the

islands over six months old were immunized against smallpox, typhoid, and

paratyphoid; all poisons were impounded, and their sale was strictly controlled;

guards were posted at water supply

sources, which underwent daily testing;

and fresh milk was prohibited in Army

messes.

In October 1942 Emmons appointed

King to the position of anti-biological

warfare officer, in addition to his other

duties. Now he combined the earlier initiatives against sabotage by germs or poison into a comprehensive program that

included sending Army agents into civilian food processing and bottling plants.

District anti-biological warfare officers

were appointed on islands other than

Oahu. Soldiers watched the mixing of

ingredients in Coca-Cola bottling plants;

employees were checked by Army intelligence; and civilian laboratories had to

register and receive military clearance

7

Thomas H. Sternberg et al., “Venereal Diseases,” in

Ebbe Curtis Hoff, ed., Communicable Diseases Transmitted

Through Contact or by Unknown Means, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1960), pp. 282–83.

8

Ibid., p. 285; CSurg, Haw Dept, Annual Rpt, 1942,

sec. 1, p. 7 (quotation) and encl. 1, file 319.1–2,

HUMEDS, RG 112, NARA. The system described here

endured until 1944, when the brothels were at last closed

down. Despite some fears of rape and uncontrolled

streetwalking, the VD rate then dropped still lower,

apparently because the added cost and bother of finding

sex partners reduced the total number of contacts.

ARMY MEDICINE IN NAVY THEATERS 85
of their work. As might be expected, the

Veterinary Corps played a considerable

part in these efforts, since its primary

work, other than the care of Army horses and war dogs, was in the field of meat

and dairy hygiene. The tensions that

might have resulted from excessive military control were mitigated by the

Hawaiian Department’s tradition of

working closely with civilians. Veterinary

officers cooperated with the Territorial

Board of Health, as well as with King’s

medical inspector and with the Army’s

chemical warfare officer, whose service

controlled the nation’s biological warfare program.9

In retrospect, much of this effort was

needless. The fear of Japanese biological

warfare in Hawaii proved to be groundless, though Japan did make and use

such weapons in China. Full military control lasted only through the period of the

most acute emergency. In February 1943

the military yielded much of its authority

to the Office of Civilian Defense and to

the normal civilian public health agencies. In August the Hawaiian Department

was replaced by a new headquarters, the

United States Army Forces in the Central

Pacific Area (USAFICPA), and King’s

duties became primarily those of medical

planning for Nimitz’ coming offensives.

By the fall of 1943 the Hawaiian

Islands had become the medical hub of

the Pacific. Vastly increased numbers of

troops and construction workers had

been accommodated and cared for.

Though understandably resented by

many civilians, military control had distinct advantages in the field of public

health during wartime. Throughout the

period of the emergency, military

responsibility for soldiers and civilians

alike had been concentrated in the

hands of one able physician. As a historian of the war years later pointed out,

“Hawaii emerged from the war with a

healthier population despite the health

hazards” of the time.10

Hospitalization

Hospitalization was the major medical function of King’s office. The need

for hospital beds increased proportionately with the influx of sick and wounded evacuees from the Pacific fighting

and with the buildup of troops for the

coming offensives. The chief surgeon

not only expanded Army hospitals on

Oahu, where prewar hospitalization had

been concentrated, but also extended

construction to the rest of the Hawaiian

Islands and to such southern outposts as

Christmas, Canton, Baker, and Fanning

Islands. Expansion took varied forms.

Existing facilities were enlarged; new

units introduced; and, to a limited

extent, civilian hospitals preempted on

a provisional basis. Change came in two

waves: The first followed Pearl Harbor,

while the second occurred during 1943,

in anticipation of casualties from the

offensives that lay ahead.

At the time of the Japanese attack,

Tripler was the only general hospital in

the islands, and it remained throughout

the war the principal one and the

largest. Located in the city of Honolulu,

Tripler grew rapidly, as its commander,

Colonel Miller, supervised the erection

of new buildings on the grounds, the

acquisition of adjacent Army structures, 9

Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 1–4, 11–13, file 314.7, HUMEDS, RG 112,

NARA. See also Armfield, Organization and

Administration, p. 376. 10Allen, Hawaii’s War Years, p. 336.

86 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
and the purchase of additional sites. The

enlarged establishment covered five

large and four small areas. One area

mainly housed hospital staff, while others specialized in surgery, medicine, contagious diseases, and convalescent care.

Together, they formed a major medical

center, the final destination of patients

evacuated from station hospitals on the

outer islands of the Hawaiian group and

from those on the islands to the south. 

Tripler also served as a station hospital for the area on Oahu between Pearl

Harbor, the mountains, and the

Nuuanu Valley to the east of the harbor—a region so crowded with military

establishments by the end of 1943 as to

constitute “one great fort.” It provided

outpatient services for military personnel and their dependents, as well as for

civilian workers hired by the Corps of

Engineers. As consultants, specialists at

Tripler made their skills available to

field medical officers; they also helped

to teach classes for the hospital’s own

staff, for doctors whose skills were rusty

after long forward service with combat

units, and for others newly assigned

from the mainland to duty in the

Pacific. Finally, in 1943 the School of

Aviation Medicine was established at

Tripler to train young and physically fit

physicians as flight surgeons.11

One of the world’s great military hospitals, the Tripler complex differed from

civilian institutions of equivalent scope in

its lack of connection with a medical

school and its lack of a research function.

Yet new and veteran Army doctors benefited from the “astonishing wealth of clinical material” that filled its wards. Even as

a station hospital providing treatment to

local people, Tripler received not only

the common diseases of any American

community but also the “hopelessly

severe crushing and mangling” injuries

that resulted from accidents at the

numerous construction sites. Casualties

flown in from the tropical battlefronts

suffered from an array of exotic diseases;

others, from the Aleutians, had to be

treated for severe cold injury. Battle

wounds and training injuries gave staff

and trainees alike broad experience with

the consequences of gunfire. New soldiers shipped hastily to the Pacific arrived

with many problems from civilian life,

including psychological difficulties intensified by absence from home, the stress of

training, and the dangers of war. On

crowded Oahu living space was at a premium, and victims of communicable diseases often went to hospitals merely to

protect their housemates—as did hundreds of cases of pulmonary tuberculosis,

whose isolation at home was no longer

feasible. “It is thought improbable,”

wrote the commander, almost visibly rubbing his hands, “that any year in the history of Tripler General Hospital has

brought with it such diversified pathology and such splendid clinical opportunities [as 1943].”12

During 1942–43 four new general hospitals joined Tripler at the apex of Army

medicine in the Pacific. Schofield Station

Hospital at Schofield Barracks, already

the second largest in the Hawaiian

Department, reorganized and expanded

in March 1942 as a general hospital.

Though authorized a bed capacity of

only 1,000, the newly christened North 11Tripler Gen Hosp Annual Rpts, 1942, pp. 5–6, and

1943, p. 1 (quotation), file 319.1–2, HUMEDS, RG 112,

NARA. Tripler admitted about 7,400 casualties in 1941,

8,700 in 1942, and 11,000 in 1943.

12Ibid., 1943, pp. 14–15, file 319.1–2, HUMEDS, RG

112, NARA.

ARMY MEDICINE IN NAVY THEATERS 87
Sector General Hospital grew to 1,800 by

the end of the year, accommodating

extra patients on enclosed porches. The

204th General Hospital had a varied history. After arriving in April, its staff

trained at Tripler and North Sector, then

split into small detachments to operate

provisional hospitals and to form provisional clearing companies and ambulance battalions; finally, in November

1943 the 204th was reunited at Waipio on

Oahu and began to receive an influx of

casualties from the Pacific fighting. The

147th General Hospital, on its arrival

from the zone of interior in June 1942,

took over Provisional General Hospital

No. 2 at St. Louis College, about 5 miles

east of downtown Honolulu. Here the

147th served the south sector of Oahu

and, like other general hospitals, the outlying islands of the Hawaiian

Department. Housed in permanent concrete buildings belonging to the college

and temporary wooden structures built

by the Army, its normal bed capacity of

938 could easily expand to 1,500. The

hospital was equipped to handle all kinds

of patients, except those with contagious

or mental diseases, who were transferred

to Tripler.13

The last general hospital to see service in Hawaii was the 148th, which

arrived on Oahu one month before the

147th. However, its staff soon scattered

to meet pressing needs. Small detachments were sent to the island of Kauai to

operate 50-bed hospitals, while some

nurses and enlisted men were borrowed

by the 147th and North Sector General

Hospitals. The remaining staff members

operated a station and a general hospital on the island of Hawaii until August

1943, when they moved to Oahu, serving first at Schofield Barracks and then

in October in new quarters at Ekahanui

Gulf, 5 miles distant. Once on Oahu the

148th General Hospital, in addition to

its normal duties, trained officers, nurses, and enlisted men for medical service

with the combat forces.14

Bustling Oahu also contained ten

other hospitals, station or field. With the

exception of the small station hospital at

Hickam Field, all arrived during the last

two months of 1943; personnel, after

training at one of the two large hospitals,

moved out to their duty stations.

Additionally, small medical stations

known as Army annexes, with bed capacities of less than 100, served Army forces

stationed on the other islands of the

Hawaiian group. Hawaii, Kauai, and

Maui boasted the larger hospitals;

Molokai and Lanai contained the Army

annexes. Though Army divisions stationed on the islands had their own medical units, the island hospitals, under the

jurisdiction of the surgeon of the island

service command, cared for their seriously ill patients. The smaller hospitals

evacuated their more difficult cases by

Army transport planes or by interisland

boats to the general hospitals on Oahu.15

13North Sector Gen Hosp Annual Rpt, 1942, pp. 1–3;

204th Gen Hosp Annual Rpt, 1942, pp. 1–5, in CSurg,

Haw Dept, Annual Rpt, 1942, sec. 2; ibid., 1943, pp.

1–3, in CSurg, USAFICPA, Annual Rpt, 1943, sec. 3;

147th Gen Hosp Annual Rpt, 1942, pp. 2–3. All file

319.1–2, HUMEDS, RG 112, NARA. See also A. Edward

Livingston, “History of the Medical Service, 147th

General Hospital,” pp. 1–7, file 314.7, HUMEDS, RG

112, NARA.

14148th Gen Hosp Annual Rpt, 1942, pp. 1–12, in

CSurg, Haw Dept, Annual Rpt, 1942, sec. 3; ibid., 1943,

pp. 1–5, in CSurg, USAFICPA, Annual Rpt, 1943, sec. 3.

Both file 319.1–2, HUMEDS, RG 112, NARA. 15See 22d, 156th, and 165th Sta Hosps Annual Rpts,

1943, in CSurg, USAFICPA, Annual Rpt, 1943, sec. 6.

See also Surgs, Kauai, Hawaii, and Maui Svc Cmds;

Surgs, Kauai, Maui, Waikapu, and Molokai-Lanai Dist

Cmds; 156th, 165th, and Barking Sands Sector Sta

Hosps; Army Annex, Shingle Memorial Hosp; and

Continued

88 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Farther still from the center of activity were the outlying islands of the equatorial Pacific. After the Japanese

attacked Pearl Harbor, hospital units

accompanied task forces that occupied

Christmas, Canton, Fanning, and Baker

Islands, previously ungarrisoned, to

build and defend air bases. Canton in

the Phoenix Islands, below the equator,

came to serve as a link in the air communications system in the Pacific, and

the small hospital there became a staging facility for evacuees from South

Pacific battlefields. In these remote dots

on the map, medics set up hospitals in

abandoned buildings, Quonset huts,

and tents, and placed dispensaries in

dugouts protected by coral coverings.

Since the outlying islands were considered too primitive and isolated for

female nurses, male hospital corpsmen

took their places. Many served ably,

doing complex tasks in the operating

room without hope of advancement,

since the Army Nurse Corps was limited

to women.16

A report of the 1st Station Hospital on

Christmas Island gave a glimpse of one

such remote area. A 150-bed unit of 14

officers and 100 enlisted men, the hospital embarked on the SS President Johnson

and sailed from San Francisco on 31

January 1942. Also on the ship was Task

Force 4591—the 2,000-plus troops of the

102d Infantry with the mission of building and defending an air base. Besides

the hospital, medical personnel for the

force consisted of the regimental detachment, with 2 officers and 27 enlisted

men, and a flight surgeon, with an 8-man

detachment. On 10 February the force

arrived at its destination, a large coral

island typical of many in the central

Pacific. As intelligence reports had predicted, the climate was good and the

island devoid of endemic disease. A medical detachment sent out by the

Hawaiian Department was already on

the scene, caring for a small force of soldiers, American civilians, and Polynesian

natives. The station hospital took over a

temporary facility that the detachment

had opened in a deserted building,

pitching beside it a tent ward to handle

bed patients. In a remarkably short time,

a small but functional hospital was at

work, with the usual array of departments—eye, ear, nose, and throat; dental; X-ray; laboratory; medicine and

surgery; registrar and receiving officer—

also under canvas. A 1.5-kilowatt generator provided power. So equipped, the

medics awaited their patients, whether

injured in the construction work or

brought by planes in transit from the

South Pacific fighting.17

Medical supply developed steadily,

supporting hospital expansion. Before

Pearl Harbor, hospitals, like other medical units in the Hawaiian Department,

drew upon the medical supply depot at

Fort Shafter on the grounds of Tripler

General Hospital. Supplies were more

than adequate, and overages built up in

some items that proved useful later on.

During 1942, in order to provide for the

expanding Army and for security in case

of another attack, King scattered subdepots throughout Oahu and the outlying Army Annex, Lanai City Hosp, Annual Rpts, 1942, in

CSurg, Haw Dept, Annual Rpt, 1942, sec. 3. Both file

319.1–2, HUMEDS, RG 112, NARA. 161st, 26th, and Task Force F Sta Hosps Annual Rpts,

1942, in CSurg, Haw Dept, Annual Rpt, 1942, sec. 3;

ibid., 1943, in CSurg, USAFICPA, Annual Rpt, 1943,

sec. 6. Both file 319.1–2, HUMEDS, RG 112, NARA.

171st Sta Hosp Annual Rpt, 1942, pp. 1–5, in CSurg,

Haw Dept, 1942, sec. 3, file 319.1–2, HUMEDS, RG 112,

NARA.

ARMY MEDICINE IN NAVY THEATERS 89
islands. By the end of the year Oahu

alone had eleven and others were established on the islands of Maui, Kauai, and

Hawaii. In July the 5th Medical Supply

Depot took over the central depot. At

the same time, a subdepot opened at

Hickam Field for air force personnel

only. Both the Army and its air forces

maintained stocks of medical supplies,

ranging from 90 to 180 days. At the end

of the year the Hawaiian Department

received an additional forty-five medical

maintenance units, each designed to

supply 10,000 men for thirty days, which

were dispersed to depots throughout the

islands to prevent excessive loss in the

event of an attack. By that time shipping

shortages that had become acute immediately after Pearl Harbor had been

remedied, and a constantly increasing

stream of supplies reached the islands.18

As the first Allied counteroffensive

was getting under way in the southern

Pacific, hospital expansion in Hawaii

showed impressive gains. By the end of

1942 the Hawaiian Department counted

nineteen hospitals in place of the three

that had existed a year earlier. Seven of

these were small, sometimes provisional,

facilities operated by personnel from

the larger establishments; in the

Hawaiian Islands, as in Australia and the

South Pacific, geography compelled the

creation of small units to serve distant

garrisons. But because the islands were

comparatively few, bed strength could

be concentrated far more effectively

than in the fighting theaters, and almost

70 percent of the department’s 7,780

beds remained on Oahu. 

In other ways as well, the expansion

produced a minimum of problems. The

Hawaiian Islands, by contrast with the

South and Southwest Pacific, were relatively close to the continental United

States, making the importation of supplies and materials much easier. Hospital

construction was given a high priority by

Admiral Nimitz; Army engineers and

sometimes Navy Seabees assisted medics

with construction far more than in the

other theaters, where doctors and hospital corpsmen often had to pitch in and

build their own structures. Most important, no fighting raged in the area to

hamper the growth of the Hawaiian

base. General King, nevertheless,

encountered several difficulties.

Personnel

As usual, wartime priorities ensured

that a continuous personnel shortage,

though not comparable to the one in

Australia, would make the chief surgeon’s task of staffing the expanded hospital facilities difficult. During 1942–43

officer strength was consistently 5 percent below that authorized. Nurses

remained in short supply—15 percent

understrength in 1942—but the deficiency was gradually reduced during

1943. Enlisted men filtered in, numbers

rising from 27 percent below authorized

strength in 1942 to only 4 percent below

in 1943. Inevitably, the theater lacked

sufficient physical therapists, dieticians,

dentists, highly qualified surgeons, and

trained psychiatrists—scarcities that

existed almost everywhere during the

war. In an effort to fill the vacancies in

specialized fields, King transferred staff

from one facility to another, split up

newly arrived organizations in order to

use their personnel as replacements,

18CSurg, Haw Dept, Annual Rpt, 1942, sec. 1, p. 11,

file 319.1–2; Whitehill, “Medical Activities in Middle

Pacific,” block 3, p. 8, file 314.7. Both in HUMEDS, RG

112, NARA. See also Armfield, Organization and

Administration, pp. 395–96, 399.

90 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
and detached individuals from one

organization to fill shortages in another.

He also recruited civilian medical personnel, particularly nurses, from the

Hawaiian Islands. Despite his efforts,

shortages lasted well into 1944.19

In some respects, the largest hospitals suffered the most. As the endpoints

of the chain of evacuation, general hospitals took up the slack for small facilities. Organized as a 1,000-bed hospital,

Tripler expanded to more than 1,500

beds by the end of 1942. Although its

authorized bed strength reached 1,500

in 1943, the hospital again expanded to

more than 2,100 beds by the end of that

year. Adding beds was easy; staffing

them was difficult and slow. As a result,

Tripler was continually understrength.

The teaching function also burdened

the big hospitals. Personnel sent to

Tripler for training required supervision, demanding additional effort from

the staff without adding proportionately to the working effectiveness of the

hospital.20

Army nurses and hired civilian nurses

found much work to do as the islands

organized, first for defense and then for

attack. After hostilities started, King sent

Army nurses from Tripler, Schofield,

and Hickam hospitals to staff the provisional facilities. As more troops came to

the islands and new hospitals were set

up, he dispersed nurses further, necessitating constant recruitment from civilian sources on the islands and from

Army sources on the mainland. The

nurse census rose from 195 at the end

of 1941 to 960 at the end of 1943. Some

of the recruits became scrub nurses;

others worked in wards. Still others took

advantage of Tripler’s four-month

course on the theory and practice of

anesthesia, and formed teams of anesthetists. In turn, they trained enlisted

technicians, since female nurses could

not accompany assault forces into battle. In 1943 squadrons of air evacuation

nurses came to Hawaii to serve with the

Army Air Forces.

Skilled women found a variety of tasks

to perform. An Army nurse served as liaison officer between the Nursing Division

of the Office of Civilian Defense and the

Army. Army nurses worked in public

health, assisting the civilian community

in the immunization campaigns and in a

variety of measures for controlling

dysentery, polio, and dengue. In general,

their morale was good as long as they

were kept busy. However, like other

Army officers, nurses griped about rotation, leaves, and promotions. Because of

the personnel shortages, many did not

return to the mainland for four or five

years. Only in 1945 was the Army

Medical Department able to adopt a policy of rotation for nurses with two years

of overseas service.21

Unlike nurses, Army dental officers

were often called upon to work outside

their own profession—by no means an

unusual demand in the Army. Hospital

units training and staffing in Hawaii

used dentists to direct their medical

supply and transport or to serve as

quartermaster officers and training

19Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 3–4, 20, file 314.7; CSurg, Haw Dept,

Annual Rpt, 1942, sec. 1, p. 13, file 319.1–2. Both in

HUMEDS, RG 112, NARA. 20Tripler Gen Hosp Annual Rpt, 1943, pp. 1–7, file

319.1–2, HUMEDS, RG 112, NARA.

21Whitehill, “Medical Activities in Middle Pacific,”

block 11, pp. 2–18, file 314.7; Intervs, Capt Edith A.

Aynes, 24 Sep 43, Capt C. Elva Collison, 16 Oct 43, and

Col Kermit H. Gates, 17 Jul 45, file 000.71; CSurg,

USAFMIDPAC, Annual Rpt, 1945, pp. 77–78, file

319.1–2. All in HUMEDS, RG 112, NARA.

ARMY MEDICINE IN NAVY THEATERS 91
instructors. During the assault phases

of combat, when practically no dentistry was practiced, dentists were

expected to perform a number of ancillary duties: assisting battalion surgeons;

treating shock and maxillofacial

wounds; administering general anesthesia; helping in the wards; and performing minor surgery to remove missile fragments and other debris. They

might also be called upon to act as sanitary, supply, and administrative officers. To prepare for these tasks, dentists received extra training in Hawaii,

especially in the areas of maxillofacial

wounds and general anesthesia.

Though traditional in the Army, such

diversions from one’s military occupational specialty may help to explain why

shortages of dentists occurred, especially at isolated garrisons. The dental

section of King’s office tried to alleviate

the problem by employing three

mobile trailers to care for troops on

outlying islands and by placing four

extra clinics on Oahu—in gymnasiums,

community halls, and even Japanese

temples—to serve units that were without dentists.22

With their varied responsibilities in

food inspection, animal care, and the

anti-biological warfare program, the

need for more veterinarians in Hawaii

was apparent early. King’s staff established schools to train food inspectors,

and Oahu soon boasted two animal hospitals—the Veterinary General Hospital

near Fort Armstrong, and the Veterinary

Station Hospital at Schofield Barracks.

By the end of 1943 the Army veterinary

service extended to all islands of the

Hawaiian group and to Christmas

Island.23

Care of the Troops

Throughout the years of preparation,

medical personnel of the Hawaiian

Department practiced their skills,

received training, and taught others.

Meanwhile, combat units were training

for their own roles in the fighting that

lay ahead.

The six Army infantry divisions that

trained and staged in Hawaii—7th,

27th, 81st, 96th, 77th, and 98th—

brought with them their own medical

support. For the 27th Division, this

meant initially the 102d Medical

Regiment. A New York National Guard

outfit, the 27th was federalized in 1940,

trained in Alabama and California, and

prepared to move overseas. Part of the

medical preparation consisted of inoculations against yellow fever and

typhoid. Cases of hepatitis began to

appear at Fort Ord, California, and the

incidence rapidly grew to the dimensions of an epidemic while the division

was moving to the island of Hawaii during March 1942. Medical personnel

inspected all divisional units for the

jaundice that was the principal symptom of the disease; several units had to

be quarantined, and many soldiers

were hospitalized. The reason—though

few were yet aware of the fact—was contaminated serum used by the

Rockefeller Institute to prepare some

batches of the yellow fever vaccine. The

contamination caused the only world- 22Whitehill, “Medical Activities in Middle Pacific,”

block 9, pp. 2–20, file 314.7; Surg, Schofield Barracks,

Annual Rpt, 1942, pp. 1–5, in CSurg, Haw Dept, Annual

Rpt, 1942, sec. 2, file 319.1–2. Both in HUMEDS, RG

112, NARA.

23Whitehill, “Medical Activities in Middle Pacific,”

block 10, pp. 3–5, 18–25, file 314.7; Interv, Col Wayne

O. Kester, 19 Sep 45, file 000.71. Both in HUMEDS, RG

112, NARA.

92 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
wide epidemic to strike American

forces during the war.24

While those with hepatitis were cared

for at the 156th Station Hospital on

Hawaii, those who were healthy worked

hard building defensive positions and

living quarters. In common with other

forces in the islands, 27th Division

infantrymen dug underground aid stations to protect the wounded in case of

renewed enemy attack. Jungle warfare

training was intensive and continuous.

Lacking the urban life of Oahu, the “big

island” yielded limited recreation for

off-hours, and water was scarce and the

diet monotonous. Perhaps in consequence, the soldiers developed a taste

for sake (rice wine), which was brewed

locally; when “mixed with beer or other

liquor . . . ,” sake had, according to the

division surgeon, “a paralyzing effect.”

Venereal disease was kept under control

by a rigorous program of inspection and

contact tracing, implemented by the

Territorial Board of Health. Preventive

medicine included programs of rat control, all the more important because

sporadic cases of plague occurred

among the local population; and mosquito and fly control, made necessary by

the warm damp climate. In July the

148th General Hospital arrived on

Hawaii, and the division surgeon

worked out consolidated plans with the

two hospitals for mutual support in case

of attack.25

A feature of life on the outer islands

was a multiplication of commands that

might have spelled confusion, but in

practice seemingly did not. Each island

had a district command, which directed

all tactical forces, and a command surgeon; each, as noted above, also had a

service command and a service command surgeon. Add a division surgeon,

and the possibilities existed for duplication or conflict. Several factors mitigated the situation. Not every island had a

division surgeon in residence, and when

it did he often took on one or more of

the other jobs as well as his own. Thus,

for five months in mid-1942 the 27th

Division surgeon on Hawaii functioned

as the district surgeon and the service

command surgeon. He cared for the

troops, supervised the immunization of

all civilians against typhoid and smallpox, and in general repeated locally the

kind of unified leadership that King

gave the medical service as a whole.26

Other divisions had similar experiences. The 40th Infantry Division was

dispersed over several islands after its

arrival on 1 September. Its division surgeon was designated district surgeon on

the island of Kauai. On Maui a medical

battalion commander served as district

surgeon, and as such supervised all tactical medical units. Meanwhile, the local

service command surgeon functioned in

much the manner of a post surgeon,

providing hospitalization for all troops

but only routine medical care for service

units.27

So organized, the medics supported

the islands’ defenders through the last

quiet months that many would see for

the remainder of the war. In September 24The epidemic caused 4,624 hospitalizations in the

Hawaiian Department; the death toll is unclear. See

CSurg, Haw Dept, Annual Rpt, 1942, sec. 1, p. 5, file

319.1–2, HUMEDS, RG 112, NARA. 25Surg, 27th Inf Div, Annual Rpt, 1942, pp. 1–3 (quotation, p. 2), in CSurg, Haw Dept, Annual Rpt, 1942,

sec. 2, file 319.1–2, HUMEDS, RG 112, NARA.

26Ibid., pp. 3–4, in ibid.

27Surg, 40th Inf Div, Annual Rpts, 1942, and 1943, p.

1, and Surg, Maui Dist Cmd, Annual Rpt, 1943, p. 1,

The Historical Unit (THU) Note Cards, Historians

files, HUMEDS, RG 112, NARA.

ARMY MEDICINE IN NAVY THEATERS 93
the 27th Division was triangularized

and, as a result, its 102d Medical

Regiment reorganized into the 102d

and 71st Medical Battalions; the 102d

remained with the 27th and the 71st was

subsequently attached to the 40th

Division. A short time later the 27th

moved to Oahu, where training became

even more intensive than before, with

the introduction of commando-type

exercises. As on Hawaii, fixed hospitals

and field units were closely integrated

for medical support, with the North

Sector General Hospital prepared to

hospitalize casualties of the 27th and

40th Divisions in case of enemy attack.

Guarding the coast between Pearl

Harbor and Diamond Head, the division enjoyed nine more battle-free

months, though the training schedule

clearly indicated what lay ahead.28

The air surgeon, Col. Andrew W.

Smith, MC, provided the Seventh Air

Force, the new name of the Hawaiian Air

Force as of March 1942, with a distinctive

medical service at the unit and dispensary level. Only the large permanent

installations—Kahuku Army Air Base and

Hickam, Wheeler, and Bellows Fields on

Oahu; Hilo Field on the big island of

Hawaii; and Barking Sands Army Air

Base on Kauai—had the medical facilities

to care for ground crews, each headed by

a flight surgeon whose age or physical status made him unavailable for combat

duty. Squadron flight surgeons and the

medical units they commanded formed

the so-called tactical service. Squadrons

and their flight surgeons rotated through

the small scattered outposts in the combat zone, including those on Midway,

Christmas, and Canton Islands, where

they received field training. For evident

reasons, the tactical service was required

to function independently of the base

medical installations. Some duplication

resulted on well-established bases, where

base and squadron medics worked side

by side. But the tactical service enabled

squadrons at a few hours notice to move

into remote bases, where local medical

support was nonexistent.

The medical problems of airmen were

varied and special. Some related to the

rigorous physical standards required for

flight status; base installations devoted

much time to examining candidates for

flight training and retesting fliers, espe28Surg, 27th Inf Div, Annual Rpt, 1942, p. 3, in CSurg,

Haw Dept, Annual Rpt, 1942, sec. 2, file 319.1–2; Surg,

40th Inf Div, Annual Rpts, 1942, and 1943, p. 2, THU

Note Cards, Historians files. All in HUMEDS, RG 112,

NARA. See also Edmund G. Love, The 27th Infantry

Division in World War II (Washington, D.C.: Infantry

Journal Press, 1949), p. 21.

94 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

COL. ANDREW W. SMITH, MC
cially their eyes and ears. A distinct subspecialty of aviation medicine was maturing during the war, as researchers studied

the effects of acceleration, depressurization, high altitude cold injury, and the

peculiar psychological stresses of combat

flying—“aerio-neurosis, or cumulative

fatigue; call it what you will,” said Colonel

Smith. Scientific considerations interacted with the drive for an independent air

service, producing a complicated worldwide struggle between the Army Air

Forces and Army Service Forces over control of medical logistics and hospitalization. During these early days in the

Hawaiian Department, the main complaint of the air surgeon was the lack of

promotions for his subordinates, resulting from the fact that the buildup of air

support had outrun paperwork. Neither

the individual air bases nor the Seventh

Air Force had an authorized table of

organization, and regular medical officers in the Hawaiian Islands found themselves outranked by newly activated

reserve officers from the mainland.29

Besides its scientific and bureaucratic

difficulties, the Army Air Forces was itself

a source of some medical problems.

Planes traveled daily from tropical battlefronts to bases in the Hawaiian Islands,

many carrying the wounded or sick.

Hence, quarantine was a pressing problem of air travel. Airmen, using hand

pumps, sprayed planes with pyrethrum

and carbon tetrachloride on their arrival

and before departure. Arriving pets were

quarantined; parrots were destroyed for

fear of psittacosis; and “any number of

disease-bearing insects, including the

dreaded Anopheles,” were wiped out.

Despite such precautions, an epidemic

was touched off in July 1943 by two fliers

who returned from the Southwest Pacific

Area with dengue (breakbone) fever. A

massive military-civilian effort to destroy

mosquitoes resulted, as the disease

spread among the civilian population.

Quick action limited the outbreak to

Oahu, but 1,500 cases were recorded

before it ended.30

Prehospital medical care for coast and

antiaircraft artillery troops was similar to

that provided for the Seventh Air Force.

On 16 March 1942 General Emmons

split the Hawaiian Coast Artillery

Command into two separate organizations, the Hawaiian Seacoast Artillery

Command and the Hawaiian Antiaircraft

Artillery Command. The medical service

of the two organizations was much alike.

The Seacoast Artillery Command was

divided into four harbor defense areas,

each with its own surgeon. The

Antiaircraft Artillery Command was reorganized into groupments of several regiments, with a surgeon for each groupment. Regimental surgeons were responsible to the groupment surgeon. Unit

medics provided care to the widely dispersed troops through many small dispensaries and regimental and battalion

aid stations. In the Seacoast Artillery

Command, as in the Seventh Air Force,

the station and the tactical medical services were separate endeavors.31

29Quotation from Surg, 7th Air Force, Annual Rpt,

1942, p. 6, in CSurg, Haw Dept, Annual Rpt, 1942, sec.

2, file 319.1–2, HUMEDS, RG 112, NARA. On air medicine, see Mae Mills Link and Hubert A. Coleman,

Medical Support of the Army Air Forces in World War II

(Washington, D.C.: Office of the Surgeon General,

USAF, 1955), pp. 305–39.

30Quotation from Surg, 7th Air Force, Annual Rpt,

1942, p. 6, in CSurg, Haw Dept, Annual Rpt, 1942, sec.

2, file 319.1–2, HUMEDS, RG 112, HUMEDS, NARA.

See also Allen, Hawaii’s War Years,” pp. 337–38. 31Surgs, Haw Seacoast Arty and Haw AAA Cmds,

Annual Rpts, 1942, in CSurg, Haw Dept, Annual Rpt,

1942, sec. 2, file 319.1–2, RG 112, HUMEDS, NARA.

ARMY MEDICINE IN NAVY THEATERS 95
Evacuation both to and from Hawaii

remained a major concern of the chief

surgeon. Among King’s problems were

the neuropsychiatric cases that formed a

large percentage of the evacuees arriving on Oahu from other parts of the

Pacific. Early in the war the Hawaiian

Department evacuated such patients to

the mainland as soon as possible.

During 1942 and 1943 psychoneurotics

and psychotics accounted for over 30

percent of evacuees. Only in 1944 did

faster diagnosis and better forward treatment prevail, causing the evacuation

rate to fall.32

The seriously ill and injured were

evacuated from the Oahu medical centers to the zone of interior, generally on

transports. Early in the war a shortage of

ships and the absence of adequate hospital facilities on board those that were

available presented serious problems.

During late 1941 and the latter part of

1942 the lack of transportation created

several months’ backlog of casualties

awaiting evacuation. (After one of these

delays, King’s office had to ship over 400

to the mainland at one time.) A more

serious difficulty resulted from the

absence aboard of adequate secure

accommodations for neuropsychiatric

cases, for most of the transports arriving

in Honolulu had either very small

secure sections or none at all.

During 1943 evacuation to the mainland increased and proceeded regularly,

except for the month of August, when a

shortage of ships caused another backlog. Medical hospital ship platoons were

organized and assigned to the transports

in the Central Pacific Area, providing better care for all evacuees during the long

voyage to the United States. Transports

continued to be the principal means

until August 1944, when more planes of

the Army Air Forces’ Air Transport

Command became available. Thereafter,

the Army was able to evacuate increasing

numbers of casualties by air.33

Within the theater, planes provided

the principal means of evacuating the

wounded or sick from other islands to

the Oahu medical centers. Early in the

war Army and Navy tactical and transport planes did the flying with a medical

officer, not always a flight surgeon, on

board. At the start of the central Pacific

campaigns in November 1943 the

32Whitehill, “Medical Activities in Middle Pacific,”

block 8, pp. 3–5, file 314.7, HUMEDS, RG 112, NARA.

33Ibid., pp. 3–5, 14, file 314.7; Memo, King to Ed.,

History of Medical Department, 22 Mar 50, p. 13, file

000.71; Interv, Brig Gen Harry D. Offutt and Col Alvin

L. Gorby, 10 Nov 49, file 000.71. All in HUMEDS, RG

112, NARA.

96 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

ZONE-OF-INTERIOR EVACUATION
Pacific Wing of the Air Transport

Command became responsible for air

evacuation of Army casualties in the

area, though the Naval Air Transport

Service continued to evacuate some of

them. To enable qualified medical personnel to be on every flight, air medical

squadrons, each consisting of a flight

surgeon, eight nurses, and twelve enlisted men, were assigned to the Air

Transport Command. If for some reason an air evacuation squadron was

unavailable, air force units were expected to provide the medics and flight surgeons. Before departure, flight surgeons had the additional responsibility

of deciding if casualties were capable of

making the trip and what medications

and supplies they would need during

the flight. Flight surgeons now were

principally employed in selecting the

cases to be evacuated and preparing

them for the trips, while a flight nurse

and a technician accompanied them on

their journeys.34

As a result of all these changes,

Hawaii evolved into a communications

zone for the central Pacific campaigns.

King’s efforts were aided immensely

both by Nimitz’ full acceptance of the

spirit of a combined command and by

Emmons’ support, shown most clearly

in his decision to unite the two top Army

medical positions under one man.

Unified and competent leadership,

ample time to prepare, and the absence

of the nightmarish jungles of less fortunate theaters marked the central Pacific

during the year and a half that elapsed

between the Pearl Harbor raid and the

launching of Admiral Nimitz’ drive to

the west.

The South Pacific Area

On 20 April 1942 the Joint Chiefs of

Staff established the South Pacific Area

as a subdivision of Pacific Ocean Areas,

at the same time deciding that the initial

offensive against Japan should be

launched there. In July, to provide unified command of Army troops, the

United States Army Forces in the South

Pacific Area (USAFISPA) was established, with headquarters in Auckland,

New Zealand, and Maj. Gen. Millard F.

Harmon, the Air Staff Chief, designated

as commanding general. Harmon was

directly responsible to Vice Admiral

Robert L. Ghormley, chief of the South

Pacific Command (COMSOPAC), and,

after October 1942, to Ghormley’s successor, Vice Admiral William F. Halsey,

who was promoted to admiral on 18

November. The area logistical command, the United States Army Services

of Supply (USASOS), was under Brig.

Gen. Robert G. Breene.

By November both COMSOPAC and

the USAFISPA headquarters moved to

Noumea, New Caledonia, near the combat zone. As the front advanced,

Ghormley created additional area combined commands on the most important islands occupied by U.S. forces.

Beginning in November, he established

service commands, in effect base sections supporting the forces on a particular island or island group. While the

island commanders, regardless of service, reported to General Harmon, the

service commanders were responsible to

General Breene. In many respects, the

theater represented a workmanlike solution to the problems of combined com3426th Sta Hosp Annual Rpt, 1943, p. 1, in CSurg,

USAFICPA, Annual Rpt, 1943, sec. 6, file 319.1–2;

Whitehill, “Medical Activities in Middle Pacific,” block

8, pp. 6–8, file 314.7; Interv, Col Paul H. Streit, 21 May

45, file 000.71. All in HUMEDS, RG 112, NARA.

ARMY MEDICINE IN NAVY THEATERS 97
mand. But geography and deficient

resources united to create difficult problems for the medics to solve.35

Most of the South Pacific Area was

open ocean. Its islands included New

Zealand, smaller but still sizable New

Caledonia, Fiji, and Espiritu Santo, and

thousands of small islands in the Cook,

Society, and Marquesas groups, many

mere dots on the map. Distances were

great. Auckland, New Zealand, lies more

than 1,100 miles from New Caledonia,

nearly 1,600 miles from Espiritu Santo

in the New Hebrides, and more than

2,000 miles from Guadalcanal. Cultural

differences divided these lands from

one another even more widely than the

miles. 

New Zealand possessed a temperate

climate, large towns, and a population

predominantly of European descent.36 It

resembled its huge neighbor, Australia,

in its dependence on grazing and on

exports—mutton, wool, butter, and

cheese. A British dominion, New

Zealand was self-governing, with a welldeveloped system of public health and

welfare. Divided into health districts,

each headed by a qualified physician

under a national director-general, the

island country of 2 million enjoyed the

lowest death rate in the world.

Americans came early to New

Zealand, but few lingered for long.

Almost from the beginning of the war,

American ships made use of its harbors,

and the 37th Infantry Division and 1st

Marine Division encamped there for a

few months in the summer of 1942.

However, Japan’s reverses at sea demonstrated that the war would be fought to

the north. With the departure of

Halsey’s and Harmon’s commands to

New Caledonia, the only headquarters

left in Auckland was the United States

Army Forces in New Zealand, with its

own surgeon—Lt. Col. Wallace I.

Douglas, MC, and later Lt. Col. Amos R.

Koontz, MC—to supervise the service

troops and others who remained.37 By

the end of the year New Zealand had

become simply an island command, but

in many ways an atypical one.

During 1942 hospital care of

American troops fell first to New

Zealand facilities and then to the U.S.

Navy, though the Army’s 18th General

Hospital stopped off briefly on its way to

Fiji. Toward the end of October work

began on a 1,000-bed general hospital

plant near Auckland, but the 39th

General Hospital, which was destined to

occupy it, found the facility incomplete

when it arrived in November. For several months its personnel worked in Navy

hospitals or repaid part of the Army’s

debt to civilian physicians by serving in

the Auckland City Hospital, where doctors were in short supply. Not until

February 1943 were the first Army

patients transferred from Navy care to

the new plant, which had been constructed by the civil government and 35Morton, Strategy and Command, pp. 256–63; John

Miller, jr., Guadalcanal: The First Offensive, United States

Army in World War II (Washington, D.C.: Historical

Division, Department of the Army, 1949), pp. 1–3;

Armfield, Organization and Administration, p. 397. 36Narrative on New Zealand based on Eugene T.

Lyons, “Australia and New Zealand,” in Ebbe Curtis

Hoff, ed., Civil Affairs/Military Government Public Health

Activities, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1976), pp. 554–64.

37Colonel Koontz found sanitary conditions in the

dairy, meat, bottling, and restaurant industries to be

unsatisfactory and the Health Department’s general

cooperativeness somewhat hampered by political considerations. See Surg, USAF and Svc Cmd [New

Zealand], Annual Rpt, 1943, file 319.1–2, HUMEDS,

RG 112, NARA.

98 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
FACILITIES OF THE 18TH GENERAL HOSPITAL (top) AND THE 39TH GENERAL HOSPITAL (bottom)
loaned to the American Army. For its

twenty-one months of operation, the

39th General Hospital remained the

only U.S. Army hospital permanently

assigned to New Zealand. In time, it

expanded to more than 2,500 beds and

added a convalescent facility as well, caring for over 23,000 casualties, mostly the

sick and wounded from the fighting in

the tropical islands to the north.

For the men and women who served

there, New Zealand offered many

amenities. Unlike their fellows in

Australia, most medics worked in established cantonments near cities with

water and sewage systems. Venereal disease was never a problem. The Army set

up prophylactic stations, and the

authorities cooperated freely, tracing

contacts and compelling infected

women to receive treatment. New

Zealand’s disease environment resembled that of other temperate lands, and

the lack of anophelines meant that

malarious servicemen who returned

from the fighting for rest and retraining

could go where they pleased, enjoying

the extraordinary scenery without

endangering their hosts.

The chief problems that developed

between American medical officers and

the New Zealand authorities had to do

with food and food products. Large

quantities of food for American troops

were procured by the Joint Purchasing

Board, an agency of the U.S. Navy with

some Army members. The board dealt

with the government procurement officials, who then signed contracts with

local producers. This setup effectively

insulated the producers from inspection

by American officers during processing;

not until 1944 were Veterinary Corps

officers allowed to begin large-scale

inspections of slaughterhouses, dairies,

and canneries. Yet wartime demands

multiplied such establishments, many in

unsatisfactory sanitary condition. Here,

as in Australia, persuasion and education in improved methods were the

main reliance for bringing about

change. Milk was a special problem.

Dairy herds were widely infected with

tuberculosis and undulant fever, and

New Zealand, despite its huge herding

industry, had comparatively few veterinarians and no school of veterinary

medicine. Milk was so often a cause of

typhoid that New Zealanders themselves

preferred to drink condensed milk and

tea. Veterinary officers failed in their

efforts to effect reforms, forcing military

commanders to place milk bars off limits to their troops. But this was the only

major sour note in an economic relationship that saw more than 500 million

pounds of animal foods purchased in

New Zealand for American forces in the

Pacific war.

Much happier were the professional

contacts between American and New

Zealand physicians, both military and

civilian. As already noted, they cared for

each others’ patients; New Zealanders

instructed Americans in tropical medicine; and the Auckland branch of the

British Medical Association held monthly meetings with the combined staffs of

the U.S. Navy hospitals and the 39th

General Hospital. Good relations continued long after New Zealand had

ceased to be the South Pacific Area’s

headquarters and main base, for it

remained a perfect spot to rehabilitate

battle casualties from the jungle warfare

to the north.

The other islands of the South Pacific

Area were either tropical or subtropical,

with heavy rainfall, high humidity, and a

variety of diseases afflicting the native

100 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
inhabitants. All were colonies of either

France or Britain. Responding to the

distribution of vectors and the accidents

of settlement, ailments differed widely

from island to island. New Caledonia

and the Fiji, Cook, Society, and

Marquesas Islands were free of malaria,

but on the New Hebrides and the

Solomons the disease was rife. The first

epidemic of the South Pacific Area

broke out in April 1942 on Efate in the

New Hebrides, where the malaria rate

reached 2,700 per 1,000 troops per year,

and lesser outbreaks occurred on

Espiritu Santo and in the Russell

Islands. Troops stationed in the eastern

part of the region suffered from filariasis, caused by a parasitic worm; epidemics of dengue broke out on New

Caledonia and Espiritu Santo. Bacillary

dysentery was common, though seldom

serious. Venereal disease varied from

island to island—a problem in the Fiji

Islands, but not on New Caledonia, for

example—influenced by local mores

and the efficiency of the civil government. Natives, reservoirs of many diseases that attacked the troops, were

themselves highly susceptible to influenza and measles, and had to be protected

from these infections. The primitive and

tropical, not the temperate and urban,

South Pacific formed the disputed

region and set the terms of the medical

problem.38

U.S. Army forces began moving into

the tropical islands of the South Pacific

Area shortly after Pearl Harbor, aiming

to prevent further Japanese advances

and to protect the Allied line of communications to Australia. Early in 1942

New Caledonia’s evident military importance caused the United States to assemble and dispatch Task Force 6184, containing a mixed bag of troops and a

brigade headquarters under Brig. Gen.

(later Maj. Gen.) Alexander M. Patch, Jr.

The Army’s most unusual division, the

Americal, was formed on New

Caledonia from this task force in May.

The 37th Division arrived in the Fijis,

while smaller units entered the Tonga

Islands and the New Hebrides. After

June, in preparation for a planned

offensive against Guadalcanal and

Tulagi, troop strength continued to

increase, reaching 104,662 (including

three divisions and five air combat

groups) by the end of the year. Marine

and naval forces were augmented as

well, and by mid-1943 the South Pacific

held more than 192,000 American

troops. Preventive medicine and treatment of those who were sick or wounded absorbed the time and efforts of

about 1,200 medical personnel.39

Medical Organization

The summer of 1942 saw the creation

of an Army medical organization in the

38Benjamin M. Baker, “South Pacific Area,” in W.

Paul Havens, Jr., ed., Activities of Medical Consultants,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

1961), pp. 569–71; Paul A. Harper et al., “New

Hebrides, Solomon Islands, Saint Matthias Group, and

Ryukyu Islands,” in Ebbe Curtis Hoff, ed., Communicable

Diseases: Malaria, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), p.

400.

39CSurg, USAFISPA, Annual Rpts, 1942, pp. 1–2, and

1943, pp. 3–4, file 319.1–2, HUMEDS, RG 112, NARA.

See also Maurice Matloff and Edwin M. Snell, Strategic

Planning for Coalition Warfare, 1941–1942, United States

Army in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army, p.

1953), pp. 301–05. By the spring of 1942 soldiers were

stationed on ten islands: New Zealand, New Caledonia,

Efate, Espiritu Santo, Fiji, Tongatabu, Bora Bora,

Aitutaki, Tongareva, and Guadalcanal.

ARMY MEDICINE IN NAVY THEATERS 101
South Pacific. On 6 August Lt. Col. Earl

Maxwell, MC, became Chief Surgeon,

USAFISPA, and assistant to the Navy’s

chief surgeon, Capt. Arthur H. Dearing,

MC. With overall responsibility for medical support in South Pacific operations

and with a staff of only three, Dearing

often turned planning over to Maxwell

and his staff of seven officers and fifteen

enlisted men. Dearing also relied on

Maxwell to plan support for Army combat troops in all operations (Maxwell

would later draw up medical plans for

both the Army and the Navy in the

Bougainville campaign), reserving for

himself only the right to final approval.

Such cooperation, a hallmark of the

South Pacific Area, was especially important to the planning and execution of

amphibious operations.40

A native of Illinois, Maxwell was 38

years old when he joined General

Harmon’s staff. He already had almost

fourteen years of experience as an

Army medical officer, as chief of the

eye, ear, nose, and throat service in several military hospitals, and as base surgeon at Army installations in the

United States and the Canal Zone. A

graduate of the Army’s School of

Aviation Medicine, Maxwell was rated a

flight surgeon, and as a representative

of the Army Air Forces he functioned

as air surgeon of the South Pacific

Area. In November, shortly after his

promotion to full colonel, he assumed

the additional function of USASOS surgeon, which conformed to Navy practice and eliminated another possible

source of friction.

Staff surgeon both to Harmon and to

Breene, air surgeon, and assistant to the

Navy chief surgeon, he surmounted

bureaucratic problems by personal qualities and the wearing of multiple hats.

Under him the theater and USASOS

medical sections, though organizationally separate, shared work space and

assignments at Noumea. Operations and

planning were the province of the theater staff, and medical supply, statistics,

personnel, food inspection service, hospitalization, and others, that of the

USASOS staff. The result was a more efficient system that eliminated duplication.

Maxwell appears to have been skillful

and above all pragmatic in his handling

40Whitehill, “Medical Activities in Middle Pacific,”

block 3, p. 71, file 314.7; Interv, Col Samuel E. Stuart,

20 Jan 45, file 000.71; Interv, Col Earl Maxwell, 11 May

50, file 000.71. All in HUMEDS, RG 112, NARA. See

also Armfield, Organization and Administration, p. 389.

Maxwell’s staff later increased to twenty-three officers

and thirty-six enlisted men.

102 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

BRIG. GEN. EARL MAXWELL, MC

(Rank as of 19 January 1944)
of the South Pacific Area. Indifferent to

formalities, he readily shared equipment with the Navy (he could get jeeps,

they could get Quonsets). He used

troopships and supply planes to move

wounded, without showing Carroll’s

concern over the lack of dedicated craft;

he was quite willing to see soldiers hospitalized in Navy facilities, or sailors in

Army ones. Confronted by opposition

from affiliated hospitals when he tried

to transfer their specialists to other units

needing their services, he simply waited,

knowing that boredom would cause

many underemployed professionals to

ask for transfers voluntarily. Finding that

the Americal Division still had the medical regiment of an old-fashioned square

division, he delayed reorganization as

long as possible, remarking to Surgeon

General Magee that “a little freedom

from the restrictions and limitation[s]

of current approved Tables of

Organization . . . would improve the

medical service in thes [sic] theater

immeasurably.” Informal, diplomatic,

and precise, Maxwell won the reputation of a competent theater surgeon,

gaining a brigadier general’s star in the

Army and, after the war, another in what

became the independent Air Force.41

But unified management at the top

could not, of itself, prevent disputes

from arising at lower levels. Though

Maxwell stood near the head of both service and island command channels, his

control was hampered by the theater’s

great distances, which forced responsibility downward to levels where cooperation among the services and between the

military and the colonial governments

might or might not prevail. Naval leadership, however tactful, created problems. A basic difficulty was the complexity of the organization built up by the theater commanders. By comparison with

General Headquarters, SWPA, a great

number of subordinate forces reported

directly to Ghormley’s headquarters—

USAFISPA, South Pacific Amphibious

Force (Task Force 32); I Marine

Amphibious Corps; ground troops of

Allied nations; South Pacific Service

Squadron (nontactical); South Pacific

Aircraft (Task Force 33), which controlled land-based air; naval forces; and

island bases. Each significant island had

its own base commander, while the various elements present on the island—soldiers, marines, airmen, Allies, and so

forth—were connected vertically to the

theater headquarters through their own

commands. In such a situation, command surgeons multiplied, each subject

to his own immediate commander.42

Espiritu Santo presented an example

of the problems that could arise. Largest

of the New Hebrides and an important,

heavily malarious base, the French-governed island lay about 480 miles from

Guadalcanal. Quartermaster depots, an

infantry training base, and coast artillery

installations, as well as Navy bases and a

Marine camp crowded a mountainous

land, where the largest native village

held only 152 people. Lt. Col. Arthur G.

King, MC, served as both Espiritu Santo

Service Command surgeon and IV

Island Command surgeon, bearing

unofficially the title of base surgeon.

41Quotation from Rpt, CSurg, USAFISPA, to SG, U.S.

Army, 7 Dec 42, p. 2, Encl to CSurg, USAFISPA, Annual

Rpt, 1942, file 319.1–2. See also Interv, Maxwell, 11 May

50, file 000.71. Both in HUMEDS, RG 112, NARA.

42On naval organization in the South Pacific Area,

see John Miller, jr., CARTWHEEL: The Reduction of Rabaul,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1959), pp. 67–70.

ARMY MEDICINE IN NAVY THEATERS 103
Seemingly, his position as, at least informally, chief surgeon of Espiritu Santo

ought to have been clear. In fact it was

not. The local Service Command was

under the Island Command, but

received all operational orders directly

from the USASOS. The surgeon of the

Thirteenth Air Force, located on

Espiritu Santo, dealt directly with the

USAFISPA headquarters, even though

air force personnel were hospitalized in

Service Command hospitals and air

installations were subject to Service

Command sanitary codes. The Navy had

no single headquarters on the island

until October 1943, and until that time

King had to negotiate on matters of

common concern with several senior

Navy medical officers, including those

who commanded two local Navy hospitals. Under a Navy surgeon, who reported directly to the island commander, the

joint malaria and insect control organization obtained its personnel and supplies from King as the Service

Command surgeon (Chart 2). Finally,

said King, the Marine Corps “was integrated with these organizations in so

cumbersome a manner that no attempts

were ever made for official action.”43

None of these complications made

practical cooperation impossible, but

they did cause endless unnecessary

problems of detail. (For example, malaria control directives from the USASOS,

the USAFISPA, or the surgeon general

in Washington sometimes contradicted

those promulgated by COMSOPAC.)

Personal relations and informal agreements proved the key to success in

bringing a semblance of order to medical policy and operations amid a baffling jumble of headquarters, services,

and chains of command.44

New Caledonia emerged as the center

of medical activity following the transfer

of the area command. A cigar-shaped

island almost 250 miles in length, New

Caledonia lies roughly halfway between

New Zealand and the Solomons. A

colony of France for almost a century,

the island comprises some 8,500 square

miles of varied countryside. In late 1942

its inhabitants included 65,000 civilians;

a Free French colonial government in

the capital, Noumea, with a battalion of

troops; the Americal Division; a large

naval base; a few Australian commandos; and a service command. From the

medical viewpoint, the ample island

with its mild subtropical climate provided an excellent base. More hospitals

were set up than anywhere else in the

South Pacific, including the 8th and

29th General Hospitals; the 52d

Evacuation Hospital; and the 9th, 27th,

31st, 109th, 331st, 332d, and 336th

Station Hospitals. 

Units newly arrived had a rough initiation, building their own hospital plants

amid torrential rains, swarming insects,

and organizational confusion. But in

time excellent structures took form

mostly of wood or prefabricated materials, with staff quarters and recreation

buildings often of native construction

set on cement floors. Bamboo walls and

thatched roofs made for cool comfortable dwellings, and tropical flowers

bloomed in landscaped gardens. Views

of Pacific breakers and “lofty mountains

and knife-like ridges cutting into the 43Arthur G. King, “Medical History of Espiritu Santo

(New Hebrides) Service Command,” pp. 3–4 (quotation), file 314.7 (South Pacific), HUMEDS, RG 112,

NARA.

44Interv, Capt Roy Wisenbaker, 4 Feb 44, file 000.71,

HUMEDS, RG 112, NARA.

104 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
sky” welcomed soldiers wounded in battle or riddled with tropical diseases.45

On other major islands, variation was

the rule. Fiji was atypical, the only island

group in which doctors, hospital corpsmen, and Army nurses (of whom about

1,000 served in the South Pacific Area)

found ready-made hospital plants like

those of New Zealand. Espiritu Santo

presented a picture more typical of the

region as a whole. Officers of the 25th

Evacuation Hospital, arriving on

Thanksgiving Day, began to build their

plant in a grove of cocoanut palms amid

a sea of mud, caused by rains so heavy

that visibility fell to three or four feet.

Surgeons worked beside enlisted men,

finishing the first structures before the

nurses arrived in February 1943.

Finding the hospital in “rainsoaked,

mud-bespattered cocoanut groves,” the

nurses spent their first weeks caring for

patients “to the tune of roaring and

clanking tanks and bulldozers.”

Gradually the noise of construction

ended, the hospital grounds were land45Ruth B. Kelly, “History of Nursing Service in the

South Pacific, World War II,” pp. 11–12 (quotation),

file 314.7 (South Pacific); Arthur G. King, “Medical

History of New Caledonia Service Command,” file

314.7–2 (Medical Activities). Both in HUMEDS, RG

112, NARA.

ARMY MEDICINE IN NAVY THEATERS 105

Army Service Command

Entomologist

Parasitologist

Army unit: 11 EM

Navy unit: 4–12 EM

Survey Unit

Skilled

Navy construction battalion

Unskilled

Army medical sanitary companies

Troop anti-malaria details

Natives

Labor

Engineer or

entomologist (Navy)

Army unit: 11 EM

Navy unit: 4–12 EM

Control Unit

Malariologist

Naval Advance Base

Island Command

Army engineers

CHART 2—TYPICAL JOINT MALARIA AND INSECT CONTROL ISLAND ORGANIZATION

Source: Adapted from Harper et al., “New Hebrides, Solomon Islands, Saint Matthias Group, and Ryukyu Islands,” in Hoff,

ed., Communicable Diseases: Malaria, p. 442.
ISLAND MEDICAL CARE, from testing for malaria to caring for a dying patient
scaped, and the warmth and rain

brought tropical shrubbery to luxuriant

flowering. Now the nurses lived in comfortable barracks with electric lights,

showers, toilet facilities, and dayrooms,

and the hospital staff enjoyed sports,

movies, and dances when not at work.46

Yet the nurses on Espiritu Santo—50

among 40,000 or so troops—experienced some rough moments still. Their

presence inevitably created sexual tensions. Soldiers broke into their quarters,

necessitating the posting of armed

guards. The nurses learned, for their

own safety, to go out only with groups,

for single escorts were sometimes

attacked, and one was shot. Some medical officers concluded, rightly or wrongly, that despite the exceptionally able

service the nurses gave to the hospital,

only male attendants should be

employed under the conditions of the

smaller South Pacific islands during

wartime.

Boredom, feelings of alienation

among the exotic surroundings, and

envy of the Navy also characterized such

situations. In the spring of 1943 Army

hospitals on Efate and Espiritu Santo,

though much improved, remained vastly

inferior to the naval hospitals, which

were housed in prefabricated buildings,

with connecting corridors and linoleumcovered floors, and were equipped with

white enameled hospital beds, white

blankets, adequate supplies of linen, and

unit laundries. Soldiers did not fail to

notice that the Navy possessed much

medical equipment that had been eliminated from Army hospital equipment

lists to conserve critical shipping space.

Maj. Gen. J. Lawton Collins of the 25th

Infantry Division declared emphatically

that the effect of such disparities on

morale and efficiency in Army hospitals

was bad. 

The old adage that the Navy got the

gravy seemed to hold true even for the

sick and wounded, and the amenities

that the Army hospitals did attain in any

case were short-lived. When the front

moved forward, orders arrived, and after

a year or two the hospital staffs “tore

down the fruits of their labor and moved

on to build other hospitals, to work and

slave in a new theater of operations.”47

Medical Innovation

The greatest problem facing Maxwell

and his staff was to adapt medical policy

and organization, originally based on

combat experience in World War I where

land warfare along a cohesive front prevailed, to the geographical conditions of

the South Pacific. Reorganization of

units and innovations in hospitalization

and supply were both needed.

Responding to some of the same imperatives as the medics in the Southwest

Pacific Area, Maxwell broke up large hospitals into small self-supporting units and

allotted beds and personnel to each

island according to need. Where islands

were too small for full hospitals, he

assigned field hospital platoons, augmenting them from time to time with

surgeons from general hospitals.48

46Kelly, “History of Nursing Service,” p. 9, file 314.7

(South Pacific), HUMEDS, RG 112, NARA.

47Quotation from ibid., p. 10, file 314.7 (South

Pacific). See also Interv, Lt Col Willis J. Potts, 6 Apr 45,

file 000.71. Both in HUMEDS, RG 112, NARA. 48CSurg, USAFISPA, Annual Rpts, 1942, pp. 1–2, and

1943, pp. 4–6, file 319.1–2; Interv, Maxwell, 11 May 50,

file 000.71; 7th Evac Hosp Annual Rpt, 1942, p. 15, file

319.1–2; Rpt, Surg, 7th Evac Hosp, to SG, U.S. Army, 10

Aug 42, p. 7, file 319.1–1 (Bleacher). All in HUMEDS,

RG 112, NARA. See also Baker, “South Pacific Area,” in

Havens, ed., Activities of Medical Consultants, p. 573.

ARMY MEDICINE IN NAVY THEATERS 107
Like Carroll, Maxwell found that part

of a hospital did not necessarily form a

unit capable of acting alone. Small hospitals on isolated islands had to function

independently, but without the necessary skilled personnel and equipment.

Despite occasional visits by consultants,

treatment at some of these facilities was

hardly up to the highest standards.

Again like Carroll, Maxwell labored

under a shortage of beds. By the end of

1942 the Army on New Caledonia, Fiji,

Tongatabu, Bora Bora, Aitutaki, and

Tongareva had only 4,200 hospital beds

for 110,047 troops—a ratio of fixed beds

to troops of only 3.82 percent. During

1943 bed capacity increased to 14,815

for 176,254 troops, or 8.41 percent, still

below the War Department’s goal of 10

percent. But the War Department’s own

priorities slowed the movement of hospitals to the theater; transportation

shortages hampered their transfer from

one station to another; and in 1943 the

Army occupied seven more islands or

island groups, worsening a problem

already severe.49

Good relations with the Navy and the

Allies took up some of the slack.

Sharing facilities kept the bed shortage

from reaching crisis proportions. As

noted above, Army casualties received

treatment either in New Zealand military and civilian facilities or in U.S.

Navy hospitals. In turn, the Army’s

109th Station Hospital in New

Caledonia treated New Zealand’s 3d

Division, and Army hospitals on Fiji

49CSurg, USAFISPA, Annual Rpt, 1942, pp. 2–3, file

319.1–2; Interv, Maxwell, 11 May 50, file 000.71. Both in

HUMEDS, RG 112, NARA.

108 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

FIELD HOSPITAL ON AITUTAKI
took care of Marine and Navy casualties

from Guadalcanal and New Georgia.

Army patients used Navy beds on Efate

and Espiritu Santo in 1942 and 1943. 

However, the services shared only

mutual ignorance in treating tropical

ills. The endemic diseases of New

Zealand resembled those of the Middle

Atlantic states at home, but the diseases

of the jungled islands were largely unfamiliar to most American physicians, the

more so because multiple infections

were common and the symptoms of

malaria—usually a component of such

conditions—were varied and confusing. Psychological problems mingled

with the physical. Psychiatrists quickly

learned that the proportion of neuropsychiatric cases in isolated garrisons

exceeded those resulting from combat.

Already inclined to depression by the

poor living conditions of the tropics

(oppressive heat, monotony, poor food,

and the pervasive strangeness of the

environment), those who fell ill found

no encouragement in the fact that

their doctors seemed to know little

about what ailed them. Unlike the

sailors, the soldiers and marines who

lived and fought ashore had a high rate

of sickness. In 1943 the Army hospitals

of the South Pacific Area counted

almost 152,000 admissions, 60,000 of

them malaria cases. About 23,000 casualties were evacuated to the United

States, and of these more than 28 percent were diagnosed with neuropsychiatric disorders.50

To bear this burden while treating the

combat casualties, Maxwell lacked

skilled hands as well as beds. As of

October 1943 the difference between

table of organization requirements and

the number of personnel actually on

hand in the theater amounted to 586

officers and nurses and 2,684 enlisted

men. Shortages of physician specialists

(psychiatrists, in particular), of dieticians, and of physical therapists were

marked, and the South Pacific was without professional consultants until July

1943, because theater headquarters was

reluctant to approve the transfer of officers for purely professional reasons.

Many doctors who bore excellent professional credentials had been inadequately trained for dealing either with

the dangers of combat or the complexities of Army administration. The physician ultimately appointed, medical consultant Lt. Col. Benjamin M. Baker, MC,

candidly termed himself “poorly prepared to meet many of the problems

that confronted him,” a condition

apparently widespread in the South

Pacific Area during 1942 and 1943.51

Geography interacted with Army personnel practices to make the medical

service less effective than it might have

been. The professional experiences of

doctors varied widely, and the lack of a

system able to distinguish among medical specialties made proper assignment

difficult. Even when headquarters

ordered reassignments, island commanders fought to retain skilled men,

50Baker, “South Pacific Area,” in Havens, ed.,

Activities of Medical Consultants, p. 598; Lindsay E.

Beaton and M. Ralph Kaufman, “As We Remember It,”

in Albert J. Glass, ed., Overseas Theaters, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1973), p. 739.

ARMY MEDICINE IN NAVY THEATERS 109

51Quotation from Baker, “South Pacific Area,” in

Havens, ed., Activities of Medical Consultants, p. 576. See

also CSurg, USAFISPA, Annual Rpt, 1943, p. 16, file

319.1–2; OofSurg, USAFISPA, ETMD, 4 Nov 43, p. 2,

file 350.05; Kelly, “History of Nursing Service,” pp.

14–16, file 314.7 (South Pacific); Interv, Potts, 6 Apr 45,

file 000.71. All in HUMEDS, RG 112, NARA.
STOCKADES FOR NEUROPSYCHIATRIC CASES, at a station hospital 

and on an Australian hospital ship
whether needed or not. Hence, one hospital with a mediocre staff might struggle under a deluge of patients, while

another wasted its professional talent on

an island where little demand for its services existed. Colonel Baker cited the

7th Evacuation Hospital, a 750-bed unit

affiliated with New York’s Post-Graduate

Hospital that was rich in surgical talent.

On Tongatabu, a small coral island of

Polynesia, its surgeons were often idle

(treating superficial infections caused

by insect bites was the hospital’s most

common activity), while fighting forces

on distant Guadalcanal were critically

short of such men. Moved to Fiji, the 7th

became largely a malaria hospital, and

later on Guadalcanal—by then securely

in Allied hands—it waited to take part in

an operation that was abandoned. Not

until January 1945, at the invasion of

Luzon, did the hospital at last serve the

purpose for which it was intended. And

Baker cited other cases of misused

resources, especially distressing in a

fighting theater where the medical system was stretched thin.52

Medical supply also had to provide

support for combat troops and garrison

forces on numerous islands that were

spread over a vast area. In November

1942 Maxwell, in his capacity as USASOS

chief surgeon, established a base depot

at Noumea. Here he could oversee the

collection of supplies for combat operations. To support garrison forces,

Maxwell established small independent

depots on the other occupied islands,

which, resupplied by standard medical

maintenance units, maintained supply

levels equal to 100–200 days’ usage. He

requisitioned some supplies from the

USAFISPA, but shortages necessitated

much swapping and sharing with the

Navy. Shortages in essential drugs—

sulfaguanidine, bismuth, opium, and

antimalarials—as well as in oxygen and

plasma plagued the system during 1942,

and all types of specialized equipment

from microscopes to dental supplies

were in short supply and badly needed.

A scarcity of shipping often kept

materiel on the docks in San Francisco,

and a dearth of intratheater ships often

prevented the marriage of personnel to

equipment that arrived on different vessels at different ports. Shipping uncertainties pointed up the importance of air

in medical supply, and the theater’s need

for a central depot to store excess supplies and to provide replacements for

the local depots, which were apt to be

suddenly depleted when units lost their

equipment to enemy action.53

Preparing for War

Compared to the Southwest Pacific

Area, the South Pacific Area presented a

medical picture of a better integrated

theater of operations, even with its geographical fragmentation and the administrative confusion resulting from the

jumbled presence of Navy, Army, Marine

Corps, island, and service commands.

However, localism may also have encour527th Evac Hosp Annual Rpt, 1943, exh. 2, p. 17, file

319.1–2, HUMEDS, RG 112, NARA; Baker, “South

Pacific Area,” in Havens, ed., Activities of Medical

Consultants, p. 573. Baker notes (p. 575) that he was

never officially named as medical consultant, but that

he served in this capacity through most of the war.

53Whitehill, “Medical Activities in Middle Pacific,”

block 3, p. 82, file 314.7; CSurg, USAFISPA, Annual

Rpt, 1942, pp. 1–3, file 319.1–2. Both in HUMEDS, RG

112, NARA. See also Charles M. Wiltse, Medical Supply

in World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1968), pp.

422–26.

ARMY MEDICINE IN NAVY THEATERS 111
aged experimentation by officers with initiative, trying out new ideas in their own

units. Thus important innovations were

made by the 101st Medical Regiment, an

organizational fossil that had escaped triangularization to become a part of the

Americal Division in March 1942.

An element of the original Task

Force 6184 assembled and sent to New

Caledonia early in 1942, the 101st

Medical Regiment, commanded by Lt.

Col. Dale G. Friend, MC, had been

inducted into federal service in January

1941 with the National Guard’s 26th

Division. All was in confusion as the

regiment embarked on the Army transport Santa Elena at the New York Port of

Embarkation. Medical materiel was on

board, but no one knew where; units

were mixed together, and officers had

trouble locating their men. The convoy

left New York on the twenty-third and,

after a voyage devoted by the medics to

training, to digging through holds to

find supplies, and to conducting courses in tropical medicine, reached

Melbourne, Australia, on 27 February.

While stevedores reloaded the ships,

the regiment was billeted in private

homes; then it shipped out again on an

“utterly filthy” vessel, where an epidemic of dysentery broke out. With “morale

and physical condition . . . seriously

impaired,” the 101st landed at Noumea

on the morning of 15 March.54

Here the 101st Medical Regiment

underwent a period of initiation much

like that of the hospitals, working in torrential rains, in mud that resembled

“heavy gear grease,” and in clouds of

mosquitoes (the campsite was dubbed

“Mosquito Hill”). Dysentery continued

to rage; drinkable water had to be

hauled from 6 miles away; and no vehicles were available to move the regiment’s 300,000 pounds of equipment

5.5 miles from Noumea to the bivouac.

Slowly, trucks were scrounged, the camp

was organized, and the real business—

learning to defend New Caledonia from

Japanese attack—got under way.

Because their brassard was not respected by the enemy, the medics armed

themselves with Model 1903 bolt-action

rifles and began learning to shoot under

the guidance of infantry-trained NCOs

and Medical Administrative Corps officers. An initial defense plan for New

Caledonia recommended that strongpoints be created all along the coast for

local resistance to any enemy landing. A

few hundred American infantrymen

and a small detachment of Australian

commandos formed sixteen to eighteen

defensive units, and the medics’ first

task was to provide them support.55

Friend split the personnel of a collecting and an ambulance company into 25-

man groups, each commanded by a medical officer, with sufficient supplies and

transport to provide first-echelon care

and evacuation to hospitals. Since no

hospital units had yet reached the island,

he substituted his own, dividing the

101st’s clearing companies into six field

hospitals—he used the term generically,

not in the sense of the regulation field

hospital unit—placed at strategic locations to furnish second- and third-echelon care. Finally, the 101st commander

set up in Noumea what he called “a complete field hospital,” operated by a clearing company platoon, to render what 54Surg, 101st Med Regt, ETMD [Annual Rpt], 1942,

pp. 2–3, file 319.1–2, HUMEDS, RG 112, NARA.

Though called an ETMD, this document is actually the

unit’s annual report and is so filed. 55Ibid., p. 3, file 319.1–2, HUMEDS, RG 112, NARA.

112 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
amounted to station hospital services for

the troops in the area. The weak point of

his plan was the lack of transport, worsened by New Caledonia’s poor roadnet.

Because the sick and injured could not

be moved without great difficulty and loss

of time, the little hospitals in the field

performed a wide range of services,

including major surgery to stabilize casualties so that they could endure “the

long, hard ride over extremely bad

roads.” Where no roads at all existed,

long litter hauls over mountain trails

toughened the bearers and familiarized

them with life in the jungle.56

As they trained, the 101st’s medics, in

effect, were readying themselves for the

conditions of warfare in the South

Pacific. They lived with the infantry and

practiced commando tactics with the

Australians. Doctors and corpsmen alike

learned to perform operations under

the conditions of the bush. Supply section personnel acquired the physical

strength and knowhow to move materiel

over 20,000 square miles of wilderness

and mountains.

After the Americal Division was

formed in May, the 101st continued as a

regiment, with added strength that it

would not have possessed if it had been

reorganized as a medical battalion. At

the same time, General Patch revised his

defense plan around the airports and

strategic landing areas, creating seven

defense areas with a field hospital and

collecting and ambulance personnel

assigned to each. Friend seized the

opportunity to ensure that, when not

otherwise engaged, the collecting and

ambulance personnel assisted in the

operation of the hospital and received

training in nursing and surgical care,

advancing further the self-sufficiency of

his small autonomous units.

Finally, as combat approached and

the division was reorganized into three

regimental combat teams (RCTs), the

101st Medical Regiment went through a

third change. Friend organized three

units, which he called “provisional vertical battalions,” to support the RCTs.

Each possessed its own headquarters

and headquarters detachments; a supply

detachment; one collecting company of

100 men, 5 ambulances, and 2 jeeps;

and one provisional clearing company,

equipped with steel beds, surgical gear,

and an X-ray machine. So equipped, it

could, Friend felt, function as a complete field hospital. In this form, the first

battalion embarked for Guadalcanal on

2 November and, ten days later, entered

combat in support of the 182d

Regimental Combat Team.57

Friend’s provisional battalions were

his own answer to the same problem

that had led Carroll in Southwest Pacific

Area to devise the portable surgical hospital. The outlook of the two innovators

was quite different. Friend declared that

his battalions plus readily available air

and sea evacuation made “the presence

of surgical and evacuation hospitals

unnecessary.” Yet he arrived at his conclusion by logic very similar to Carroll’s:

“It is believed essential that all hospitals

used in the type of warfare experienced

here . . . [must] be field equipped,

mobile, and be capable of operating

close to the lines of combat. . . . It is

believed essential to give good, complete treatment as soon as possible after

wounds have been received and to prepare patients adequately for air and

56Ibid., p. 5, file 319.1–2, HUMEDS, RG 112, NARA.

57Ibid., encl. 2, p. 2, file 319.1–2, HUMEDS, RG 112,

NARA.

ARMY MEDICINE IN NAVY THEATERS 113
water evacuation.” Maxwell agreed:

“The chief problem in island warfare,”

he declared, “is to obtain definitive

surgery at the front.”58

The experiences of 1942 brought into

being a rough and ready organization in

the South Pacific Area, armed with an

innovative spirit and ideas of real merit

about interservice cooperation, hospital

construction, and forward medical support. In a variety of ways, a medical organization intended to support mass

armies in land campaigns had been

adapted to the exigencies of island

war—how successfully, would now be

determined in battle.

58First two quotations from ibid., encl. 6, p. 2. Third

quotation from CSurg, USAFISPA, Annual Rpt, 1943, p.

14. Both file 319.1–2, HUMEDS, RG 112, NARA.

114 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
In January 1942 the Japanese, moving

southeast toward the AmericanAustralian line of communications, had

captured the harbor of Rabaul on the

northeast coast of New Britain Island in

the Bismarck Archipelago. Entering the

Solomon Islands, they took Tulagi in

May and thereafter planned the seizure

of Port Moresby on New Guinea’s south

coast. Their advances threatened

Australia, separated from New Guinea

only by the Torres Strait, and provoked

Allied counteraction. The struggle to

halt Japan opened with an inconclusive

naval battle in the Coral Sea, which

turned into a war of attrition on land,

sea, and in the air. Geography made it a

logistical nightmare, and climate and

disease harassed the contending armies. 

On 2 July, in order to dislodge the

Japanese from New Guinea, the

Bismarcks, and the Solomons, the U.S.

Joint Chiefs of Staff ordered a twopronged counterattack. One offensive

was to move up the Solomon chain and

the other toward northern New Guinea

from Port Moresby, with the recapture

of Rabaul, the heavily defended main

Japanese base, as the final objective. For

both the Army Medical Department

and the theater medical service, the

projected operations meant their first

experience in supporting attacks on

Japanese-held islands in the South and

Southwest Pacific Areas and a long,

exhausting encounter with jungle warfare at its worst.

Guadalcanal

Overall direction of the initial campaign against Tulagi and “adjacent positions” rested in the hands of Admiral

Nimitz, who assigned it to Admiral

Ghormley. On Guadalcanal, where the

Japanese had begun to build an airstrip,

the landing force was to consist of the

1st Marine Division. Army forces were to

relieve the marines at a later date. The

Navy was to support the campaign, and

its construction battalions were to build

or expand air bases ashore for Army and

Navy aircraft.1

Ghormley and his successor, Admiral

Halsey, consulted General Harmon, the

USAFISPA commander, in the design

and execution of the campaign, particularly in the preparation and execution

of plans involving Army forces. Though

Harmon was to have no operational

control over those forces, the Navy

CHAPTER IV

Jungle Warfare

1

John Miller, jr., Guadalcanal: The First Offensive,

United States Army in World War II (Washington, D.C.:

Historical Division, United States Army, 1949), pp. 1–21

(quotation, p. 17).
would later delegate authority to him

over specific operations and for limited

amounts of time, making him much

more powerful than had originally been

intended. From the first, however,

Harmon was responsible for the administration, training, and logistical support

of all Army ground and air forces that

were to participate in the Guadalcanal

campaign. Captain Dearing, Admiral

Halsey’s chief surgeon, planned medical

support for 18,134 marines, whose

infantry regiments had been organized

into battalion landing teams for the

invasion.2

Providing medical support for Army

forces participating in the Guadalcanal

campaign and coordinating that support

with the Navy were the responsibilities of

Colonel Maxwell. His duties as both the

theater chief surgeon and USASOS surgeon included providing for the personnel necessary to support Army forces;

gathering information about the diseases, climate, and terrain on

Guadalcanal; requisitioning medical supplies through General Breene’s USASOS

headquarters; storing and readying, at

the depot on New Caledonia, the supplies to be shipped on troopships and aircraft to the combat zone; and supervising

a program for training medics, with the

divisions they were to support, in jungle

and island warfare.

Training was essential, for

Guadalcanal was not a picturesque

South Pacific island paradise. Ninety

miles in length and about 30 in width,

the volcanic island possessed jungled

mountains, a hot, wet climate with temperatures ranging between 70o and 95o

F., and a monsoon season that lasted

from November to March. Flat coastal

plains, covered with cocoanut palms or

thick jungle, rose gradually to grassy

plateaus. Split by deep jungle-choked

ravines, the plateaus merged into precipitous mountains, all thickly forested.

On that “pestilential hellhole hated by

soldier, sailor and marine,” two-thirds of

the U.S. forces became ill, and almost

two-thirds of the Japanese who died

apparently succumbed to disease.3

Invasion and Battle

On 7 August the 1st Marine Division

under Maj. Gen. Alexander A.

Vandegrift, USMC, invaded Guadalcanal,

aiming to seize the island and its partially

completed airfield. Landing without

opposition, by the next day the marines

had taken the airstrip, renamed it

Henderson Field, and established a

defensive perimeter around it. But

attacks from Japanese bombers out of

Rabaul caused the American fleet to sail

away, leaving the marines without naval

or air support and with only meager supplies. Reinforcements and supplies had

to be brought in by blockade-running

ships and by air transport.

Both Japanese and Americans began

to reinforce Guadalcanal. The marines

2

Louis Morton, Strategy and Command: The First Two

Years, United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History,

Department of the Army, 1962), p. 261.

3

Quotation from Jack Coggins, The Campaign for

Guadalcanal: A Battle That Made History (Garden City,

N.Y.: Doubleday and Co., 1972), p. 28. See also Surg,

101st Med Regt, ETMD [Annual Rpt], 1942, encl. 5, p.

1, file 319.1–2, Historical Unit Medical Detachment

(HUMEDS), Record Group (RG) 112, National

Archives and Records Administration (NARA),

Washington, D.C. Though called an ETMD, this document is actually the unit’s annual report and is so filed.

Richard B. Frank’s Guadalcanal: The Definitive Account of

a Landmark Battle (New York: Random House, 1990) is

a recent and excellent retelling of the battle, with a

broad range of sources, including Japanese sources.

116 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
fought off attacks against Henderson

Field, while naval and air forces struggled for control of the Solomon waters.

On 13 October the first Army unit—the

164th Infantry of the Americal

Division—arrived from New Caledonia.

By this time the 1st Marine Division,

weakened by an inadequate diet, was

beginning to suffer the ravages of tropical disease, including malaria, skin

infections, and gastrointestinal disorders. During October malaria alone put

1,960 marines into the hospital.4

In early November Nimitz ordered

the remainder of the Americal Division

to Guadalcanal, where the battle was

entering its final phase. Midmonth

naval and air successes halted attempts

by the Japanese to reinforce their

troops, and desperate enemy attacks

against the perimeter failed. Marines

and soldiers now sallied from the defensive perimeter to attack the Japanese in

the northwestern end of the island. The

struggle quickly developed into a kind

of Bataan in reverse, as a stubborn

enemy, cut off from his supplies, resisted

final defeat. 

As in that earlier battle, the defense

was tenacious and the battleground—for

the most part, a series of steep ridges rising from the coast to the central mountains—well adapted to prolonged resistance. Green troops made slow progress;

some collapsed from exhaustion. The

Japanese covered the entire front with

small arms, automatic weapons, artillery,

and mortars. The Americans were not

able to gain ground, and casualties

mounted until headquarters stopped the

advance on 25 November. By this time

the 164th Infantry numbered less than

200 effectives; between the nineteenth

and twenty-fifth the unit suffered 117

killed and 625 wounded or sick. Medics

evacuated more than 300 from the island

and sent another 300 to rear areas for

treatment of wounds, malaria, dysentery,

or combat fatigue. The malaria rate for

Allied troops on Guadalcanal reached

1,781 per 1,000 per year in November,

the month when malaria control personnel at last arrived on the island.5

The Joint Chiefs now ordered the

25th Infantry Division, stationed on

Hawaii, to Guadalcanal to relieve the

marines. Harassed for months by air

raids, naval attack, inadequate diet,

malaria, and dysentery, the 1st Marine

Division had taken 10,635 casualties up

to 10 December. Only 1,472 suffered

gunshot wounds, while malaria

accounted for 5,749. Malnutrition and

disease had weakened many others as

well. On the ninth General Patch of the

Americal Division succeeded General

Vandegrift as commander of U.S.

forces on Guadalcanal, including the

2d Marine Division, and the Army

assumed responsibility for the conclusion of the campaign. The troops were

fortunate in facing an outnumbered

enemy ravaged by disease, living on

inadequate rations, and, in a few

instances, reduced to cannibalism. 

After sharp preliminary fighting, on

10 January 1943 the last offensive began.

5

Miller, Guadalcanal, pp. 173–89, 203–09, 226–27;

121st Medical Bn Unit History (copy), [1942–43], pp.

5–8, file 300-Med-0.1, HUMEDS, RG 112, NARA. Under

the process of triangularization, the 101st Medical

Regiment was reorganized as the 121st Medical

Battalion on 1 May 1943, when the Guadalcanal campaign was over.

4

For background, see Miller, Guadalcanal, pp.

59–196. See also Francis D. Cronin, Under the Southern

Cross: The Saga of the Americal Division (Washington,

D.C.: Combat Forces Press, 1951). The 164th Infantry

was supported by Navy medics until Army medical units

arrived.

JUNGLE WARFARE 117
The push aimed northwestward, with

Cape Esperance at the northwestern tip

of the island as its goal. The enemy put

up strong resistance, but continuous

American pressure, coupled with the

successful naval blockade, forced many

Japanese to flee Guadalcanal. The

remainder, though starving and diseased, skillfully withdrew to areas

around Cape Esperance, completing

their evacuation during the night of 7–8

February. The next day, however, a final

attack brought the campaign to a close

as Cape Esperance fell.6

The campaign had been exceptionally bloody. Of the more than 37,000

Japanese who fought on Guadalcanal,

14,800 were dead or missing. The

60,000 Army and Marine ground forces

suffered less, both absolutely and proportionately. Yet casualties included

1,702 killed (1,152 marines and 550 soldiers) and 4,088 wounded (2,799

marines and 1,289 soldiers). Thousands

more U.S. forces suffered from disease.

Quinine was not an effective prophylactic in heavily infected men, and

Atabrine had not been standardized.

Vector control and the use of headnets

were impossible in combat, and repellants were worthless. Of the soldiers put

out of action on Guadalcanal, nearly 65

percent were victims of disease and only

25 percent of wounds.7

Medical Support

To drive the enemy off Guadalcanal,

U.S. troops had to seek out and dislodge

him from well-fortified positions on

ridges and in ravines, hacking out trails

through tangled jungle as they

advanced. Evacuating the wounded was

a tedious and exhausting task. Because

the rugged terrain slowed the transport

of supplies to the front, aid stations

stocked extra plasma and surgical

instruments. Since bearers had to rest

after one or two carries, the litter

squads, reinforced by infantrymen,

hauled casualties to battalion aid stations located only 100 yards behind the

front. Working in dugouts roofed by

shelter tents, medics applied sulfonamides to wounds, arrested hemorrhage, splinted fractures, and treated

shock with blankets and plasma.

Then, in oppressive heat or rain,

through jungle and across ravines,

medics carried the wounded on litters or

piggyback to forward collecting stations,

located 1,000 yards to the rear. Just to

evacuate a single casualty often required

litter hauls of several hours by a number

of relay teams. Medics reinforced Navyissue Stokes litters with planks; to cross

ravines, they hoisted them on steel

cables strung by the engineers or, using

ropes, slid them down muddy slopes like

toboggans. Sometimes hospital corpsmen formed a human chain to pull the

walking wounded uphill. Despite such

improvisations, the steep ridges exhaust6

Arthur H. Thompson, “Operation of the Division

Medical Battalion,” in “Operations of the 25th Infantry

Division, 17 December 1942–5 February 1943” (copy),

sec. 5, pp. 160–61, file 370 SWPA (Guadalcanal),

HUMEDS, RG 112, NARA; Miller, Guadalcanal, pp. 212,

229–300, 348–49. The Japanese contrived to evacuate

some 13,000 men by destroyers at night. 7

Miller, Guadalcanal, pp. 227, 350; Frank O. Hough,

Verle E. Ludwig, and Henry I. Shaw, Jr., Pearl Harbor to

Guadalcanal, History of U.S. Marine Corps Operations

in World War II (Washington, D.C.: Historical Branch,

G–3 Division, Headquarters, U.S. Marine Corps, 1958),

p. 374. A staff study prepared in 1944 counted much

118 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

heavier casualties, estimating that only about 12,000 of

33,600 escaped, for a total loss of about 65 percent. See

Historical Section, G–2, Far East Command, “17th Army

Operations,” Japanese Studies in World War II, 2:49,

bound as Japanese Monograph No. 35, “Southeast Area

Operations Record, Volume 2, February 1943–August

1945,” Ms 8–5.1 AC 35, U.S. Army Center of Military

History, Washington, D.C.
ed the bearers so quickly that infantrymen had to augment the squads, enlarging them from the usual four to six,

eight, and even twelve. After the 2d

Battalion, 132d Infantry, Americal

Division, took a hill on 2 January, 175 litter-bearers took five hours to evacuate its

20 casualties. To protect bearers from

sniper and machine gun fire, 1 noncommissioned officer and 3 enlisted men,

armed with submachine guns and a rifle,

accompanied each squad. As Colonel

Maxwell wrote, “The work of the bearer

squads to date has been superhuman

and no praise of their efforts could be

excessive.”8

Collecting stations were commonly

set up in bunkers that were covered with

cocoanut logs, sandbags and dirt—or,

during an advance, in the open, under

forest cover. Here medical personnel

prepared casualties for evacuation by

jeep, boat, or litter to ambulance loading points at rear collecting stations that

stood under canvas about 2.5 miles

behind the aid stations. Additional

emergency care—mostly plasma and

shots of morphine—was provided at the

rear stations, and then any available

transportation took the casualties to

field hospitals, also under canvas, about

3 miles to the rear.9

Col. Dale G. Friend’s 101st Medical

Regiment discovered, however, that jungle trails could sometimes be bypassed.

On the waterways—the Matanikau River

or smaller streams—ambulance section

personnel paddled rubber boats, each

with 2 litter or 6 sitting casualties.

Manned by collecting station personnel,

evacuation craft carried plasma, morphine, dressings, and splints. Sometimes

captured Japanese assault boats—collapsible wooden craft fitted with outboard motors—towed the rubber boats

to their destinations. Running along the

coast, Navy tank lighters, flying boats,

and motor torpedo boats evacuated

many casualties from otherwise inaccessible locations. After debarking, ambulances took them to division hospitals in

the Lunga area, near the airfield. The

jeep proved its value as an ambulance,

enabling evacuation from aid and col8

Rpt, CSurg, USAFISPA, to SG, U.S. Army, 7 Dec 42,

p. 5 (quotation), Encl to CSurg, USAFISPA, Annual

Rpt, 1942; Surg, 101st Med Regt, ETMD [Annual Rpt],

1942, encl. 2, pp. 3–4. Both file 319.1–2, HUMEDS, RG

112, NARA. 9

Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 8, pp. 111–12,

file 314.7, HUMEDS, RG 112, NARA.

JUNGLE WARFARE 119

LITTER-BEARERS NEGOTIATING A STEEP SLOPE
lecting stations wherever some semblance of a road existed. Mechanics of

the 101st Medical Regiment modified

the jeep with a clip-on frame to carry 1

sitting and 3 litter casualties, plus the

driver and an orderly armed with a submachine gun.10

The weary litter-bearers with their suffering casualties made their way to hospitals, which on Guadalcanal were and

remained few. During the first four

weeks of Army activity, a Navy hospital

took care of the 164th Infantry. Then

the Americal Division’s wounded were

treated by the three reinforced clearing

companies of the 101st Medical

Regiment. During the intense fighting

of late November and early December

Clearing Company H, later designated

as Field Hospital II, was attached to the

Americal Division’s 182d Infantry. As the

only hospital apart from a small naval

facility present in the combat area, its

personnel performed tasks, including

surgery, that usually were done by larger,

better equipped, and better manned

installations. From 15 November 1942

to 28 February 1943 this small group of

6 medical officers, 2 dental officers, and

less than 100 enlisted men, treated a

total of 3,719 casualties, besides donating much of the blood that was given to

the wounded. In early December 1942

Clearing Company G took over a Navy

hospital, with 80 Marine and Army

patients, to establish Field Hospital I. A

surgical hospital with separate wards for

POWs—victims of malaria, vitamin deficiency, and extreme starvation—the

facility treated more than 2,200 patients

in all. On the fifteenth Clearing

Company I established the Field

Hospital III near Lunga Beach (Map 5).

Farthest from the front line, it became

primarily a medical and psychiatric

installation, treating approximately

3,800 patients, of whom more than

3,600 were victims of disease.11

10Surg, 101st Med Regt, ETMD [Annual Rpt], 1942,

encl. 2, pp. 3–5, and encl. 3, p. 1, file 319.1–2; 121st

Medical Bn Unit History (copy), [1942–43], p. 8, file

300-Med-0.1; Thompson, “Division Medical Battalion,”

in “25th Infantry Division” (copy), sec. 5, pp. 160–61,

file 370 SWPA (Guadalcanal). All in HUMEDS, RG 112,

NARA. See also Department of the Navy, Bureau of

Medicine and Surgery, “The United States Navy

Medical Department at War, 1941–1945,” 1:73–74, files

of Bureau of Medicine and Surgery Archives,

Washington, D.C.

11Surg, 101st Med Regt, ETMD [Annual Rpt], 1942,

encl. 2, p. 3, file 319.1–2; 121st Med Bn Unit History

(copy), [1942–43], pp. 6–7, 11–13, file 300-Med-0.1.

Both in HUMEDS, RG 112, NARA. See also the Army’s

Medical Service in Joint Overseas Operations, Field Manual

8–25 (1940).

120 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MOVING CASUALTIES UNDER GUARD
The disproportion between casualty

load and bed strength became even

more marked when the 25th Division

entered the battle in early January 1943.

The 25th Medical Battalion’s two-platoon clearing company set up a forward

and a rear hospital, with a total of 250

beds. Soon both were overwhelmed by

casualties. By the twenty-sixth they held

432 patients, and the daily admission

rate reached 100. At the end of the campaign Lt. Col. Arthur H. Thompson,

MC, the medical battalion commander,

reported that the division would have

benefited from corps or Army hospitalization, since “the clearing company of

a medical battalion was not designed

nor equipped to furnish semi-permanent hospitalization for divisional casualties.” The arrival on the sixteenth of

the 250-bed 20th Station Hospital

offered only partial relief. The hospital

received wounded directly from the

front line or from the clearing companies of the Americal and 25th Divisions.

Its staff dug shelters to protect the casualties from enemy night shelling.

Because there were too many to handle,

early air and sea evacuation—far easier

once the Navy established control of the

JUNGLE WARFARE 121

S e a l a r k C h a n n e l

SOLOMON SEA

Beaufort

Bay

Kamimbo

Bay

Visale

Kokumbona

Matanikau Kukum

Volinavua

Tetere Tasimboko Tenaru

Verahue

Marovovo

Tenaro

Cape Esperance

Doma Cove

Pt Cruz

Lunga Pt

Koli Pt

Taivu Pt

MT AUSTEN

ELEVATION IN FEET

0 1500 3000 4500 and Above

Airfield

0 15

Miles

ARMY HOSPITAL SUPPORT

GUADALCANAL

November 1942–January 1943

Note: Division clearing companies acted as field hospitals.

101st Medical Regiment

 Clearing Company G

 Clearing Company H

 Clearing Company I

25th Medical Battalion

 Clearing Company

20th Station Hospital

MAP 5
122 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

waters around Guadalcanal—became

the norm.12

Largely determined by the shortage

of beds, evacuation policy depleted the

forces on the island. Since the sick and

wounded could be kept for only seventytwo hours, those with slight injuries or

minor fevers who could have remained

on Guadalcanal and been returned to

their units were instead evacuated to

New Caledonia, the New Hebrides, New

Zealand, or Fiji. Ships—usually attack

transports with small hospitals, staffed

by Navy medical personnel—and Navy

transport planes took casualties off the

island. Air evacuation, begun as soon as

the marines captured Henderson Field,

increased steadily until the end of the

campaign. At first, one Army and two

Marine troop carrier squadrons of the

South Pacific Combat Air Transport

Service flew in gasoline, ammunition,

and supplies to the isolated troops and

returned with a load of casualties. In

September Navy medical corpsmen

were assigned to each plane and Navy

flight surgeons to accompany the seriously wounded. Transport planes carried an average of 20 evacuees per trip,

or up to 80 a day, to the Navy hospitals

on Espiritu Santo or Efate. From there,

Navy aircraft or ships took them to New

Caledonia, Fiji, or New Zealand. 

Medical personnel preferred air to

sea, for evacuation by ship entailed

many transfers of the wounded, from

ambulance to lighter, and from lighter

to ocean craft. Journeys were long: two

to three days by ship, compared to four

hours by air, to cross the 600 miles from

Guadalcanal to Espiritu Santo; and four

to five days, compared to six or seven

hours by air, to cross the 950 miles from

Guadalcanal to New Caledonia. By the

end of the campaign 7,000 casualties

had been evacuated from Guadalcanal

by air.13

Air transport also played a prominent

role in medical supply. Beginning when

the marines captured Henderson Field,

Army and Navy planes flew in supplies

from the base depot on New Caledonia.

The supply section of the 101st Medical

Regiment, responsible for the Americal

Division and certain Navy and Marine

personnel, moved materiel forward over

evacuation routes, using the same ambulances, jeeps, litter-bearers, and boats on

the Matanikau River that brought the

wounded to the rear. Though excesses

developed in some items, the many

casualties on Guadalcanal produced

shortages, especially of blood plasma,

intravenous fluids, morphine syrettes,

and antidiarrheal drugs.

The free use of the same aircraft to

bring supplies in and to ferry casualties

out emerged as a crucial asset in dealing

with the immense distances of the South

Pacific Area. Although the use of ordinary military aircraft entailed some danger to the wounded, who traveled without the protection that dedicated and

plainly marked medical evacuation air12Thompson, “Division Medical Battalion,” in “25th

Infantry Division” (copy), sec. 5, p. 163 (quotation), file

370 SWPA (Guadalcanal); 121st Med Bn Unit History

(copy), [1942–43], p. 6, file 300-Med-0.1; Rpt, Lt Col

Arthur G. King, Med Insp, OofSurg, Americal Div, to

CG, Americal Div, 15 Oct 42, sub: Intelligence Report

on Cactus (Guadalcanal), pp. 3–4, file 350.05. All in

HUMEDS, RG 112, NARA.

13Interv, Lt Col Leon K. Gurjian, 20 Aug 43, file

000.71; Whitehill, “Medical Activities in Middle Pacific,”

block 8, pp. 43–44, file 314.7; Air Evacuation Board,

SWPA, “The Medical Support of Air Warfare in South

and Southwest Pacific, 7 December 1941–15 August

1945,” Report No. 35, sec. 1, vol. 2, pt. 2, pp. 477–78,

483, file 314.7–2 (Army Air Forces—Medical Services)

SPA, SWPA. All in HUMEDS, RG 112, NARA. 
craft might have afforded, trips out of

Guadalcanal became safer as the Allies

established control of the air. Both coming and going, military air transport

served the wounded well.14

Disease and Stress

For the first three months of the campaign, the environment and the desperate military situation combined with a

lack of understanding on the part of

responsible officers to make control of

malaria impossible on Guadalcanal.

Malaria discipline was poor in both U.S.

and enemy units. Topography helped to

spread the disease. The American forces

occupied a flat alluvial plain of undrainable clay soil, cut by streams and spotted

with lagoons. They dug foxholes, and

heavy vehicles made myriad ruts that

filled with each rainstorm, multiplying

mosquito breeding areas. Native laborers, who were heavily seeded with malaria parasites, carried the disease into the

American perimeter. As soldiers and

marines advanced, they entered areas

with a large population of malaria-carrying Anopheles mosquitoes. Falciparum

malaria was common, and potentially

fatal.15

Part of the problem among American

troops resulted from the introduction of

the new synthetic antimalarial Atabrine.

Though the drug was more effective

than quinine in suppressing the symptoms of malaria, the original recommended dose—.2 grams a day, twice a

week—made 20 percent of the Americal

Division, including General Patch, ill

with nausea, vomiting, and headaches. A

rush for quinine resulted, but short supplies meant that the drug could not be

issued for prophylactic purposes. When

the Atabrine dose was reduced to .05

grams a day, however, almost everyone,

including the commanding general, was

able to tolerate it. 

Yet many soldiers remained suspicious of the drug. Stories spread that the

tablets were poisonous or caused impotence. In fact, Atabrine like quinine was

somewhat toxic, and excessively so to a

few individuals. Some deliberately avoided prophylaxis, hoping to catch malaria

as a means of being evacuated. To see

14Surg, 101st Med Regt, ETMD [Annual Rpt], 1942,

encl. 2, pp. 3–6, file 319.1–2, HUMEDS, RG 112, NARA;

Miller, Guadalcanal, pp. 240, 431. 15Paul A. Harper et al., “New Hebrides, Solomon

Islands, Saint Matthias Group, and Ryukyu Islands,” in

Ebbe Curtis Hoff, ed., Communicable Diseases: Malaria,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 404, 419, 425–27.

JUNGLE WARFARE 123

TAKING QUININE TABLETS
that tablets were swallowed, medics

stood in mess lines and looked into

mouths. However, the troops were obliged to go out on small patrols, interrupting such supervision, and frequent

alerts required them to spend much

time in foxholes, making mosquito nets

ineffective as well.16

In order to improve malaria discipline, General Patch, on the advise of

Colonel Friend, in January 1943 issued

the Americal Division a memorandum,

in which he pointed out that less than 1

in a 1,000 was unable to take Atabrine

and that yellow discoloration of the skin

disappeared within ten days after discontinuing the drug. Commanding officers were instructed to impress upon

their subordinates the necessity of using

mosquito nets and especially of covering

the body at dusk and dawn, when mosquitoes are most prevalent. But by this

time malaria had reached epidemic proportions. Ninety percent of the 1st

Marine Division acquired the disease.

The monthly malaria rate for Allied

units ran as high as 1,781 per 1,000

troops per annum in November. From 1

November 1942 to 13 February 1943

hospital admissions for malaria from

Army units alone averaged 420 per

1,000 troops per year. Malaria so depleted some units that General Vandegrift

ordered doctors not to excuse soldiers

with temperatures of 103o F. or less from

frontline duty or patrol missions.17

Attempts to lessen the rising toll were

made by both armed services. The Navy

on 20 November 1942 established a base

malaria control unit, consisting of two

officers and eight enlisted men, to oil

pools, to improve drainage, to help

units choose healthful campsites, and to

train 101st Medical Regiment technicians in diagnostic work. In midDecember Colonel Friend instituted a

plan of action for the Americal Division,

which included an all-out campaign to

educate personnel in malaria control.

He established Field Hospital III, a

malaria facility of 400 beds staffed by

medical officers and clearing company

personnel, including trained technicians who provided laboratory diagnosis

and classification of cases. Friend made

treatment with suppressive Atabrine a

command responsibility, and appointed

a division malaria control officer to train

two enlisted men of every company and

battery in malaria control.18

But malaria discipline had been late

in coming. In January 1943, when the

final offensive was on, the admission

rate for Allied units remained high,

1,169 per 1,000 troops per annum.

Hence, the control program contributed little to the defeat of the

Japanese. In the post-combat period,

however, conditions on Guadalcanal

16When the Germans were unable to obtain quinine

during World War I, they began to experiment with synthetic substitutes. Work continued after the war, and in

1930 they produced Atabrine. See Bennett F. Avery, ed.,

The History of the Medical Department of the United States

Navy in World War II, 3 vols. (Washington, D.C.: Bureau

of Medicine and Surgery, Department of the Navy,

1950–53), 1:73. See also Rpt, King to CG, Americal Div,

15 Oct 42, p. 6, file 350.05, and Surg, 101st Med Regt,

ETMD [Annual Rpt], 1942, encl. 11, p. 2, file 319.1–2,

HUMEDS, RG 112, NARA; Miller, Guadalcanal, p. 227;

and Frank, Guadalcanal, pp. 259–60.

124 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

17Harper et al., “New Hebrides, Solomon Islands,

Saint Matthias Group, and Ryukyu Islands,” in Hoff,

ed., Communicable Diseases: Malaria, pp. 422, 426; Miller,

Guadalcanal, pp. 210, 227; Surg, 101st Med Regt, ETMD

[Annual Rpt], 1942, encl. 11, p. 1, file 319.1–2,

HUMEDS, RG 112, NARA. 18Harper et al., “New Hebrides, Solomon Islands,

Saint Matthias Group, and Ryukyu Islands,” in Hoff,

ed., Communicable Diseases: Malaria, p. 426; Surg, 101st

Med Regt, ETMD [Annual Rpt], 1942, encl. 11, pp. 1–2,

file 319.1–2, HUMEDS, RG 112, NARA.
noticeably improved. More Army malariologists came into the area and took

over and expanded the control work.

The malaria rate fell from 1,052 per

1,000 per annum in March to 149 in

December (see Table 2). By then, large

portions of Guadalcanal were Anophelesfree, and the command policy of administering suppressive Atabrine to the garrison was rescinded.19

Other problems were less important

than malaria, but all added to the misery of the fighting men. Diarrhea afflicted almost all new arrivals on

Guadalcanal, but soon disappeared

after treatment with sulfadiazine or

sulfaguanidine. In the hills, water was in

short supply and the troops went

unbathed for weeks at a time. Dirt plus

heat, high humidity, and filthy clothing

promoted fungus infections of the skin;

athlete’s foot was particularly common,

as were epidermophytosis and tinea.

Heavy perspiration depleted the body’s

fluids and salts, causing excessive

fatigue, cramps, headaches, and vertigo; some suffered from mental confusion, and some passed out. Avitaminosis

was common, apparently because field

rations were so unappetizing that soldiers ate only the more palatable items,

frustrating quartermaster efforts to provide a balanced diet. Weight loss was

apparently about twenty pounds per

man, on the average. Impressed by his

experience with the effects of jungle

warfare, Colonel Friend believed that

troops should not serve more than ten

days in continuous combat and should

not remain in such an environment for

more than four months because disease

and lowered morale depleted combat

efficiency.20

Psychological disorders, usually

termed war neurosis or battle fatigue,

accounted for a large percentage of

evacuees. Much of the problem resulted

from the many pressures of combat—

constant air attacks, the lack of sleep,

the enemy’s tactics of infiltration and

night attack. Compounding such stresses were the Guadalcanal climate and

environment. The profound jungle

darkness, the unnerving night sounds of

animals and birds, the tormenting

attacks by insects and leeches, and the

painful and distressing skin diseases all

sapped the troops’ energy and made

them more susceptible to real and imaginary terrors.21

Medical personnel learned to look for

impending psychological breaks and,

when they spotted early symptoms, to

secure the victims’ release from duty

before they jeopardized the lives of

themselves and others. By the end of

1942 the 3d Field Hospital was treating

neuropsychiatric (NP) patients as well as

possible malingerers. Unit surgeons

began to relearn—too late to prevent

many evacuations—a lesson taught by

World War I but since forgotten: The

best way to handle cases of war neurosis

was to hold them as close as possible to

the front lines.22

“We believe,” said a physician with the

182d Infantry, “that the majority of these

cases are nothing but a direct result of

19Harper et al., “New Hebrides, Solomon Islands,

Saint Matthias Group, and Ryukyu Islands,” in Hoff,

ed., Communicable Diseases: Malaria, p. 423.

20Surg, 101st Med Regt, ETMD [Annual Rpt], 1942,

encl. 5, p. 3, file 319.1–2; Rpt, King to CG, Americal Div,

15 Oct 42, pp. 5–6, file 350.05. Both in HUMEDS, RG

112, NARA. 21Rpt, King to CG, Americal Div, 15 Oct 42, pp. 5–6,

file 350.05; Interv, Maj Theodore Lidz, 26 Mar 45, file

000.71. Both in HUMEDS, RG 112, NARA. 22Interv, Lidz, 26 Mar 45, file 000.71, HUMEDS, RG

112, NARA.

JUNGLE WARFARE 125
exposure to the sun and the elements,

lack of rest and sleep, mental tension . . .

and mental and physical fatigue. Our

experience showed that when these men

were given one or two weeks rest, regular

food, a chance for a bath and rest, and

common sense psychotherapy was practiced, 85% to 90% . . . requested to be

returned to their respective units.”23

Guadalcanal contributed significantly

to the development of combat psychiatry, partly because a psychiatrist, Maj.

Martin A. Berezin, MC, for a time was

acting surgeon of the Americal Division.

Early on, the attitude of the line officers

was, if possible, even less receptive to

combat psychiatry than to malaria discipline. General Patch himself informed

Berezin that “neuropsychiatric cases

were a disgrace to the service, and he

insisted that all cases should be courtmartialed.” When Berezin protested,

Patch agreed to a compromise—treating enlisted NPs as medical cases but

court-martialing officer NPs. In consequence, Berezin diagnosed such officers

as victims of blast concussions and other

organic injuries. Meanwhile, early complaints from unit commanders over

removing NPs from the line gave way to

attempts to have them evacuated, as

their uselessness in combat became

clear.24

Lacking almost all equipment for a

psychotherapeutic program, Berezin

gave barbiturate sedation and, after one

23Interv, Gurjian, 20 Aug 43, p. 3, file 000.71,

HUMEDS, RG 112, NARA.

24M. Ralph Kaufman and Lindsay E. Beaton, “South

Pacific Area,” in Albert J. Glass, ed., Overseas Theaters,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1973), p. 461. Definitive studies of the psychiatric problems of combat, however,

were associated with the North African rather than the

Pacific theaters. Berezin contributed the material for

the section on Guadalcanal in the above-referenced

chapter. 

126 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

With Only With Other

Month Malaria Diseases

January . . . . . . . . . . . . . . . . . . . . . 1,169

February . . . . . . . . . . . . . . . . . . . . 878

March . . . . . . . . . . . . . . . . . . . . . . 1,052

April . . . . . . . . . . . . . . . . . . . . . . . 1,182

May . . . . . . . . . . . . . . . . . . . . . . . 900

June . . . . . . . . . . . . . . . . . . . . . . . 396 636

July. . . . . . . . . . . . . . . . . . . . . . . . . 342 608

August . . . . . . . . . . . . . . . . . . . . . . 142 263

September . . . . . . . . . . . . . . . . . . 181 287

October . . . . . . . . . . . . . . . . . . . . 124 230

November . . . . . . . . . . . . . . . . . . . 91 206

December . . . . . . . . . . . . . . . . . . . 71 149

TABLE 2—MALARIA ADMISSION RATE FOR ALLIED UNITS,

a

GUADALCANAL, 1943

a

Reflects the number of cases per annum per 1,000 troops.

Source: Adapted from Harper et al., “New Hebrides, Solomon Islands, Saint Matthias Group, and Ryukyu Islands,” in Hoff, ed.,

Communicable Diseases: Malaria, p. 423.
or two days of rest, returned most of his

cases to duty. The problems of evacuation from the island probably played a

positive role in the next development.

Searching for some kind of positive

therapy, he decided that his NPs could

best be used to extend the dugouts that

the hospital needed because of continuing Japanese air attacks. Hence, the prescribed remedy was an enigmatic “P&S,”

meaning pick and shovel. Under the eye

of hospital corpsmen, the NPs worked

out their convalescence, and the results

were satisfactory. “The combination of

sedation, a few days of respite from combat as such, the physical work, and the

sympathetic but dignified attitude of the

hospital personnel enabled many of

these soldiers to return to duty—some

to full duty and others to limited duty in

a rear echelon.” Reports from

Guadalcanal and other battlefronts contributed to the Army’s decision in

November 1943 to create the post of

division psychiatrist, which previously

had not existed.25

The Japanese on Guadalcanal suffered the same diseases as the

Americans. Although the enemy had

access to quinine—Japan had occupied

the Netherlands East Indies, the world’s

chief supplier—he appeared to lack any

systematic malaria control. Army historian John Miller, jr., later wrote, “Among

the Japanese probably every man was a

victim.” As the Allies took control of the

air and sea lanes, thus cutting off delivery of food supplies, the Japanese

starved as well, and physical depletion

increased the incidence of disease. The

few enemy prisoners captured revealed

evidence of nutritional diseases, including beriberi. During the last stages of

the fight for Guadalcanal, disease,

despite continuing high rates among

Americans, probably became more an

ally than an enemy, weakening the

defenders here as it had those on

Bataan. Their own failings, however,

caused Americans to forfeit much of the

advantage that an early program of

malaria control might have brought

them. Like the Japanese, Americans

stood at the beginning of a long learning process in the waging of jungle war.26

Papua

While South Pacific Area forces

planned and launched the Guadalcanal

campaign, Japanese expansion on New

Guinea ignited a counteroffensive by

Southwest Pacific Area forces under

General MacArthur. The Japanese

hoped to capture Port Moresby, clearing

their flank for later attacks against Fiji

and New Caledonia. The Battle of the

Coral Sea in May 1942 thwarted enemy

plans for an amphibious attack on

Moresby. Instead, after seizing the north

coast settlement of Buna in July ahead

of the Allies, the Japanese launched

their forces overland along the narrow

Kokoda Trail through the Owen Stanley

Range. 

The struggle that followed imposed

terrible burdens both on the troops who

fought and on the medics who attempted to preserve their lives in some of the

world’s most hostile terrain. New Guinea

is, next to Greenland, the world’s largest

island—over 300,000 square miles of

dense jungles, reeking swamps, and towering cloud-swathed mountains. In

shape, it appropriately resembles a prehistoric creature, with the beaked head

25Ibid., p. 462. 26Miller, Guadalcanal, p. 229.

JUNGLE WARFARE 127
of the Vogelkop Peninsula turned to the

west and the tail of the Papuan

Peninsula, scene of the fighting, extending to the southeast. For Army medics,

the climate was a nightmare. Many parts

of Papua’s 90,540 square miles receive

150 to 300 inches of rain a year, and 8 to

10 inches a day during the monsoon season from November to March. The

northern coastal areas, where the Allies’

ultimate objective lay, consisted of dense

jungle, marshy floodplain, and fields of

tall kunai grass, giving way at the edge of

the sea to a sandy coastal ridge dotted

with palms. The heat of the lowlands

contrasted sharply with the cold of the

higher elevations in the Owen Stanleys.

Besides malaria, troops encountered

dengue, scrub typhus, dysentery, and tormenting skin diseases that they

described as “jungle rot.”27

Port Moresby, a small copra port on

Papua’s south coast, was the key to supply

and communications for the campaign.

Army engineers built airfields in northern Australia and others in New Guinea

to defend it. In late August the

Australians turned back a Japanese move

down the coast, securing the Allied base

for the time being. Several weeks later,

they halted the Japanese advance toward

Port Moresby at Imita Ridge on the

Kokoda Trail. Meanwhile, troops filtered

in during June and July, including

Australian and American air, antiaircraft,

engineer, and service units. On 11 August

1942 the USASOS created a base section,

called Advance Base, under Brig. Gen.

Dwight F. Johns. The Advance Base aided

in the operation of Moresby and other

New Guinea ports, directed the activities

of U.S. service personnel in the area, and

supplied U.S. troops in the combat zone.

To consolidate U.S. and Australian supply

services in New Guinea, General

Headquarters, SWPA, on 5 October

established on Papua the Combined

Operational Service Command.28

By this time Port Moresby was on its

way to becoming a major base, with new

roads, airfields, and harbor facilities. In

public health it resembled a frontier

town. American and Australian units put

up latrines along the beach, dumped

their refuse into open pits, and burned

their garbage. The soldiers ate most of

their food from cans, discarding the containers. A plague of flies beset the town,

and soon almost all troops passing

through Port Moresby could report experiences similar to those of the 4th

Portable Surgical Hospital,29 which

debarked in November. Seventy-five percent of its personnel contracted diarrhea,

“from which several . . . never completely

recovered.” At first there was little malaria, but the troops, by creating a multitude

of small water catchments exposed to

sunlight, provided perfect breeding spots

for the local anophelines.30

On 2 September Colonel Carroll, the

USASOS chief surgeon, sent Col. Julius

27Quoted words from Robert L. Eichelberger, in collaboration with Milton Mackaye, Our Jungle Road to

Tokyo (New York: Viking, 1950), p. 39. See also Samuel

Milner, Victory in Papua, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, 1957), pp. 56–58.

28Milner, Papua, pp. 72–77, 87, 103. 29Although not official until May 1943, the designation

portable surgical hospital is used throughout this volume. 30Rpt, Maj Neil W. Swinton, CO, 4th Port Hosp, to

Surg, 32d Inf Div, 12 Mar 43, sub: Criticism of Portable

Hospitals—Final Report, p. 2 (quotation), file 319.1;

OofSurg, Adv Base, New Guinea, Sanitary Rpt, Sep 42,

p. 1, file 721.5 SWPA (Adv Base D Monthly Reports)

1942–1943. Both in HUMEDS, RG 112, NARA. See also

D. Clayton James, The Years of MacArthur, 3 vols.

(Boston: Houghton Mifflin Co., 1970–85), 2:247, and

Alan S. Walker, The Island Campaigns, Australia in the

War of 1939–1945, Series 5, Medical (Canberra:

Australian War Memorial, 1957), pp. 15–37. 

128 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
M. Blank, MC, with a small staff to

Moresby to set up the Office of the

Advance Base Surgeon at General

Johns’ headquarters. During the next

few months Blank’s staff established a

supply depot in the Moresby area for

stores coming in from Brisbane and

Townsville; arranged for the delivery of

hospital units and equipment to the

combat zone by aircraft, parachute, and

ship; investigated the available water

supply; and selected sites around

Moresby for three fixed hospitals and a

medical laboratory. With the surgeons

of the corps, the divisions, the Fifth Air

Force, and the Australian Army, Colonel

Blank worked on problems of hygiene,

sanitation, and malaria control.

Unfortunately, no real medical planning was possible. No malaria control

units were available to accompany the

troops. Hospitals arrived slowly; at the

end of November the total available to

American forces in New Guinea were

one 200-bed facility near Port Moresby

and a 500-bed station hospital 17 miles

away. As the I Corps surgeon, Col.

William J. Miehe, MC, remarked, “The

simultaneous movement of medical

installations and combat units was not

well coordinated.” When epidemics

began, inadequate bed strength compelled an evacuation policy of only

seven days and the hasty dispatch to

Australia even of minor cases, depleting

the strength of the Army.31

Shortcomings notwithstanding, the

chief surgeon hoped to condition his

portable hospital personnel for the coming campaign. Carroll recommended a

training program that included setting

up exercises, marching, climbing hills

with loads, and surviving on reduced

rations. Meanwhile, Colonel Miehe,

with the assistance of his division surgeons, reorganized the medical units of

the 32d and 41st Infantry Divisions.

Both divisions were triangular, and their

three regiments, strengthened by additional units, were intended to function

separately as combat teams. Hence, the

107th Medical Battalion of the 32d

Division and the 116th Medical

Battalion of the 41st Division had to be

divided as well. Each regimental combat

team (RCT) received a three-platoon

collecting company and a clearing company platoon to provide organic support. Since the clearing company of the

divisional medical battalion contained

only two platoons, Miehe was obliged to

reduce the personnel and equipment of

each in order to support all three RCTs.

Similarly, hospital corpsmen in the collecting companies faced the backbreaking labor of littering the wounded

through jungles without respite. In an

attempt to prepare themselves, the medical units supporting the regimental

combat teams trained vigorously, attended lectures by Australian instructors on

jungle warfare, and participated in landing and field maneuvers with the units

they supported. But their time was limited. By October most were on their way

to New Guinea.32

31Surg, I Corps, Annual Rpt, 1942, pp. 1–24 (quotation, p. 15), file 319.1–2, HUMEDS, RG 112, NARA. See

also Blanche B. Armfield, Organization and

Administration in World War II, Medical Department,

United States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1963), pp. 431–32, 442–43.

32Simon Warmenhoven, “Medical Department, 32d

Division, Papuan Campaign,” pp. 22–23, file 370

(Papuan Campaign) SWPA; 163d Inf [Regt] Combat

Team Quarterly Rpt, Jan–Mar 43, p. 4, file 319.1. Both in

HUMEDS, RG 112, NARA. The terms regimental task force

and infantry combat team were used interchangeably at the

time for the official designation regimental combat team.

JUNGLE WARFARE 129
The Campaign

Alarmed by the situation on

Guadalcanal, Japanese support for taking over New Guinea abated. Devastated

by starvation and disease, an enemy

force that had attempted to reach Port

Moresby by crossing the mountains

began to retreat along the Kokoda Trail

in September, with Australian forces in

hot pursuit. Meanwhile, Japanese units

in the Buna area dug in for a protracted

defense.33 The Allies seized a rough airfield at Kokoda and, when their forces

reached the northern coast, hastened to

build others at Pongani and later on a

grassy plain at Dobodura, 15 miles

southeast of Buna.

MacArthur ordered the 32d Division’s

126th and 128th Regimental Combat

Teams, which were built around the division’s 126th and 128th Infantry, to New

Guinea, although they had scarcely five

weeks of training, none of it in jungle

warfare. The decision to send green, or

untrained, and poorly led troops to New

Guinea ultimately had major medical

consequences. After assembling at

Moresby, they boarded Douglas C–47s or,

in some instances, planes of Australian

civilian airlines, which flew them to the

front, across the Owen Stanleys. The battle for the north coast, already under way,

grew in intensity as the November–March

wet season began.34

Some troops were not fortunate

enough to fly into battle. In an attempt

to encircle the retreating Japanese, the

2d Battalion, 126th Regimental Combat

Team, supported by a collecting platoon

of the 32d Division’s 107th Medical

Battalion and the 19th Portable Surgical

Hospital, crossed the mountains on foot.

On 8 October the infantry, medics, and

native carriers started up the Kapa Kapa

Trail toward Jaure, beyond the divide,

climbing through dense jungle up steep

ridges to a pass at 9,000 feet and then

descending the northern slopes. The

soldiers took five or six hours to go 1

mile; exhausted, they discarded shelter

halves and mosquito nets. Those who

were out of condition broke down quickly and fell beside the trail, gasping for

breath. Two weeks into the march,

native guides evacuated thirty who could

not keep up; the 2d Battalion’s commanding officer, who had suffered a

heart attack, was returned to Port

Moresby. But most went forward with

the help of their comrades.

The medics struggled to keep themselves and others going. Medical officers

following the column shepherded the

stragglers ahead of them, for fear of

enemy patrols. They attempted to treat

an outbreak of acute diarrhea, caused by

contaminated bully beef, that forced

some in their distress to cut the seats out

of their trousers. Fires could not be built

or food cooked, and rain thundered

down the matted slippery gorges,

swelling the mountain streams to torrents. A young officer scribbled in his

diary: “Our strength is about gone. . . .

We seem to climb straight up for hours,

then down again. God, will it never

end?” Between 25 and 28 October the

trekkers dragged themselves into Jaure.

Their clothes were in tatters, their shoes

worn and moldy; many were beginning

to have chills and fever. For the remain33The term Buna area was loosely applied to the

entire battleground, from Cape Endaiadere on the east

to the mouth of the Kumusi River on the west. 34Warmenhoven, “Medical Department, 32d

Division,” p. 1, file 370 (Papuan Campaign) SWPA,

HUMEDS, RG 112, NARA; Eichelberger, Our Jungle

Road, p. 12; Charles E. Heller and William A. Stofft,

eds., America’s First Battles, 1776–1965 (Manhattan:

University Press of Kansas, 1986), pp. 186–92.

130 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
der of the campaign, they carried the

fever with them.35

The rest of the 126th and 128th

Regimental Combat Teams had arrived

in the Buna area from the airfields or by

shuttle boat during the first half of

October, and the Fifth Air Force flew in

the 32d Division’s third regimental combat team, the 127th, direct from

Australia in November. The entire division was now in place. The Japanese, dug

in along the sandy palm-dotted coastal

ridge, waited in three highly fortified

defense areas. Buna, a hamlet boasting

twelve houses, was the objective of the

32d Division, while Gona, with its ten

houses, and Sanananda Point were the

goals of the Australian 7th Division.36

Between the forces of the two Allies

ran the Girua River, now at flood stage.

Drier areas held coconut and rubber

plantations and native gardens of taro,

yams, sugarcane, bananas, and breadfruit. The troops had to cut their way

through the jungle, dense with undergrowth and festooned with thorny vines.

Thriving mangrove and sago choked the

swamps, now flooded to depths up to 7

feet. Roads were mere tracks, and rainfall averaged 121 inches a year. The

region was “literally a pesthole,” with

endemic malaria, dengue, scrub typhus,

various forms of dysentery, and the usual

array of tormenting skin diseases to add

to the misery of the troops.37

Soon a logistical and medical disaster

threatened the American and Australian

forces. Reaching the front weary and

short of food and medical supplies, the

troops lived on one-third rations, barely

enough to sustain life, and hunger

increased their susceptibility to disease.

Their feet were swollen; those who had

thrown away their shelter halves on the

march slept without protection from the

heavy rains. Bad weather and Japanese

air attacks launched from Rabaul disrupted supply by air and by sea. (Much

of the horror of the campaign resulted

from the fact that in the beginning each

side proved strong enough to interdict

the other’s supplies but not strong

enough to protect its own.) 

Quinine, salt tablets, vitamin pills,

and tablets for chlorinating water in the

early days were hard to come by.

Dysentery, accompanied by bloody

stools, high fever and prostration, afflicted almost all. The incidence of malaria

steadily rose. Only victory could bring

relief, but the attackers lacked tanks,

mortars, artillery, and flamethrowers,

and the Navy refused to risk its ships

among the uncharted reefs offshore.

For a time the Japanese bunkers, built in

the drier soil of the coast, appeared

invulnerable. Sick, hungry, and dispirited, the Americans showed little stomach

for fighting, and yet immobility might

mean their destruction by disease.38

Angered by the lack of progress,

General MacArthur ordered the I Corps

commander, Lt. Gen. Robert L.

Eichelberger, to Buna to revitalize the

American effort. The appearance of the

troops horrified him: “No one,” he

wrote, “could remember when he had

been dry. The feet, arms, bellies, chests,

35Quotation from E. J. Kahn, Jr., “The Terrible Days of

Co. E,” Saturday Evening Post, 8 Jan 44. See also Hanson

W. Baldwin, “Doughboy’s March—A High Point in War,”

New York Times, 7 May 44, and Lida Mayo, Bloody Buna

(New York: Doubleday and Co., 1974), pp. 70–75. 36Sanananda Point was quite swampy; here Japanese

bunkers had to be built aboveground. 37Milner, Papua, pp. 126–128 (quotation, p. 126);

Mayo, Bloody Buna, p. 87; Rpt, Col George W. Rice,

Surg, GHQ, SWPA, 20 Nov 42, sub: Medical Estimate of

the New Guinea Situation (Buna Area), p. 2, file 705,

HUMEDS, RG 112, NARA. 38Milner, Papua, pp. 196–97; James, MacArthur, 2:241.

JUNGLE WARFARE 131
armpits of my soldiers were hideous with

jungle rot.” He ordered the medics to

take the temperatures of an entire company of hollow-eyed men near the front.

“Every member—I repeat, every member—of that company was running a

fever. Yet to evacuate all those with fever

at Buna would have meant immediate

victory for the enemy. I had to encourage most of those troops back into combat.” Finding the 32d Division officers

unwilling to lead and their subordinates

rapidly becoming unable to fight,

Eichelberger relieved the division commander, as MacArthur had authorized

him to do, and several battalion commanders as well. Waiting to starve the

enemy into submission was impossible.

“Disease,” wrote Eichelberger, “was a

surer and more deadly peril to us than

enemy marksmanship. We had to whip

the Japanese before the malarial mosquito whipped us.”39

Eichelberger chose 5 December for a

new attack. Despite the command

changes, the effort met with strong

enemy opposition and failed. However,

on the ninth the Australians took Gona,

and that same day American reinforcements arrived. On the fourteenth the

32d Division took Buna Village.

Throughout the battle zone fringing the

Solomon Sea, the logistical picture

brightened as well. The relatively small

Allied and enemy forces fighting on

Papua represented the apex of huge

logistical pyramids, which the United

States was better fitted than Japan to support. Though losses there and on

Guadalcanal were few in absolute

terms—neither encounter could be

compared to the sustained battles fought

that year in the Soviet Union or even in

North Africa—Japanese casualties

included a disproportionately heavy loss

of irreplaceable airmen. In November

the Navy smashed a Japanese fleet off

Guadalcanal, and the Fifth Air Force

steadily tightened a noose about Buna. 

As control of the air and sea shifted,

supply became ever easier for the Allies.

More luggers plied the coastwise traffic,

and the airlift grew rapidly as the 32d

Division opened a succession of airfields

at Dobodura. Though the surviving

enemy soldiers on Papua defended well

in cleverly concealed bunkers, they were

ill and starving, with some resorting to

cannibalism to survive. Allied as well as

Japanese atrocities were recorded; at

Sanananda the patients in an enemy

hospital were massacred by their captors. Japanese prisoners brought into

American hospitals after the fall of Buna

Mission all had malaria, and were “a terribly malnourished and debilitated lot.”

Surly and uncooperative, they appeared

to want to die and had to be watched at

night, when the stronger would try to

kick the weaker to death.40

By the end of January 1943 the whole

disputed coastline from Cape Endaiadere

to the Kumusi River was in Allied hands.

The Buna campaign had ended, after

almost six months of savage fighting, and

39Quotations, in order, from Eichelberger, Our Jungle

Road, pp. 39, 23, and 43. See also Milner, Papua, pp.

202–03, and Mayo, Bloody Buna, pp. 113, 117. The I

Corps arrived in the Southwest Pacific Area in October

1942 and served directly under General Headquarters,

SWPA.

403d Port Surg Hosp Quarterly Rpt, Jan–Mar 43, p. 5

(quotation), bound in “Histories, Portable Surgical

Hospitals in WW II”; Rpt, Lt Col S. Alan Challman, NP

Consultant, to CSurg, USASOS, SWPA, 5 Mar 43, sub:

Report of Trip Through Base Sections 2 and 3 and

U.S.A. Advance Base, p. 9, file 333 SWPA (Trip by

Challman) 1943. Both in HUMEDS, RG 112, NARA.

See also Milner, Papua, pp. 238–321; Mayo, Bloody Buna,

pp. 145–68. 

132 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Allied planners were turning their eyes to

the Japanese forces further up the coast,

at Lae and Salamaua.41

On 9 January Eichelberger relieved

the 126th Regimental Combat Team,

which had been aiding the Australians

on the Sanananda front. Fourteen hundred strong when first committed to

action in the third week of November,

the unit now numbered 165. Five days

later, in the 32d Division area, the I

Corps commander greeted the weary

survivors “with band music and with

what might well be described as a martial welcome. Actually it was whatever

face could be put upon it, a melancholy

homecoming. Sickness, death, and

wounds had taken an appalling toll. . . .

They were so ragged and so pitiful that

when I greeted them my eyes were wet.”

On the twenty-first the last remaining

enemy, half-starved and disease-ridden,

gave up.42

On 10 January 1943 Maj. E.

Mansfield Gunn, MC, a medical officer

on General Eichelberger’s staff, wrote

to a friend: “Sickness of all sorts, particularly of the various tropical fevers is on

the increase also, so I expect that almost

everyone in the division will come out

of here either wounded or sick. I do not

intend to paint a depressing picture,

but that is the truth as things stand

today.” Immediately following the campaign, Lt. Col. Simon Warmenhoven,

MC, the 32d Division surgeon, ordered

his enlisted medics to take the temperatures of 675 soldiers—a cross section of

the combat teams. Warmenhoven

reported that “53 percent of this group

of soldiers were running a temperature

ranging between 99 degrees to 104.6

degrees. . . . In order of prevalence, the

cause of the rise in temperature is due

to the following: Malaria, Exhaustive

States, Gastro-Enteritis, Dengue Fever,

Acute Upper Respiratory Infection, and

Typhus (scrub).” He noted that the division sick call rate was 24 percent and rising. Some 2,952 soldiers suffering from

disease and fever were already in the

hospital, and medics were evacuating 50

to 100 daily to Port Moresby because of

illness. The fighting had ended for the

moment, but many veterans would

carry the effects of the campaign

throughout their lives.43

Medical Support

Under the conditions of Papua, medical support was never more than a holding operation. Care in the combat zone

was limited to aid stations, collecting

and clearing stations, eleven portable

surgical hospitals, and one field hospital

platoon. Medical officers and hospital

corpsmen sought to keep the troops

going, providing suppressive treatment

for malaria and first aid for skin diseases, and they sought to treat the

wounded as far forward as possible,

knowing well the slowness of evacuation

and the dangers of infection.

Aiding the wounded entailed considerable risk. On Papua the red cross gave

no protection. The 17th Portable

Surgical Hospital “never displayed the

Red Cross and our men never wore the

arm brassard.” Hospitals were bombed

41Milner, Papua, p. 368. 42Quotation from Eichelberger, Our Jungle Road, pp.

56–57. See also Milner, Papua, p. 334, and Mayo, Bloody

Buna, pp. 170–71. Some enemy forces were able to infiltrate Allied lines and escape to the west bank of the

Kumusi River, where they reestablished contact with the

defenders of Lae and Salamaua.

43As quoted, to include statistics, in Milner, Papua,

pp. 323–24. See also Mayo, Bloody Buna, pp. 180–88.

JUNGLE WARFARE 133
unmercifully, and medics were shot

while carrying litters, dressing wounds

on the field, or dragging casualties to

aid stations. They learned that dressings

had to be dyed khaki or jungle green,

because snipers took aim at white bandages. Even casualties tore off their bandages in order not to be an easy target.44

From the battalion aid stations, relay

teams carried the wounded 800 to 1,200

yards back over twisting trails to collecting stations and portable surgical hospitals, often housed in shelters of leaves

cut from the jungle, where they received

additional treatment. Casualties were

sorted; ideally, those needing immediate

surgery went to the portables, while

those not so seriously wounded or too ill

to remain near the front were sent to

clearing stations, usually 2 miles farther

to the rear. Though Carroll had intended portables to be divisional units, in

this campaign they were attached to the

regimental combat teams and worked in

the regimental areas.

Hard labor and danger were the lot of

the staffs. The four officers and twentyfive enlisted men of the 3d Portable

Surgical Hospital, after flying from Port

Moresby into Dobodura, carried their

1,250 pounds of equipment in pack

frames to the front near Buna. Here

they set up close to the regimental collecting station, forward of the command

post and only about 300 yards from the

Japanese. Sheltered by tents—probably

the mercerized cotton tents that had

been developed for the portables,

lighter than canvas but even more

prone to decay in the moist heat of New

Guinea—the hospital occupied a hollow, shielded by tall black-rubber trees

and the luxuriant vegetation of the

swamps. The surgeons worked exactly as

Carroll had intended (a rare occurrence

on Papua), providing emergency stabilizing treatment. They did not hold any

soldier ill with fever or who could safely

travel to the rear, and gave those who

arrived after dark beds until morning.

All day and night bullets struck the trees

and perforated the tops of the tents; the

fact that the Japanese had little artillery

made the position tenable. Yet during a

single week—its first on the line—the

tiny hospital performed sixty-seven

major surgical procedures, including

amputations, resections of the bowel,

and serious chest operations.45

Besides the skill and courage of its

staff, the 3d Portable Surgical Hospital’s

success depended on the sulfa drugs to

prevent infection and on the extraordinary toughness of the human frame,

able in many cases to survive fatigue,

hunger, sickness, wounds, and the trauma of surgery. The surgeons hoped for

the death of one young man who had

lost the left side of his face to shrapnel—

nothing remained, recorded their commander, but “one big hole.” But the soldier had “an uneventful convalescence”

and was evacuated, hideously disfigured

but alive.46

The portables played many roles on

Papua. To Miehe, Carroll made a plea 44Quotation from 17th Port Surg Hosp Quarterly

Rpt, Jan–Mar 43, p. 6, file 319.1. See also

Warmenhoven, “Medical Department, 32d Division,”

pp. 4, 7, file 370 (Papuan Campaign) SWPA. Both in

HUMEDS, RG 112, NARA. Pvt. Hymie Y. Epstein on the

Sanananda Track and T. Sgt. Edwin C. DeRosier in

front of Buna, killed while retrieving the wounded,

were awarded the Distinguished Service Cross posthumously. See Milner, Papua, pp. 165, 175.

45Warmenhoven, “Medical Department, 32d

Division,” pp. 1–9, 23, 24, file 370 (Papuan Campaign)

SWPA, HUMEDS, RG 112, NARA. 463d Port Surg Hosp Historical Rpt, Sep–Dec 42, p. 6,

bound in “Histories, Portable Surgical Hospitals in WW

II,” HUMEDS, RG 112, NARA.

134 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
for their proper use as surgical hospitals,

endorsing a proposal of Colonel Rice,

soon adopted, to rename them portable

surgical hospitals to emphasize their

main purpose. But as the number of

wounded increased—and especially, as a

tide of sick mounted—regimental surgeons, desperately short of beds and facing great difficulties in evacuating

through jungle and swamps, began to

exploit the portables as supplementary

aid stations or as holding wards for

malaria cases. Surgeons, trained for a

specific task involving specialized skills,

found themselves giving first aid and

providing for the care and evacuation of

the sick. 

Then, as engineers built usable roads,

the basic logic of the portable was

upended. Medics scrounged for tentage, often heavy canvas, and equipment

that was both unauthorized and nonportable; they acquired vehicles to move

their patients to the airstrips, especially

the invaluable jeep ambulances,

equipped with brackets to hold litters.

Unable to move their possessions, with

beds full of malaria cases, sometimes

housed in huts of grass or palms, many

portables ended the Buna campaign

looking like anything but the units

Carroll had designed for frontline

surgery. Yet much surgery continued to

be done in them. Orthodox or not, they

gained universal praise.47

In fact, versatility was their prime

virtue in a campaign so hastily organized

and so poor in resources. In one of the

many small forward chains of evacuation, the 23d Portable Surgical Hospital

did frontline surgery beside the collecting station of the 128th Regimental

Combat Team. Fever victims and the

slightly wounded were sent back to the

14th Portable Surgical Hospital, a mile

to the rear, while the 18th and 22d

Portable Surgical Hospitals formed an

evacuation point from which casualties

were dispatched either by boat down the

coast to Pongani or by native litter-bearers or jeep ambulances up the trail to

Dobodura. The 19th Portable Surgical

Hospital, operating in the Australian

sector, served as both a surgical hospital

and a small evacuation facility. In all

ways, said Colonel Warmenhoven, the

32d Division surgeon, the portables

“proved to be of tremendous value to

the medical service given the division. It

would be hard to give an exact estimate

of the number of lives that were definitely saved by their emergency surgery

and heroic work performed near the

front lines. They have proven that they

have a definite place with combat troops

in this type of warfare.” The portables

reported a mortality rate of 3.6 percent

in their patients, equal to many hospitals that were more elaborately staffed

and more safely situated. Signifying

their success was the reluctance of the

units they served to part with them.

Early in March 1943 the portables were

temporarily removed from the USASOS

and assigned to the field forces.48

Success was gained at the cost of

much suffering. In part, the portables’

47Ltr, Col Percy J. Carroll, CSurg, USASOS, SWPA, to

Col William J. Miehe, Surg, I Corps, 21 Dec 42, p. 1, file

322 Correspondence re: Portable Surgical Hospitals

(SWPA) 1942, HUMEDS, RG 112, NARA.

48Warmenhoven, “Medical Department, 32d

Division,” p. 27 (quotation), file 370 (Papuan

Campaign) SWPA, and the Port Surg Hosp Annual

Rpts, 1942, file 319.1–2, for the 14th, p. 2; 18th, p. 3;

19th, p. 4; 22d, pp. 4–6; and 23d, pp. 2–3. All in

HUMEDS, RG 112, NARA. See also Augustus

Thorndike, “Surgical Experiences With the Wounded

of the Buna Campaign,” New England Journal of Medicine

231 (1944): 649–51.

JUNGLE WARFARE 135
problems reflected New Guinea conditions. Estimates that soldiers could

carry sixty to seventy pounds of equipment proved quite unrealistic on

Papua, where native carriers by law

could not be burdened with more than

forty pounds. Complaints of exhaustion

and reports of portables discarding

equipment on the trail caused new

efforts to lighten their authorized

equipment still further. Other difficulties stemmed from the fact that no one

seemed sure of what equipment

belonged to whom. Working at the

front line under fire, with antiaircraft

and mortar fragments falling into the

operating room as the surgeons

worked, the 23d Portable Surgical

Hospital was unable to get supplies

from either regiment or division, and

fed itself and its patients by foraging. Its

commander complained that his subordinates needed contact with a chain of

supply; that they needed rest and relief

periods as much as other troops; and

that they needed native carriers to move

their gear, if key technicians were not to

arrive at each new location too exhausted to do their work. Miehe, as the I

Corps surgeon, urged that all mobile

hospitals should come under the field

forces; however, Carroll strenuously

opposed the idea and, using his shortlived position as USAFFE chief surgeon,

136 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

THE JEEP AMBULANCE
had the portables back under the

USASOS within a month.49

Despite much courage and ingenuity, the units that served the fighting

forces on the New Guinea battlefields

were, as Colonels Rice and Miehe both

pointed out, simply not adequate for

the needs of the sick and wounded.

Increased holding capacity near the

front line was essential. “A section of a

field hospital, or even a complete field

hospital,” Rice observed after a tour of

Buna, “is not large enough to handle

the sick and wounded for a triangular

division.” Rice believed that unless a

mobile hospital not smaller than an

evacuation hospital was attached, the

collecting and clearing stations and

portable surgical hospitals would soon

become immobilized with casualties.

But a section of the 1st Evacuation

Hospital did not reach the north coast

until 10 February 1943, when it became

part of the mushroom growth of a new

USASOS sub-base at Oro Bay, on the

coast near Dobodura.50

The Ravages of Disease

The prime source of the casualties

that choked the hospitals and burdened

the evacuation system was another

malaria epidemic, whose course formed

a sad commentary on the amateurism

and poverty of the theater and its medical service. Nothing was easier to foresee than the danger of malaria in New

Guinea; but, since a unified anti-malaria

effort had barely begun in Australia, little could be hoped for in Papua. There

was, as yet, no theater malariologist; no

trained American anti-malaria units; an

inadequate supply of suppressive drugs;

a marked lack of urgency at General

Headquarters, despite the experiences

of Bataan; and a corresponding lack of

concern among the line officers in the

field. The anophelines of Papua preferred to breed in sunlight and multiplied around bases as the jungle was

cleared. The disease became more virulent by passage through many human

hosts, and by late 1942 was “increasing

absolutely, proportionately, and in

degree.”51

At Milne Bay, a particularly hard-hit

base, the incidence of malaria among

all units reached 4,000 per 1,000 troops

per year, and cost the service command

an estimated 12,000 man-days a month.

During the campaign more than 1.5 as

many American soldiers were evacuated from the combat zone for malaria as

for battle wounds; disease caused 71

percent of evacuations by air, and

three-fifths of the sick were malaria

cases. Malaria, said Colonel Miehe, was

51Surg, Fall River Sub-base [Milne Bay], Monthly Rpt,

12 Dec 42, p. 3, file 319.1 (HQ USASOS Fall River

Monthly Reports) Oct 42–Dec 43, HUMEDS, RG 112,

NARA.

JUNGLE WARFARE 137

49Surg, I Corps, Annual Rpt, 1942, p. 5, file 319.1–2;

Rpt, Maj Alfonso M. Libasci, n.d., sub: Report of Trip to

New Guinea, 5–7 January 1943, pp. 3–4, file 333.1 (Trip

to New Guinea) SWPA; Ltr, Col Percy J. Carroll, CSurg,

USAFFE, to CSurg, USASOS, SWPA, 23 Mar 43, sub:

Portable Hospitals, pp. 1–3, file 322 Correspondence

re: Portable Surgical Hospitals (SWPA) 1943. All in

HUMEDS, RG 112, NARA. 50Ltr, Col George W. Rice, Surg, GHQ, SWPA, to Col

Percy J. Carroll, CSurg, USASOS, SWPA, 12 Jan 43, p. 2

(quotations), file 322 Correspondence re: Portable

Surgical Hospitals (SWPA) 1943; 2d Field Hosp Annual

Rpt, 1942, p. 5, file 319.1–2; U.S. Adv Sub-base [Oro

Bay] Quarterly Rpt, Jan–Mar 43, p. 1, file 319.1

(Advance Sub-base B) 1943. All in HUMEDS, RG 112,

NARA. Oro Bay developed into an important part of

the chain of evacuation during the next phase of the

New Guinea fighting. See also Clarence McKittrick

Smith, The Medical Department: Hospitalization and

Evacuation, Zone of Interior, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1956), p.

144.
paramount in New Guinea, and no

effective response took shape until

after the Buna campaign was over.

General Eichelberger considered the

health conditions at Buna a command

and training failure, and Chief of Staff

General Marshall noted the prevalence

of disease, reporting that “priorities for

munitions overrode those for the necessary [mosquito] screening and other

materiel to provide protection at the

bases, also there has not been sufficiently rigid sanitary discipline as to the

individual soldier.”52

The whole theater, from the Supreme

Commander down, had to become

involved in the fight against malaria. It

did so in 1943. In April Carroll was able

to announce the appointment of a

Public Health Service officer, Col.

Howard F. Smith, MC, as theater malariologist. MacArthur had already established the Combined Advisory

Committee on Tropical Medicine,

Hygiene, and Sanitation. In turn, the

committee estimated the amounts of

antimalarial drugs needed by the theater

and used its direct access to MacArthur

to ensure top shipping priority for drugs,

equipment, and supplies. The north

coast of New Guinea, from Dobodura to

Oro Bay, was divided into sections, and

malariologists and survey units, now

arriving from the United States, were

assigned to each. Native villages, potential sources both of malaria and venereal

disease, were put off limits. Experts located and mapped mosquito breeding

areas, and they turned the information

over to unit commanders, who were

assigned the responsibility for control

measures. Parasitologists with the survey

units took blood smears from the troops

on suppressive Atabrine to determine

the minimum effective dosage, not only

to save supplies of the drug but also to

minimize its toxic side effects. 

By then, such work was all the more

essential because the engineers had

extended their efforts, clearing jungle,

letting in sunlight, and spreading the

transient pools of water in which the

local vectors preferred to breed. Indeed,

the 32d Division’s disease rate for all

fevers—malaria, dengue, and of undetermined origin—peaked in February,

when the battle was over, at 5,358 per

1,000 troops per year. Carroll, backed by

his commanders, launched a program

for training unit anti-malaria details

before their outfits departed to fight in

malarious areas. He wanted to see many

more American enlisted men supplement the few then attending an antimalaria school established by the

Australian Army at Port Moresby, and

malaria survey units to accompany or

immediately follow the battalion combat

teams that had begun leapfrogging up

the New Guinea coastline. The 41st

Division, replacing the hard-hit 32d,

adopted a policy of treating uncomplicated cases as far forward as possible

and returning them to duty.53

For a time, such measures appeared

to succeed. But when fighting began

again, the malaria rate rose once more;

53Warmenhoven, “Medical Department, 32d

Division,” p. 10, file 370 (Papuan Campaign) SWPA,

HUMEDS, RG 112, NARA.

138 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

52Ibid.; Ltr, Brig Gen Charles C. Hillman, OSG, ASF,

WD, to SG, U.S. Army, 12 Jul 43, sub: Report of

Observations of Medical Service in Southwest Pacific

and South Pacific Areas, pp. 2–4, file 333 (Hillman)

1943; Surg, I Corps, Quarterly Rpt, Jan–Mar 43, p. 5,

file 319.1. All in HUMEDS, RG 112, NARA. Quotation

as cited in Armfield, Organization and Administration, p.

442. See also Jay Luvaas, ed., Dear Miss Em: General

Eichelberger’s War in the Pacific, 1942–1945 (Westport,

Conn.: Greenwood Press, 1972), p. 39.
in the summer of 1943 “medical casualties which lead to evacuation from the

forward areas . . . outnumbered surgical

casualties by 7 to 10 fold,” and as usual

the prime cause of disease was malaria.

As Carroll prepared to leave the theater

in December 1943, he admitted that

losses to malaria still ran too high—

about 5,000 soldiers a month were then

falling ill (see Table 3). He ended his tour

as chief surgeon with the plea that “the

malaria control problem be given more

consideration by all commanders from

the top down.”54

The Buna campaign was Southwest

Pacific Area’s own school, in which

General Headquarters learned the

power of malaria and began to adopt

measures in hopes of combating it. Why

a new lesson was needed, after Bataan, is

still far from clear, but the improvised

nature of the campaign, the lack of

resources, and the divided medical

establishment were contributory factors.

What a strong chief surgeon with direct

access to the commander-in-chief might

have accomplished must remain problematical. As matters actually went, the

Allies were fortunate that the enemy,

54Ibid., pp. 9–10, file 370 (Papuan Campaign) SWPA;

Comments and Recommendations, Medical

Department, USAFFE, p. 2 (first quotation), attached

to Exh. 1 of Ltr, Brig Gen Hugh J. Morgan, OofCSurg,

USAFFE, to Brig Gen Percy J. Carroll, CSurg, USAFFE,

12 Aug 43, file 333 (Brig Gen Hugh J. Morgan) SWPA;

JUNGLE WARFARE 139

Ltr, Brig Gen Percy J. Carroll, CSurg, USASOS, SWPA,

to CG, USASOS, SWPA, 8 Dec 43, sub: Medical Service

in the Southwest Pacific Area, p. 6 (second quotation),

file 333 (Carroll) 1943. All in HUMEDS, RG 112,

NARA.

PAPUAN NATIVES SPRAYING MALARIOUS AREAS
here as on Guadalcanal, was also unable

to control the disease. At least both sides

suffered more or less equally, and by the

end of the campaign the Japanese had

entirely lost the power to supply either

medicine or food to their remaining

troops.

Other diseases meant less than malaria in military terms, though all were distressing and at least one was far more

deadly. Infectious hepatitis, dengue,

and respiratory infections occurred.

Sanitation was impossible and diarrhea

common, though Miehe recorded that

newly introduced tablets for chlorinating water “are working out excellently.”

Skin diseases were persistent and sometimes disabling. Caused by a variety of

agents, including bacteria, fungi, and

yeasts, such afflictions increased in proportion to the amount of clothing

worn, because clothing prevented evaporation of sweat and kept the skin

damp. Yet, without long trousers and

shirts, the troops were more susceptible

to insect bites and insect-carried diseases, as well as abrasions that quickly

became infected. One group of diseases

was not a problem on Papua. Whether

because of exhaustion, Atabrine, or the

appearance of the local women, venereal disease ceased to matter for the duration of the campaign.55

Scrub typhus, a disease related to epidemic louse-borne typhus, was spread by

chiggers, the larvae of trombiculid mites

that lived in a variety of locations but

especially favored the four- to seven-foot

stands of knife-edged kunai grass that

spotted the landscape. Fortunately, the

disease spread only from mite to man

and not from man to man, and consequently never became epidemic. Yet the

mortality caused by scrub typhus (as

high as 30 percent of those infected)

made it important. Clearing vegetation

likely to harbor the mites and using

insect repellants were about the only

measures available; no means of immunization existed, and treatment meant,

in essence, careful nursing of the

patient through a dangerous period of

very high fever, often accompanied by

vivid hallucinations. Hence, a visiting

consultant recommended to Surgeon

General Kirk that “one or more medical

officers with suitable laboratory assistants, qualified in the study of rickettsial

infections, should be assigned to a labo55Surg, I Corps, Annual Rpt, 1942, p. 22, file 319.1–2,

HUMEDS, RG 112, NARA.

140 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

TABLE 3—MALARIA INCIDENCE IN U.S. ARMY FORCES, SWPA, 1942–1945

Year Number of Casesa Attack Rateb

1942 . . . . . . . . . . . . . . 4,451 62.49

1943 . . . . . . . . . . . . . . 47,663 250.98

1944 . . . . . . . . . . . . . . 33,475 62.08

1945 . . . . . . . . . . . . . . 38,520 49.03

Total 124,109 78.25

a

Consists of new admissions and readmissions with only malaria, as well as admissions with malaria and other diseases.

bReflects the number of cases per annum per 1,000 troops.

Source: Adapted from Thomas A. Hart and William A. Hardenbergh, “The Southwest Pacific Area,” in Hoff, ed., Communicable

Diseases: Malaria, p. 579.
ratory in New Guinea to conduct

research studies in the prevention and

therapy of the disease.”56

Scrub typhus also helped to point up

the theater’s organizational confusion.

MacArthur required the Combined

Advisory Committee to advise him, not

only on malaria but also on the prevention and treatment of all tropical diseases, both in operational areas and in

Australia. In some respects, these

requirements made the AustralianAmerican group a substitute theater

chief surgeon. Yet no committee member, from Colonel Fairley down, possessed the authority of a true chief surgeon. The committee lacked full access

to the medical reports of component

commands, and its members were not

cleared to participate in operational

planning. Furthermore, resentment of

the anomalous situation by the higherranking surgeons (including the putative chief surgeon) caused the committee to move with caution in many areas. 

On malaria the need was so evident

and the means of control so well understood that the Combined Advisory

Committee scored a great success. But

on scrub typhus, in the opinion of its

secretary and one of its ranking members, Col. Maurice C. Pincoffs, MC,

results were far less impressive.

Disagreeing with Col. William A.

Hagins, MC, the Sixth Army surgeon,

over proper methods of prevention, the

committee was unable or unwilling to

try to assert authority over him, and the

question was resolved only by a lengthy

series of field tests, during which the

most useful preventive measure—

impregnating the troops’ clothing with

miticide—was long delayed.57

Overall, the Papuan campaign, like

that on Guadalcanal, was notable for its

almost pre-twentieth century disease

rate. The predominance of vivax malaria was apparently the main factor in

assuring that the death rate did not follow the same pattern; soldiers continued to die by enemy action rather than

disease. But the morbidity impacted

heavily on the few medical units near

the front, making quick evacuation

essential.

Evacuation

The combat zone, so short in holding

capacity, depended mainly on evacuation to keep its few hospital beds empty.

Close to the fighting, methods were

primitive. Litter-bearers of the 107th

Medical Battalion, 32d Division, “had

the toughest job of any,” hauling casualties in steamy heat, under enemy fire,

over jungle trails too rough even for

jeeps. Though Papuan litter-bearers

would not approach the front line, they

used litters of split bamboo and balsa

wood to transport the wounded from

the clearing stations, carrying them ever

so gently that Miehe called this the best

56Ltr, Hillman to SG, U.S. Army, 12 Jul 43, p. 4 (quotation), file 333 (Hillman) 1943; Warmenhoven,

“Medical Department, 32d Division,” p. 12, file 370

(Papuan Campaign) SWPA; Surg, 41st Inf Div,

Quarterly Rpt, Jan–Mar 43, pp. 6–7, file 319.1. All in

HUMEDS, RG 112, NARA. See also Cornelius B. Philip,

“Scrub Typhus and Scrub Itch,” in Ebbe Curtis Hoff,

ed., Communicable Diseases: Arthropodborne Diseases Other

Than Malaria, Medical Department, United States Army

in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1964), p.

344. Rickettsia, which cause all forms of typhus, are

intracellular microscopic parasitic organisms, smaller

than bacteria but larger than viruses.

57Maurice C. Pincoffs, “History of Preventive

Medicine, SWPA,” pp. 11–15, Maurice C. Pincoffs

Papers, Medical Unit Historical Collection, U.S. Army

Military History Institute, Carlisle Barracks,

Pennsylvania.

JUNGLE WARFARE 141
way to avoid increasing shock. Along the

coast, medics turned to boats to evacuate casualties, sometimes taking them all

the way to Milne Bay at the tip of the

Papuan Peninsula, an increasingly

important base despite the fact that it

was “one of the most unhealthy malarial

spots in the world.” Some of the sick and

wounded traveled to offshore luggers on

native double canoes, the platform

between the two hulls accommodating

ten litters. But as airstrips opened, the

tedious voyage down the coast was largely abandoned, and the quick flight over

the passes of the Owen Stanleys to Port

Moresby became the standard route of

evacuation.58

On 24 November the 2d Platoon, 2d

Field Hospital, flew in to Dobodura and

began operating a hospital of 150–200

beds in a large flat area close to the

airstrip. With the 2d and 9th Portable

Surgical Hospitals, the platoon soon

58107th Med Bn Quarterly Rpt, Jan–Mar 43, Co C, p.

2 (first quotation), file 319.1; Surg, Fall River Sub-base

[Milne Bay], Monthly Rpt, 12 Dec 42, p. 2 (second quotation), file 319.1 (HQ USASOS Fall River Monthly

Reports) Oct 42–Dec 43; 18th Port Surg Hosp Annual

Rpt, 1942, pp. 3–4, file 319.1–2. All in HUMEDS, RG

112, NARA.

142 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

AWAITING EVACUATION BY PAPUAN LITTER-BEARERS
formed the main combat evacuation station for the Buna front (see Map 6).

Army engineers carved roads through

the bush, and by the third week of

December collecting stations and

portable surgical hospitals operating on

the coast had moved to the Dobodura

trail. Casualties leaving the combat zone

by air soon numbered on average over

100 a day. 

Here, as at the front, the war spared no

one. In the Philippines the Japanese had

generally respected hospitals, but on

Papua they attacked deliberately and

often. The 2d Field Hospital platoon was

repeatedly struck; on 7 December

Japanese planes strafed and bombed in

the morning, and in the afternoon eighteen bombers, shielded by Zeros,

returned to rain demolition and antipersonnel bombs. Many ambulatory casualties fled back to their units for safety, and

the unit commander, Maj. Lemuel C.

Day, MC, later died of a heart attack,

brought on by the labor of moving the

hospital under deep forest cover. In

“heavy jungle . . . damp, dark, muddy, and

mosquito ridden,” the medics like their

patients soon fell victims to malaria.59

On the Sanananda front, collecting

platoons supporting the 126th

Regimental Combat Team evacuated

casualties to combined collecting and

clearing stations, and thence to the

portable surgical hospitals that had set

up on the main trail leading to the

point. In January 1943, as the Japanese

defense fell apart, medical units

attached to the 163d Regimental

Combat Team, which was built around

the 163d Infantry, 41st Division, evacuated the sick and wounded by litter to

three portable surgical hospitals strung

out in a line extending north from

Soputa. Casualties might go through all

three, bypass one or another, or go

directly to an airfield for transport out

of the combat zone.60

C–47 transports, after ferrying troops

and supplies in, returned to Port

Moresby filled with either 6 or 9 litters

or 15 to 25 walking wounded. Incoming

planes signaled to the ambulances at

their destination by displaying a white

flag for ambulatory and a red for litter

patients. The quick removal of casualties

from the combat zone—often soldiers

wounded in the morning were in hospital beds in the afternoon—improved

troop morale, relieved the straining of

forward area hospitals, and reduced the

need for carrying medical supplies forward. During the Buna campaign the

old question of military medicine—is it

better to bring medical treatment to the

wounded or the wounded to medical

treatment?—was answered, despite the

portables, on balance by evacuation. In

December 1942 planes carried some

3,300 American and 4,300 Australians

on the 90-mile, 45-minute flight to

Ward’s Drome near Port Moresby. Over

the course of seventy days of fighting,

about 13,000 American and Australian

casualties followed the same route, sav592d Field Hosp Quarterly Rpt, Jan–Mar 43, p. 2

(quotation), file 319.1, and Annual Rpt, 1942, pp. 4–6,

file 319.1–2, HUMEDS, RG 112, NARA. The hospital’s

other platoons were operating at Base Section 2, in

Australia, and at Milne Bay; see Warmenhoven,

“Medical Department, 32d Division,” pp. 3, 7, 8–22, file

370 (Papuan Campaign) SWPA. West of the Girua,

evacuation was primarily from the Australian airstrip at

Popondetta; see 163d Inf [Regt] Combat Team

Quarterly Rpt, Jan–Mar 43, p. 12, file 319.1. Both in

HUMEDS, RG 112, NARA.

60163d Inf [Regt] Combat Team Quarterly Rpt,

Jan–Mar 43, pp. 1–14, file 319.1, HUMEDS, RG 112,

NARA. The 163d had replaced the 126th Regimental

Combat Team earlier in the month.

JUNGLE WARFARE 143
ing many a life that would otherwise

have been lost on the interminable jungle trails or during the long, dangerous

voyages along the coast.61

The first two months of U.S. troop

operations showed that the fixed hospital facilities around Port Moresby were

inadequate to meet the need. By the

end of November, when American

wounded and fever casualties began

arriving in increasing numbers, hospital

facilities around the Advance Base headquarters consisted only of the 500-bed

61Rpt, Capt M. M. Steinberg, 7 Mar 43, sub:

Evacuation of Patients by Air, pp. 1–2, file 314.7–2

(Evacuation); 5th Air Force Annual Rpt, 1942, pp. 7–8,

file 319.1–2; Surg, I Corps, Quarterly Rpt, Jan–Mar 43,

p. 7, file 319.1. All in HUMEDS, RG 112, NARA.

144 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

NEW BRITAIN

Goodenough I

Kiriwina I

Finschhafen

Arawe

Lae

Salamaua

Wau

Gona Buna

Dobodura

Kokoda

Port 

Moresby

NORTHEAST 

NEW GUINEA

PAPUA

O W E N

S T A N L E Y

R A N G E

Huon 

Peninsula

Huon Gulf

Milne Bay

SOLOMON 

SEA

Collingwood

Bay

Pongani

Kapa Kapa

Abau

Wanigela

Tufi

Embogo

Pinga

Wairopi Bofu

Jaure

Fasari

Ioribaiwa

ELEVATION IN FEET

0 3000 6000 9000 and Above

Miles

0 150

HOSPITALS ON PAPUA

November 1942–January 1943

Airfield

153d and 171st Station Hospitals

10th Evacuation Hospital

2d Platoon, 2d Field Hospital

2d and 9th Portable Surgical Hospitals

5th and 19th Portable Surgical Hospitals

4th, 3d, 23d, and 17th Portable Surgical Hospitals

22d, 14th, and 18th Portable Surgical Hospitals

MAP 6
153d Station Hospital and a 200-bed

mission hospital operated by a provisional battalion of the 135th Medical

Regiment. At Colonel Miehe’s request,

the 10th Evacuation Hospital (750 beds)

and the 171st Station Hospital (500

beds) arrived at Moresby in December.

In a period of three weeks the bed

capacity of hospitals on the south shore

of New Guinea expanded to approximately 2,428. From 21 November 1942

to 29 January 1943 the hospital units in

the Port Moresby area cared for over

10,000 casualties, nearly 6,000 from the

32d Division alone.62

Living conditions remained poor. In

January an inspecting officer found that

the hospitals were operating in the deep

mud of the rainy season and that nurses

quarters were “very, very poor” and the

staffs overworked. Makeshifts of inadequate equipment were ingeniously contrived; fuse boxes served as containers

for sterile dressings and metal ammunition-box liners for operating room sinks.

Work performed at the 10th Evacuation

Hospital was limited to additional

debridement of wounds, putting casts on

fractures, and occasional amputations

where signs of gangrene had appeared.

As its name implied, the unit served primarily to ready casualties for evacuation,

not to return them to the battle, and the

lack of a convalescent center and a

replacement depot ensured that few

would find their way back to the north

coast before the campaign was over.63

The pressure of the malaria epidemic

caused the evacuation policy for New

Guinea to remain low. After treatment,

those who were expected to be unfit for

duty more than fourteen days were sent

on to mainland Australia, usually to

Townsville or Brisbane. Returning transport planes, bombers, an Australian hospital ship, and two sea ambulance transports took part in the lift. Since planes

flew the 680 miles to Townsville in less

than five hours and a ship took two days,

doctors here, as on Guadalcanal, preferred air evacuation. For the three

months from November 1942 through

January 1943, 3,405 casualties left New

Guinea by air, only 935 by sea.64

Necessary as it was, evacuation

removed substantial numbers of fighting men from New Guinea as a whole, as

well as from the fighting zone on the

north shore. If all evacuees had been

severely injured, their departure would

have been essential both to their own

well-being and to the needs of the

Advance Base, which could not hope to

maintain facilities for definitive care

equal to those of the Australian hospitals. But such was not the case. Miehe

complained that hospitals in Australia

received many quite trivial cases.

Indicating the same problem was the

theater’s neuropsychiatric evacuation

rate.65

Like the marines and soldiers on

Guadalcanal, fighting men on Papua

faced the danger of violent death in a

62Surg, I Corps, Annual Rpt, 1942, p. 15, file 319.1–2,

HUMEDS, RG 112, NARA. 63Rpt, Libasci, n.d., p. 1 (quoted words), file 333.1

(Trip to New Guinea) SWPA; 10th Evac Hosp Annual

Rpt, 1942, p. 8, The Historical Unit (THU) Note Cards,

Historians files. Both in HUMEDS, RG 112, NARA.

64Air Evacuation Board, SWPA, “Medical Support of

Air Warfare,” Report No. 35, sec. 1, vol. 2, pt. 2, p. 483,

file 314.7–2 (Army Air Forces—Medical Services) SPA,

SWPA, HUMEDS, RG 112, NARA. 65Surg, I Corps, Annual Rpt, 1942, p. 19, file 319.1–2,

HUMEDS, RG 112, NARA. A thirty-day evacuation policy was inaugurated in December 1942. The transfer of

the 1st Marine Division from Guadalcanal to the

Southwest Pacific Area brought thousands of new

malaria cases, thus complicating the situation in

Australia.

JUNGLE WARFARE 145
hostile and alien environment, harassed

by insects and oppressed by smothering

heat. Hunger, dysentery, attacks of malaria, and the daily grind of combat

inevitably caused breakdowns. Symptoms

ranged from an exaggeration of the startle reflex to uncontrollable weeping, irrational behavior, and panic fear. At first

some patients, wrote the commander of

the 23d Portable Surgical Hospital,

“would lie on the ground holding hand

grenades and threatening to throw them

at the slightest noise,” but later they

became “quiet and stuporous.”66

Meeting the problem in the

Southwest Pacific Area was far from easy.

The theater lacked psychiatrists, and

Carroll seemed to distrust his psychiatric

consultant. Commanders wanted to be

rid of their psychiatric cases, and doctors, baffled by seemingly causeless physical symptoms of stress, seized on the

quick expedient of shifting the problem

to the rear. Stress and malaria interacted. Soldiers hoping to escape danger

evaded taking their Atabrine or quinine,

acquiring the disease. Hunger and

exhaustion turned subclinical malaria

cases into disabling ones. In the process

of evacuation the neuropsychiatric cases

learned that bizarre behavior meant

6623d Port Surg Hosp Annual Rpt, 1942, p. 3, file

319.1–2, HUMEDS, RG 112, NARA.

146 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

BUNA CASUALTY ARRIVING AT THE 171ST STATION HOSPITAL
escape from danger, and therefore exaggerated their symptoms. By the time

they reached the general hospitals in

Australia most were, for all military purposes, ruined men. Often their journey

did not stop there. During 1943 almost

40 percent of evacuations out of theater

were listed as “mental” and over 10 percent as psychotics, meaning, in the parlance of the time, that they had severe

and tenacious symptoms.67

The same year brought the beginning

of a determined effort by Carroll and his

psychiatric consultant to reverse these

extraordinary figures by educating medical officers to substitute a diagnosis of

exhaustion for that of mental illness and

by providing small treatment centers

close to the line. But, as with malaria,

reform came later. The Buna campaign

created the problem, and ended with it

still unsolved.68

Supply

Medical supply was one of the

brighter spots of the campaign, despite

the fact that it remained a rough and

ready affair. Any available ship carried

materiel from Australia to New Guinea.

The 9th Medical Supply Depot at Port

Moresby stored and distributed supplies via C–47 transports that flew over

the Owen Stanleys or to Milne Bay,

where boats forwarded materiel up the

coast to Buna. The 2d Platoon, 2d Field

Hospital, at Dobodura was not only the

main evacuation unit but the issue

point for medical supplies as well.

Where no airfields existed, supplies

were dropped by parachute. Jeeps,

native porters—indeed, any available

transport—carried them to the front

from the airstrips, the beaches, and the

coastal inlets. Early in the campaign,

supply was disrupted by shipping

uncertainties in Australia, enemy air

attacks on ship convoys, bad weather,

and lack of land transport.

Widespread, though temporary, shortages of tents, litters, cots, rations, and

quinine resulted. Litters remained a

problem, accumulating at Moresby,

where they were not needed, and disappearing with the wounded from

Buna, where they were.

But by mid-December more luggers

had become available for coastwise shipment, while the construction of additional airfields on coconut plantations

permitted expansion of the airlift.

Though supply remained tenuous, sustained by expedients, the efficiency of

Major Libasci’s section in forwarding

materiel from Australia, as well as the triumph of the Allies on the sea and in the

air, enabled the system to improve

steadily to the end of the campaign.69

The Papuan campaign gave the Allies

their first land victory in the war against

Japan. But because their soldiers were

67Interv, Col S. Alan Challman, 13 Sep 45, file 000.71,

HUMEDS, RG 112, NARA. 68Memo, Col William L. Wilson to Ex Off, [OSG], 1

Nov 43, sub: Visit to Southwest Pacific Area, p. 10, file

333 (Visit of [Col Wilson] to SWPA) 1943, which suggests that many NPs were actually retarded men who

should not have been overseas in the first place. For an

interesting and detailed account by Carroll’s neuropsychiatric consultant, see Rpt, Challman, 5 Mar 43, file

333 SWPA (Trip by Challman) 1943. Both in HUMEDS,

RG 112, NARA. See also Lindsay E. Beaton and M.

Ralph Kaufman, “As We Remember It,” in Glass, ed.,

Overseas Theaters, pp. 748–49.

69Charles M. Wiltse, Medical Supply in World War I,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1968), pp. 417–18, 438;

Warmenhoven, “Medical Department, 32d Division,”

pp. 14, 25, file 370 (Papuan Campaign) SWPA,

HUMEDS, RG 112, NARA; James, MacArthur, 2:231,

234; Eichelberger, Our Jungle Road, pp. 34–35, 39.

JUNGLE WARFARE 147
insufficiently trained and equipped for

jungle warfare, they paid a high price

for their triumph. Of the 33,000 soldiers

committed to battle on New Guinea,

3,095 lost their lives (2,291 Australians,

804 Americans), or about 1 in 11. On

Guadalcanal, by contrast, out of 60,000

Americans, 1,600 lost their lives, or

about 1 in 38. The official U.S. Army history of the Papuan campaign declares:

“The conclusion is inescapable that the

fighting in Papua had been even costlier

than had at first been thought, and that

the victory there, proportionate to the

forces engaged, had been one of the

costliest of the Pacific War.”70

Of a total strength of 10,825, the 32d

Division’s three combat teams suffered

over 9,600 casualties, including some

7,000 sick—a casualty rate of almost 90

percent. The 126th Infantry virtually

ceased to exist as a unit. Australian losses to sickness were even heavier, more

than 15,000 cases of infectious disease

during 1942 alone. Among the 32d

Division more than 5,000 cases of malaria occurred, including some 4,000 first

attacks. The disease, though seldom

fatal, proved to be extraordinarily tenacious, with one relapse following another until more than 2,000 officers and

enlisted men had to be dropped from

the division rolls, “all of them casualties

of the campaign just as surely as if they

had been wounded in battle.” Similarly,

malaria accounted for 12 percent of the

airmen removed from flying in the theater by the Fifth Air Force.71

Such figures did not record a triumph

for the theater or its medical officers.

Much can be forgiven those who were

obliged to provide for inexperienced soldiers fighting a jerry-built campaign in an

appalling environment. Overall, however,

medical support was inadequate to meet

the extraordinary needs of the troops.

The battles on Guadalcanal and Papua

revealed that American armed forces—

despite their nation’s lengthy experience

in the tropics and its distinguished contributions to tropical medicine—had

much to accomplish in preventive medicine if they were to fight the Pacific war

without paying an unacceptably high ransom to malaria and other diseases.

70Milner, Papua, pp. 371–72 (quotation); Miller,

Guadalcanal, p. 350.

71Milner, Papua, pp. 371–72 (quotation); 5th Air

Force Annual Rpt, 1942, p. 10, file 319.1–2, HUMEDS,

RG 112, NARA.

148 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
An environment of quite another sort

confronted Americans who fought in

the frigid and storm-swept North

Pacific. Islands could hardly have been

found on earth that differed more in climate, environmental hazards, and disease threats than the treeless Aleutians

and the jungled Solomons.

Yet some similarities marked the two

theaters. The distances of the North

Pacific Area were as formidable as those

of the South Pacific Area. The Territory

of Alaska comprised some 584,000

square miles, equal to almost one-fifth

the area of the forty-eight United States.

The capital of Anchorage lay more than

1,500 miles from Seattle, Washington,

and almost 1,700 miles from the island

of Attu. In the region where fighting

occurred, conditions were as primitive

as in remote Melanesia.1

In the Aleutians the Army made its

first amphibious landing upon a hostile

shore and suffered casualties proportionately as heavy as any in the entire

Pacific struggle. A recent writer on

World War II has suggested that

Guadalcanal gave American armed

forces their basic lesson in how not to

carry out an amphibious operation. “On

Guadalcanal, command arrangements

were confused and missions unclear,

reconnaissance was ineffective and naval

protection withdrawn at a critical

moment; unloading of supplies was

incomplete, air power and reinforcement slow in being brought forward,

and organized logistic backup at the

start nonexistent.” Not every one of

these complaints could be lodged

against the joint performance of the

Army and Navy in the Aleutians, but the

action was marked by failures of many

sorts. The medics who supported the

landing bore much of the resulting burden, from the beaches of Massacre Bay

to the frenzy of the enemy’s final banzai

charge.2

The Medical Picture

On the verge of World War II, Alaska

was a vast and undeveloped territory

without road connections to the United

States. Its remoteness, size, rugged land1

Gordon H. McNeil, “History of the Medical scape, and severe winters provided its

Department in Alaska in World War II,” pp. 6–8, file

314.7–2 (Medical Activities) Alaska, Historical Unit

Medical Department (HUMEDS), Record Group (RG)

112, National Archives and Records Administration

(NARA), Washington, D.C.

CHAPTER V

Alaska: The Pyrrhic Victory

2

Eric Larrabee, Commander in Chief: Franklin Delano

Roosevelt, His Lieutenants, and Their War (New York:

Harper and Row, 1987), p. 637.
chief defense. A few Army medical personnel—2 officers and 20 enlisted

men—served the territorial garrison of

400 soldiers, comprising two rifle companies, at Chilkoot Barracks near

Skagway on the southern panhandle.3

According to War Department policy

established in 1938, safeguarding Alaska

from enemy attack was essentially a

responsibility of the Navy, supported by

Army ground and air units. In 1940 an

influx of new forces gradually increased

the Alaskan Department’s defense forces

until, by 7 December 1941, Alaska contained naval bases at Sitka, Kodiak, and

Dutch Harbor, each protected by the

Army; a new Army base called Fort

Richardson, near Anchorage; and a network of air bases, including Elmendorf

Field near Fort Richardson, and airfields

near Fairbanks, Ketchikan, Yakutat,

Seward, and Nome, each with its garrison

drawn from the Army’s Alaskan contingent of about 21,500 officers and enlisted

men. Troops were stationed in the three

major climatic regions of Alaska: the rainsoaked but relatively mild southern panhandle; the colder southwestern coast,

where bitter winds from the Bering Sea

encountered the warmer air over the

Japan Current, breeding frequent storms;

and the dry cold of the central plateau,

where winter temperatures of -50o F. and

below were common. Breathtaking

scenery abounded, in the fjords and glaciers of the south coast, the mountainous

coastal range, the Brooks Range in the

north, and the Arctic north coast.

Construction of weatherproof cantonments was slow-paced and difficult,

impeded by distance, mud, and shortages of materials. Transportation was a

problem everywhere; until the Alcan

Highway opened in November 1942,

almost all supplies had to be brought

from the United States by boat or plane.

Railroads were few, and the climate and

mountains made all road-building arduous. Even in the valleys and lowlands,

work was slowed by the muskeg, or peatforming bogs, and by the wetness of the

ill-drained grassy plains called tundra.

Throughout the vast region, medical

personnel struggled “in the cold, snow,

rain and fog to establish a medical service at each of the new posts activated in

Alaska.” Unit dispensaries opened in

tents and such odd sites as an abandoned cannery or two Yakutat huts

placed end to end, while civilian hospitals took in the seriously ill or injured.4

During the first half of 1942 six more

posts opened, including those at

Naknek and Cold Bay, on the Alaska

Peninsula, and the one on Umnak

Island, west of Dutch Harbor, in the

Aleutians. Army strength increased to

51,000, including airmen of the

Eleventh Air Force, antiaircraft units,

and engineer contingents who had been

rushed to the construction sites at air

bases. A command structure in the

Alaskan Department took form, as Army

forces in Alaska were designated the

Alaska Defense Command under Maj.

Gen. Simon B. Buckner, Jr. In turn,

Buckner was subordinate to the Fourth

Army commander, Lt. Gen. John L.

DeWitt, who also took charge of the San 3

Stetson Conn, Rose C. Engelman, and Byron

Fairchild, Guarding the United States and Its Outposts,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, 1964), p. 223;

McNeil, “Medical Department in Alaska,” p. 52, file

314.7–2 (Medical Activities) Alaska, HUMEDS, RG 112,

NARA.

4

McNeil, “Medical Department in Alaska,” p. 54, file

314.7–2 (Medical Activities) Alaska, HUMEDS, RG 112,

NARA.

150 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Francisco–based Western Defense

Command after Pearl Harbor. Overall

strategic command of the Alaskan combat zone was vested in the naval commander of the Alaskan Sector, and ultimately in Admiral Nimitz.

The Alaska Defense Command chief

surgeon was Col. Luther R. Moore, MC,

a gruffly humorous long-service Regular

Army officer with a background in

Alaska that qualified him to understand

the problems of the region; as he said,

“The Army has come knowing little or

nothing . . . but learning much by experience.” Other figures of importance

were Lt. Col. Ellis M. Altfather, MC, the

Eleventh Air Force flight surgeon, technically a subordinate but, here as elsewhere, one with substantial autonomy,

and Navy Capt. William L. Mann, Jr., MC,

the Alaskan Sector chief surgeon.

Because Army forces in Alaska were comparatively few and difficult medical problems rare, the Office of the Chief

Surgeon remained small, even though

Moore’s duties combined those of theater chief surgeon and services of supply

surgeon. In early 1941 the office consisted of the chief surgeon, assistant surgeon, and a varying number of enlisted

men; after the fighting began, personnel

increased by two Medical Administrative

Corps officers, three noncommissioned

officers, and twelve permanent enlisted

men—a minuscule group compared to

other theaters. In some ways the burdens

facing Moore’s staff were made heavier,

and in other ways lighter, by the Alaskan

environment.5

The control of disease posed few serious problems. Alaska, with a population

5

Ibid., pp. 57, 63–65, 80, file 314.7–2 (Medical

Activities) Alaska; CSurg, Alaska Def Cmd, Annual Rpt,

1942, p. 3 (quotation), file 319.1–2. Both in HUMEDS,

RG 112, NARA. Altfather also served as acting chief surgeon of the command from February to June 1941.

ALASKA: THE PYRRHIC VICTORY 151

UNIT DISPENSARY AT NOME, consisting of two Yakutat huts placed end to end
of only 75,000, was too sparsely settled

for acute sanitary or venereal disease

problems to develop. For most of the

soldiers who served there, access to

women was limited. Yet the 32,000

native Indians, Aleuts, and Eskimos, by

reason of their isolation, were highly

susceptible to the white man’s diseases

and readily fell victims to common

childhood diseases, such as measles and

whooping cough, and to tuberculosis as

well. Among some tribes, local customs

permitted casual sex and, through contact with infected outsiders, many

women had acquired venereal disease

(VD); amazing some soldiers, they not

only asked no money for sexual favors

but also gave their lovers ivory trinkets

and other keepsakes when they parted.

Army medics provided treatment for

civilians as well as soldiers and, to ensure

that VD did not become a problem for

the command, pursued an active program of prevention among the troops by

physical inspections and propaganda

films, posters, and lectures. Prophylactic

stations and individual kits were both

made available. The result of all these

factors was an extraordinarily low incidence of VD throughout the war, never

exceeding 8.3 per 1,000 troops per year.

Outbreaks of other diseases, either

among new soldiers on post or among

civilians in remote villages, were contained by distance and never posed the

threat of a serious epidemic outbreak.

Overall, the Alaskan Department

enjoyed excellent health. The cold climate proved on balance to be more a

blessing than a curse. Gnats and mosquitoes were abundant in summertime but

were mere pests, spreading no infections; brown rats swarmed in some areas,

but typical rat-borne diseases were

absent. As might be expected, the most

widespread problem was common respiratory infection, which reached its highest rate (249.5 per 1,000 troops per

annum) in 1942 and thereafter fell

rapidly as a result of increased experience, better clothing, and the construction of weathertight cantonments. Even

in this respect, Alaska was not much

worse off than the United States; troops

stationed in the department largely

escaped a national epidemic of respiratory diseases in the winter of 1943–44,

except for fliers who picked up infections in the zone of interior and, on their

return, became sources of disease

among the Alaska garrison. As in other

theaters, troops in the department suffered from the hepatitis epidemic of

1942, caused by contaminated yellow

fever vaccine. But the 2,749 cases of 1942

fell to 37 in 1943, and by the end of the

war the disease had almost disappeared. 

Some sanitary problems were encountered, especially when the new posts

were under construction. Especially in

the tundra, the high Alaskan water table

posed some difficulties in waste disposal,

and may have helped to account for a

fairly high level of diarrheal diseases

during 1942–43. Clothing was a matter

of intense medical interest under

Alaskan conditions, and medical officers

worked with Quartermaster Corps representatives to devise protective gear.

Experts from both branches were frequent visitors to Alaska, and an experimental board was set up by the Alaska

Defense Command to study all aspects

of cold weather operations.

The most notable medical feature of

service in Alaska was a paradox. Soldiers

were healthier than in any other overseas theater, and in some respects

healthier than in the United States, and

yet their isolation and perhaps their lack

152 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
of a significant role in the war caused

them to believe, and report to the

medics, that their health deteriorated in

Alaska.6

If disease was rare, the problems of

providing medical support for the

troops and evacuating the few who

became ill were severe. Alaskan geography dictated defense by scattered garrisons, rather than by concentrations of

mobile reserves. Medical support was

necessarily dispersed as well. The rapid

opening of twenty-one posts and the

increase in Army forces to 94,000—

more than the civilian population of

Alaska—made the first thirteen months

of the war a difficult time at best, and

distance and unit fragmentation made

the difficulties worse. Typically, the medical detachment supporting the 4th

Infantry was divided into battalion medical sections, one remaining with the

regimental headquarters and the 1st

Battalion at Adak Island, another

accompanying the 2d Battalion to

Nome, and a third following the 3d

Battalion to Fort Richardson. 

Even this degree of dispersion caused

some problems, among them the question of how the regiment’s two dentists

were to be divided among three sections. But there were worse cases. Some

units were not so much divided as disintegrated. The 138th Infantry, for example, served simultaneously in eight posts

from Juneau to Atka, a distance of 2,000

miles! To function properly, medical

sections needed additional personnel

and equipment, but X-ray and laboratory technicians, pharmacists, anesthetists,

and dental technicians were not easy to

obtain. Personnel shortages throughout

1942 paralleled other Alaskan shortages,

notably in housing and equipment. As

in all combat theaters, troops of the

combat arms built up more rapidly than

support troops, and in consequence

Moore was unable to reach his goal of

medical self-sufficiency at each Alaskan

station.7

The workings of the personnel system

did little to relieve his difficulties.

Medical personnel were requisitioned by

grade and number through the Western

Defense Command under procedures

that proved to be inflexible and slow.

Enlisted men were sometimes transferred from other types of units in Alaska,

but, as usual, commanders seized the

opportunity to reassign those of poor

quality. In December 1941 all the Alaskan

stations together provided only 744

medics (128 officers and 616 enlisted

men) to support 23,800 soldiers and airmen. Five months later, however, on the

eve of the Japanese attack, 2,089 medics

(211 officers and 1,878 enlisted men)

supported 51,000 troops—46 per 1,000,

or slightly below the 5-percent ratio that

Army doctrine held to be adequate.8

Equally strained during the days of the

buildup was the hospital system. The

Alaskan environment and the military situation, by tying troops to their scattered

7

CSurg, Alaska Def Cmd, Annual Rpt, 1943, p. 1, 4–5,

file 319.1–2; McNeil, “Medical Department in Alaska,”

pp. 67, 96–98, file 314.7–2 (Medical Activities) Alaska.

Both in HUMEDS, RG 112, NARA. See also Clarence

McKittrick Smith, The Medical Department:

Hospitalization and Evacuation, Zone of Interior, United

States Army in World War II (Washington, D.C.: Office

of the Chief of Military History, Department of the

Army, 1956), p. 142. 8

Strength of the Army, 1941, 1942; McNeil, “Medical

Department in Alaska,” p. 80, file 314.7–2 (Medical

Activities) Alaska, HUMEDS, RG 112, NARA.

ALASKA: THE PYRRHIC VICTORY 153

6

CSurg, Alaska Def Cmd, Annual Rpts, 1942, pp. 5–7,

12–14, and 1943, pp. 6–7, file 319.1–2; McNeil,

“Medical Department in Alaska,” pp. 289–92, file

314.7–2 (Medical Activities) Alaska. All in HUMEDS,

RG 112, NARA.
stations, precluded large centralized hospitals. Hence, as each post opened in

turn, Moore established an unnumbered

station hospital with a bed capacity equal

to 5 percent of the post’s planned

strength. General, evacuation, surgical,

and convalescent hospitals were never

sent to Alaska. By the end of 1940 Moore

had a long-established 25-bed hospital at

Chilkoot Barracks, plus new 100-bed

facilities at Annette Island, Yakutat, and

Ladd airfields, and a new 600-bed hospital at Fort Richardson, and one year later

five station hospitals at Sitka, Kodiak,

Dutch Harbor, Seward, and Nome. By 31

May 1942 he had added 50-bed hospitals

at Juneau and Cordova; a 100-bed facility

at Naknek; and larger station hospitals,

each with a potential bed capacity of 500,

at Cold Bay and on Umnak Island (see

Map 7). Upon these facilities fell the burden of caring not only for soldiers and

airmen but also for some sailors, for

Allied servicemen including both

Canadians and Russians, for civilians

unable to find care in understaffed hospitals off post, and for Alaskan natives in

need of emergency help.

In September numbered station hospitals were assigned to Alaska, and the

period of most intense shortage was

over. Problems of personnel procurement were eased, and station hospitals

were sent from the United States to help

support the many new posts. By the end

of the year the Alaska Defense

Command counted 539 officers and

3,789 enlisted men of the Medical

Department to support more than

94,000 troops, or 4.6 percent as against

the authorized 5 percent. Bed strength

rose rapidly; in July only 1,565 of 3,724

authorized beds were available, but by

the end of the year the total neared

2,000. Nevertheless, the general rule

that the strength of support forces

lagged during a buildup continued to

hold true. By that time, the increased

strength of the command meant that

4,600 beds were now authorized. In

terms of formal requirements, the

medics had actually lost a little ground.9

Hence, familiar problems continued.

In remote areas small troop units were

fragmented beyond the capacity of

organic medical units to support them.

The station hospitals had to come to the

rescue. On the island of Adak, for example, many small groups of soldiers were

entirely without medical care, obliging

hospital personnel to organize dispensaries and to staff them themselves.

Scattered posts and Alaskan weather

combined to put heavy burdens on evacuation as well. To move casualties

between stations in Alaska, medics used

water, rail, and air. Of these, air was by

far the best—a quick, flexible mode of

transport that exploited the many new

airfields and gave the sick and injured an

easy ride. Roads tended to be few, long,

and poor, and water transport slow and

hard to schedule. Evacuation by rail was

only possible between points on the

Alaska Railroad. In 1941 a few patients

had been carried by air in bombers, but

in 1942, after much difficulty, Moore

obtained light planes for use as air ambulances and even equipped them with skis

or floats for greater flexibility in reaching remote outposts. Transportation

between large bases and between Alaska

and the United States was provided in

the same manner as elsewhere in the

Pacific. When Moore’s requests for dedi9

CSurg, Alaska Def Cmd, Annual Rpts, 1942, pp. 3–5,

and 1943, p. 1, file 319.1–2; McNeil, “Medical

Department in Alaska,” pp. 99, 169–73, 176, file

314.7–2 (Medical Activities) Alaska. All in HUMEDS,

RG 112, NARA.

154 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
cated C–53 transports were rejected, he

turned, like other chief surgeons, to

cargo and transport planes of the Air

Transport Command’s Alaska Wing.

Straps or brackets were installed to hold

litters on return flights. Eventually, even

heat was provided, though many evacuees traveled under blankets in unheated cargo compartments, where temperatures fell below 0°F.10

No summary account can convey the

problems that had to be overcome to

treat and evacuate the sick and injured.

As Colonel Moore remarked, “Weather

[in Alaska] is always available in a variety

of forms.” Medical personnel won hardearned decorations for work that would

have been routine anywhere else.

Equipment authorizations provided too

few vehicles for local conditions and the

wheeled vehicles that could be obtained

were largely roadbound. In February

1943 a three-vehicle convoy—a 21

⁄2-ton

truck, an ambulance, and a caterpillar

tractor—required nine hours to carry

one injured man 33 miles; the ambulance failed when the road ended, and

the tractor dragged the truck through

snowdrifts, up steep slopes, and through

three frozen streams to the destination.

At Nome a dog team evacuated patients

from outlying posts to the station hospital, dragging a basket sled large enough

to carry a litter. The sled litter, called an

akhio, was the handiwork of an Eskimo

enlisted medic. Other medics developed

toboggans for carrying patients.11

The rain and rough seas of maritime

Alaska proved even more of a challenge

than the Arctic interior. Aleutian storms

could isolate an island for days or weeks

at a time, and turn much of the landscape into a morass. On Adak, station

hospital personnel watched in amazement as a tractor and trailer used to

move patients sank “halfway out of

sight” in muskeg. A medical officer, dispatched to aid an injured man on

Nikolai, was “swamped once or twice” in

rough seas, finally reaching shore in a

crash boat; the patient, despite a severely fractured skull, was brought off

through “terrific surf” and survived.

Another doctor walked with a rescue

party for seventeen hours through a

snowstorm to treat a Seabee with appendicitis; at journey’s end he operated on

the spot, saving the man’s life. Such

incidents were almost as harrowing as

combat.12

Limited transportation, distance, and

climate also affected medical supply.

During the buildup Moore had little to

do with supply. Medical units arrived

with their equipment, and the Seattle

Port of Embarkation shipped medical

maintenance units to the various posts

on the basis of strength reports. Without

such automatic resupply the remoter

stations would have been in desperate

straits, and yet to ship the maintenance

units from Seattle was not to ensure that

they arrived. Ship sailings and air service

were both irregular, ports of entry might

be icebound, and transshipment within

Alaska ran afoul of the poor transport

system. Hence, delay was common. At

McGrath some medical apparatus

10McNeil, “Medical Department in Alaska,” pp. 136,

268–70, file 314.7–2 (Medical Activities) Alaska; CSurg,

Alaska Def Cmd, Annual Rpt, 1942, pp. 17–18, file

319.1–2. Both in HUMEDS, RG 112, NARA. 11CSurg, Alaska Def Cmd, Annual Rpt, 1942, p. 2

(quotation), file 319.1–2; McNeil, “Medical

Department in Alaska,” p, 258, file 314.7–2 (Medical

Activities) Alaska. Both in HUMEDS, RG 112, NARA.

12As quoted in McNeil, “Medical Department in

Alaska,” pp. 261, 263, file 314.7–2 (Medical Activities)

Alaska, HUMEDS, RG 112, NARA.

ALASKA: THE PYRRHIC VICTORY 155
arrived partly in the fall of 1942 and the

rest in the spring of 1943. Nothing

moved during the winter.

In November 1943 Moore implemented a requisition system, but problems continued. Eight months might

pass from the time a requisition was submitted until the article was received, and

perishables, such as X-ray film and biologicals, might be outdated at the time

they arrived. Local procurement was

only a partial answer to shortages,

though the larger cities provided

imported products and sold some local

items and manufactured others. Many

posts, however, were far from such

156 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

BERING

SEA

Kodiak

Sew

Nome

Naknek

Cold Bay

Dutch Harbor

Iliamna

A L A S K A P E N I N S U L A

ALAS

St. Lawrence I

Pribilof Is

Umnak I 

Unalaska I

Unimak I

Kodiak I

St. Matthew I

ALEUTIAN IS

Nome Post Station Hospital

Naknek Post Station Hospital

Fort Randall Station Hospital

Fort Mears Station Hospital 

Fort G

Fort Glenn Station Hospital

MAP 7
sources. Storage was a continuing

headache. Sometimes, as on Adak, supplies brought into half-built camps were

simply dumped on the open tundra.

Not surprisingly, linens mildewed, plaster set, and film deteriorated. Many

items, especially biologicals, required

not only shelter but also heated buildings in the intense cold of the central

plateau. A clutter of different shelters—

Quonsets, dugouts, basements of post

buildings, pyramidal tents, and off-post

structures like schools—served to protect medical supplies. The chief surgeon

found that coordinating the movement

of supplies was one of his most imporALASKA: THE PYRRHIC VICTORY 157

GULF OF ALASKA

Anchorage

ward

Cordova

Yakutat

Haines

Juneau

Sitka

Fairbanks

Ketchikan

Skagway

CANADA

K A

Ladd Field Station Hospital

Chilkoot Barracks (Fort Seward)

Station Hospital

Juneau Post Station Hospital

Yakutat Post

Station Hospital

Cordova Post

Station Hospital

Fort Richardson Station Hospital

Elmendorf Field

Fort Raymond Station Hospital

Fort Ray Station Hospital

Annette Island Post Station Hospital

Greely Station Hospital

A L C A

N

H I G H W A Y

HOSPITALS IN ALASKA

May 1942

Airfield

0 200

Miles
tant duties, for spot shortages remained

the rule even after supplies became generally adequate.13

In mid-1942 the medical service in

Alaska was in its most difficult phase of

growth—short of personnel and hospital

beds and intermittently embarrassed for

essential supplies. The Alaska Defense

Command was able to live with these

shortages, but only as long as it remained

essentially disengaged from the fighting.

Its ability to support combat operations

was uncertain. Efforts by General

Buckner to make his command a significant part of the war effort had not, at

that point, convinced Washington that a

serious threat existed to the nation’s

northernmost outpost. Only the

Japanese proved able to do that.

The Enemy Attacks

The Japanese plan to strike at Midway

Island also provided for a diversionary

assault upon the Aleutians. Scheduled

for early June 1942, the invasion objectives were to conquer new outposts for

the Japanese defense perimeter, to prevent Americans from using the

Aleutians to attack Japan, and to

obstruct U.S.-Soviet military cooperation in the North Pacific. Forewarned by

naval intelligence, the Army strengthened Alaska’s air defenses, sending limited reinforcements, including some

13Ibid., pp. 141–42, 496–501, file 314.7–2 (Medical

Activities) Alaska; CSurg, Alaska Def Cmd, Annual Rpts,

1942, p. 7, and 1943, p. 2, file 319.1–2. Both in

HUMEDS, RG 112, NARA.

158 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

HOSPITAL DOG TEAM
B–17s, to the Eleventh Air Force. The

war suddenly veered toward Alaska, and

soon resulted in the Alaska Defense

Command’s first combat casualties.14

During the first morning hours of 3

June, fighters and bombers from two

carriers of a Japanese amphibious task

force attacked Dutch Harbor on the

island of Unalaska. High explosive and

incendiary bombs struck naval installations and nearby Fort Mears. Late the

following day the Japanese planes

returned, destroying oil storage tanks,

wrecking one wing of a naval hospital,

and damaging a beached barracks ship.

The two-day attack claimed forty-three

lives, including thirty-three soldiers.

Though it stood in the target area, the

Fort Mears Station Hospital treated

sixty-four wounded, evacuating bed

patients to foxholes and performing

nonemergency surgery at night. An

underground hospital, begun after the

first attack, was pushed to completion by

medical personnel in the aftermath of

the raids. Surprised observers noted an

immediate rise in morale. The monotony was broken, the enemy had become

visible, and the war was real at last.15

Meanwhile, on 6 June Japanese forces

occupied the island of Kiska, in the western Aleutians. Then they seized remote

Attu, briefly abandoned it, but later

returned. Defeat of their main thrust in

the Battle of Midway far to the south left

their forces in the Aleutians dangerously isolated and exposed to counterattack. Though Buckner and DeWitt

argued for a northern approach to

Japan along the Aleutians, the real

motive for the American action that followed was probably psychological—to

remove the sole enemy lodgment on

American soil.

In any case, preparations for an

assault soon were under way. The

buildup was rapid, though always constrained by the greater importance and

more pressing needs of the South and

Southwest Pacific campaigns. New posts

were established, some in the interior

and some on the Pribilof Islands in the

Bering Sea. Most, however, were in the

Aleutians for use as bases in offensive

operations. U.S. forces occupied Adak

on 30 August and nearby Atka on 16

September 1942, where, as they huddled in foxholes, seeking shelter from

ceaseless cold rain and biting wind, they

learned the misery of the Aleutian fighting. By mid-September Army planes

from a newly built airstrip on Adak were

bombing Kiska, only 200 miles to the

west. 

The growth in air strength signaled

the approaching battle in the Aleutians.

In early 1943 a joint operation for ejecting the Japanese began. In January

Army troops seized Amchitka, only 70

miles from Kiska, and constructed an

airfield there. By mid-February the

Eleventh Air Force was harassing the

invaders whenever the weather would

allow. An enemy relief convoy was driven off, and the coming of spring found

the Japanese seemingly cut off from

their homeland, with U.S. bases extending up to their front door. On 1 April

14Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 58–61; Maurice Matloff and Edwin M.

Snell, Strategic Planning for Coalition Warfare, 1941–1942,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1953), pp. 224–25. 15CSurg, Alaska Def Cmd, Annual Rpt, 1942, p. 15,

file 319.1–2; McNeil, “Medical Department in Alaska,”

p. 544, file 314.7–2 (Medical Activities) Alaska. Both in

HUMEDS, RG 112, NARA. See also Conn, Engelman,

and Fairchild, Guarding the Outposts, pp. 261–62.

Underground operating rooms provided protection

both from the enemy and the weather, and were constructed at several hospitals.

ALASKA: THE PYRRHIC VICTORY 159
Nimitz and DeWitt issued a joint directive for the invasion of Attu.16

Basic to the preparations under way

was the organization of an amphibious

force to strike at the enemy. Doctrine

for such a force derived primarily from

Marine Corps thinking during the 1920s

and, more especially, from the creation

of the Fleet Marine Force in 1933.

Marine experiments in amphibious warfare had grown up in the context of prewar plans that envisioned a fighting

advance by the Navy across the Pacific in

the event of war with Japan. The concept demanded advanced bases for refueling, supply, and repair, and suggested

to marine officers a new function for

their organization. The doctrine they

developed had been accepted by the

Navy, and, according to Marine Corps

historians, “the War Department put the

Navy text between Army covers and

issued it [in 1941] as Field Manual

31–5.”17

Amphibious warfare was not new, but

the technique for making a successful

attack by large modern forces against a

hostile shore was one of the major military innovations of World War II.

Complex problems in command, tactics,

and supply had to be solved for such

operations to work. During the

approach to the target the naval commander was in charge of the attacking

force; then, as the landing force

advanced inland, the ground commander took charge. Medical care was likewise a joint endeavor. Aboard ship, the

Navy took responsibility for the health

and care of the entire force. When a

landing was accomplished, control

passed from one service to the other at

the water’s edge or the high-tide mark.

Elements of the divisional medical battalion were designated to accompany

the assault forces, followed by a carefully orchestrated succession of units that

gradually built up a comprehensive

Army-run medical system as the beachhead expanded. Eventually, hospital platoons gave the forces ashore the power

to hold substantial numbers of casualties, obviating the need to evacuate that

would have depleted their strength. In a

successful operation, evacuation policy—that is, the number of days of treatment that could be given ashore—rose

continuously from the first lodgment.

Clearly, much training was needed if

officers and enlisted men of two services

were to play well their roles in so complex a drama, staged under enemy fire.

Like others, medical units had to learn

the art of combat-loading their supplies,

with the items they would need first on

top in the holds. They had to provide

medical personnel to assist the Navy in

staffing landing craft that were marked

for use as seagoing ambulances. At the

same time, the medics had to learn the

skills that all soldiers needed to get

themselves and their basic equipment

ashore, to organize their units, and to

work under fire. 

The 7th Infantry Division and other

units destined to participate in the inva16Louis Morton, Strategy and Command: The First Two

Years, United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History, Department

of the Army, 1962), pp. 421–28; Conn, Engelman, and

Fairchild, Guarding the Outposts, pp. 270–76; CSurg,

Alaska Def Cmd, Annual Rpt, 1942, pp. 3–4, file 319.1–2,

HUMEDS, RG 112, NARA. A good account of the war of

the Aleutians can be found in Brian Garfield, The

Thousand-Mile War: World War II in Alaska and the

Aleutians (New York: Doubleday and Co., 1969). 17Frank O. Hough, Verle E. Ludwig, and Henry I.

Shaw, Jr., Pearl Harbor to Guadalcanal, History of U.S.

Marine Corps Operations in World War II

(Washington, D.C.: Historical Branch, G–3 Division,

Headquarters, U.S. Marine Corps, 1958), pp. 14–15

(quotation, p. 14).

160 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
sion trained under Marine guidance at

Fort Ord, near Monterey. Using techniques developed during the

Guadalcanal and North African campaigns, Maj. Gen. Holland M. Smith,

USMC, director of the amphibious

training course, led the 7th under its

commander Maj. Gen. Albert E. Brown,

who also was named commander of the

landing force, through amphibious

training that included wet and dry net

practice, boat landings on Monterey

Beach, training cruises, and landings

elsewhere along the coast. General

Brown’s troops were organized into regimental landing teams, each composed

of three autonomous battalion landing

(or combat) teams. Each sailed on a single ship, accompanied by a platoon

drawn from the collecting companies of

the 7th Medical Battalion under Lt. Col.

Robert J. Kamish, MC. Remembering

the events at Guadalcanal, where the

transports had been withdrawn soon

after the landing, Lt. Col. Laurence A.

Potter, MC, division surgeon and task

force surgeon, divided the 14th and the

20th Field Hospitals into three platoons,

each capable of operating independently as a 100-bed holding facility. Since

combat impended, the hospital platoons were staffed with male nurses.18

Though rigorous, the training was deficient in some crucial ways. For one thing,

the climatic conditions on the California

coast were altogether unlike those the

troops would face in the Aleutians. They

practiced amphibious tactics but received

no training in protecting themselves

against the cold, and the medics learned

nothing of the problems they would face

in the mountainous country that lay

ahead. Indeed, the training was directed

almost wholly toward the landing and little toward the problems that would be

faced once ashore. Some command decisions about equipment were ill-considered. In May Quartermaster Corps

experts recommended the use of winterized boots called shoepacs, only to have

the division commander select a leather

boot instead. Clad in hoodless field jackets, rather than parkas, and in unlined

woolen trousers that garrison troops in

Alaska had already learned were too thin

for the climate, the invading force departed with little understanding of the physical ordeal before them.19

Medical personnel were assigned their

roles in the invasion. Aidmen and battalion medical sections sailed in the same

ships as the units they supported. At

each beachhead a single collecting platoon would go ashore with the first wave,

to gather the wounded and administer

first aid. Battalion medical sections

would land with the fifth and sixth waves,

to set up and operate the aid stations. As

the battalions moved inland, the aid stations were to follow, leaving a few personnel on the beach to receive casualties

18Surg, 7th Inf Div, Annual Rpt (copy), 1943, pp. 2–3,

file 319.1–2; Rpt (copy), Lt Col Robert J. Kamish, Cdr,

7th Med Bn, n.d., sub: Medical Evacuation on Attu, p.

1, file 319.1; Rpt (copy), Lt Col Laurence A. Potter,

Surg, Task Force [51], 10 Jun 43, sub: Attu Operation,

pp. 5–6, file 319.1; McNeil, “Medical Department in

Alaska,” pp. 555–57, file 314.7–2 (Medical Activities)

Alaska. All in HUMEDS, RG 112, NARA. For a general

discussion of amphibious medical support in the Pacific

war, see Mary Ellen Condon-Rall, “Medical Aspects of

Amphibious Operations Involving U.S. Army Forces

During the War Against Japan,” in Daniel M.

Masterson, ed., Naval History: The Sixth Symposium of the

U.S. Naval Academy (Wilmington, Del.: Scholarly

Resources, 1987), pp. 276–88. 

ALASKA: THE PYRRHIC VICTORY 161

19Nelson L. Drummond, Jr., “The Attu Operation,” 6

Jul 45, pp. 37–40, and Rpt, R & D Br, Mil Planning Div,

OQMG, to Opns Br, Mil Planning Div, OQMG, 13 Oct

43, sub: Operations on Attu, The Historical Unit

(THU) Note Cards, Historians files, HUMEDS, RG 112,

NARA. 
until relieved. Litter-bearers from the

collecting platoons followed to evacuate

the aid stations. Last would come the

division clearing company, divided into

two platoons to support the major invading forces. With their arrival, the first

small hospital-type facilities and their

holding wards would be ashore on Attu.

Shore party medical sections would take

over care of the wounded on the beaches, delivering serious cases to the ships

for evacuation. Field hospital platoons,

each capable of independent action,

would follow at the orders of the landing

force commander.20

Of Attu itself and the enemy force little was known. Unsuited to agriculture

and devoid of mineral resources, Attu

had received slight attention in the past,

except from a government geodetic survey that mapped its coastline. The interior was largely a blank, and aerial photographs yielded little because of the fog.

“The loneliest spot this side of hell,” the

40-by-20-mile island lies at the westernmost end of the Aleutian chain and has

the same uninviting climate and terrain

as the rest. The Japan Current moderates

Attu’s temperature at the price of causing

dense fog and frequent storms, when

“the wind relieves the monotony . . . by

providing rain or snowfall in any combination of three directions: down, up, or

horizontal.” In the warmer months the

snow melts, making the soil wet and

boggy, and barely capable of holding a

man, much less a vehicle. Above the treeless valleys loom ridges of bare rock and

20McNeil, “Medical Department in Alaska,” pp.

554–57, file 314.7–2 (Medical Activities) Alaska,

HUMEDS, RG 112, NARA. The contemporary doctrine

and techniques of amphibious action are outlined in

the Navy’s Landing Operations Doctrine, U.S. Navy, 1938,

and in the Army’s Medical Service in Joint Overseas

Operations, Field Manual 8–25 (1940), and Landing

Operations on Hostile Shores, Field Manual 31–5 (1941).

162 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

WINTER VIEW OF ATTU HOSPITAL FACILITY
patchy snow, and beyond is the “jumbled,

barren mountain-mass of the interior,”

where peaks rise to 3,000 feet.21

Many soldiers must have thought the

desolate island was not worth fighting

for. But many died to secure it, in part

because information on the Japanese

defenders was scanty, including the fact

that reinforcements had increased their

number to about 2,400.22

Regaining Attu 

Task Force 51, the armada of ships

carrying the invasion forces to Attu, rendezvoused in late April at Cold Bay.

General Brown’s assault force totaled

about 11,000, including a reserve landing force held in readiness on Adak for

use if needed. Three bays indent the

eastern coast of Attu: Massacre Bay in

the south, Sarana in the middle, and

Holtz in the north. The Japanese had

concentrated on a rocky bulge of land

between Sarana and Holtz Bays, where

an airfield was under construction, and

the Americans planned two major landings to envelop them. 

On 4 May the task force, including

warships, transports, and mine sweepers, left Cold Bay. Foul weather and

high waves delayed the planned landing on the seventh, and, while the

troops waited below decks in the

rolling transports, Army planes from

Amchitka hit Attu with ninety-five tons

of bombs. Before dawn on 11 May, in

thick fog, a party of scouts went ashore

from U.S. submarines. The invasion

was on.

By evening Brown’s troops were landing in force on the shore of Massacre

Bay, on beaches Blue and Yellow, and

north of Holtz Bay, on beaches Red and

Scarlet. The enemy, blinded by the fog,

provided no opposition. By the end of

D-day 1,500 soldiers were ashore in the

north and 2,000 in the south. With no

casualties to care for on the beaches, the

medics methodically carried out their

part of the plan. The collecting platoons

of the 7th Medical Battalion landed and

established contact with the combat

team medics. Shore party medical sections relieved the collecting platoons on

the beaches, allowing them to follow the

combat teams in search of the enemy.

All seemed to be going well.23

Hopes of a quick victory vanished in

the days that followed. The Southern

Landing Force was the first to meet

trouble. The fog, lifting from the lowlands, clung to the upper slopes of the

ridges, and rifle and mortar fire from

above the fogline hit the Americans as

they advanced up Massacre Valley from

the beaches. Clearly visible in the treeless landscape to an enemy they could

not see, they made slow and costly

progress. By 13 May their advance had

reached a stalemate in the passes leading out of the valley. Meanwhile, the

Northern Landing Force bogged down

as well. The troops from beach Red

advanced along a ridgeline on the

north shore of Holtz Bay, but the

Japanese, driven off the high ground,

23Rpt (copy), Kamish, n.d., pp. 1–2, file 319.1;

McNeil, “Medical Department in Alaska,” pp. 557–58,

file 314.7–2 (Medical Activities) Alaska; Surg, 7th Inf

Div, Annual Rpt (copy), 1943, pp. 2–3, file 319.1–2. All

in HUMEDS, RG 112, NARA.

ALASKA: THE PYRRHIC VICTORY 163

21McNeil, “Medical Department in Alaska,” p. 548

(first quotation), file 314.7–2 (Medical Activities)

Alaska, and CSurg, Alaska Def Cmd, Annual Rpt, 1942,

p. 2 (second quotation), file 319.1–2, HUMEDS, RG

112, NARA; Conn, Engelman, and Fairchild, Guarding

the Outposts, p. 280 (third quotation). 22Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 279, 295.
clung tenaciously to the reverse slope

and gradually brought the invaders to a

standstill.

As casualties mounted, medics and

combat units alike faced the fact that

two enemies were in the field, the

Japanese and Attu itself. Both supply

and evacuation were proving to be a

nightmare. Until roads could be built,

wheeled and even tracked vehicles sank

into the wet and spongy tundra. Soldiers

walked as if on mattresses of moss. Every

needed article had to be hand-carried to

the front from dumps on the beaches.

There, disorder and confusion reigned.

Officers and enlisted men “were forced

to search along the beach for necessary

equipment, stand guard over it afterward, and then carry it over almost

impassable ground. . . .”24

Casualties had to be borne to the rear

on litters, across the rocks and tundra,

and the long litter hauls resulted in

many deaths among head and abdominal cases. Soldiers died from internal

hemorrhage only a few miles but many

hours from treatment. Morphine

syrettes, introduced on Attu, proved

invaluable in keeping the wounded

quiet and relatively pain-free during

long rough hauls. Aside from morphine,

the medic’s best friend was the fog,

which hid him and his patient from the

foe—a fickle friend, however, apt to fade

briefly before the pale Aleutian sun or

blow away at critical moments. Litterbearers worked at night, but in the late

Arctic spring the hours of darkness were

all too brief. 

Nothing could lessen the combination of backbreaking labor and constant danger that was the litter-bearers’

daily lot. The steep slopes of the ridges

exhausted them, forcing medical officers to augment the squads from the

customary four to six or even eight

men. Inert, suffering bodies had to be

manhandled through morasses and

hauled by ropes up ridges of slippery

bare rock under sniper and machine

gun fire. Without cover, the bearers

sometimes had to roll a casualty off the

litter to lower his profile by a few inches. Additional bearers were drafted

wherever they could be found, from

the medical battalion, the hospitals, the

shore parties, the Navy’s corpsmen, or

the line units. All were needed; over

one especially difficult route, 400 bearers worked in relays to evacuate the

wounded of three infantry battalions.

Everywhere, the litter-bearers were targets themselves. The enemy fired on litter parties without mercy, obliging

medical personnel to arm themselves,

fight, and sometimes die for their

patients.25

Forward treatment and evacuation

were marked by many expedients. In

the cold forward aid stations dried plasma proved to be a liability, hard to dissolve and likely to plug the needles. In

consequence, most casualties received

their first plasma at the clearing stations, which had moved close to the

25Rpt (copy), Kamish, n.d., pp. 1–2, 14, file 319.1;

McNeil, “Medical Department in Alaska,” pp. 559–67,

file 314.7–2 (Medical Activities) Alaska; Surg, 7th Inf

Div, Annual Rpt (copy), 1943, p. 3, file 319.1–2; Rpt

(copy), Potter, 10 Jun 43, pp. 2, 7, file 319.1; Rpt, Plt

Cdr, 14th Field Hosp, to HQ, Task Gp 16.11, 16 Jun 43,

sub: Brief Summary of the Highlights of Organization,

pp. 1–2, Encl to 14th Field Hosp Annual Rpt (copy),

1943, file 319.1–2. All in HUMEDS, RG 112, NARA.

Each syrette contained a half-grain dose.

164 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

2429th Field Hosp Annual Rpt (copy), 1943, p. 14

(quotation), file 319.1–2; McNeil, “Medical

Department in Alaska,” p. 559, file 314.7–2 (Medical

Activities) Alaska. Both in HUMEDS, RG 112, NARA.

See also Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 288–91.
MORPHINE SYRETTES; below, LITTER-BEARERS HAULING A CASUALTY OVER THE ATTU TUNDRA
fighting in order to shorten litter

hauls. (The move also made them

extremely vulnerable, as events were to

show.) In the north the wounded were

taken to a platoon of the 20th Field

Hospital, situated at the base of a 250-

foot cliff that rose a few hundred yards

from the beach. Here, the medics had

constructed an elevator—a caterpillar

tractor on the clifftop that winched a

12- by 12-foot sled loaded with two litters down the long slippery slope.

Because enemy fire restricted shore-toship evacuation, the platoon did much

surgery ashore. The hospital’s other

two platoons landed at Massacre Bay,

pitching a cluster of pyramidal tents in

ankle- or knee-deep mud. By the end of

the fighting its wards held 443 patients.

The more serious cases were taken offshore by landing craft for treatment on

shipboard, through pounding surf.

Once they were aboard, Army ship hospital platoons and personnel of the

179th Station Hospital took over their

care.

Gradually greater order emerged in

the rear areas. The casualty who

reached the hospital platoons was out of

serious danger. As the field hospitals

became established and X-ray equipment was brought ashore, evacuation

policy was set at three weeks. Some

longer-term cases—especially of cold

injury and battle fatigue—were held on

the island; Colonel Potter set up a convalescent hospital on the west side of

Massacre Bay, where, at one point, 600

patients were under treatment. The seriously wounded were, for the most part,

quickly evacuated. A few of the worst

injured went by ship or plane to Adak

for transfer to other Alaskan station hospitals, where preparations had been

made to receive them. Most, however,

were taken by Navy ship or plane direct

to the zone of interior.26

The Japanese were still far from beaten. After four days of fighting, senior

military leaders realized that they had

underestimated the enemy. While

General Brown demanded more troops

and road-building equipment, the

mounting evidence that his forces were

bogged down convinced the North

Pacific Fleet commander, Vice Admiral

Thomas C. Kinkaid, to replace him. The

new commander, Maj. Gen. Eugene M.

Landrum, arrived on Attu on 16 May,

just as the Northern Landing Force was

breaking the deadlock around Holtz

Bay. The next day the enemy retreated

in the direction of Chichagof Harbor.

Threatened in the rear, the Japanese

force in the south that had been blocking one pass out of Massacre Valley also

withdrew. By the twentieth the Southern

Landing Force had cleared a second

pass as well, and emerged from the valley. Then the two American pincers

closed upon the enemy’s last redoubt.27

Medical support by now had become

easier. By 20 May engineer-built roads

enabled tractors and jeeps to carry supplies forward from the beach and casualties back from relay stations, putting an

end to many of the long litter hauls.

Units already ashore advanced, and others landed. The complicated lines of

evacuation were simplified. Additional

slides were built, where tractors could

26Surg, 7th Inf Div, Annual Rpt (copy), 1943, p. 3, file

319.1–2; Rpt (copy), Potter, 10 Jun 43, pp. 3, 7, 9, file

319.1; 20th Field Hosp Annual Rpt (copy), 1943, p. 2,

file 319.1–2; McNeil, “Medical Department in Alaska,”

pp. 568–72, file 314.7–2 (Medical Activities) Alaska. All

in HUMEDS, RG 112, NARA. 27Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 293–94; McNeil, “Medical Department in

Alaska,” pp. 552–53, file 314.7–2 (Medical Activities)

Alaska, HUMEDS, RG 112, NARA.

166 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
lower sleds with their burden of litters

down the more difficult slopes. Ahead,

the line units continued to drive the

Japanese slowly back. By the twenty-first

the front line in the southern sector

extended across Sarana Valley, and a

clearing station moved up to Sarana

Pass. Litter-bearers brought casualties

from the battalion aid stations and relay

posts across the valley floor and, by

means of a slide, up a prominence nicknamed Engineer Hill to the clearing station in the pass. From a relay post at the

brow of the hill, tractors and sleds picked

up the casualties and hauled them back

via Massacre Valley to the hospitals. 

Three days later U.S. troops were

fighting Japanese forces on a ridge west

of Chichagof Valley, and collecting platoons were moving into the area. Soon

tractors were operating across Sarana

Valley to the slide. On 28 May the clearing station moved to one of the relay station sites on the Chichagof side of the

Sarana Valley, leaving only a few medics

behind at the old site on Engineer Hill.

At the time, the new location did not

seem especially perilous.28

Meanwhile, the collecting units in the

north had been advancing with their

infantry battalions. On 23 May medics

set up a collecting station on the East

Arm, an inlet of Holtz Bay. Casualties

there were evacuated after treatment to

the field hospital on the West Arm inlet

by boat. On the twenty-fifth the northern and southern sectors met, enabling

some northern casualties to be evacuated south, through a connecting pass.

The Japanese were encircled, and the

lengthy ordeal of the troops fighting

and freezing on Attu appeared to be

drawing to an end. But the enemy had a

surprise in store.29

At 0330 on 29 May 700–1,000 surviving Japanese charged the American

lines, “screaming, killing, and being

killed.” Armed with rifles and bayonets

on long poles, they overran American

positions in the Chichagof area, including medical installations located in two

ravines in Sarana Valley. The attackers

slashed their way into tents filled with

casualties. Despite the experience of

29Rpt (copy), Kamish, n.d., p. 10, file 319.1; McNeil,

“Medical Department in Alaska,” pp. 574, file 314.7–2

(Medical Activities) Alaska. Both in HUMEDS, RG 112,

NARA.

ALASKA: THE PYRRHIC VICTORY 167

28Rpt (copy), Kamish, n.d., pp. 6–7, file 319.1;

McNeil, “Medical Department in Alaska,” pp. 573–74,

file 314.7–2 (Medical Activities) Alaska. Both in

HUMEDS, RG 112, NARA.

OFFSHORE EVACUATION OF THE

SERIOUSLY WOUNDED
days past, the medical units were unprotected either by the infantry or by

defenses of their own. Medics, like their

patients, lay helpless in sleeping bags

and were stabbed to death through the

bags and the canvas of their collapsing

tents. Capt. John W. Bassett, MC, a clearing company commander, was shot and

killed instantly while trying to organize a

defense. Another officer woke from his

sleep as a Japanese bayonet pierced his

nose, tongue, and neck, pinning him to

the ground; the attacker withdrew the

weapon, and the officer miraculously

escaped, wounded but alive. On top of

the hill that bore their name, engineer

troops finally stopped the Japanese near

the site of the clearing station. But the

enemy held much of the American rear

area for the greater part of the day. In

the fighting 19 medical officers and

enlisted men were killed and 27 others

wounded.30

Since the Japanese now blocked many

evacuation routes, casualties of the

heavy fighting could not be moved back.

Medics at forward posts stayed with their

patients; at the clearing station on

Engineer Hill, almost encircled by the

Japanese, treatment continued throughout the fighting. American forces counterattacked, and by sunset the enemy

had retreated. The wounded from the

valley floor began to move again by tractor-loads to the hilltop. By the next afternoon 238 wounded had reached the

beaches of Massacre Bay. As for the

Japanese, they had virtually ceased to

exist. Though a few surviving snipers

still had to be hunted down, the brief,

bitter campaign was over.31

The Balance Sheet

Counting up their casualties and the

bodies of the enemy, the Americans

recorded some grim statistics. Out of a

force totaling some 15,500 soldiers by

the end of the campaign, 549 had been

killed and 1,148 wounded. For the

Japanese, 2,350 had been killed and 29

taken prisoner. The bitterness of the

fighting was reflected in the fact that 71

Americans had been either killed or

wounded for every 100 defenders on the

island; only Iwo Jima was to exact a proportionately heavier toll. Sixty-nine percent of the American battle dead had

perished of gunshot wounds. Some 12

percent were victims of the bayonet, in a

war where much less than 1 percent was

the norm—remarkable testimony to the

price exacted by the enemy’s final banzai charge. But battle injuries were not

the whole story. More than 2,100

Americans had been put out of action

by disease and nonbattle injuries. Total

American casualties outnumbered the

whole Japanese defense force by a ratio

of 3 to 2.32

The medics had suffered their own

losses—32 killed and 58 wounded, or

about 7.5 percent of their personnel,

more than half during the enemy’s final

charge. Though they had armed themselves by one means or another, their lack

of training had made them ineffective

30Quotation from Conn, Engelman, and Fairchild,

Guarding the Outposts, p. 294. See also Rpt (copy),

Kamish, n.d., p. 7, file 319.1; McNeil, “Medical

Department in Alaska,” pp. 554, 575, file 314.7–2

(Medical Activities) Alaska. Both in HUMEDS, RG 112,

NARA.

31McNeil, “Medical Department in Alaska,” pp.

575–76, file 314.7–2 (Medical Activities) Alaska,

HUMEDS, RG 112, NARA. 32Conn, Engelman, and Fairfield, Guarding the

Outposts, p. 295; McNeil, “Medical Department in

Alaska,” pp. 577–78, file 314.7–2 (Medical Activities)

Alaska, HUMEDS, RG 112, NARA.

168 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
fighters and a danger to themselves and

others. Their relative helplessness provoked much bitter comment, causing

Colonel Kamish to recommend “that

medical troops operating against Japs be

armed with a carbine and given adequate

instruction in its use and in the use of

hand grenades[;] that medical troops be

instructed in security in the battle zone[;]

that line commanders be impressed with

the responsibility of guarding medical

installations in their vicinity[; and] that

Division Headquarters furnish such

installations . . . fighting protection.”33

The lack of experience and foresight

that pervaded the whole Attu operation

did not reflect on individual medics.

Colonel Kamish wrote: “The [Medical]

Battalion Command is proud that the

line soldier, notoriously contemptuous

of the Medical Corps, has nothing but

praise for its members since the operations on Attu.” War correspondent

William Gillman was critical of the

Army’s overall performance, but he

praised the medics for defending their

patients at risk of their own lives when

the enemy, bayonet in hand, stormed

through the lines. “Everybody agreed

that the medics were heroes,” he

declared. For its service during the battle, the 7th Medical Battalion received a

presidential citation that hailed its “gallant efforts” and its achievements in

evacuation under fire.34

Accomplishments and failings of the

medical service on Attu showed up

clearly by contrast with that of the

enemy. Although the Japanese were virtually exterminated, and their medical

equipment and installations destroyed,

the Americans were able to piece

together an instructive picture of their

medical service. For first-echelon care,

each company had one officer or noncommissioned officer and two enlisted

men attached, with litter-bearers drawn

from the combat troops when necessary.

The next echelon consisted of a dressing station and an ambulance section to

evacuate casualties to the rear. This echelon was variously called a medical unit,

casualty clearing station, or divisional

bearer section. During the battle the

enemy set up such stations in tents in

the forward areas; some semipermanent

dispensaries, which accommodated perhaps 25 casualties each, were established

in well-camouflaged structures that were

dug into the ground. In one of these the

Americans found 18 dead: The Japanese

medical officer had killed his patients

before he shot himself.

The next and highest Japanese medical echelon on Attu was the field hospital. At first the Japanese had evidently

used a building on the eastern side of

Holtz Bay; later, after converting the

building into a barracks, they began construction of a new hospital further up

Holtz Valley, where the Americans found

only equipment stored. The enemy had

also used as an aid station or hospital a

large cave overlooking Holtz Bay. Total

beds on the island were estimated at 200

for a garrison of 2,300—a respectable

number by American standards. 

The Japanese on Attu apparently suffered no epidemics, although pneumonia, tuberculosis, and dysentery cases

had, on occasion, been evacuated from

the island. On the other hand, medical

33Rpt (copy), Kamish, n.d., p. 19 (quotation), file

319.1; McNeil, “Medical Department in Alaska,” p. 577,

file 314.7–2 (Medical Activities) Alaska. Both in

HUMEDS, RG 112, NARA. 34First quotation from Rpt (copy), Kamish, n.d., p.

16, file 319.1; second and third quotations as cited in

McNeil, “Medical Department in Alaska,” p. 577, file

314.7–2 (Medical Activities) Alaska. Both in HUMEDS,

RG 112, NARA.

ALASKA: THE PYRRHIC VICTORY 169
practice had been primitive. Recovered

enemy medical officers’ diaries and an

interview with a captured Japanese medical sergeant supplied a wealth of details

on enemy medical service. Medical officers and enlisted men carried first aid

kits, containing instrument sets, an antiseptic—usually tincture of iodine—dressings and bandages, a few drugs, syringes

in metal cases, and needles. No evidence

could be found that the Japanese used

sulfa drugs on Attu; they did not use plasma or give blood transfusions. Their surgeons performed major operations with

local or spinal, rather than general, anesthetics. Faced with defeat, medical personnel sometimes injected the seriously

wounded with morphine before the

wounded committed suicide with hand

grenades. Addiction, however, was rare

among the Japanese soldiers, and popular stories that the frenzy of the banzai

charge had been drug-induced were

without foundation.

Preventive medicine was a curious

melange. Japanese soldiers took creosote to prevent food poisoning and

downed cod liver oil and vitamins as

dietary supplements. A medical officer’s

diary recorded, “We are all taking vitamin pills. Cases of typhus and TB come

up. We can take no chances.” Other

cases of the seemingly magical use of

preventive measures were observed. The

Japanese poured oil on pools of water,

although Attu had no mosquitoes; the

garrison reportedly had participated in

the Burma campaign, and may have

continued a practice learned there on

the assumption that it was somehow

related to health.35

In other respects, the Japanese had

made intelligent efforts to preserve the

health of their men. They chlorinated

their water and followed their national

custom of providing weathertight bathhouses with heated communal tubs. The

clothing and boots of the Japanese soldiers were serviceable and warm, so

much so that American soldiers sometimes took caps and footwear from the

enemy dead at risk of being shot by their

own comrades. Living and dead,

Japanese soldiers showed no evidence of

cold injury—a startling contrast to the

Americans.36

Nonbattle injuries put more U.S. soldiers out of commission than the enemy

did, and by far the greatest source of

incapacitating injury was the wet cold of

Attu. Average temperature in the valleys

was a relatively mild 37°

F., but on the

ridges, where most of the fighting took

place, the average was 24°

, and nightly

temperatures sank as low as 10°

. As the

fighting grew heavy, U.S. troops were

pinned down for several days at a time

in water-soaked foxholes, unable to

exercise their feet and legs. Since the

boggy tundra made evacuation difficult,

many injured walked to aid stations on

sore, swollen feet and in temperatures

that averaged about 35°

F. 

Originally trained for desert fighting,

the landing force troops were unable to

cope with these problems. They had not

been taught to remove their wet boots

frequently, dry their socks and inner35Rpt (copy), ASurg, Advance CP, Alaska Def Cmd, to

SG, U.S. Army, 22 Jul 43, sub: Japanese Medical Service,

p. 3, file 319.1–1 (Bitner), HUMEDS, RG 112, NARA. 

170 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

36Rpt (copy), ACofS, G–2, Alaska Def Cmd, to ACofS,

G–2, Advance CP, Adak, Alaska Def Cmd, 17 Jul 43, sub:

Japanese Medical Facilities on Attu, p. 3, file 319.1–1

(Fergusson), HUMEDS, RG 112, NARA. The Japanese

use of creosote pills for internal antisepsis dates back to

the Russo-Japanese war. For a good description of

Japanese medicine on Attu, see Ronald V. May, “Battle

at Attu—the Japanese Side,” Journal of the Council on

America’s Military Past 13 (Dec 85): 3–9.
soles, and massage their feet to increase

circulation. Lack of training interacted

with equipment failures. The Alaska

Defense Command, as already noted,

issued the wrong boots and chose the

wrong clothing for the wet, muddy

Aleutian weather. The experience of

three special units pointed up the

importance of command errors. The

7th Scout Company and the 7th Cavalry

Reconnaissance Troop landed on beach

Scarlet; promptly lost their way; and, in

the course of five days, suffered 401

cases of exposure. On the other hand,

the Alaskan Scouts, a combat intelligence force that had been trained for

the climate and terrain, fought the

entire campaign wearing shoepacs and

suffered only 1 case of cold injury.37

Soldiers on Attu suffered three types

of cold injury—mild exposure, general

exposure, and immersion or trench

foot. Medics did not hospitalize cases of

mild exposure, but returned them to

duty after rest behind the lines and

nourishment with warm drinks, whiskey,

and food. Cases of general exposure

went to the hospital; the 20th Field

Hospital, for example, treated 116 cases

during the battle. The same facility

cared as well for 342 cases of exposure

with trench foot. Although not lifethreatening, trench foot was a disabling

injury. Within twelve to fourteen hours

after exposure, throbbing, tingling,

cramping, and increasing numbness of

the feet signaled the onset of the problem. The victims’ feet swelled, turning

blue or mottled blue and white and the

soles waxy white; severe cases became

painful and blistered. Many felt as if they

were walking on wooden feet. The severity of injury was directly proportionate

to the length of time that shoes and

socks were worn unchanged. 

In the field and convalescent hospitals, medics treated trench foot by bed

rest, elevating the feet, and maintaining

asepsis, allowing the feet to warm gradually without artificial heat. When the

skin was broken, they gave the patient

sulfadiazine orally to prevent infection.

During the battle 1,242 cases were taken

to the hospitals on the shore, and 241

severe cases were evacuated to the ships.

Overall, the rate of cold injury for the

twenty-two days of the campaign was

equivalent to 1,301 per 1,000 troops per

year. The ratio of wounded in action to

cold injury equaled 1:1 at Attu, an unacceptable wastage of soldiers.38

Other nonbattle losses included the

usual range of neuropsychiatric, gas3820th Field Hosp Annual Rpt (copy), 1943, pp. 4, 7,

file 319.1–2; Rpt (copy), Potter, 10 Jun 43, pp. 7–8, file

319.1; McNeil, “Medical Department in Alaska,” pp.

581–84, file 314.7–2 (Medical Activities) Alaska. All in

HUMEDS, RG 112, NARA. See also Patterson, “Effect

on Extremities,” p. 63; Whayne and DeBakey, Cold

Injury, p. 94; Lesser, “Immersion Foot Casualties,” p.

259; and Whayne, “Clothing,” in Hoff, ed., Personal

Health Measures, p. 66–67.

ALASKA: THE PYRRHIC VICTORY 171

37Rpt (copy), Potter, 10 Jun 43, pp. 5, 6, 8–9, file

319.1; McNeil, “Medical Department in Alaska,” p. 582,

file 314.7–2 (Medical Activities) Alaska. Both in

HUMEDS, RG 112, NARA. See also Tom F. Whayne and

Michael E. DeBakey, Cold Injury, Ground Type, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1958), pp. 90–92; Albert

Lesser, “Report on Immersion Foot Casualties From the

Battle of Attu,” Annals of Surgery 121 (Mar 45): 259;

Constantin P. Yaglou and William L. Hawley,

“Disabilities Due to Environmental and Climatic

Factors,” in Ebbe Curtis Hoff, ed., Special Fields, Medical

Department, United States in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1969), pp. 242–44; Tom F.

Whayne, “Clothing,” in idem, Personal Health Measures

and Immunization, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, 1965), pp. 66–67; and R. H.

Patterson, “Effect of Prolonged Wet and Cold on the

Extremities,” Bulletin of the U.S. Army Medical Department

75 (Apr 44): 62.
172 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

trointestinal, and respiratory cases. The

20th Field Hospital admitted 94 neuropsychiatric cases, a small number considering the conditions of the fight, only

29 of whom had to be evacuated from

the island. The 46 cases of acute diarrhea treated at the same field hospital

reflected the problems of sanitation in

battle: Soldiers ate their rations from

unwashed canteen cups, and sometimes

failed to chlorinate their drinking water;

streams, their source of drinking water,

were also preferred spots for excretion,

perhaps because of the protection

offered by the banks. But these problems

were minor, and despite the cold wet climate and the great number of exposure

cases, respiratory ailments were few.39

In sum, Attu presented a picture both

of high battle losses, resulting in part

from intelligence failures that included

ignorance of the terrain and enemy

strength, and also of high nonbattle losses, many traceable to erroneous command decisions regarding the training,

clothing, and equipment of the troops.

The all but forgotten battle deserves to

be remembered, among other things, as

another painful step taken by American

commanders on the way to learning the

difficult art of protecting their soldiers

in a worldwide war.

Regaining Kiska

After Attu, the last enemy toehold

upon American soil to be recaptured was

Kiska. Initially considered the main target for the American counterattack,

Kiska had been bypassed because its

defenses were deemed stronger than

those on Attu. Hence, preparations to

invade had been under way since before

the Attu operation. In late 1942 assault

forces began assembling at Fort Ord for

amphibious training. Medical units

emphasized rigorous physical conditioning for litter-bearers, and went through

the usual exercises with the other troops

as well: climbing down cargo nets; taking

part in small-boat landings; and gaining

familiarity with LSTs (landing ship,

tank). Field hospital platoons were again

to land with the units they supported.

Taking heed of the Attu lessons

learned, and of intelligence estimates

that about 10,000 enemy troops garrisoned Kiska, the Army doubled the size

of the assault force to 34,400 ground

troops, including 5,300 Canadians. All

were commanded by Maj. Gen. Charles

H. Corlett, U.S. Army. Units were added

with experience in the type of fighting

that had developed on Attu, including a

mountain combat team, a regimental

combat team from the Alaska Defense

Command, and the tough 1st Special

Service Force. The 17th Infantry, which

had fought on Attu, took the place of a

nonveteran infantry regiment. All of this

introduced some confusion into medical

planning, for different components were

making ready in California, Canada, and

Alaska. Advanced amphibious training

continued at Adak and Amchitka even as

Navy warships began to hurl shells at

Kiska, and the Eleventh Air Force, using

airstrips on Attu and the nearby island of

Shemya, started bombing runs. The invasion was set for 15 August 1943.40

40Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 295–96; McNeil, “Medical Department in

Alaska,” pp. 589–90, file 314.7–2 (Medical Activities)

Alaska, HUMEDS, RG 112, NARA.

3920th Field Hospital Annual Rpt (copy), 1943, p. 4,

file 319.1–2; McNeil, “Medical Department in Alaska,”

p. 584, file 314.7–2 (Medical Activities) Alaska. Both in

HUMEDS, RG 112, NARA.
In making their plans the medics

relied heavily upon reports from Attu,

the advice of veterans of the Aleutian

fighting, and lessons learned from

amphibious operations in the South

Pacific. Once again, they assumed that

they had to provide care in case the

Navy should be pulled away within thirty-six hours of the landing, as had happened on Guadalcanal. The danger of

cold injury was treated with utmost seriousness by Corlett, and the troops were

issued shoepacs, parkas, rain suits,

water-resistant trousers, and face masks.

All received instruction in caring for

themselves, and especially for their feet;

before the troops went ashore, they

rubbed lanolin into their feet, and medical personnel performed a last-minute

foot inspection. The medics went armed

with the weapons they had fired at Fort

Ord—carbines for officers and M–1

rifles for enlisted men. This time they

were to have a fighting chance.

Nearly 3,000 medical personnel

accompanied the invasion forces. Task

force surgeon, Lt. Col. H. E. Bill, MC,

with a staff of 4 officers and 6 enlisted

men, operated out of Corlett’s headquarters. Four landings were planned on two

major sectors of the coast; hence, two

medical officers from the 59th Medical

Battalion acted as sector surgeons on the

staffs of the sector commanders. In order

to make self-sufficient the autonomous

battalion landing groups—the basic tactical units of the campaign—the field medical units again had to be reorganized.

The medical battalion was first expanded

with additional collecting and clearing

ALASKA: THE PYRRHIC VICTORY 173

GENERAL AREA OCCUPIED BY A MEDICAL BATTALION ON KISKA
companies, drawn from nondivisional

sources, and then split into sections,

which in turn were attached to the landing groups. This setup was even more

radical than on Attu; the medical battalion ceased to exist for the duration of the

campaign, no plans being made to reconstitute it as the assault forces converged.41

Hospital platoons were to carry

ashore, in rucksacks and on packboards,

enough supplies for thirty-six hours;

other medical units were to take with

them supplies for three days. Additional

supplies, including medical maintenance units, were combat loaded on

transports and cargo vessels for early

debarkation. A supply depot on every

beach was to distribute supplies to the

troops. In case units became isolated,

fifty-eight parachute packs were ready

with morphine syrettes, heating pads,

bandages, sulfa drugs, and brief instructions for use. Casualty estimates reflected the harsh experience of Attu; almost

2,500 were expected to die and 7,000

more to fall sick or be wounded. The

Alaska Defense Command designated

station hospitals to receive casualties—

the 179th Station Hospital at Adak with

1,500 beds; Fort Richardson with another 800 beds, if needed; Forts Mears at

Dutch Harbor, Randall at Cold Bay, and

Greeley in Kodiak, with 300 beds each;

and Fort Glenn at Umnak, with 100

beds. Further evacuation was to be by air

and water from Adak to Seattle. The tactical and medical planning for Kiska

grappled with the perceived reality—a

large force of defenders who would fight

to the death in a wilderness of fog,

rocks, and tundra.42

Early on the morning of 15 August—it

was that rarity, a fine Aleutian day—the

amphibious force of nearly 100 ships

under the command of Rear Admiral

Francis W. Rockwell began arriving off

Kiska, an island 25 miles long and less

than 2 miles wide. Intelligence indicated

that the enemy was concentrated on the

eastern side, in the Kiska Harbor area

and around Gertrude Cove. Hence, landings began on the island’s west side. By

0840 landing craft were putting ashore

the first troops of the Southern Landing

Force, their destination the hills above

the beach. Next morning, the Northern

Landing Force landed at two beaches

near Kiska volcano on the northwestern

side of the island. As on Attu, the landings were unopposed. The weather rapidly returned to the Aleutian norm in the

days that followed. But no one could find

the Japanese. U.S. forces penetrated the

mist-covered interior of Kiska, encountering no defenders and hearing only the

shots of their own tense, trigger-happy

men. At night they huddled in wind and

rain, awaiting the enemy, and patrols

fired on one another in the darkness,

killing and wounding. Until 22 August

the Americans searched for the Japanese

in vain. Apparently, the enemy had evacuated the island, perhaps as early as 28

July; exploiting the Aleutian fog,

Japanese cruisers and destroyers had carried away the entire garrison. Now with

only the weather as the enemy, the troops

on the beaches of Kiska smashed crates

into kindling, appropriated tents and 41McNeil, “Medical Department in Alaska,” pp.

594–97, file 314.7–2 (Medical Activities) Alaska; 59th

Medical Bn War Diary, 1943, pp. 6–11, file 319.1. Both

in HUMEDS, RG 112, NARA. See also G. Allen Lane,

“Medical Experiences With the 13th Canadian Infantry

Brigade at Kiska,” Journal of the Canadian Medical

Services, May 44, p. 284.

174 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

42McNeil, “Medical Department in Alaska,” pp. 597,

599–600, file 314.7–2 (Medical Activities) Alaska,

HUMEDS, RG 112, NARA.
stoves, and broke open medical supplies

in search of whiskey.43

During the first days, as U.S. forces

moved inland expecting to see the

enemy, attached aidmen and part of a

collecting company went with them to

provide first-echelon care. In view of the

casualties from friendly fire, the medics

were needed. Carrying litters remained

as difficult as ever, because of the boggy

tundra and snow-covered hills. Other

medical units followed. The field hospitals landed, pitched tents, gathered cots,

and treated the first days’ casualties. The

6th Field Hospital was able to provide

definitive treatment within twenty-four

hours of the first landing and X-ray service within three days. When it became

clear that the enemy had evacuated the

island, the field hospitals moved into

the area around Gertrude Cove and

Kiska Harbor. The following month they

reorganized as station hospitals. 

Meanwhile, most of the invasion force

moved ashore, a total of 28,452 troops.

Despite the lack of opposition, they, too,

gave the medics some work to do, suffering a casualty rate of 2.7 per 1,000

troops per day. Accidents, friendly fire,

booby traps, and land mine explosions

accounted for most casualties, and

trench foot for the rest. But for evident

reasons, the nonbattle casualty rate was

low. Of 130 diagnoses of trench foot, 76

came from the 17th Infantry, the consequence of injuries suffered on Attu. One

man died of gas gangrene; another

required the “inevitable appendectomy,” which was performed in a hospital

tent by the light of a gasoline lantern.

Overall, 28 died, about a tenth of 1 percent of those who came ashore, as

against the 30-percent casualties and 9-

percent deaths that had been predicted

for the invasion force as a whole.44

In deserting Kiska, the Japanese gave

up their last foothold on Alaska. The

threat of invasion vanished, though the

enemy continued intermittent air activity

over the Aleutians for another two

months. On Attu, medics turned into

builders, as they had on other Pacific

islands, constructing sturdy huts to house

the 328th Station Hospital that was to

serve the garrison. Meanwhile, American

planes based on Shemya Island shifted to

the offensive, mounting an attack on the

Japanese-held Kurile Islands. But serious

fighting in the Aleutians was over.

The Alaskan theater remained inactive

but not useless from the autumn of 1943

to the end of the war. The air raids on the

Kuriles tied down hundreds of Japanese

aircraft, and tens of thousands of

Japanese troops prepared to oppose a

possible American invasion. Nevertheless,

in response to complaints by Secretary of

War Stimson that too many doctors were

being wasted there, Surgeon General

Kirk reduced the fixed-bed requirement

to 4 percent of total troop strength.

Dispersion and distance, however, still

required a more substantial medical

establishment than numbers alone might

have suggested. In most respects, the subsequent medical history of the territory

was unremarkable, except for a brief flur43Ibid., p. 603, file 314.7–2 (Medical Activities)

Alaska; 30th Field Hosp Annual Rpt (copy), 1943, pp.

9–11, file 319.1–2. Both in HUMEDS, RG 112, NARA.

See also Conn, Engelman, and Fairchild, Guarding the

Outposts, pp. 297–98, and Samuel Eliot Morison, History

of United States Naval Operations in World War II, 15 vols.

(Boston: Little, Brown and Co., 1964), 7:62–63.

44McNeil, “Medical Department in Alaska,” pp.

606–08 (quotation, p. 606), file 314.7–2 (Medical

Activities) Alaska; Rpt (copy), Potter, 10 Jun 43, p. 8, file

319.1. Both in HUMEDS, RG 112, NARA. Cold injury,

by damaging the tissues, predisposes to subsequent

injury. See Lane, “Medical Experiences,” p. 287.

ALASKA: THE PYRRHIC VICTORY 175
ry over Japanese balloons in the last year

of the war. Colonel Moore was named

anti-biological warfare officer on the supposition, which proved baseless, that the

balloons, launched from the enemy’s

home islands, might carry biological

weapons.45

Beginning with serious blunders, the

nation’s third amphibious campaign of

World War II ended with an attack

upon a deserted island. Yet the preparations for the Kiska invasion showed

both willingness and capacity to learn

from the mistakes of the past. The techniques of amphibious warfare were

steadily being refined, and in the South

and Southwest Pacific—less than a year

after Guadalcanal, and only a few

months after Attu—were applied with

impressive competence in a series of

victories in the Solomons, New Guinea,

and nearby islands.

45Ltrs, Henry L. Stimson, SofW, to Maj Gen Norman

T. Kirk, SG, U.S. Army, 20 Nov 43, and Kirk to Stimson,

23 Nov 43, THU Note Cards, Historians files; 20th Field

Hosp Annual Rpt (copy), 1943, p. 3, file 319.1–2; 6th

Field Hosp Annual Rpt (copy), 1943, pp. 6–7, file

319.1–2; Scioto Herndon, “Organization of the Medical

176 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

Service in the Defense Commands, 1942–1945,” pp.

36–37, file 314.7. All in HUMEDS, RG 112, NARA.

Some personal accounts of medical activities on Attu

can be found in the War Department’s publication The

Capture of Attu as Told by the Men Who Fought There

(Washington, D.C: Infantry Journal Press, 1944).
The closing of the Papuan and

Guadalcanal campaigns left the forces

of General MacArthur’s Southwest

Pacific Area (SWPA) and Admiral

Halsey’s South Pacific Area (SPA) free

to embark on new efforts against the

Japanese. The enemy’s stronghold was

his fortified base at Rabaul on New

Britain, a large island separated from

the northeastern coast of New Guinea

by the Vitiaz Strait. 

At the Casablanca Conference in

early 1943 the Allies decided on new

advances in the region. The Joint

Chiefs devised an arrangement by

which Halsey would command a new

advance up the Solomon chain under

the general direction of MacArthur,

while the latter’s own forces would

simultaneously resume their fighting

advance westward along New Guinea’s

north coast, exploiting the sea to avoid

endless slogging through jungles and

mountains. Southwest Pacific forces

would fight in New Guinea, New

Britain, and the Admiralty Islands,

while South Pacific troops would

engage the enemy in the Solomons.

Ground forces from both theaters

would secure the Woodlark and

Kiriwina Islands off Papua. The pincer

movement resulting from these campaigns would gradually isolate and

strategically encircle Rabaul, whose

conquest was the ultimate objective of

both commanders. In April at a conference in Brisbane, MacArthur and

Halsey agreed on a plan that aimed at

the capture of successive forward air

bases. The complex operations

involved received the code name

CARTWHEEL.

1

Troops of both theaters would be

obliged to fight once again in New

Guinea and the Solomon Islands, with

their harsh mountains, roadless jungles, and tropical diseases that included malaria, dengue, and scrub typhus.

Yet by mid-1943 the SWPA medical service was better able to support combat

operations. Hard lessons had been

learned in preventive medicine;

amphibious support techniques were

rapidly improving, with many landing

craft to double as floating ambulances

or hospital ships; and the 2d Engineer

Special Brigade, with its own medical

CHAPTER VI

Amphibious Advance

1

John Miller, jr., CARTWHEEL: The Reduction of Rabaul,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, 1959), pp. 1–19,

26–27; Samuel Eliot Morison, History of United States

Naval Operations in World War II, 15 vols. (Boston: Little,

Brown and Co., 1947–62), 6:95–96; D. Clayton James,

The Years of MacArthur, 3 vols. (Boston: Houghton

Mifflin Co., 1970–85), 2:308. Unless otherwise noted,

the framework of strategy and military events for this

chapter is drawn from these sources.
battalion, the 262d, had arrived to

move troops ashore, to organize the

beaches, and to provide smooth evacuation to ships offshore. In the South

Pacific Area, by contrast, whether

because of the complex command

arrangements or some other factor, the

opening battles would show that the

SPA medical service had fallen behind

in its planning and preparations.2

While the forces assembled and

trained, the theater surgeons brought in

replacements, requisitioned supplies,

and did preliminary planning for hospitalization, sanitation, and malaria control. Since the USASOS was responsible

for the logistical support of American

ground forces in the Southwest Pacific

Area, Carroll, as the chief surgeon, and

his staff provided medical support for

the coming campaign, including base

development. On 15 June the forward

echelon of the Sixth Army surgeon’s

office was redesignated as the Office of

the Surgeon, ALAMO Force, an organization under the direct command of

General MacArthur.3 Sixth Army surgeon Colonel Hagins, assisted by I Corps

surgeon Colonel Miehe, planned tactical medical support and coordinated

the medical services of Army, Navy, and

Marine units. Both Hagins and Miehe

kept in close contact with Colonel

Kennard, the senior flight surgeon, and

with Navy Capt. Albert T. Walker, MC,

the surgeon of Rear Admiral Daniel E.

Barbey’s VII Amphibious Force.4

CARTWHEEL Opens

CARTWHEEL opened at the end of June

with three simultaneous thrusts. In the

first, SPA and SWPA forces seized

Woodlark and Kiriwina, “practically virgin jungle islands” off Papua’s northeastern coast, and built bomber bases to

strike at the Solomons and Rabaul. In

the second, mounted from the New

Guinea coastal town of Morobe, a battalion combat team of the 162d Infantry,

41st Infantry Division, landed at Nassau

Bay in heavy seas and blinding rain, aiming at the Japanese-held town of

Salamaua. Here, medical support was

provided by the 116th Medical

Battalion—its collecting company and a

platoon of its clearing company—and by

three portable surgical hospitals, one

for each battalion combat team. The

clearing platoon remained at Morobe.

The other medical units accompanied

the combat team; they advanced in single file along narrow coastal trails to join

an Australian brigade fighting its way

northeastward from Wau. Reinforced by

the rest of the 162d Infantry, the com2

On the development of landing craft, see Frank O.

Hough, Verle E. Ludwig, and Henry I. Shaw, Jr., Pearl

Harbor to Guadalcanal, History of U.S Marine Corps

Operations in World War II (Washington, D.C.:

Historical Branch, G–3 Division, Headquarters, U.S.

Marine Corps, 1958), pp. 23–34. On the engineer

brigades, see William F. Heavey, Down Ramp! The Story of

the Army Amphibian Engineers (Washington, D.C.:

Infantry Journal Press, 1947). The 3d and 4th Engineer

Special Brigades followed at the end of 1943 and in

mid-1944, respectively. 3

The ALAMO Force, an independent tactical organization virtually interchangeable with the Sixth Army,

was MacArthur’s way of evading the creation of a true

combined command by isolating the Australian ground

force commander, General Sir Thomas Blamey. For a

personal view of MacArthur as a leader, strategist, and

friend, see Roger O. Egeberg, General MacArthur and the

Man He Called “Doc” (New York: Hippocrene Books,

1983). Egeberg was MacArthur’s physician.

4

Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 18g, pp. 52–53,

file 314.7; Rpt, Surg, Alamo Force, 30 Sep 43, sub:

Medical Activities, p. 1, The Historical Unit (THU)

Note Cards, Historians files. Both in Historical Unit

Medical Detachment (HUMEDS), Record Group (RG)

112, National Archives and Records Administration

(NARA), Washington, D.C. 

178 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
bined force under Australian command

fought an enemy dug in along the tops

of steep jungle-covered ridges.5

From battalion aid stations casualties

were carried by native litter-bearers to

the beach. “Over trails hardly wide

enough for a man to walk,” wrote the

41st Division historian, “skirting cliffs

often five hundred feet high, they carried the wounded safely and gently.

Always there was the soothing comment,

‘Sorry Boss,’ at the lightest jolt of the litter.” On the shore a collecting platoon

and portable surgical hospitals stood

ready with operating rooms dug into the

sand, embanked with logs or sandbags

and covered with tents. In the later

stages of the Salamaua fight the 24th

Portable Surgical Hospital moved

inland to aid the Australians, sending its

transportable wounded to the coast over

the same steep and winding trails. Both

supply and evacuation were by landing

craft, which continuously provided support from the sea. Salamaua fell on 12

September, but the cost was high: The

162d Infantry lost 102 killed and 447

wounded, and malaria, dysentery, and

skin infections further reduced its

troops from 2,554 to 1,763.6

While the Japanese still resisted at

Salamaua, the Australian 9th Division

stormed ashore to the enemy’s rear,

near Lae. Medics of the two Allies each

had their assigned tasks. Australian

organic medical units—regimental aid

posts and an advanced dressing station—accompanied the assault troops.

Forty minutes after H-hour the 532d

Engineer Boat and Shore Regiment of

the 2d Engineer Special Brigade came

ashore in its own landing craft (all other

vessels were provided by the Navy’s VII

Amphibious Force) to organize the

beach and bulldoze a road inland

through the cocoanut groves that lay

beyond. The regimental medical

detachment set up aid stations on the

sand, and a medical company of the

262d Medical Battalion established a

clearing station beside the central axis

of the beach. Medics unloaded and carried their own equipment; all went

armed with rifles, pistols, or carbines.

The only potentially serious foul-up was

a breakdown in communication with

the Navy. Fearing enemy bombers at

Morobe, the large troop carriers—LSTs

(landing ship, tank) and LCIs (landing

craft, infantry)—were rerouted to Buna,

a fact discovered by a medical officer

from the Sixth Army headquarters, who

instructed the 262d to shift medical

resupply down the coast.7

Then American paratroopers of the

503d Parachute Infantry descended on

an enemy airstrip at inland Nadzab, in

the Markham River valley. Their C–47s

came in low and fast, and each jumped

with some 90 pounds of equipment.

Many drifted into the jungle, snagging

their chutes in the tops of trees. Natives

again helped to retrieve casualties, and

prompt action by the regimental medical detachment in administering blood

5

Surg, Med Det, 112th Cav, Quarterly Rpt, Jul–Sep

43, p. 1, THU Note Cards, Historians files; Surg, 41st

Inf Div, Quarterly Rpt, Apr–Jun 43, p. 1, file 319.1. Both

in HUMEDS, RG 112, NARA. 6

Quotations from William F. McCartney, The

Jungleers: A History of the 41st Infantry Division

(Washington, D.C.: Infantry Journal Press, 1948), p. 55.

Statistics from Miller, CARTWHEEL, p. 202. See also 116th

Med Bn Diary, 1 Jul–5 Oct 43, file 319.1 (116th Medical

Battalion Diary) 14 Dec 42–30 Oct 43; Notes on Surg,

Med Det, 162d Inf, Sanitary Rpt, Aug–Sep 43, pp. 1–2,

and on idem, Quarterly Rpt, Jul–Sep 43, pp. 1–2,

Historians files. All in HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 179

7

Rpt, Maj Albert M. Dashiell, 14 Sep 43, sub: Landing

Operations, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA. 
plasma saved many lives. Three died and

34 were injured in the jump; skirmishing on the ground cost an additional 8

killed and 12 wounded—all in all, a

small price for a major prize.8

A few weeks later the Australians, supported by the 2d Engineer Special

Brigade and by Company B, 262d

Medical Battalion, landed on the tip of

the Huon Peninsula, capturing

Finschhafen on 2 October (see Map 8).

Again the Navy provided partially converted LST–Hs, each carrying a naval

medical officer and equipment for

emergency surgery. A medical corpsman

rode each of the smaller “Higgins

boats,” landing craft with drawbridge

bows. The assault force was without dedicated hospital ships, but one LST—

number 464—was converted into a 175-

bed hospital to care for casualties from

the landing beaches and transport them

to Milne Bay. Six to eight Navy medical

officers and about forty corpsmen

staffed the vessel.9

The Japanese fought back with vigor,

both on the ground and with heavy air

raids from fields in New Guinea and

Rabaul. Casualties were evacuated to the

beaches during the hours of darkness, a

8

503d Parachute Inf Quarterly Rpt (copy), Jul–Sep

43, file 319.1, HUMEDS, RG 112, NARA.

9

“Seventh Amphibious Force Command History, 10

January 1943–23 December 1945,” pp. 65, 76–77, file

314.7 (7th Amphibious Force) SWPA; Surg, 2d Engr

Spec Bde, Quarterly Rpt (copy), Jul–Sep 43, pp. 11, 13.

Both in HUMEDS, RG 112, NARA. See also Alan S.

Walker, The Island Campaigns, Australia in the War of

1939–1945, Series 5, Medical (Canberra: Australian

War Memorial, 1957), p. 182. The partially converted

LST–H also was used in the New Britain and Hollandia

campaigns, which are discussed later in this chapter. 

180 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MEDICS ADMINISTERING PLASMA
tedious task complicated by blackouts,

continuous rain, and muddy roads.

When jeeps and even high-wheeled

Australian ambulances could not get

through, native litter-bearers hand-carried the wounded, sometimes for three

hours or more, on rough corduroy

tracks laid down over the mud.

Throughout the operations from

Nassau Bay to Finschhafen, litters also

were used to transport those suffering

from the familiar New Guinea triad of

dysentery, malaria, and scrub typhus.

Malaria was commoner among the

Australian forces, whose personal malaria discipline was, despite officer supervision, often lax—for example, mosquito

nets were routinely discarded. But sickness was not serious enough to interfere

with operations. By the end of 1943

MacArthur’s forces controlled most of

the Huon Peninsula, and with it Vitiaz

Strait, the strategic waterway that separated New Guinea from Japanese-held

New Britain.10

Despite SWPA’s growing competence

in amphibious warfare, the campaign

underlined a need for further refinements. Problems in coordinating the

movement of casualties showed that a

naval medical officer should be attached

to the beach party to act as liaison with

Navy evacuation craft. “Such an officer,”

noted the VII Amphibious Force historian, “would be familiar with the capacities of ships, the medical specialties

available in them, and able to classify

and move the wounded quickly.”

Forward bed strength proved to be inadequate. Despite the diversion of some

wounded farther down the coast, the

190 beds in the clearing station at

Morobe were overwhelmed, with an

average occupancy rate of 87 percent.

Such problems indicated that the lack of

a functional chief surgeon was felt not

so much in the planning phases of an

operation but rather in the later periods, when a single coordinating authority was needed to make readjustments to

meet unexpected events. Overall, however, the joint and combined operations

had brought a brilliant success, in which

the medics fully shared.11

New Georgia

Meanwhile, the marines and soldiers

of the South Pacific Area, advancing

against the enemy-held islands of the

Solomons, fought a more wearing campaign with less adequate medical support. The loss of Guadalcanal moved the

Japanese to strengthen their forces in

the central and northern Solomons. The

new objective for American forces was

New Georgia, the largest island group in

the archipelago. The main island of New

Georgia measures 45 miles along its

northwest-southeast axis; to the south,

west, and northwest smaller islands cling

like satellites, among them Kolombangara, Arundel, Rendova, and Vangunu.

A threatening environment awaited

America’s fighting men, and strong

11“Seventh Amphibious Force History,” p. 65 (quotations), file 314.7 (7th Amphibious Force) SWPA; Surg,

Med Det, 162d Inf, Quarterly Rpt, Jul–Sep 43, THU

Note Cards, Historians files. Both in HUMEDS, RG 112,

NARA.

AMPHIBIOUS ADVANCE 181

10Walker, Island Campaigns, pp. 169–89; App. S,

Medical, to 7th Australian Div Opns Rpt, 1–16 Sep 43,

pp. 199–204, file 98 GHQ 1–3, box 857, RG 407, NARA;

Department of the Navy, Bureau of Medicine and

Surgery, “The United States Navy Medical Department

at War, 1941–1945,” 1:188–90, files of Bureau of

Medicine and Surgery Archives (BMSA), Washington,

D.C. See also Surg, 2d Engr Spec Bde, Quarterly Rpt

(copy), Jul–Sep 43, pp. 8–14, and 22d Port Surg Hosp

Quarterly Rpt, Jul–Sep 43, pp. 3–5, file 319.1,

HUMEDS, RG 112, NARA. 
ADMIRALTY IS

NEW 

 IRELAND

NEW BRITAIN

D'ENTRECASTEAUX 

 ISLANDS

Goodenough I

Kiriwina I

BISMARCK

ARCHIPELAGO

Madang

Finschhafen

Arawe

Lae

Salamaua

Wau

Gona Buna

Dobodura

Kokoda

Port 

Moresby

Rabaul

NORTHEAST NEW GUINEA

PAPUA

O W E N

S T A N L E Y

R A N G E

Huon 

Peninsula

Huon Gulf

Milne Bay

SOLOM

SEA

Saidor

Cape Gloucester

116th Medical Battalion (-)

262d Medical Battalion (-)

10th, 16th, and 24th Portable Surgical Hospitals

Medical Detachment, 532d Engineer Boat and Shore Regiment

107th Medical Battalion (-)

262d Medical Battalion (-)

670th Medical Clearing Company (-)

5th, 6th, 8th, 13th, 17th, and 22d Portable Surgical Hospitals

23d Field Hospital

5th Malaria Survey Unit

135th Medical

29th Evacuati

6th, 8th, and 13th Porta

30th Evacuati

1st Medical Squadron

603d Medical Clearing Company

58th Evacuation Hospital

27th and 30th Portable Surgical Hospitals

52d Malaria Control Unit

28th Malaria Survey Unit

MAP 8
BOUGAINVILLE

CHOISEUL

SANTA ISABEL

GUADALCANAL

NEW 

 GEORGIA

Woodlark I

Russell Is

Florida I

Rendova

Kolombangara

Vella 

 Lavella

Treasury Is

Shortland I

Buka I

Green Is

Feni Is

SOLOMON

ON ISLANDS

THE

S LOT

ELEVATION IN FEET

0 3000 6000 9000 and Above

Miles

0 150

ARMY MEDICAL SUPPORT

OPERATION CARTWHEEL

June 1943–May 1944

Note: Not all inclusive.

118th Medical Battalion (-)

25th Medical Battalion (-)

112th Medical Battalion (-)

17th Field Hospital

112th Medical Battalion

52d Field Hospital

21st Evacuation Hospital

31st and 33d Portable Surgical Hospitals

l Regiment (-)

ion Hospital

able Surgical Hospitals

ion Hospital
Japanese units garrisoned the natural

harbors as well as the airfields on

Kolombangara, Vangunu, and New

Georgia’s Munda Point.

Colonel Maxwell, the USAFISPA chief

surgeon, prepared for an advance

against New Georgia with the assistance

of Col. Franklin T. Hallam, MC, the XIV

Corps surgeon. Responsible for tactical

coordination of the medical services of

the Army and the Navy, Hallam established good working relations with the

senior medical officers of both services

and the restive Army Air Forces. But

even as ships headed north from bases

in the Russell Islands and Guadalcanal,

deficiencies in medical manpower cast

shadows over the large, complex campaign that lay ahead. Maxwell had not

yet adopted SWPA’s innovation of the

portable surgical hospital, and the 43d

Infantry Division entered battle some

30–35 percent understrength in medical

personnel, both officer and enlisted—a

forbidding statistic, given the primitive

tropical terrain where both soldiers and

marines would have to fight. The medical evacuation plan relied on support

by a single clearing company, which

would act as the division hospital, and by

two collecting companies. For the

moment, the 17th Field Hospital

remained on call in the Russells.12

On the night of 29–30 June elements

of the 43d Division, supported by the

collecting companies of its 118th

Medical Battalion, made simultaneous

landings on Rendova, southern New

Georgia, and Vangunu. Bitter fights in

sodden jungles and flooded marshes

yielded control of important anchorages

as staging areas for further action. The

enemy garrison on Rendova scattered,

and the clearing company and

Collecting Company C set up there. But

Japanese air attacks wreaked havoc on

American supply dumps along the

beach, destroying most of the clearing

station’s equipment. For a time only

emergency treatment could be given,

and wounded waited twenty-four hours

or more for hospital care on

Guadalcanal. Of all deaths by enemy

action sustained during the campaign,

50 percent occurred in the first two

weeks.

Leaving the clearing company to

replace its equipment, the 43d

Division’s 172d and 169th Infantry, supported only by a few collecting platoons,

crossed Blanche Channel to northwest

New Georgia, aiming an assault at

Munda airfield. Meanwhile, a mixed

force of soldiers and marines from

Guadalcanal landed north of Munda to

cut Japanese communications. On both

fronts jungle fighting at its worst

ensued. The troops pushed their way

through trackless terrain, alternately

steep and swampy. Mud, heat, and

unceasing rain slowed progress. All the

dismal complications of diarrhea, dysentery, and skin infections harassed the

men. Malaria, despite rigorous control

measures, was a constant problem for

units whose soldiers were already infected when they came ashore. Fatigue, danger, and sickness brought on stress reactions; tension was unrelenting, for the

enemy skillfully infiltrated American

lines at night. Even veterans were subject to strange delusions: “In their

minds, the phosphorescence of rotten

logs became Japanese signals. The smell

of the jungle became poison gas. . . .

The slithering of the many land crabs

12Memo, Lt Col H. S. Tubbs to CofS, USAFISPA, 6

Jun 43, sub: Planning New Georgia Operation, THU

Note Cards, HUMEDS, RG 112, NARA.

184 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
was interpreted as the sound of

approaching Japanese.”13

In the darkness the troops fired their

weapons and hurled grenades blindly.

Almost 16 percent of casualties were

later judged to have been caused by

friendly fire—a high proportion, even

for jungle fighting. Neuropsychiatric

casualties were many; the 169th Infantry

alone suffered 700 by 31 July.

Contributing to a crisis in morale were

hunger and the difficulty of getting the

wounded to treatment. Since the

absence of roads prohibited the use of

vehicles, except jeeps on the wider trails,

some regiments had to carry forward

their own ammunition, supplies, and

casualties. The clearing station on

Rendova was quickly overwhelmed,

exposing the inadequacy of medical

support for the bruising battle.14

Soon the theater command realized

that the New Georgia front must be revitalized, new tactics developed, and a

more efficient supply system established. At the urging of General

Harmon, the USAFISPA commander,

Admiral Halsey ordered the XIV Corps

staff to New Georgia to take over supply,

administration, and planning. On 11

July Maj. Gen. Oscar W. Griswold, the

corps commander, arrived on Rendova.

Shortly afterward, elements of the 25th

Infantry and 37th Infantry Divisions

were ordered in, and on 17 July

Griswold took command of the expanded New Georgia forces. Medical support

was likewise enlarged, with the newly

arrived 25th Division supported by its

25th Medical Battalion and the 37th

Division by its 112th Medical Battalion.

On 28 July the 17th Field Hospital landed and opened on the islet of Kokorana,

off Rendova (see Map 8). (A Navy malaria control unit had landed two weeks

earlier, surveyed campsites, and oiled

troop bivouac areas.)15

Meanwhile, a new offensive began,

employing infantry, tanks, flamethrowers, and artillery support. Fighting as difficult and bloody as any on Guadalcanal

followed before Griswold’s forces

secured Munda airfield on 6 August.

Mopping-up operations and seizure of

the nearby islands of Vella Lavella and

Arundel took another six weeks.

Between 23 July and 10 September the

112th Medical Battalion alone treated

more than 3,000 cases, including almost

1,000 battle casualties.16

The four-month campaign for the

central Solomons was over, but at a

heavy cost. American battle casualties

totaled 1,094 dead and 3,873 wounded;

added to the victims of accident, disease, and stress, more than 8,300 casualties were evacuated during July, August,

and September. As the initial invasion

force, the 43d Division suffered the

most; its 172d Infantry counted 1,550

wounded or sick, 777 from a single battalion. The Japanese numbered about

2,500 dead, and successfully evacuated

some 9,400 others. They lost the fight,

but had perhaps more reason than the 13Quotation from Miller, CARTWHEEL, pp. 108–09. See

also ASF [Army Service Forces] Monthly Progress Rpt,

30 Nov 43, sec. 7, p. 8, THU Note Cards, Historians

files, HUMEDS, RG 112, NARA. 14Rpt, Surg, XIV Corps, to CSurg, USAFISPA, 31 Oct

43, sub: Medical Service, New Georgia Campaign, p. 32,

Encl to 1st End, CSurg, USAFISPA, to SG, U.S. Army, 11

Nov 43, file 370 (Medical Service, New Georgia

Campaign) SPA, HUMEDS, RG 112, NARA.

15112th Med Bn Annual Rpt, 1943, p. 4, THU Note

Cards, Historians files; CSurg, USAFISPA, Annual Rpt,

1943, pp. 9–10, file 319.1–2. Both in HUMEDS, RG 112,

NARA. See also “Navy Medical Department at War,”

1:109, BMSA. 16112th Med Bn Annual Rpt, 1943, p. 4, THU Note

Cards, Historians files, HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 185
Americans to be satisfied with the behavior of their troops and the skill of their

leaders. In the words of Samuel Eliot

Morison: “We had Munda, and we needed it for the next move toward Rabaul;

but we certainly took it the hard way.”17

Medical Support

The long catalogue of medical problems began with a shortage of not only

leaders but those with essential skills.

Competent surgeons were particularly

scarce. At least 90 percent of the medical officers sent to the South Pacific

Area as replacements had little or no

field training and no combat experience. Tyros were assigned to battalion

aid stations or to clearing stations, while

senior medical officers shifted their

small supply of qualified surgeons to the

most critical positions. Officers of the

Dental, Veterinary, and Medical

Administrative Corps filled nonclinical

jobs and, in some cases, devoted full

time to the management of evacuation.

Despite such expedients, the wounded

suffered, a report of 4 November noting

“improper treatment of war wounds due

to the inexperience and lack of training

of the medical officers who first treat the

casualties.”18

Fundamental problems in supply

underlay other difficulties. After ordering far in excess of its needs, the 43d

Division had left the bulk of its medical

supplies behind in the Russell Islands,

or on Guadalcanal, indiscriminately

dumped on the beaches awaiting transportation. Since ships were scarce, and

supplies improperly labeled, many necessary items never arrived at all, including most of the division’s medical maintenance units and hence its resupply

capability. Often what did arrive could

not be found; careless marking of containers resulted in medical supplies

becoming mixed with rations, fuel, and

ammunition. Within three days of the

initial landing, emergency requisitions

had to be forwarded to Guadalcanal,

and only prompt action by the depot

there made it possible for the division to

receive its medical supplies. 

Units that arrived later handled medical supply better, and Colonel Hallam,

after arriving on New Georgia with the

XIV Corps headquarters, improved the

situation further. He ordered a search of

the island’s beaches for the 43d’s supplies, set up a depot on Rendova, and

ordered new thirty-day medical maintenance units from Guadalcanal.19

Manpower was as short as leadership

and supplies. The result was to hinder

evacuation. Jungle warfare meant dispersion, with small units often operating

alone, and in consequence, company

aidmen—the first link in the medical

chain—were too few. Replacements for

losses in medical units were slow to

arrive, and a lack of litter-bearers resulted in many casualties left lying where

they fell, easy prey to enemy infiltrators,

insects, leeches, and the jungle dampness. Surgeons sought to correct the situation by borrowing combat troops, 17Quotation from Morison, Naval Operations in World

War II, 6:224. Statistics from Miller, CARTWHEEL, pp.

187–88. See also Whitehill, “Medical Activities in

Middle Pacific,” block 18g, pp. 1–3, file 314.7; Interv, Lt

Col Hobart Mikesell, 18 Nov 43, file 000.71. Both in

HUMEDS, RG 112, NARA. 18OofSurg, USAFISPA, ETMD (copy), 4 Nov 43, p. 2,

file 350.05, HUMEDS, RG 112, NARA.

19Ibid., 17 Sep 43, p. 6, and 2 Oct 43 (copy), pp. 4–5,

file 350.05; Whitehill, “Medical Activities in Middle

Pacific,” block 18g, pp. 14–20, file 314.7; Intervs,

Mikesell, 18 Nov 43, and Lt Col C. P. Slaughter, 23 Dec

43, file 000.71. All in HUMEDS, RG 112, NARA.

186 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
which depleted the line units. Matters

were no better when the battle wounded

reached the rear areas, for hospitalization was inadequate in the beginning

and, despite improvements, remained so

throughout the campaign. During the

first month of combat, a period of heavy

casualties when no hospitals at all were

available, the clearing station on

Rendova provided beds equal to only 1.5

percent of the entire force. (By contrast,

on Guadalcanal the Americal Division

had been supported by three clearing

companies, all reinforced, with a total of

800 beds—about 5 percent of division

strength.) Nor did the available Navy

and Marine units ashore and afloat provide adequate hospital facilities; no hospital was available until the Navy’s Cub

Three unit arrived in late September.20

In late July matters improved. The

37th Division brought in its clearing

company, which worked in two platoons;

and the 25th Division brought one clear20Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 7–13, file 314.7; 118th Med Bn Annual

Rpt, 1943, p. 2, file 319.1–2; CSurg, USAFISPA, Annual

Rpt, 1943, p. 10, file 319.1–2; Rpt, Surg, XIV Corps, to

Surg, USAFISPA, 31 Oct 43, pp. 2–3, 8–9, Encl to 1st

End, CSurg, USAFISPA, to SG, U.S. Army, 11 Nov 43,

file 370 (Medical Service, New Georgia Campaign)

SPA. All in HUMEDS, RG 112, NARA. The Navy’s Cub

Continued

AMPHIBIOUS ADVANCE 187

CLEARING COMPANY, 37TH DIVISION, AT WORK
ing platoon to New Georgia, while the

other supported its 35th Infantry in the

invasion of nearby Vella Lavella. In all,

about 375 clearing station beds were

added to 250 made available through

expansion of the original clearing station on Rendova. And on the twentyeighth the 250-bed 17th Field Hospital

arrived. Yet the average bed strength of

875 during August was equal only to 3

percent of the expanded forces in the

New Georgia group, still insufficient

given the level of combat and the hostile

environment. Casualties were slow to

reach these facilities but quick to leave

them. Until 15 August an evacuation

policy of twenty-four hours prevailed,

and after that three to five days. Only on

20 September, when the campaign was

drawing to a close, did the command at

last attain a seven-day policy.

For wounded troops returning to the

bases, “hurry up” once more gave way to

“wait.” The road to treatment proved

longer than the 200 miles of water to

Guadalcanal might suggest. LSTs bore

87 percent of New Georgia’s casualties,

averaging 100–200 or more per trip, but

their management was far from ideal.

Problems began with scheduling.

Medical units ashore had to make their

own arrangements with the ships’ commanders, an uncertain method at best;

careful coordination was needed even to

ensure that basic preparations were

made—that the holds were clean and

cots readied before the customary

departure time of 1800. Frequently, the

ships unloaded so late in the afternoon

that little time was left to bring casualties

aboard, make them comfortable, and

exchange litters and blankets. Sailors

joked that LST meant “Large Slow

Target,”21 and the voyages to

Guadalcanal, lasting between twenty

and twenty-four hours, lent credence to

the name. For many of the wounded,

taking into account delays on New

Georgia and on shipboard, seventy-two

or even eighty-four hours might elapse

between initial injury and definitive

treatment. Inevitably, wounds became

infected, and gas gangrene sometimes

set in.22

Until Munda airfield became operational on 14 August, evacuation by air

was limited to those whose condition

required immediate care. Navy amphibious planes carried such casualties,

despite Hallam’s complaint that the slow

and clumsy “dumbos” required the protection of fighter planes urgently needed for combat. The whole situation was

greatly eased when the airfield opened;

wounded soldiers, sailors, and marines

alike were dispatched in marine-piloted

craft of the Air Transport Command’s

Pacific Wing. Until then, New Georgia

too often presented the image of an

area of severe combat and rampant dis21Arrangements on LSTs improved after Colonel

Hallam contacted Navy officers with whom he had

worked before the campaign to see that more medical

supplies and a second medical officer were added to

each ship. 22Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 2–8, file 314.7; Rpt, Surg, XIV Corps, to

CSurg, USAFISPA, 31 Oct 43, pp. 5–6, Encl to 1st End,

CSurg, USAFISPA, to SG, U.S. Army, 11 Nov 43, file 370

(Medical Service, New Georgia Campaign) SPA. Both

in HUMEDS, RG 112, NARA.

188 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

Three unit was established in September 1942 to operate as a 200-bed base hospital or, depending on the mission, as a number of dispensaries. Hospital personnel

and equipment could be divided to function as separate groups, where needed. Arriving in the South

Pacific in the spring of 1943, elements of the Cub

Three unit participated in the Rendova and New

Georgia operations before, in its entirety, being sent to

Munda, New Guinea, in September. On 16 January

1944, effective 24 December 1943, the Cub Three unit

was redesignated as U.S. Naval Base Hospital No. 11. 
ease, its sick and wounded unable to be

treated or even to be evacuated in sufficient time to promote their recovery.23

The New Georgia disease picture was

mixed but on the whole unsatisfactory.

Anopheles mosquitoes were not abundant

by Solomon Islands standards, and a

Navy malaria control unit, landing in

July, helped to prevent new cases of the

disease from becoming a major problem. Practically, all malaria cases were

recorded in soldiers previously infected

on Guadalcanal. There the 25th

Division had an admission rate of 1,313

per 1,000 troops per year; the unit actually recorded a lower rate on New

Georgia during the fighting. Yet those

who entered battle “thoroughly saturated with malaria” fell sick with alarming

frequency, as New Georgia’s 2,900

admissions for malaria testified.24

Other diseases were clearly of local

origin. Poor field sanitation produced

serious outbreaks of diarrhea and dysentery, to which line commanders, soldiers, and the medics all contributed,

because of poor discipline and inadequate supervision. Waste disposal was

ineptly handled, and the absence of

screens on messes, kitchens, and latrines

allowed the fly population to increase; a

limited water supply made washing of

utensils difficult, and the troops’ hands

were seldom clean. Medical personnel

treated patients with fluids, rest, and

doses of sulfaguanidine. But prevention,

not cure, ensures combat readiness, and

by that standard performance was poor.

Admissions reached 500 per 1,000

troops per year in August; 18 percent of

hospital admissions were caused by diarrhea and dysentery, a substantial drain

on the command.25

The major medical problem encountered at New Georgia, however, was the

high incidence of stress-related ailments, all lumped under the general

classification of war neuroses. Included

were problems that ranged from

exhaustion to psychosis. The 43d

Division, though it comprised only 40

percent of the forces on the island, contributed almost 80 percent of the victims. Most cases occurred during the

first month of combat, when hospitalization was severely limited, a 24-hour evacuation policy was in effect, medical personnel were 30–35 percent short of

authorized levels, and no psychiatrist

was in the area. Some casualties were

“the picture of utter exhaustion”; others

were agitated, trembling and starting at

every sound, “crying, wringing their

hands, mumbling incoherently,” and

“trying to escape impending disaster.”26

At first, these victims were simply

shipped out. The 43d evacuated 1,950 of

its 2,500 neuropsychiatric (NP) cases; a

psychiatrist working at Fiji later remembered receiving several hundred such

patients from New Georgia in a single

day. Yet for many there was a simple

cure. Removing NPs from the line and

giving them three to four days of rest, a

25ASF Monthly Progress Rpt, 30 Nov 43, sec. 7, p. 8–9,

THU Note Cards, Historians files, HUMEDS, RG 112,

NARA. 26Whitehill, “Medical Activities in Middle Pacific,”

block 18g, p. 36, file 314.7, HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 189

23Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 6–7 (“dumbos,” p. 6), file 314.7; Rpt,

Surg, XIV Corps, to CSurg, USAFISPA, 31 Oct 43, p. 6,

Encl to 1st End, CSurg, USAFISPA, to SG, U.S. Army, 11

Nov 43, file 370 (Medical Service, New Georgia

Campaign) SPA. Both in HUMEDS, RG 112, NARA. 24ASF Monthly Progress Rpt, 30 Nov 43, sec. 7, p. 9

(quotation), THU Note Cards, Historians files;

OofSurg, XIV Corps, Summary of New Georgia

Campaign, pp. 1–2, file 370 (New Georgia Campaign)

SPA; Whitehill, “Medical Activities in Middle Pacific,”

block 18e, pp. 28–29, file 314.7. All in HUMEDS, RG

112, NARA.
bath, and nourishing food enabled

75–80 percent to recover completely.

Later to reach the combat zone, both

the 37th and the 25th Divisions set up

rest camps, salvaging, in Hallam’s opinion, about 2,000 who might otherwise

have been evacuated. Again, the need

for forward-area psychiatrists was driven

home. In response to such combat experience, and to “continued and repeated

pressure from senior medical officers in

the combat theaters,” the War

Department established the position of

division psychiatrist in November

1943.27

Summarizing the New Georgia situation, Hallam emphasized that disease

(including psychiatric disorders) warranted major consideration in operational planning. Of a force of soldiers

and marines that never exceeded

35,000, a total of about 13,500 admissions had been recorded—again, as at

Attu, more than the whole enemy garrison. Of these, 27 percent had been

wounded, 11 percent injured, and 62

percent sick. In future operations,

Hallam emphasized, the forces would

need mobile surgical units; forward surgical teams; medical, surgical, and psychiatric consultants; convalescent camps

to conserve manpower; and more adequate hospitals, with laboratory personnel to speed diagnosis of the many tropical ills.28

If the medical side of the campaign

for New Georgia was run worse than the

campaign for Guadalcanal, the struggle

itself was in some respects more wearing. The soldiers and marines on New

Georgia were unable to fight a largely

defensive battle, as the marines had on

Guadalcanal, where the fighting was

aggressive throughout. In the earlier

campaign Henderson Field had fallen

to the Americans almost at once, virtually undefended; on New Georgia, Munda

airfield yielded only after a bitter and

protracted struggle. Of courage there

was much evidence on New Georgia,

among the medics as well as the line.

The medics of the 118th Medical

Battalion alone received three Silver

Stars, a Legion of Merit, twenty-one

Purple Hearts, and a variety of other

decorations; one medic, Pfc. Frank J.

Petrarca, was awarded the Medal of

Honor. Yet in the last analysis the battle

was won by the sheer weight of numbers,

and the medical support system did not

work very well at all.29

The situation cried out for planning

that would not again send one division to

do the work of three, or a clearing station

to perform the duties of a field hospital.

To the theater’s credit, learning was swift.

It was New Georgia, not Guadalcanal,

that compelled USAFISPA headquarters

to face up to the medical realities of jungle warfare, and the theater’s last major

fight, at Bougainville, was conducted in a

far more competent style.

28OofSurg, XIV Corps, Summary of New Georgia

Campaign, pp. 1–2, file 370 (New Georgia Campaign)

SPA, HUMEDS, RG 112, NARA. 29118th Med Bn Annual Rpt, 1943, an. 3, p. 2, file

319.1–2, HUMEDS, RG 112, NARA.

190 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

27Quotation from Lloyd J. Thompson, “Early

Developments, Personnel, and Education and Training,”

in Albert J. Glass, ed., Overseas Theaters, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1973) p. 196n9. On the division psychiatrist position, see WD Cir 290, 9 Nov 43, p. 2.

See also Intervs, Slaughter, 23 Dec 43, and Maj Theodore

Lidz, 26 Mar 45, file 000.71; Ltr, M. Ralph Kaufman to

Col Earl Maxwell, 16 Dec 43, sub: Neuropsychiatric

Experiences With the 17th Infantry Division, in OofSurg,

USAFISPA, ETMD, 6 Jan 44, file 350.05; and Personal

Opinion of Maj Harold J. Barker, MC, as to the New

Georgia Campaign, 6 Sep 43, THU Note Cards,

Historians files. All in HUMEDS, RG 112, NARA.
Bougainville

While MacArthur’s forces battled on

the Huon Peninsula and the soldiers and

marines on New Georgia bogged down,

Colonel Maxwell prepared to support

Halsey’s assault against Bougainville, on

the northernmost and largest island of

the Solomon chain. Bougainville is 125

miles long and 30 to 48 miles wide, with

a mountainous spine formed by two

ranges with active volcanoes, the largest

of which rises to 10,000 feet. The slopes

are covered with rainforest even denser

than on Guadalcanal. On the southern

coast an undulating plain 15–20 miles

wide fans out from the base of one

range, with cocoanut plantations, most

of the native population, two enemy airfields, and, in 1943, the only roads on

the island that were passable to vehicles.

Here the Japanese concentrated their

forces, expecting attack. 

To traverse the rest of the island,

natives used a network of jungle trails

and, along the coast, dugout canoes. A

thinly inhabited area fronted Empress

Augusta Bay on the west coast, where

swamps and brackish lagoons formed by

many small rivers provided nurseries for

disease-bearing insects. On this inhospitable but weakly garrisoned shore the

Americans proposed to land, establish a

beachhead, and seize or build airfields

to mount strikes against Rabaul.30

The attack was a joint operation,

involving both Army and Marine units.

General Vandegrift, reassigned as commander of the I Marine Amphibious

Corps and a hero of Guadalcanal, led

the landing forces. Detailed planning of

naval operations was the responsibility

of Rear Admiral Theodore S. Wilkinson,

commander of the III Amphibious

Force. Maxwell coordinated planning

with the Navy, aiming above all to avoid

the medical mistakes that had darkened

previous campaigns in the islands. 

He augmented divisional support,

attaching to the collecting companies

surgical teams, each of which consisted

of two surgeons, an anesthetist, and two

enlisted technicians. Clearing companies were reinforced with both personnel and equipment so that they could

function, in effect, as division hospitals.

(Portable surgical hospitals were on

order, but had not yet arrived in the

theater.) With the 37th Division’s 112th

Medical Battalion went surgical, medical, orthopedic, and psychiatric consultants; laboratory teams; malaria control and survey units; and a casual company to operate a rest camp.31 Maxwell

also planned to land hospitals soon

after the assault; however, shipping

shortages at the time prevented the

move. As soon as conditions permitted,

he sent from Guadalcanal the 380-bed

52d Field Hospital, mainly to care for

the service troops, and the 750-bed 21st

Evacuation Hospital—a highly skilled

affiliated unit staffed by the University

of Oklahoma—to care for the combat

troops (see Map 8).32

30Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 57–58, file 314.7, HUMEDS, RG 112,

NARA.

31A casual company was part of a clearing company,

but it actually functioned as a separate unit, successfully operating a convalescent camp that provided casualties with food, quiet surroundings, and light activity

before their return to frontline duty. See ibid., p. 75,

file 314.7, HUMEDS, RG 112, NARA. 32Ibid., p. 66, and block 8, p. 122, file 314.7, HUMEDS,

RG 112, NARA; Benjamin M. Baker, “South Pacific

Area,” in W. Paul Havens, Jr., ed., Activities of Medical

Consultants, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1961), pp. 589–90.

AMPHIBIOUS ADVANCE 191
In similar fashion, the Navy bolstered

medical support. To the I Marine

Amphibious Corps were assigned three

reinforced medical companies, each

capable of functioning as a 400-bed hospital. Until facilities were ready on

shore, casualties were to be treated on

several LSTs and the attack transport

USS American Legion, all staffed and

equipped to perform surgery.33

After preliminary seizure of the nearby Treasury Islands and a feint against

Choiseul, the 3d Marine Division landed

on the jungled shore of Empress

Augusta Bay on 1 November, a brilliant

tropical morning. The few defenders

were killed or driven inland, and the

marines quickly established a perimeter.

By the end of the first week work had

begun on an airfield at Cape Torokina.

The 37th Division landed to help

defend the perimeter, and on 9

November Maj. Gen. Roy S. Geiger,

USMC, replaced Vandegrift. In some

respects, a replay of the defensive struggle on Guadalcanal ensued. The

Americans prepared for counterattacks

on the ground, while sharp battles in

the air and on the sea effectively

destroyed the significance of Rabaul

except as a defensive bastion. 

Meanwhile, the beachhead grew in

the face of piecemeal counterattacks

from Japanese forces that were still awaiting a nonexistent American assault on

the southern coast. On 15 December

General Griswold’s XIV Corps took over

what was now a heavily fortified 12-milelong perimeter. The swamps were

drained, roads extended, and gardens

dug to provide fresh vegetables for the

troops; the airstrip was completed,

enabling Marine fighters to support

Army bombers in intensive and destructive raids against Rabaul. At last, in

January and February 1944 the Japanese

moved by foot along jungle trails and by

barge around the coast to launch a belated counterattack. Heavy fighting along

the perimeter reached a climax during

March, as Griswold’s well-organized

defense, aided by naval gunfire and air

support, defeated three strong enemy

assaults. After a few engagements in

April the Japanese, long cut off from

reinforcements and supplies by

American command of the sea and air,

withdrew from the perimeter, never

again to play a significant part in the war.

Medical Support

When the 37th Infantry Division landed on Bougainville, the Navy hospitals of

the 3d Marine Division, already well

established, cared for Army casualties

until the collecting and clearing stations

of the 112th Medical Battalion were

ready. Thereafter, hospitalization was

more than adequate. Indeed, the low

casualty rate early in the campaign

made the surgical teams attached to the

collecting companies unnecessary and,

after serving briefly, they returned to

New Caledonia. In mid-December the

52d Field Hospital became the principal

facility for the care of serious cases, until

the 21st Evacuation Hospital opened in

February 1944. Working only 4,000

yards from the front line, the 21st

received most of those seriously wounded in the March attack, often directly

from the aid stations. Ample bed

strength well forward made possible a

thirty-day evacuation policy as soon as

the assault stage was over. Casualties

judged to be fit for duty within that time

33“Navy Medical Department at War,” 1:123–24,

BMSA.

192 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
were not lost to their units through evacuation; only forty-eight were removed

from the island during the first six

weeks. The campaign’s record in this

respect set it apart from all previous

Allied efforts in the Pacific fighting.34

Yet the jungle and the enemy combined to impose serious difficulties on

the medics and their charges. Until midDecember the marines evacuated from

battalion aid stations to field hospitals

by amphibious tractors through the

swamps. Then construction crews completed a road system within the perimeter that allowed motor ambulances to

provide rapid and efficient service even

during the March attacks. Most casualties arrived at a hospital within three

hours of wounding, and many within

one hour. But evacuation for those who

ventured outside the perimeter

remained difficult and dangerous.

Patrols moved as far as 8,000 yards into

enemy-held territory. Casualties had to

be littered back over ridges and draws,

exhausting bearers and patients alike.

Some who were wounded on patrol did

not reach a hospital until twenty-four to

forty-eight hours had elapsed, receiving

only the care that a single aidman could

provide during that window of time.35

Before airfields opened, ships and

PBY “Catalina” amphibious planes evacuated casualties from Bougainville. Both

proved unsatisfactory. For casualties to

reach an amphibious plane entailed

transfers by litter or jeep to the beach,

and from there by tank lighter to a small

crash boat. The crash boat then maneuvered to the plane’s side gunport,

through which the stretcher was manhandled aboard. Evacuation by LST

required movement by litter or jeep to

the beach, and then by tank lighter to

the ship. Most Army casualties, however,

came late enough in the campaign to be

evacuated by land-based aircraft, as airfield construction on Bougainville

enabled Marine C–47s to carry casualties back to Guadalcanal on return runs.

Those needing a long period of convalescence went further, by ship or air to

Espiritu Santo or New Caledonia. 

The primary innovation that distinguished Bougainville was that the Navy

assumed sole responsibility for planning

and coordinating all evacuation from

the beachhead. Centralized control

resulted in minimal confusion and delay

and, in combination with adequate bed

strength on shore, assured that those to

be evacuated were truly in need of care

that went beyond the capacities of the

island.36

Strict attention to the mistakes made

on New Georgia also enabled the Office

of the Chief Surgeon, USAFISPA, to

deal more effectively with disease.

Except for combat fatigue and malaria

brought in by the troops, problems were

few. Of 40,500 who served on

36Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 66–67, file 314.7, HUMEDS, RG 112,

NARA; “Navy Medical Department at War,” 1:132–37,

BMSA.

AMPHIBIOUS ADVANCE 193

34Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 58–77, file 314.7; Surg, XIV Corps,

Annual Rpt, 1943, pp. 1–2, file 319.1–2. Both in

HUMEDS, RG 112, NARA. See also “Navy Medical

Department at War,” 1:123–24, 135, BMSA; Sir Duncan

Stout, “The New Zealand Medical Services,” in Sir

Arthur Salusbury MacNalty and W. Franklin Mellor,

eds., Medical Services in War: The Principal Medical Lessons

of the Second World War (London: Her Majesty’s

Stationery Office, 1968), pp. 701–11. 35Whitehill, “Medical Services in Middle Pacific,”

block 18g, pp. 64–65, file 314.7; Rpt (Extract), Col J. M.

Roamer, Intel Dir, ASF, 12 Jul 44, sub: Lessons From the

Experiences of the 3d Marine Division in the

Bougainville Operations, p. 25, file 350.07

(Bougainville Operations, 3d Marine Div) SPA. Both in

HUMEDS, RG 112, NARA.
Bougainville, only about 5,000 suffered

ailments other than enemy-inflicted

wounds, a remarkably low proportion

on an island afflicted with many infectious diseases. Perhaps because of its

larger population, Bougainville (unlike

New Georgia) recorded malaria,

dengue, scrub typhus, filariasis, pneumonia, influenza, and intestinal parasites among its endemic ills. Skin diseases were common among the natives,

as were eye infections and diphtheria.37

In such an environment the American

forces suffered much discomfort and

scattered cases of severe illness: scrub

typhus, contracted by troops on patrol;

amebic dysentery; diphtheria; and hookworm infection. Malaria was fairly common, and yet, despite the island’s dense

Anopheles population, almost all cases

resulted from earlier infections. Credit

for preventing more infections belonged

to the efforts of the joint malaria and

insect control organization (similar to

SWPA’s joint tropical disease control

committee) under Comdr. James J.

Sapero, MC, USN. Pre-invasion indoctrination of the troops, stressing individual

malaria discipline, was supplemented on

Bougainville with a well-planned and

well-executed program of ditching,

draining, dusting, and oiling that was

begun immediately after the first landing

37Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 58, 69–77, file 314.7, HUMEDS, RG 112,

NARA; “Navy Medical Department at War,” 1:130–31,

BMSA.

194 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

UNLOADING CASUALTIES AT A COLLECTING STATION
and carried out by malaria survey and

control detachments, which had gradually increased in number during 1943.

Other health problems were less

threatening. The wet, steaming jungle

and the limited opportunities to bathe

resulted in the usual skin conditions,

which were painful and distressing but

seldom required hospitalization. The

casual company’s rest camp, by treating

skin diseases along with ear, eye, and

sinus infections, enabled many soldiers

to stay on the island who might otherwise have been evacuated; an expert

dermatologist, had one been assigned,

might have saved more. The majority of

casualties, however, were victims of

exhaustion or combat fatigue; for them

the camp provided a quiet respite

before they returned to duty. In contrast

to the heavy evacuations from New

Georgia, over 90 percent of the 37th

Division’s battle fatigue cases returned

to duty. Division psychiatrists, appearing

for the first time during this campaign,

provided expert diagnoses to the 37th

and the Americal Divisions, which

already had good records in avoiding

excessive numbers of NPs. Veterans of

earlier campaigns, with good morale

and capable leadership, the soldiers of

the two divisions were matured campaigners, like the medical service that

supported them, and the results were

AMPHIBIOUS ADVANCE 195

LOADING CASUALTIES ON A TANK LIGHTER
nowhere more apparent than in their

NP and evacuation records.38

Overall, the success of the two armed

services in cooperative support for the

campaign was outstanding. For the

Japanese, the consequences of defeat

were grimly predictable. About 10,000

of their soldiers, deprived of supplies

and weakened by hunger, died from

beriberi, dysentery, and malaria. As a

direct result, the Allies’ slight numerical

advantage in November grew to a

marked superiority by March 1944. The

fact that the Army’s mission on

Bougainville was largely defensive

played a substantial role in limiting losses and making the medics’ task easier.

Yet, without good preventive medicine,

fighting on the defensive could have

presented grave health risks of its own to

troops occupying a crowded perimeter

in so hostile an environment.

Henceforth, professionalism and competence were the rule rather than the

exception, a fact confirmed in the last

CARTWHEEL operation—the occupation

of the Green Islands, a little more than

100 miles from Rabaul, against light

enemy opposition.39

New Britain

Meanwhile, important decisions had

emerged about the future of CARTWHEEL

as a whole. At the crucial Casablanca

Conference in early 1943 the Allies had

approved an advance in the central

Pacific. In the spring the Joint Chiefs

resolved upon a double advance, of

which CARTWHEEL was the southern arm.

Though compelling the Japanese to face

two threats had obvious advantages, the

decision meant that the forces

MacArthur and Halsey had counted

upon to aid their advance, notably the 2d

Marine Division, would be diverted

north. General Marshall now perceived

the benefits of bypassing rather than capturing Rabaul; General MacArthur, after

initial resistance, tacitly accepted the idea

as well—and in time became a noted

exponent of bypassing Japanese bases

once they had been isolated and neutralized by the destruction of their air power.

When MacArthur’s forces moved

again in the autumn of 1943, they

sought first to control the northern side

of the straits between New Guinea and

New Britain (the capture of Finschhafen

and the Huon Peninsula had given

them the southern side) by seizing part

of western New Britain, at whose opposite tip lay Rabaul. Cape Gloucester and

the natural harbor of Arawe were chosen as objectives. Arawe was the lesser of

Public Information, Headquarters, U.S. Marine Corps,

1948), pp. 114–19; T. Duncan M. Stout, Medical Services

in New Zealand and the Pacific in Royal New Zealand Navy,

Royal New Zealand Air Force and With Prisoners of War,

Official History of New Zealand in the Second World

War, 1939–45 (Wellington: War History Branch,

Department of Internal Affairs, 1958), pp. 56–63. See

also Notes on Surg, Med Det, 967th AAA Gun Bn,

Quarterly Rpt, Apr–Jun 44, pp. 3–4, and 157th Sta Hosp

Quarterly Rpt, Jul–Sep 44, pp. 2–3, Historians files,

HUMEDS, RG 112, NARA.

196 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

38Whitehill, “Medical Activities in Middle Pacific,”

block 18g, pp. 58, 69–77, file 314.7; Rpt (Extract),

Roamer, 12 Jul 44, pp. 24, 26, file 350.07 (Bougainville

Operations, 3d Marine Div) SPA; Ltr, Kaufman to

Maxwell, 16 Dec 43, in OofSurg, USAFISPA, ETMD, 6

Jan 44, file 350.05. All in HUMEDS, RG 112, NARA. See

also “Navy Medical Department at War,” 1:127–32,

BMSA, and Blanche B. Armfield, Organization and

Administration in World War II, Medical Department,

United States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1963), p. 393. Marine combat fatigue cases,

which outnumbered casualties from all other diseases,

were kept near the front as well. 39The Green Island campaign was carried out by New

Zealand troops, supported by U.S. Army artillery and by

New Zealand and American medical personnel. See

John N. Rentz, Bougainville and the Northern Solomons

(Washington, D.C.: Historical Section, Division of
the two, defended by only a few hundred of the more than 80,000 Japanese

on New Britain.40

The Army task force was built around

the veteran 112th Cavalry. Supporting

medical units included a clearing company and a collecting platoon of the

135th Medical Regiment, the 29th

Evacuation Hospital, and three portable

surgical hospitals. On 15 December the

main landing, led by amphibious tractors, took place against light opposition.

Two enemy companies quickly retreated, but planes from Rabaul attacked the

invaders. Army landing craft, dodging

bomb bursts and strafing, rescued the

survivors of sinking boats.

Hospitals provided close support. A

surgical team of the 29th Evacuation

Hospital landed with the assault troops

and worked on the beach, beside the aid

station (see Map 8). For the first time,

portables operated aboard LCTs (landing craft, tank), assisted by mobile surgical teams of two surgeons and ten corpsmen each. The LCTs frequently came

under enemy air attack, both when they

stood inshore to evacuate casualties

from the beach and when they ferried

the wounded across the embattled

straits. The 29th established itself on the

boot-shaped peninsula that enclosed

the harbor. The swampy ground and the

destruction of cover by American bombardment and Japanese air attacks

AMPHIBIOUS ADVANCE 197

40Arawe was never used either for an airstrip or a PT

boat harbor, the original justifications for taking it. The

118 dead and 352 wounded apparently suffered to no

purpose.

29TH EVACUATION HOSPITAL FOLLOWING THE AIR ATTACK
forced hospital personnel to work in

dugouts, protected by cocoanut logs

and sandbags. Despite this protection,

on 16 December a direct hit blasted the

operating room and killed two enlisted

men, indicating that too large a unit had

come ashore too soon in too vulnerable

an area.41

Meanwhile, the 1st Marine Division

invaded Cape Gloucester on 26

December. The marines secured the

beach with ease, their main obstacle proving to be the swampy jungle that lay

inland. But the campaign thereafter was a

slow, tough advance that involved hacking out jungle trails, maneuvering

through swamps, and fighting a tenacious

enemy on rain-drenched jungle ridges

and in stifling fields of shoulder-high

kunai grass. Ashore, a Navy beach party

officer, for the first time in the Southwest

Pacific Area, worked with the 1st Marine

Division to organize the evacuation of

casualties. Medical units staffed by the

Navy bore the burden of support

throughout the fighting; except for one

collecting company of the 135th Medical

Regiment, Army medical units did not

arrive to relieve them until 30 January

1944. In the opinion of Army observers,

forward care left much to be desired. Col.

William B. Parsons, MC, surgical consultant to General Headquarters, SWPA,

observed some of the evacuees and

reported: “A large percentage . . . were

dehydrated, toxic, running a temperature, and exhausted. The wounds were in

bad shape, and a large number, about 60

percent, had to be operated [on] immediately upon arrival [in a hospital].

Several cases of gas infection amputations

were involved.”42

LSTs specially converted for hospital

care were used for both surgery and

evacuation. The LST–H crewmen made

the necessary physical alterations,

installing a watertight hatch in the tank

deck bulkhead to provide ready entry

into the forward troop compartments,

which were then converted into a receiving room, a scrub room for the surgeons, and an operating room.

Ambulances entered the ship just as

tanks had left it, by driving up the ramp.

Ward space was provided by cots on the

tank deck and by bunks in the troop

compartments of the ship. Even when

converted, the LST–H remained far

from a safe or comfortable means of

treating the wounded. But the

Southwest Pacific Area had few ships

and came to rely upon the LST–H more

than any other theater, for the ship

served medical needs without losing its

capacity for carrying troops and cargo.

The 6th, 8th, and 13th Portable Surgical

Hospitals all worked aboard such ships,

stabilizing the wounded while moving

through the still-dangerous waters of the

Dampier Strait toward Army hospitals at

Finschhafen, Goodenough Island,

Buna, and Milne Bay.43

41“Seventh Amphibious Force History,” pp. 65–66,

file 314.7 (7th Amphibious Force) SWPA; Interv, Sgt

Charles T. Downer, 23 Jan 45, file 000.71; 29th Port

Surg Hosp Annual Rpt, 1943, p. 2, file 319.1–2;

Quarterly Rpts, Oct–Dec 43, for 17th Port Surg Hosp,

pp. 1–2, 135th Med Regt (copy), p. 3, and 29th Evac

Hosp (copy), p. 2, file 319.1. All in HUMEDS, RG 112,

NARA.

198 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

42Interv, Col William B. Parsons, 19 Aug 44, p. 5 (quotation), file 000.71; 135th Med Regt Unit History

(copy), [1942–44], p. 3, file 300-Med-0.1. Both in

HUMEDS, RG 112, NARA. 43“Seventh Amphibious Force History,” p. 66, file

314.7 (7th Amphibious Force) SWPA; 6th Port Surg

Hosp Quarterly Rpts, Oct–Dec 43 and Jan–Mar 44, and

8th Port Surg Hosp Quarterly Rpt, Jan–Mar 44, THU

Note Cards, Historians files; Notes on 13th Port Surg

Hosp Quarterly Rpt, Jan–Mar 44, Historians files. All in

HUMEDS, RG 112, NARA.
After the battle, Army medical units

ashore still found much work to do, for

the enclave was scourged by disease. The

135th Medical Regiment furnished

ambulance service, accompanied marine

patrols, ran a holding unit for air evacuees, and relieved a Navy clearing station

that was performing poorly its job of supporting the marines. Then the 30th

Evacuation Hospital arrived to support

the varied forces in the area—the

marines, Army service troops, and air

force units. A site for the hospital’s semipermanent buildings had to be handhacked out of the jungle’s high hardwood trees and matted undergrowth,

mostly by native laborers. Twelve of the

twenty wards held marines suffering

from scrub typhus, Cape Gloucester’s

most dangerous endemic disease

acquired in the kunai grass inhabited by

rats harboring infected mites. The disease featured high fever and prostration,

and in this area resulted in a mortality of

8.3 percent.44

Treatment required a long period of

hospitalization, with careful nursing.

When 155 casualties were admitted during February and March, the 30th

Evacuation Hospital requested assistance from the companies of the 135th

Medical Regiment. Control measures

included clearing undergrowth from

unit areas, burning off kunai grass, and

eradicating rodents. Orders were issued

to the troops to tie their pant legs and

cover their bodies as much as possible—

no easy prescription to follow, given the

climate.45

An overture to the coming campaign

along the New Guinea coast, and to

some degree a distraction from it, the

New Britain battles were marked by useful innovations in amphibious medical

support. While the Japanese prepared

for an attack against Rabaul that never

came, MacArthur now gathered his

forces—battle-tested and strengthened

by improved intelligence, amphibious

capability, and air support—to strike

deep behind enemy lines.

CARTWHEEL Ends

Lying on the north side of the Huon

Peninsula, 110 miles from Finschhafen,

the target town of Saidor was a useful

site on which to construct a forward

airstrip. Expecting sharp counteraction

to an assault that would divide the

Japanese 18th Army, the SWPA medical

service provided twice as much support

as for Salamaua, an operation of similar

size. A task force built around the 126th

Regimental Combat Team of the battletested 32d Infantry Division—about

7,000 soldiers in all—received support

from an amphibious medical company,

a collecting company, a clearing pla44135th Med Regt Unit History (copy), [1942–44],

pp. 3–6, file 300-Med-0.1; Quarterly Rpts (copies),

Jan–Mar 44, for 30th Evac Hosp, pp. 1–2, and Surg,

Sixth Army, pp. 3–4, file 319.1. All in HUMEDS, RG

112, NARA. The Cape Gloucester mortality was about

standard for New Guinea, though some areas reported

much worse; on Goodenough Island, 25 percent of

those who became ill died. 

AMPHIBIOUS ADVANCE 199

45135th Med Regt Unit History (copy), [1942–44],

pp. 3–6, file 300-Med-0.1; Quarterly Rpts (copies),

Jan–Mar 44, for 30th Evac Hosp, pp. 2–3, and Surg,

Sixth Army, pp. 10–11, file 319.1. All in HUMEDS, RG

112, NARA. See also Francis G. Blake et al., “Studies on

Tsutsugamushi Disease (Scrub Typhus, Mite-Borne

Typhus) in New Guinea and Adjacent Islands:

Epidemiology, Clinical Observations, and Etiology in

the Dobodura Area,” American Journal of Hygiene 41

(May 45): 243–373; Cornelius B. Philip, “Scrub Typhus

and Scrub Itch,” in Ebbe Curtis Hoff, ed., Communicable

Diseases: Arthropodborne Diseases Other Than Malaria,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1964), pp. 275–91, 340–44.
toon, six portable surgical hospitals, a

field hospital, a malaria survey unit, and

a medical supply aviation platoon.

Other medical units were to arrive after

the initial landing. Again, four of the

portables functioned in effect as small

evacuation hospitals aboard converted

LSTs.

The troops went ashore on 2 January

1944, as scheduled, but the array of

medical units proved to be unnecessary.

Resistance to the landing amounted to

no more than a few rifle shots; the

enemy failed to counterattack, and the

Allies missed an opportunity to trap two

withdrawing Japanese divisions between

the American invaders and the

Australians advancing overland.

Casualties remained few, although

some cases of scrub typhus appeared

when troops bivouacked in kunai grass

and neglected to apply a miticide

recently recommended by Army typhus

experts to their clothing and blankets.

While the Allies consolidated their

gains and planned new advances, the

Japanese escaping through the jungle

suffered new and heavy losses to hunger

and disease.46

The concluding act of CARTWHEEL was

an invasion of the Admiralty Islands.

Lying north of Saidor, the group consists of a principal island, Manus; a

smaller island, Los Negros; and a number of islets paralleling Manus’ northern

coast. Possessing a superb harbor and

two airfields, the Admiralties promised

to make an excellent forward air base to

control the Bismarck Archipelago, as

well as a future staging area for later

moves against the Philippines.

Brig. Gen. Guy B. Denit, MC, who

replaced Carroll as chief surgeon in

January, had to provide medical units

for a large task force built around, not

a regimental combat team or two, but

the veteran dismounted 1st Cavalry

Division. Support included the division’s 1st Medical Squadron, a separate

clearing company, one evacuation and

two portable surgical hospitals, and

malaria control and survey units. The

division’s unusual structure—four regiments organized into two brigades—

caused a portable to be assigned to

each brigade, to land and move forward with the troops. Native litter-bearers were to be employed, to overcome

the obstacles of terrain that was known

to be difficult.47

Such preparations were timely, for

the infantrymen found hard fighting in

the Admiralties. For a month after landing on 28 February, the division fought a

slow, arduous battle for Los Negros,

enduring heavy casualties. Japanese

counterattacks sent many to the rear

with grenade and mortar wounds. The

30th Portable Surgical Hospital went in

early, with the reconnaissance force, and

settled into Japanese dugouts near an

aid station 150 yards inland. Surgeons

operated in one bunker, and used two

others as wards; the flow of plasma

rarely stopped, and surgery went on all

47Surg, lst Cav Div, Quarterly Rpt (copy), Jan–Mar 44,

p. 2; Surg, Sixth Army, Quarterly Rpt (copy), Jan–Mar

44, pp. 4–6. Both file 319.1, HUMEDS, RG 112, NARA.

200 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

46See Quarterly Rpts (copies), Jan–Mar 44, for 22d

Port Surg Hosp, pp. 1–2; Surg, Sixth Army, pp. 4, 10–11;

Surg, 32d Inf Div, pp. 1–3, 7; 23d Field Hosp, pp. 1–3,

5; 670th Clearing Co, p. 1; and FSurg, Adv Echelon, 5th

Air Force, p. 1, all file 319.1, as well as for 6th Port Surg

Hosp, THU Note Cards, Historians files, and Notes on

13th Port Surg Hosp, p. 1, Historians files. All in

HUMEDS, RG 112, NARA. In loc. cit., see also Interv,

Downer, 23 Jan 45, file 000.71; 135th Med Regt Unit

History (copy), [1942–44], p. 4, file 300-Med-0.1; and

“Seventh Amphibious Force History,” p. 67, file 314.7

(7th Amphibious Force) SWPA.
night under blackout conditions.

Casualties from the other islands were

moved to Los Negros by landing craft,

and from there evacuated to Oro Bay or

Finschhafen in Navy destroyers, LSTs,

C–47s, B–17s, and B–25s.48

On the line, corpsmen crawled under

the guard of tommygunners to retrieve

the wounded. Litter-bearers stood in the

surf to wash blood from litters with cold

brine. The 58th Evacuation Hospital

arrived on 6 March and the 27th

Portable Surgical Hospital three days

later (see Map 8). The division clearing

station handled 1,013 surgical and 195

medical cases that month. On the ninth

Los Negros was firmly in American

hands, but further sharp fighting on

Manus followed.49

In all respects but one, the infantrymen who were not wounded by enemy

fire stayed a relatively healthy lot.

Preventive medicine began while the

fighting still raged. Navy malaria teams

and Army anti-malaria units enrolled

native laborers and embarked on a control program that included inspecting

units to maintain individual malaria discipline and oiling, draining, and filling

mosquito breeding areas. Meanwhile, a

malaria survey unit drew blood from

both Americans and natives to determine the existing scope of infection. By

the end of March the unit was able to

report that, although malaria and

dengue were highly endemic, the transmission rate among American forces was

being kept low by the mixture of individual and area control measures.

Similarly, anti-fly precautions kept down

diarrheal diseases. The small number of

NPs indicated abler leadership and

more experienced and better disciplined troops. But the familiar plague of

skin diseases appeared again, making

life as miserable as ever.50

The Admiralties in Allied hands

became an important new base for

future operations, but their conquest

exacted a heavy price. Even after

Seeadler Harbor and the airfields were

secure, enemy resistance continued; not

until 18 May 1944 did Lt. Gen. Walter 48Surg, 1st Cav Div, Quarterly Rpt (copy), Jan–Mar

44, pp. 2–3, file 319.1, HUMEDS, RG 112, NARA; De

Witt Mackenzie, Men Without Guns (Philadelphia:

Blakiston Co., 1945), p. 15. 49Surg, 1st Cav Div, Quarterly Rpt (copy), Jan–Mar

44, pp. 2–3, file 319.1, HUMEDS, RG 112, NARA;

Mackenzie, Men Without Guns, p. 15. 

5028th Malaria Survey Unit Quarterly Rpt (copy),

Jan–Mar 44, pp. 1–2; Surg, 1st Cav Div, Quarterly Rpt

(copy), Jan–Mar 44, p. 1. Both file 319.1, HUMEDS, RG

112, NARA.

AMPHIBIOUS ADVANCE 201

BRIG. GEN. GUY B. DENIT, MC
Krueger, commanding general of the

Sixth Army, declare the operation

ended. In all, the 1st Cavalry Division

lost 326 killed, 1,189 wounded, and 4

missing; the Japanese apparently lost

about 4,000 killed and 75 captured.51

The Road to Hollandia

With Rabaul neutralized, the conquest of Japanese-held western New

Guinea moved into high gear. Able to

follow enemy troop dispositions

through breakthroughs in signal intelligence, General MacArthur planned a

surprise assault on Hollandia and

Aitape, coastal towns in the Netherlands

New Guinea. The region near Hollandia

boasted harbors, three working airfields, and a fourth partly completed—a

Japanese base second only to Rabaul in

strength. Yet, because the enemy did not

expect to be attacked so far from Allied

bases and airfields (Hollandia lies nearly 600 miles west of Finschhafen), the

16,000 defenders were known to be

mostly airmen and service troops.52

For the attack MacArthur chose the

24th and 41st Infantry Divisions, organized as the RECKLESS Task Force, a temporary headquarters for I Corps and its

commander, General Eichelberger.

Carrying the troops was Admiral

Barbey’s VII Amphibious Force of transports, escorts, and landing craft. This

flotilla was part of the Navy’s Task Force

77, which also included an armada of

battleships, cruisers, destroyers, plus

escort carriers sent by Admiral Nimitz to

provide air cover. In this amphibious

operation, the largest ever in the

Southwest Pacific Area, converted

LST–Hs would be employed, with the

medical officer aboard each control vessel regulating the movement of casualties to the ships and of medical supplies

and equipment to the shore. Some LSTs

were to be beached to provide immediate surgical care to the wounded, after

which a naval medical officer was to

route them to the appropriate ship. 

Landings were planned at two inlets:

Humboldt Bay, on which Hollandia lies;

and Tanahmerah Bay, lying westward

beyond the towering Cyclops Mountains.

The major objective was Lake Sentani,

which had three airfields on its north

shore. But the way there was long—18

miles from Humboldt and 14 from

Tanahmerah Bay—and threatened to be

difficult and costly. To support its thrust

at Tanahmerah Bay, the 24th Division

had available its 24th Medical Battalion,

two portable surgical hospitals, a separate

clearing company, and an amphibious

medical company; held in reserve were a

collecting company from its medical battalion, medical units supporting its 34th

Regimental Combat Team, the division

reserve, and the 36th Evacuation

Hospital. Medical support was similarly

abundant for the 41st Division’s projected landing in Humboldt Bay.

At dawn on 22 April 1944, under a

naval smoke screen and a rocket barrage,

the RECKLESS Task Force came ashore

from a calm sea without opposition. The

barrage had sent the Japanese service

troops flying into the hills, leaving

behind their half-eaten breakfast of warm

51Miller, CARTWHEEL, pp. 348–49. 52Unless otherwise noted, combat narrative for

remainder of this chapter drawn from Robert Ross

Smith, The Approach to the Philippines, United States

Army in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1953). On Hollandia, see Heavey, Down Ramp!, pp.

114–17, and “Navy Medical Department at War,” 1:192,

196, BMSA. On the VII Amphibious Force, see Edwin P.

Hoyt, MacArthur’s Navy: The Seventh Fleet and the Battle for

the Philippines (New York: Orion Books, 1989).

202 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
rice and tea. Beachheads were established; success came so quickly that, at

1500, Generals MacArthur and Krueger

waded ashore in Tanahmerah Bay.

Understandably, medical support at

first went smoothly. At Humboldt Bay

the 116th Medical Battalion followed

the 41st Division inland along rough

mountain trails. At Tanahmerah, however, problems developed. The two assault

regimental combat teams, built around

the 24th Division’s 19th and 21st

Infantry, landed on separate beaches

unconnected by any road. On Red

Beach 2 the troops were bottled up not

by the enemy but by an inland swamp,

which neither they nor their vehicles

could penetrate. At Red Beach 1 soldiers made their way up the

Depapre–Lake Sentani trail, but even

jeeps could not negotiate the winding

mountainous way. Offshore, coral reefs

prevented LSTs from approaching closely, and days passed before supply depots

could be established ashore.53

Meanwhile, a disaster occurred

behind the lines. In Humboldt Bay one

beach had been a major Japanese supply dump, with piles of ordnance,

rations, airplane engines, and medical

supplies. The Americans similarly piled

their own materiel beside the dump.

But on the night of D+1 a lone enemy

bomber scored three direct hits on the

captured dump, setting off thunderous

blasts and sending burning missiles

hundreds of feet into the air. Sailors in

ships offshore could see the glow from

miles away, as fires spread along the

beach, burning for two days and

destroying 60 percent of the supplies,

American and Japanese. 

The calamity killed twenty-four

Americans and injured sixty-four, and

delayed the landing of the 92d

Evacuation Hospital and the portable

surgical hospitals. But the collecting platoon of Company B, 262d Medical

Battalion, had established an aid station

in the center of the area. Throughout

the night of 23–24 April the two officers

and forty-four enlisted men held their

post, working amid the holocaust of

flame and flying shrapnel to pull the

burned and injured from the wreckage

and give first aid. Their courage won a

presidential unit citation.54

Away from the devastation on the

beach, 41st Division forces encountered

minimal enemy resistance but rugged

terrain and heavy downpours.

Meanwhile, troops on the Tanahmerah

Bay–Depapre trail coped with countless

defiles, swollen streams, and frequent

landslides. On the march, collecting

companies provided medical support,

first aid, and even basic surgery.

Supplies had to be hand-carried forward

and casualties littered back to the beaches. By D+3 the supply and evacuation

line to Tanahmerah Bay was 12 miles

long, rainsoaked, and so difficult that it

took one to two days to walk. All the collecting companies and portables at

Tanahmerah were sent forward to assist.

Relay points were established, where

casualties received treatment and litter53 bearers rested. Clearing stations and an Rpt, Surg, 116th Med Bn, sub: Letterpress LF

[Landing Force], 17 Apr–5 May 44, p. 2, file 341-Med0.3, box 10649, and Tanahmerah Historical Rpt, 22

Apr–6 Jun 44, an. 14, p. 216, file 324.0–3, box 7667, RG

407, NARA. See also Surg, 24th Inf Div, Quarterly Rpt

(copy), Apr–Jun 44, p. 2, file 319.1, HUMEDS, RG 112,

NARA.

54Rpt, Surg, 116th Med Bn, pp. 2–3, file 341-Med-0.3,

box 10649, RG 407, NARA; Surg, 24th Inf Div,

Quarterly Rpt (copy), Apr–Jun 44, pp. 2–3, file 319.1,

HUMEDS, RG 112, NARA. Unit citation reprinted in

Heavey, Down Ramp!, p. 208.

AMPHIBIOUS ADVANCE 203
advance surgical team of the 36th

Evacuation Hospital cared for casualties

on the Red beaches before moving

them by boat to the 92d Evacuation

Hospital, now established at Humboldt

Bay. There Japanese medical supplies

that had escaped the fire—surgical

instruments, soap, dressings, peroxide,

microscopes, an X-ray machine, and ten

tons of quinine—were put to good use

by the hospitals.

On 26 April the weary 24th Division

made contact with the 41st Division at

Lake Sentani, a beautiful and refreshing

scene below grassy hills with “stranded

trees scattered in lonely fashion.” The

Allies now possessed three airfields—

Hollandia, Sentani, and Cyclops. The

fourth at Tami, 6 miles west of

Humboldt Bay, fell shortly afterward.

The Depapre Trail was abandoned, and

casualties were taken to Humboldt Bay

instead. But as the airfields were put to

use by Allied planes, evacuation by air

rapidly took precedence and soon was

moving twice as many evacuees as the

longer, slower route by sea. During the

weeks that followed, combat patrols

hunted down the remaining enemy; service troops took over the region, and

General Krueger officially declared the

operation closed. American casualties

numbered only 124 killed, 1,057 wounded, and 28 missing; Japanese losses were

estimated at 611 captured and over

3,300 killed. Another 7,000 enemy

troops tried to escape by making their

way through the jungle to Sarmi, but

apparently few survived the ravages of

starvation and disease.55

55Surg, 32d Inf Div, Quarterly Rpt (copy), Jul–Sep 44,

p. 6 (quotation), and Surg, 24th Inf Div, Quarterly Rpt

(copy), Apr–Jun 44, pp. 3–5. Both file 319.1, HUMEDS,

RG 112, NARA. See also Rpt, Surg, 116th Med Bn, pp.

3–4, file 341-Med-0.3, box 10649, RG 407, NARA.

Statistics from Smith, Approach to Philippines, p. 83.

204 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

EVACUATION BY AIR
Treatment of the wounded was greatly improved by use of the new antibiotic

penicillin, which had begun to appear

in the theater the previous November.

Although the doctors did not completely understand the new drug, they used it

with excellent results in suppressing

wound infections. Disease rather than

battle wounds produced more casualties, and yet morbidity rates were low

compared to earlier campaigns. Fevers

of unknown origin were the principal

cause of hospitalization, followed by

diarrhea that resulted from poor sanitary conditions on the congested beaches and in bivouac areas taken over from

the Japanese. Mosquitoes in large numbers brought some cases of dengue, but

preventive measures kept both dengue

and malaria rates low. A few cases of

scrub typhus appeared, as well as the

usual skin diseases. 

Hollandia had been a daring move,

made possible by foreknowledge of the

enemy’s unpreparedness. The low casualties had been an unexpected bonus. A

simultaneous thrust of the campaign,

however, 125 miles to the east at Aitape,

brought on a counterattack and a fierce

battle.56

The Driniumor Battle

American forces seized Aitape in

hopes of using its half-completed airfields to provide fighter cover for the

larger operation at Hollandia. The initial landing by elements of the 32d

Division was uneventful, although the

location was unpleasant: a flat, wet

coastal plain lying one degree below the

Equator, compressed between the sea

and the towering Torricelli Mountains

to the south. The PERSECUTION Task

Force was supported by medical battalion detachments, by separate collecting

and clearing companies, and by hospitals attached for the operation.

Between 23 April and 3 May medical

care was administered with few problems. Casualties were light; supply was

adequate; and, as the troops expanded

their beachhead, crossing a series of

watercourses (the Nigia River, the X-ray

River, the Koronal Creek, and the

Driniumor River), ambulances used the

Japanese-built roads. Beach medical

units treated the few wounded. Among

the first prizes seized were three airfields near the Tadji Plantation, just

inland from the original landing beach.

Here, behind the main line of resistance, a portable surgical hospital and a

clearing station were set up, treating

mainly nonbattle injuries and the first

cases of sickness.57

A systematic medical organization

began to take shape as the 32d Division

took charge ashore. Its surgeon, Lt. Col.

John F. Wurz, MC, appointed an air evacuation officer, contacted hospitals and

56Surg, 24th Inf Div, Quarterly Rpt (copy), Apr–Jun

44, p. 6; 36th Evac Hosp Quarterly Rpt (copy), Apr–Jun

44, pp. 2–5; Rpt, Lt Col Robert Sterling, CO, 92d Evac

Hosp, to Surg, 41st Inf Div, 12 May 44, sub: 92d

Evacuation Hospital (SM), Medical History of

Hollandia Operation, 1 April–5 May 1944, pp. 3–7, Encl

to 92d Evac Hosp Quarterly Rpt (copy), Apr–Jun 44. All

file 319.1, HUMEDS, RG 112, NARA. See also Robert L.

Eichelberger, in collaboration with Milton Mackaye,

Our Jungle Road to Tokyo (New York: Viking Press, 1950),

pp. 100–12, and Walter Krueger, From Down Under to

Nippon: The Story of the Sixth Army in World War II

(Washington, D.C.: Combat Forces Press, 1953), pp.

56–77. The role of ULTRA intelligence in the campaign

is brought out in Edward J. Drea, Defending the

Driniumor: Covering Force Operations in New Guinea, 1944

(Fort Leavenworth, Kans.: Combat Studies Institute,

1984), pp. 3–18.

57See Quarterly Rpts (copies), Apr–Jun 44, for Surg,

32d Inf Div, pp. 1–2; 135th Med Regt, pp. 3–4, 6; 3d

Port Surg Hosp, pp. 2–5; Surg, Sixth Army, pp. 6–8; and

54th Evac Hosp, pp. 1–2. All file 319.1, HUMEDS, RG

112, NARA.

AMPHIBIOUS ADVANCE 205
units in the area, ensured that small

detachments had dispensary service, and

informed all units of his scheme of evacuation and the location of the hospitals.

At his disposal were a 200-bed section of

the 54th Evacuation Hospital, one

portable surgical hospital for each regiment, a malaria survey unit, a malaria

control unit, a separate clearing company, and the 30th Evacuation Hospital.

Such resources were more than sufficient

to support forces engaged in maintaining

a defense perimeter around the airfields

and in skirmishing with Japanese patrols.

Company aidmen accompanied the

infantry; medical personnel set up aid

stations at outlying posts, rotating back to

Aitape every four to seven days for rest, a

bath, a change of clothes, and a hot meal.

But the invasion had isolated the

Japanese 18th Army to the east, leaving

the enemy few options but to attack the

forces at Aitape. As the level of combat

rose, the 112th Cavalry arrived to augment the 32d Division. Outposts were

reinforced, and a covering force along

the Driniumor River was strengthened.

About 7 miles long, the river line was

held by the 112th and three battalions

of the 32d’s 127th and 128th Infantry.

Casualties were carried back from

advanced stations by native litter-bearers; amphibious trucks evacuated coastal

and swampy areas; and twice a day

barges transported serious cases to the

54th Evacuation Hospital, on an island 2

miles offshore.58

On the night of 10–11 July Japanese

attackers crossed the Driniumor, overrunning an aid station in the process,

and moved into the jungle beyond.

American units were compelled to withdraw to the X-ray River, 3 miles to the

west. Next day, while American artillery

opened up, patrols clashed with the

enemy. Determined to restore the

Driniumor line, they attacked on the

thirteenth. The 1st, 5th, and 18th

Portable Surgical Hospitals accompanied them through jungle fighting that

slowly destroyed the Japanese forces

west of the river and reestablished

American control of the river’s west

bank. In the foothills at Afua the 127th

Infantry and the 112th Cavalry withstood desperate attacks from all directions by enemy soldiers who were starving and fanatical, with nothing to lose. 

Heavy combat continued until

August. The portables worked in close

support of the regimental and battalion

aid stations; in late July the 5th Portable

Surgical Hospital was so close to the

front that its staff dug foxholes and

armed its ambulatory patients to defend

against infiltrators. Surgeons operated

at night in blacked-out pyramidal tents.

In theory, each portable supported one

regimental combat team, but in practice

all took their wounded as they came and

served all of the infantry regiments.

Many serious cases went back to the

30th Evacuation Hospital, which provided the bulk of third-echelon medical

care. Set up near the airfields, its 440

beds were filled with those suffering

severe wounds, often of the chest, head,

and abdomen.59

Evacuation moved by water and by

jungle trails to the coast road. During

58See Quarterly Rpts (copies), Apr–Jun 44, for Surg,

32d Inf Div, pp. 3–6; 607th Med Clearing Co, p. 1; 54th

Evac Hosp, pp. 3–4; and Surg, Sixth Army, pp. 8–9. All

file 319.1, HUMEDS, RG 112, NARA.

59See Quarterly Rpts (copies), Jul–Sep 44, for Surg,

32d Inf Div, pp. 1–3; 30th Evac Hosp, pp. 1–2; Surg,

Sixth Army, pp. 5–7; and 656th Med Clearing Co, p. 2.

All file 319.1, HUMEDS, RG 112, NARA.

206 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
most of the fighting casualties were evacuated from Afua down the Driniumor to

the coast, and after the big enemy breakthrough of 10–11 July the route followed

was the X-ray River and Koronal Creek

to the coast. Those wounded in the fighting inland were transported to the same

small rivers, a two-day trip that was made

as seldom as possible. Litter-bearers carried casualties from battalion aid stations

to the portables. Then litter trains of

native carriers, protected by infantry,

brought them to collecting points to be

picked up by ambulances or amphibious

vehicles. Precautions were needed

because the enemy dealt ruthlessly with

casualties, medics, and bearers alike.

Despite the guards, several trains were

ambushed along Koronal Creek, coming

through intact after sharp firefights.

Walking wounded formed parties for

mutual protection, and reached the

loading points under their own power.

Yet evacuation remained slow and hazardous, never more so than during an

American advance into the foothills in

early August. Casualties had to be carried back through densely wooded and

mountainous terrain; three abdominal

cases died en route, and none reached

the 5th Portable Surgical Hospital in less

than seventy-two hours after wounding.60

Inevitably, the pressure of combat

increased the incidence of disease.

Atabrine discipline often rested on the

individual soldier, and as a result both

relapses and new cases were common.

“The division is well seeded with malaria,” Colonel Wurz noted. “The old

timers are gradually losing their physical effectiveness.”61 Although malaria

survey and control units had landed

early, control work had been delayed by

initial problems in hiring native labor;

most local tribesmen had fled the

Japanese occupiers and the Allied bombardments into the mountains. Then,

with control work under way, combat

interfered. Spraying and oiling were

necessarily confined to the area within

the perimeter, while troops at outposts

or on patrol remained exposed. In July

every soldier was ordered to take two

tablets of Atabrine a day, and more

malaria control and survey units

arrived. Malaria rates fell; however, in 60See Quarterly Rpts (copies), Jul–Sep 44, for Surg,

32d Inf Div, pp. 9–10; 30th Evac Hosp, p. 2; 656th Med

Clearing Co, p. 2; and Surg, Sixth Army, pp. 6–7, plus

Apr–Jun 44, pp. 9–10. All file 319.1, HUMEDS, RG 112,

NARA.

61Surg, 32d Inf Div, Quarterly Rpt (copy), Jul–Sep 44,

p. 9, file 319.1, HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 207

NATIVE LITTER-BEARERS, with soldier escort,

evacuating a battle casualty down the

Driniumor River to the coast
the meantime scrub typhus had

appeared, and the disease continued to

harry the fighters until they left infested

Afua and until kunai grass areas near

the airstrips and the Nigia River were

burned or cleared.

Despite all of these major illnesses,

the commonest reason why soldiers

reported to sick call was a mixture of

skin diseases. Some 85–90 percent of all

combat troops at Aitape were affected.

Their condition was miserable and

essentially untreatable during combat,

although rest, sunbathing, and dispensary treatment cleared up most cases as

soon as the fighting ended. Infestation

with hookworms and other intestinal

parasites was common in line units.

Completing a familiar litany of woes, the

psychoneurosis rate rose sharply during

and just after combat, especially among

replacements newly arrived from the

United States. The fundamental cause

was the exhaustion and strain of jungle

fighting upon those who could not be

relieved while the long, confused, complex struggle continued.62

Yet, supported by artillery and supplied by sea and air, the much-tried soldiers and their medics possessed clear

advantages over Japanese troops, who

were compelled to attack despite

hunger and disease that stalked them

“with deadlier effects than the Allied

shelling and bombing.” Medical control

of the swampy enclave that stretched

over some 20 miles of coast was never

adequate, yet disease did not become

serious enough to affect operations.

Supplies continued to move forward

over the trails and jungle waterways, and

most casualties were retrieved, treated,

and extricated from the morasses and

jungles. The 43d Division arrived from

the South Pacific Area to participate in

the last stages of the battle, and by 11

August Japanese resistance had been

broken.63

The end of combat was sudden. By

the last week of August GIs were drinking American beer, laying out sports

fields, and viewing Bob Hope’s USO

show at Aitape. American casualties

included 440 killed, 2,550 wounded,

and 10 missing. In a war often characterized by small-unit actions, this was a

major battle; the Japanese lost 8,821

killed and 98 captured, and American

forward units suffered heavily, the 112th

Cavalry losing about 27 percent of its

personnel. Disease rates reached 1,776

per 1,000 troops per annum in August.

Yet even while the struggle near Aitape

went on, others no less severe were

being fought to the west.64

On to Wakde and Sarmi

The next target area lay 120 miles

west of Hollandia, a flat and swampy

coastline with the village of Sarmi at its

western end and that of Toem at its eastern end. Two miles off Toem, a pair of

coral islands formed the Wakde group;

the Americans called the larger Wakde

Island. Two Japanese airstrips were

located along the coast and a third on

Wakde Island. The entire region was

defended by 11,000 Japanese troops,

62Ibid., pp. 5–9, and Apr–Jun 44, pp. 9–10; Jul–Sep 44

for 656th Med Clearing Co, p. 2, and 607th Med

Clearing Co., p. 1; Apr–Jun 44, p. 1, for Surg, Med Det,

112th Cav; and Apr–Jun 44, pp. 9–10, and Jul–Sep 44,

pp. 6–7, for Surg, Sixth Army. All file 319.1, HUMEDS,

RG 112, NARA.

63Drea, Driniumor, pp. 28 (quotation), 129, 132. 64Smith, Approach to Philippines, pp. 204–05; Surg,

Sixth Army, Quarterly Rpt (copy), Jul–Sep 44, p. 7, file

319.1, HUMEDS, RG 112, NARA.

208 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
about half of whom were combat

trained. To attack the area, General

Headquarters, SWPA, created the

TORNADO Task Force, whose nucleus was

the 163d Regimental Combat Team,

41st Division. Shortly before the action

began, a change of plans limited the

objective to the island and the adjacent

shoreline. Now the aim was to seize the

Wakde airstrip for further operations

against the larger and more strategic

island of Biak, far to the west.

The landing on 17 May went almost

unopposed. Elements of three battalions quickly established beachheads on

the shore and seized Wakde’s small

neighbor island. Medical support followed. One collecting company accompanied the infantry, while the other,

assisted by a portable surgical hospital,

set up a station to receive casualties at

Toem.65

But trouble developed on Wakde.

The island, a cocoanut plantation

before the war, turned out to be heavily

fortified. From more than a hundred

well-camouflaged bunkers and pillboxes, and a dozen caves, the Japanese hit

the landing craft with machine gun and

rifle fire. Hard fighting followed, costing

the Americans 40 dead and 107 wounded; at the end of the struggle 759 enemy

dead were counted, and more lay buried

in the caves. Mainland observers, watching through field glasses, saw medics of

the single aid station on Wakde begin to

load wounded aboard landing craft as

soon as the craft emptied. Serious cases

were cared for by a Navy surgical team,

and evacuees flooded the small facility

at Toem, whose staff worked without rest

for two days to provide care to all.

Meanwhile, the 1- by 2-mile Wakde

began to serve the purpose for which so

much blood had been spilled: By 21 May

Army engineers had the airstrip in operation, and the first planes landed that

afternoon.66

To the west, substantial Japanese

forces—another lost army, written off by

the Imperial General Headquarters after

Allied planes and submarines made

their evacuation or resupply equally

impossible—were assembling around

the mainland’s coastal airfields. They

now formed a danger to the WakdeToem beachheads. Fighting began

along the mainland’s western perimeter,

where the 506th Medical Collecting

Company and the 3d Portable Surgical

Hospital received over 100 casualties

and evacuated by ambulance along a

beach road. But heavier fighting was to

come. The 158th Infantry, ALAMO Force

Reserve, arrived to reinforce the

Americans, and TORNADO Task Force

units launched a drive up the coast

toward Sarmi. Blocking the way was an

eminence called Lone Tree Hill—

despite its name, “a coral mass . . . covered with dense rain forest and jungle

undergrowth.” Adjacent masses (Hill

225, Mount Saksin) formed a natural

obstacle that the Japanese fortified and

prepared to defend.67

At the same time, smaller forces

harassed the eastern end of the beachhead. On the night of 27–28 May the

enemy surprised the Americans, and the

65Surg, Sixth Army, Quarterly Rpt (copy), Apr–Jun

44, p. 17, file 319.1, HUMEDS, RG 112, NARA.

66Ibid., pp. 17–18, plus 3d Port Surg Hosp, pp. 7–8,

and 135th Med Regt, p. 3; and 398th Med Collecting

Co, Jul–Sep 44, p. 1. All file 319.1, HUMEDS, RG 112,

NARA. 67Quotation from Smith, Approach to Philippines, p.

244. See also Quarterly Rpts (copies), Apr–Jun 44, for

3d Port Surg Hosp, pp. 8–10; Surg, Sixth Army, p. 18;

135th Med Regt, pp. 6–7; and Surg, Med Det, 158th Inf,

p. 1. All file 319.1, HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 209
2d Portable Surgical Hospital and one

collecting company retreated under fire

to the 54th Evacuation Hospital area

and established a perimeter. Another

collecting company dug in and held its

position, taking 11 casualties among its

staff and patients before the attack

ended. But the situation remained perilous. The beach was too long and narrow to be held, and the enemy repeatedly infiltrated through the jungle. On

28 May the Japanese attacked in great

force. Reinforcements had yet to arrive,

and two battalions of the 163d

Regimental Combat Team had left for

Biak Island to strengthen hard-pressed

troops fighting there. Remaining in the

Wakde-Sarmi area were only four

infantry battalions.

Hence, General Krueger issued

orders to contract the western and eastern perimeters. As often happens,

nobody thought to tell the medics and

some were left behind. For three days

before escaping to the Toem perimeter,

Clearing Company H, ALAMO Force

Reserve, was caught in a no-man’s-land

and forced to provide for its own

defense. The unit constructed pillboxes

and manned them in shifts of twentyfour hours, its soldiers armed with carbines, submachine guns, and grenades. Personnel of the 3d Portable

Surgical Hospital, receiving their

orders late, learned how quickly they

could break camp and move when they

had to. The commander, Maj. William

L. Garlick, MC, remembered how “the

hospital melted before your eyes.”

Within two hours the patients were

resting under canvas beside an

American mortar company. Not a single casualty had been suffered, and

Garlick reported with amazement that

“for the first time in our moving life

there was no confusion in clearing and

setting up camp.”68

Reinforcements now turned the tide.

During 7–20 June elements of the 6th

Infantry Division arrived to replace the

weary 158th Infantry. Supporting the

division was its 6th Medical Battalion, the

2d and 11th Portable Surgical Hospitals,

the 37th Field Hospital, and a 200-bed

section of the 54th Evacuation Hospital.

Lt. Col. Bernard J. MacCauley, MC, the

6th Division surgeon, now became the

TORNADO Task Force surgeon. The attack

resumed, with hard fighting in the

rugged and heavily jungled terrain

around Lone Tree Hill. Here the many

casualties strained the available medical

facilities; the 20th Infantry, 6th Division,

suffered 305 on the first day alone.

Litter-bearers were hard-pressed, with no

time to rig cables and move the wounded by tramway; instead, squads of six,

working in relays over sloping terrain,

carried casualties from the forward aid

station to an advanced ambulance post,

seventy-five yards beyond.69

The fierce struggle continued for

three days, with frontline medical units

using over 1,000 pints of plasma. Under

the circumstances the quality of care was

admirable, and most casualties arrived

at the rear in good condition. Normally

a 25-bed facility, the 11th Portable

Surgical Hospital expanded to 50,

admitting 102 during 17–27 June. In

one four-day period the hospital per68See Quarterly Rpts (copies), Apr–Jun 44, for 3d

Port Surg Hosp, pp. 10–11 (quotations); 135th Med

Regt, pp. 6–7; and Surg, Sixth Army, pp. 19–20. All file

319.1, HUMEDS, RG 112, NARA. 69Rpt (copy), CO, 6th Med Bn, to CG, 6th Inf Div, 19

Jul 44, sub: Operational Report, pp. 1–2, file 306-Med0.3; 11th Port Surg Hosp Historical Rpt, 30 Aug 44, p.

2, file 319.1; Quarterly Rpts (copies), Apr–Jun 44, for

54th Evac Hosp, pp. 2–3, and Surg, Sixth Army, pp.

20–21, file 319.1. All in HUMEDS, RG 112, NARA.

210 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
formed eighty-seven operations, with

only 1 death. The operating room staff

worked continuously for seventy-two

hours, taking only an occasional nap.

The 37th Field Hospital set up on the

shore of Maffin Bay, in direct support of

the fighters; the 54th Evacuation

Hospital worked at Toem. Air evacuation from the Wakde strip carried evacuees to Hollandia, Nadzab, or

Finschhafen, functioning smoothly

throughout the struggle. SWPA’s hospital ships visited the enclave, providing a

supplementary means of evacuation.70

Defeat at Lone Tree Hill broke the

Japanese, who had fought a desperate

but hopeless battle. Now the Americans

moved westward, cleaning out the

remaining pockets of resistance. The

mop-up included some hard fighting

and cost a number of casualties. By the

end of July the 31st Infantry Division

had relieved the 6th Division, and on 1

September a regimental combat team of

the 33d Infantry Division replaced the

31st as the garrison force in an area now

secure. The next day General Krueger

declared the Wakde-Sarmi operation

over. From 17 May through 1 September

American losses were approximately 400

killed, 1,500 wounded, and 15 missing.

The Japanese lost 3,870 killed and 51

captured. Since only about 2,000 enemy

troops remained in the area, many of

70See Quarterly Rpts (copies), Apr–Jun 44, pp.

21–22, and Jul–Sep 44, pp. 8–9, for Surg, Sixth Army;

respectively, p. 3, and pp. 2–3, for 54th Evac Hosp; and

pp. 1–2, and pp. 1–2, for 37th Field Hosp. All file 319.1,

HUMEDS, RG 112, NARA. In loc. cit., see also 11th

Port Surg Hosp Historical Rpt, 30 Aug 44, p. 2.

AMPHIBIOUS ADVANCE 211

11TH PORTABLE SURGICAL HOSPITAL MEDICS TAKING CARE OF CASUALTIES
the original garrison apparently died of

sickness and starvation or lay buried in

blasted caves. In return for their efforts,

the Allies obtained a valuable air base

and a staging area for campaigns to

come.71

On to Biak

Simultaneously with the Wakde campaign, an assault began on Biak, an

island in the northwest portion of

Geelvink Bay. As usual, the targets were

airfields—three of them, lying on a

coastal plain backed by a coral ridge covered with dense tropical rainforest.

Fiercely hot, the island was unhealthy

and soon to become more so, as the

bodies of the slain piled up, for it was

strongly defended by Japanese forces

fighting from caves.

Upon this uninviting spot the

HURRICANE Task Force, comprised of the

162d and 186th Regimental Combat

Teams of the 41st Division, staged surprise landings on the morning of 27

May. The troops came ashore in

Buffaloes over fringing reefs near the

village of Bosnek, about 2 miles east of

heavily defended Mokmer, Sorido, and

Borokoe airfields. Initial resistance was

light. Navy beach party aid stations treated the few casualties, and amphibious

medical company personnel evacuated

to a collecting station on Japanese-built

coral jetties and from there to LSTs,

where Navy surgical teams awaited

them.

The first serious resistance developed

as the 162d Regimental Combat Team,

supported only by a collecting company,

advanced west along the beach road

toward the Mokmer airfield. During the

afternoon and evening of D-day, casualties with mortar and gunshot wounds

began to filter back to battalion aid stations and eventually to the clearing station on the beach. On D+1 fighting

intensified. The Japanese, dug into the

ridges and caves above the coast road,

poured mortar and machine gun fire

upon the 162d, especially from strongpoints called the East Caves and the Ibdi

Pocket. Collecting company ambulances evacuated the wounded until the

enemy built a roadblock, cutting off the

route. With casualties mounting and

supplies dwindling, the 162d commander ordered ammunition, water, and a

portable surgical hospital to be loaded

on amphibians and taken up the coast

to support the isolated regiment. Once

set up under a twenty-foot ridge that

offered protection from mortar fire, the

hospital kept three operating tables

busy through the night of 28 May and

most of the following day. Wounded

were so numerous that only emergency

surgery and administration of plasma

were attempted. Amphibians ferried the

casualties across the reef, and landing

craft transported them to Bosnek or to

the 92d Evacuation Hospital on offshore

Owi Island.72

Seeking to flank the defenders, the

186th Regimental Combat Team set out

to cross an inland plateau and descend

71Smith, Approach to Philippines, p. 278.

72Rpt (copy), Lt Col William H. Chapman, Acting

Surg, 41st Inf Div, 30 Aug 44, sub: Medical History of

Biak Campaign, pp. 2–3, file 341.26 Historical Reports,

Hurricane (Biak) TF, 41st Inf Div, 27 May–19 Aug 1944;

116th Med Bn Med History (copy), pp. 2–4, file 319.1–2

(116th Medical Battalion) SWPA, 27 May–2 Aug 1944;

Surg, I Corps, Quarterly Rpt (copy), Apr–Jun 44, pp.

1–2, file 319.1; Rpt, Lt Col Robert Sterling, CO, 92d

Evac Hosp, to Surg, 41st Inf Div, 12 May 44, sub: 92d

Evacuation Hospital (SM), Medical History of Biak

Operation, 6 May–30 June 1944, pp. 1–2, Encl to 92d

Evac Hosp Quarterly Rpt (copy), Apr–Jun 44, file 319.1.

All in HUMEDS, RG 112, NARA.

212 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
upon the airstrips from the northeast.

The 186th, attended by a collecting

company and a portable, marched for

four days in sweltering heat on a route

without water and through thickets of

towering evergreens, not the familiar

tropical rainforest. Both supplies and

wounded had to be hand-carried

through harassing enemy fire. Once at

the cliffs overlooking the Mokmer airfield, the infantry encountered devastating mortar and artillery fire from the

inland face of the ridge. Still commanded by enemy guns, the airfield was useless. Evacuation of the wounded to

Bosnek proved to be painful and slow,

via exhausting litter hauls to the sea and

night voyages by amphibians.73

During the third week in June more

forces, including additional medical

support, invested the airfields. General

Krueger, displeased with the slow

progress, replaced the 41st Division

commander, Maj. Gen. Horace H.

Fuller, with Brig. Gen. Jens A. Doe and

sent in General Eichelberger, the I

Corps commander, to take charge.

Bringing with him the 34th Infantry,

24th Division, Eichelberger was able to

pit larger forces against an enemy

depleted in numbers, though still holding out in strong positions.

Under intensive bombardment, most

defenders evacuated the East Caves. The

Ibdi Pocket fell to assault. On 21 June

the 162d and 186th Regimental Combat

Teams reached the formidable West

Caves, where the Japanese commander

made his last stand. Of 900 defenders

about 235 survived, and of these 109

elected to stage a banzai attack that

night. All were killed; the Japanese commander, with many of his subordinates,

committed suicide. The assault on the

caves lasted until the twenty-seventh,

when patrols penetrated the last recesses, now filled with burned and mangled

bodies.74

Mopping-up operations resumed

against some 4,000 Japanese who had

escaped, and by 20 August, when

Krueger declared the operation over, all

organized resistance had ceased. The

Japanese lost an estimated 4,700 killed

and 220 captured on Biak. Most of the

survivors perished later by disease, starvation, and suicide, or were killed during the long mopping up, which continued into the following year as one

occupying force succeeded another. By

early 1945 probably fewer than 1,500 of

the original Japanese garrison were

alive.75

The victory cost the Allies approximately 400 killed, 2,000 wounded, 150

injured, and 5 missing. Casualties to disease and stress numbered 7,234. No less

than 1,000 caught scrub typhus, and

about 3,500 suffered fevers of undetermined origin, reflecting not only the

unhealthiness of Biak but, as the 41st

Division surgeon lamented, the fact that

“the laboratories attached to station and

general hospitals never reach us and at

times are four to five hundred miles

away.” American casualties totaled

73116th Med Bn Med History (copy), pp. 4–6, file

319.1–2 (116th Medical Battalion) SWPA, 27 May–2

Aug 1944; Rpt (copy), Chapman, 30 Aug 44, pp. 4–5,

file 341.26 Historical Reports, Hurricane (Biak) TF,

41st Inf Div, 27 May–19 Aug 1944. Both in HUMEDS,

RG 112, NARA.

74116th Med Bn Med History (copy), pp. 6–7, file

319.1–2 (116th Medical Battalion) SWPA, 27 May–2

Aug 1944; Rpt (copy), Chapman, 30 Aug 44, pp. 5–6,

file 341.26 Historical Reports, Hurricane (Biak) TF,

41st Inf Div, 27 May–19 Aug 1944. Both in HUMEDS,

RG 112, NARA. See also Eichelberger, Our Jungle Road,

pp. 143, 153, and Harold Rigelman, The Caves of Biak

(New York: Dial Press, 1955), pp. 136–55. 75Smith, Approach to Philippines, p. 392.

AMPHIBIOUS ADVANCE 213
9,790—mark of a struggle as harsh and

unforgiving as any in the Pacific war.

Medical personnel suffered unusually

heavy losses. Portable surgical hospitals

worked in dugouts under mortar and

artillery fire; litter squads were prey to

snipers. In the 41st Division the medical

casualty rate exceeded that of the line

troops: Collecting Company C, 186th

Regimental Combat Team, recorded

losses of 35 percent. In testimony to

their sufferings, the medics received a

proportionately greater share of combat

decorations than any other branch,

including the infantry.76

Despite this record of individual heroism and collective achievement, Biak represented a backward step in both prevention and treatment. The medics had to

do extraordinary things in part because

too few of them were on hand.

Hospitalization for the HURRICANE Task

Force proved barely adequate. The 92d

Evacuation Hospital provided 400 beds;

each of the two clearing companies,

about 250; and each of the four portables, 25—about 1,000 beds in all. Every

unit had an expansion capability, which

most were obliged to use. Thus, the initial allotment was equal to 6 percent of

the force but declined as the fierce fighting brought in new line units, with no

equivalent increase in hospital support.

Because of poor intelligence on terrain,

disease, and enemy fortifications, projected casualty rates were underestimated.

For certain, the low shipping priority for

hospitals meant that medical support for

the troops oftentimes was inadequate.77

Proportionate to troop strength, bed

strength shrank by 2.2 percent in

August, even as epidemics broke out,

overcrowding the hospitals further and

compelling the speedy evacuation of

minor cases. The ten- to fifteen-day evacuation policy contemplated in the original medical plan had to be abandoned.

Meanwhile, the hospitals worked under

the poorest of conditions. At Bosnek

both the 92d Evacuation Hospital and

Clearing Company D, 41st Division,

spent the first ten days ashore in an area

congested with military targets, under

daily air attack. Neither could deploy

fully for lack of engineer equipment to

clear the wrecked and cratered area

(hence, the hospital’s removal to Owi).

Further forward, portables sometimes

worked in shell holes under mortar and

artillery fire, and the clearing platoons

on the beach road faced conditions just

a little less perilous.

Only evacuation worked well. The

116th Medical Battalion took responsibility for all evacuation ashore and the

amphibious medical company for moving casualties from the beach. Roads

enabled vehicles to do most of the work,

a substantial advantage even though

broken springs, caused by the rough

coral tracks, shook the wounded.

Though difficult and dangerous, most

litter hauls were short, down to the nearest road, and the 135th Medical

Regiment had provided additional litterbearers. Along the shore, amphibious

vehicles did yeoman service. Offshore

evacuation was coordinated by a beach

76Ibid. See also Interv, Lt Col William J. Shaw, 2 Sep

44, p. 5 (quotation), file 000.71; Surg, Sixth Army,

Quarterly Rpt (copy), Jul–Sep 44, pp. 10–12, file 319.1;

116th Med Bn Med History (copy), pp. 8, 11, file

319.1–2 (116th Medical Battalion) SWPA, 27 May–2

Aug 1944; Rpt (copy), Chapman, 30 Aug 44, pp. 7–9,

file 341.26 Historical Reports, Hurricane (Biak) TF,

41st Inf Div, 27 May–19 Aug 1944. All in HUMEDS, RG

112, NARA. 

77Rpt (copy), Chapman, 30 Aug 44, p. 13, file 341.26

Historical Reports, Hurricane (Biak) TF, 41st Inf Div, 27

May–19 Aug 1944, HUMEDS, RG 112, NARA.

214 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
party medical officer and performed

usually at night; LSTs, hospital ships,

and, ultimately, aircraft carried the

wounded to Hollandia for treatment.

But efficient evacuation in combination

with inadequate hospitalization meant

depletion of the fighting units—a throwback to the conditions of Buna.78

The epidemics of Biak marked a failure of preventive medicine in the face of

great odds imposed partly by nature,

partly by the enemy. The island presented sanitation problems that proved

unanswerable under combat conditions.

Countless flies bred in the abandoned

Japanese food dumps that lined the

beach and on the unburied dead that

lay aboveground or deep in caves; both

the dumps and the dead were all too

close to Army kitchens. Disposal of offal,

body waste, and corpses alike was made

difficult by a hard subsoil of coral and

lava that prevented quick burial. The little water that was available was polluted,

not only by decaying flesh but also by

alkalies leached from the coral. Bad

water and abounding flies both contributed to outbreaks of diarrhea and

dysentery that harried the troops.79

But the most serious medical problem

was scrub typhus. On Biak and the small

neighboring island of Owi 1,050 cases

were recorded in July and August 1944,

about as many as in the whole Southwest

Pacific Area for the previous two years.

Although fewer of those who fell ill died

than in previous outbreaks, the disease

put its victims, most of whom belonged to

the Army Air Forces, out of combat for

about nine weeks. No preparation had

been made to meet the disease, for in

earlier campaigns it had always occurred

in kunai grass, from which Biak was free.

But here large areas were covered with

low ferns and rotting vegetation inhabited by rats, which harbored the mites

whose larvae transmitted scrub typhus. 

As the incidence rose to epidemic

proportions, General Denit sought help

from the United States of America

Typhus Commission—an interservice

group established by executive order

under the leadership of the Army

Medical Department. Two experts

arrived at Biak on 18 July. After studying

the flora and the rats and mites, they discovered the presence of two new species

of mites implicated in spreading the disease. They then assisted in implementing control measures and helped to

indoctrinate the troops in the proven

methods of prevention—impregnating

clothing with either dibutyl or dimethyl

phthalate, clearing underbrush from

unit areas, and killing wild rats. Scrub

typhus cases were concentrated at the

92d Evacuation Hospital for a long

course of nursing care, followed by evacuation to rear bases, sometimes as far as

the zone of interior.80

78116th Med Bn Med History (copy), an. 3 to Admin

Order 1, Hurricane TF Med Plan, p. 4, file 319.1–2

(116th Medical Battalion) SWPA, 27 May–2 Aug 1944;

Rpt, Sterling to Surg, 41st Inf Div, 12 May 44, sub: Biak

Operation, pp. 2–4, Encl to 92d Evac Hosp Quarterly

Rpt (copy), Apr–Jun 44, file 319.1; Rpt (copy),

Chapman, 30 Aug 44, pp. 3, 5–6, file 341.26 Historical

Reports, Hurricane (Biak) TF, 41st Inf Div, 27 May–19

Aug 1944. All in HUMEDS, RG 112, NARA. In loc. cit.,

file 319.1, see also Quarterly Rpts (copies), Apr–Jun 44,

for 135th Med Regt, pp. 4, 6–7; Surg, I Corps, p. 14; and

Surg, Sixth Army, pp. 24–26, plus Jul–Sep 44, p. 11. 79Rpt (copy), Chapman, 30 Aug 44, p. 7, file 341.26

Historical Reports, Hurricane (Biak) TF, 41st Inf Div, 27

May–19 Aug 1944, HUMEDS, RG 112, NARA.

80Ibid., p. 8, file 341.26 Historical Reports, Hurricane

(Biak) TF, 41st Inf Div, 27 May–19 Aug 1944; Surg, Sixth

Army, Quarterly Rpts (copies), Apr–Jun 44, pp. 29–30,

and Jul–Sep 44, pp. 12, 24–26, file 319.1; Ltr (copy), Lt

Col Cornelius B. Philip to Surg, USAFFE, 5 Aug 44, sub:

Scrub Typhus on Owi and Biak Islands, pp. 1–5,

Historians file. All in HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 215
The HURRICANE Task Force also

underwent the first epidemic of infectious hepatitis in the Pacific war. The disease appeared a few days after the first

landing and peaked during the week

ending 2 September at a rate of 712 per

1,000 troops per annum—clearly, an

outbreak that could have decimated the

force, had it continued at the same level.

A special team came from the United

States to investigate, but learned nothing new about a disease whose agent was

yet to be discovered. Tests suggested

that the virus could be found in body

wastes, which led medical officers once

again to stress the need for preventing

food and water contamination. In contrast to the spectacular symptoms of

scrub typhus, those of hepatitis were

chiefly lassitude, loss of appetite, and

jaundice. Usually the jaundice cleared

in one to five weeks, and the patient

recovered rapidly; the occasional fatal

case resulted from acute yellow atrophy

of the liver. Treatment consisted chiefly

of rest, which meant evacuation for

most. Both the major diseases of the

Biak campaign—one caused by rickettsiae, the other by viruses—were

reminders of the fallibility of preventive

medicine and the continuing dangers of

the Southwest Pacific environment,

even in an age when many once deadly

infections were becoming controllable.

The failures also pointed up the need of

planners for accurate and timely medical intelligence.81

Conquest of the Vogelkop

With Biak in his hands, MacArthur

moved against the smaller island of

Noemfoor to advance his air bases and

cut the enemy’s remaining lines of supply and reinforcement. The victory was

comparatively easy, for the airstrips fell

in short order. Thereafter, the fighting

consisted mainly of energetic patrols

that hunted out the remaining

Japanese. 

At least part of the reason for the

weak defense was starvation. The captured Japanese suffered from malnutrition, but much worse was the condition

of Formosan and Javanese laborers.

Eating less than the Japanese, and

forced to do exhausting work on the airfields of Noemfoor, these unfortunates

were riddled with malaria, beriberi, and

dysentery. Of 3,000 laborers the

Japanese had originally brought to the

island, only 403 survived to be liberated.

An American clearing company treated

the survivors and then transferred them

to a Dutch civil affairs unit that accompanied the CYCLONE Task Force, the designation given to the Noemfoor operation forces.

Other and even grislier evidence documented the failure of the Japanese supply system. About 1 August American

patrols began to discover Japanese bodies with fleshy portions cut away. Later,

American dead left outside the defensive perimeters overnight were recovered in similar condition. Prisoners

acknowledged that they had resorted to

cannibalism, with freshly killed

Formosans as the principal victims.

Some tribes of New Guinea had tradi81Surg, Sixth Army, Quarterly Rpt (copy), Jul–Sep 44,

pp. 12, 26, file 319.1; Rpt (copy), Chapman, 30 Aug 44,

p. 8, file 341.26 Historical Reports, Hurricane (Biak)

TF, 41st Inf Div, 27 May–19 Aug 1944. Both in

HUMEDS, RG 112, NARA. See also Philip, “Scrub

Typhus and Scrub Itch,” in Hoff, ed., Communicable

Diseases: Arthropodborne, pp. 284–347, and Henry M.

Thomas, Jr., “Southwest Pacific Area,” in Havens, ed.,

Activities of Medical Consultants, pp. 536–59. Penicillin

and the sulfa drugs were useful against bacterial infections but not against viruses and rickettsiae.

216 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
tionally performed ritual cannibalism,

but at least one desperate small unit of

the Japanese Army practiced it on

Noemfoor, as individual soldiers had at

Buna, merely to delay starvation.82

Four weeks after Noemfoor, on 30

July 1944, the last act began as Allied

forces landed unopposed on the

Vogelkop Peninsula to seize a region

near Cape Sansapor and construct new

airfields. By this time the Imperial General

Headquarters had written off New

Guinea, which the now depleted and

harried enemy shipping could no

longer supply or reinforce under the

attacks of land-based aircraft. The

defenders of Sansapor fled into the hills.

But if the medical personnel of the

6th Division expected an easy time, they

were disappointed. The Japanese might

be defeated, but New Guinea remained

hostile. A new and severe scrub typhus

epidemic broke out in August, and by

the end of September 931 cases had

been recorded, with a fatality rate of 3.4

percent—higher than at Biak. Again, no

kunai grass gave warning of the disease;

here a rank Bermuda-like grass harbored the vectors, and the troops who

slept on the ground were apt to rise with

the telltale marks of infection. In one

regiment 403 were hospitalized within

the first twenty days ashore, including

the regimental commander, his executive officer, ten staff officers, and five

company commanders.83

Strict control measures were

imposed, and gradually new admissions

dropped. But the sick remained to be

cared for. The clearing company of the

6th Medical Battalion was swamped with

those who were too sick to be moved.

On 15 August the 29th Evacuation

Hospital arrived, and by nightfall held

630 patients in place of its normal 400.

Nursing care remained intense, for

scrub typhus cases could not safely be

evacuated during the critical first three

weeks, when complete bed rest, spoon

feeding, and bedpan and urinal use

were necessary. The burden was too

great for the ward personnel, and drivers from the motor pool, mess personnel, and sanitation teams had to be

pulled in to assist. Each victim was out of

full service for about nine weeks; even

after returning to duty, he remained

weak, tired, and clumsy. The forces at

Sansapor lost 60,000 man-days to the

disease, which demonstrated that at the

end of the New Guinea fighting as at the

beginning, and despite ever-growing

sophistication in preventive medicine,

the environment could be a more dangerous foe than the enemy.84

With the capture of Sansapor the

long, often desperate struggle for New

Guinea came to an end. Now thrusts

against the Netherlands East Indies and

the Philippines impended—no longer a

remote dream but an almost present

reality. The danger to the Japanese

occupiers of the Philippines did not

come from MacArthur’s forces only.

82See Quarterly Rpts (copies), Jul–Sep 44, for Surg,

Sixth Army, pp. 12–15; Surg, Med Det, 158th Inf, p. 1;

3d Port Surg Hosp, pp. 4–10; and 71st Evac Hosp, pp.

2–3. All file 319.1, HUMEDS, RG 112, NARA. 83Philip, “Scrub Typhus and Scrub Itch,” in Hoff, ed.,

Communicable Diseases: Arthropodborne, pp. 287–88.

84Ibid., pp. 288–91; Mae Mills Link and Hubert A.

Coleman, Medical Support of the Army Air Forces in World

War II (Washington, D.C.: Office of the Surgeon

General, USAF, 1955), pp. 811–14; [6th] Division

Public Relations Section, The 6th Infantry Division in

World War II, 1939–1945 (Washington, D.C.: Infantry

Journal Press, 1947), pp. 52–59. See also Quarterly Rpts

(copies), Jul–Sep 44, for Surg, Sixth Army, pp. 15–19,

and 29th Evac Hosp, pp. 1–2, file 319.1; and Rpt (copy),

CO, 6th Med Bn, to CG, 6th Inf Div, 19 Jul 44, pp. 2–3,

file 306-Med-0.3. All in HUMEDS, RG 112, NARA.

AMPHIBIOUS ADVANCE 217
While soldiers, sailors, and marines

fought in the South and Southwest

Pacific, others advanced across the central Pacific, only a few hundred miles to

the north but, for the medics who supported them, a world away from the jungled islands of the Solomons and New

Guinea.

218 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
For a time in the spring of 1943,

before opting for a balanced advance in

the Pacific, the Joint Chiefs considered

the possibility of selecting the central

Pacific for the main American effort

against Japan, in part because of its relative freedom from disease. In fact, the

absence of endemic malaria and scrub

typhus sharply distinguished conditions

in the central region from those farther

south. Yet other perils existed in plenty.

Many central Pacific islands were too

small for the invaders to land on an

undefended or lightly defended shore;

costly frontal assaults were unavoidable.

And disease, though less severe than on

the jungled islands, was by no means

absent. 

Planning for the campaigns fell to the

Joint Staff, set up by Admiral Nimitz in

September at his headquarters. Its

Logistics Division included a medical

section of two officers, Navy Capt.

Thomas C. Anderson, MC, and Lt. Col.

Romeyn J. Healy, Jr., MC, who also

worked in the Joint Intelligence Center,

Pacific Ocean Areas, serving in effect as

a medical G–2 to the Joint Staff. Army

participation in medical planning and

theater coordination increased in early

1944 with the assignment of a second

medical officer; shortly afterward, a

senior surgeon of the U.S. Public Health

Service joined also, to assist in planning

for civil affairs and military government

in conquered and liberated areas.

Thereafter, as the breadth and complexity of the Central Pacific Area campaigns

increased, the medical section grew not

only in number but also in experience

and sophistication.1

Good medical intelligence on selected targets was often sketchy because of

their long occupation by the Japanese.

Both Army and Navy intelligence-gathering agencies made relevant data available to medical planners; prisoners of

war with medical training and backgrounds were interrogated; and prewar

sources of information were exploited

to develop a picture of local diseases

and vectors, sanitation, recent epidemics, and the state of public health.

With such basic information in hand,

CHAPTER VII

The Fortified Islands

1

Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 3, pp. 22, 25–27,

file 314.7; Office of the Surgeon (OofSurg), United

States Army Forces in the Middle Pacific (USAFMIDPAC), “Organization of the Armed Forces in the Pacific

Ocean Areas,” 28 Jan 46, pp. 1, 14–15, 17, 20, 24, 28,

Historians files. Both in Historical Unit Medical

Detachment (HUMEDS), Record Group (RG) 112,

National Archives and Records Administration

(NARA), Washington, D.C. The latter manuscript was

derived from “History of the Medical Section, Logistics

Division, Joint Staff, CINCPAC-CINCPOA,” prepared in

1945 and presently in the files of the Naval Historical

Center Operational Archives, Washington, D.C. 
planners sought to prepare U.S. forces

for short but intense operations on

islands, most of which were primitive

but some of which were heavily settled

by friendly or hostile populations. 

In the Central Pacific Area, as in the

South and Southwest Pacific Areas, combat team organization determined the

basic support requirements. The aim

was to saturate the island battleground

with small relatively self-contained medical support units that could work either

alone or in combination with others.

The Joint Staff planners sought to provide each reinforced division of about

20,000 troops, in addition to organic

medical personnel, with a field hospital;

two portable surgical hospitals, or the

equivalent in auxiliary surgical detachments; one malaria control detachment;

and one malaria survey detachment.

The portables quickly proved their

value, supporting anything from a divisional or separate clearing company or a

field hospital to a small landing force

that was isolated. Surgical detachments

often augmented field hospital platoons, collecting companies, or clearing

stations by providing forward surgery

for the seriously wounded. But experience showed that the portable, with its

component of 33 trained enlisted men,

gave greater flexibility and depth than

the surgical unit of a few medical officers, a single surgical nurse, and a surgical technician.

Since mobility counted for little on

tiny islands and bed strength was crucial, clearing companies often received

additional equipment that enabled

them to operate as 200–400-bed hospitals. Proper distinctions between smaller

and larger islands, however, were not

always made. On tiny coral islands the

expanded clearing station played a useful role; on larger landmasses its relative

immobility restricted the support that it

could offer to a constantly shifting battle

line. Similarly, the semimobile evacuation hospital proved to have little place

on the atolls, and its absence from the

medical service of the Central Pacific

Area caused few difficulties there. On

the larger islands, however, where several divisions were engaged, the unit

might have been highly useful, and the

efforts of field hospitals to function in its

place proved unsatisfactory, for lack of

equipment and specialized professional

skills.2

Landings were planned in accord

with familiar amphibious doctrine.

Company aidmen were to land with the

assault platoons and initiate care for the

wounded on the beach. The battalion

medical section usually landed with the

fifth wave and the collecting platoon

with the seventh and eighth waves. The

battalion aid station would work on the

beach until relieved by the collecting

platoon; shore party medical sections

would set up near the beach as well.

Clearing stations were to follow as soon

as enough ground had been won to provide them a site free from small-arms

fire. The brevity of the fighting on most

islands meant that all wounded who

could not immediately return to duty

must be evacuated to the transports

waiting offshore. Each task force carried

2

“History of the United States Army Forces, Middle

Pacific and Predecessor Commands, During World War

II, 7 December 1941–2 September 1945,” pt. 7,

“Administration of Manpower,” 12:2642–44, Ms 8–5.6

AA 7/3. See also “History of Office of the Surgeon,

United States Army Forces, Middle Pacific and

Predecessor Commands, 7 December 1941–2

September 1945,” sec. 2, “Central Pacific Area,” pp.

61–63, Ms 8–5.6 AA 30/2 (hereafter cited as “History of

OofSurg, USAFMIDPAC”). Both in files of U.S. Army

Center of Military History (CMH), Washington, D.C. 

220 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
with it all the food, medicines, and other

supplies the landing forces would need

for thirty days—even the drinking water.

Ashore, the assault forces drank from

their canteens, from coconuts, and from

tanks of chlorinated water; later, while

using distillation equipment to make

seawater potable, deep wells were dug.

The experience of the other Pacific

theaters clearly influenced these

arrangements. The Central Pacific Area

benefited from its late start as a combat

theater, but by the same token found

only limited opportunities to introduce

important innovations. What the Joint

Staff planners needed to refine

amphibious warfare in their theater was

the experience of actual operations.

This came quickly in the autumn of

1943.3

Winning the Gilberts

The first targets were three of the sixteen coral atolls that make up the Gilbert

Islands. Lying athwart the Equator more

than 2,000 miles from Hawaii, the

Gilberts, with their coconut palms and

Micronesian inhabitants, formed an outlying ring of the Japanese defense

perimeter. Unknown to Americans at the

time, the Imperial General Headquarters

had already decided to establish its main

line in the Caroline and Marianas

Islands. However, the garrisons of the

Gilberts and Marshalls had been

strengthened rather than weakened, in

order to fight the most effective possible

delaying action.

Makin was a triangular atoll, comprising the two large islands of Kuma and

Butaritari, where the Japanese had a seaplane base with substantial fortifications

and a permanent garrison. A little over

100 miles to the south lay heavily defended Tarawa, a similar subgroup whose

main island of Betio contained an airfield and the administrative headquarters for their naval forces in the Gilberts.

Still farther south, Apamama was the site

of a lightly defended observation post.4

Under Admiral Nimitz, Vice Admiral

Raymond A. Spruance commanded the

Central Pacific Forces, including the V

Amphibious Force under Rear Admiral

Richmond Kelly Turner. Turner also

commanded Task Force 54, the assault

force—consisting of the Northern

Attack Force (Makin), the Southern

Attack Force (Tarawa), and lesser attack

groups—whose troops were supplied by

the V Amphibious Corps under General

Holland Smith. Components of the

corps were the 2d Marine Division

under Maj. Gen. Julian C. Smith, USMC,

and the 27th Infantry Division under

Maj. Gen. Ralph C. Smith. Supporting

the Makin operation was the Army’s task

force, consisting of the 27th’s 165th

Infantry and elements of its 105th

Infantry. The task force surgeon was Lt.

Col. Abraham Norman, MC, then commander of the 27th’s 102d Medical

Battalion and later division surgeon.

The medical service provided an

enlisted medic for every 10 and a doctor

3

CSurg, USAFPOA, Annual Rpt, 1944, p. 4, file

319.1–2; Whitehill, “Medical Activities in Middle

Pacific,” block 3, pp. 24, 30, file 314.7. Both in

HUMEDS, RG 112, NARA. See also “History of

OofSurg, USAFMIDPAC,” sec. 2, pp. 60–63, 67–69,

88–99, Ms 8–5.6 AA 30/2, CMH. 

THE FORTIFIED ISLANDS 221

4

Whitehill, “Medical Activities in Middle Pacific,”

block 18a, pp. 3–5, file 314.7, HUMEDS, RG 112,

NARA; Philip A. Crowl and Edmund G. Love, Seizure of

the Gilberts and Marshalls, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1955), p.

210. Unless otherwise noted, the combat narrative for

the Gilberts and Marshalls campaigns is drawn from the

latter source.
for every 250 combatants. In addition to

company aidmen and battalion medical

detachments, the 27th Division’s 102d

Medical Battalion was present to

strengthen the battalions and to provide

second-echelon support. The clearing

company was augmented by a provisional portable surgical hospital—the first to

appear in the Central Pacific Area. The

portable, provided by General King, the

USAFICPA chief surgeon as of August

1943, soon proved to be a highly adaptable unit, able both to maintain and to

move itself in the field and to assume

many different guises as needed. Added

equipment allowed the collecting company to establish a 400-bed hospital. In

anticipation of combat, medics gave

physicals and immunizations, checked

their equipment, and completed their

own training.

Supplies were ample. Most, including

medical requirements, were palletized—covered with waterproof paper

and strapped to wooden sleds for easy

movement ashore. Combat loading

ensured that all members of a unit occupied the same ship and that their supplies were arranged for easy access, with

the items needed first on top. Each battalion carried supplies for ten days on its

assigned vessel. Supporting the fleet was

a mobile supply base of tenders, repair

ships, tugs, minesweepers, and fuel

barges. Among its stores was an additional thirty-day supply of food and medicines for 10,000 troops.5

On 10 November, while the marines

headed for Tarawa, the Army’s 7,000-

man task force, plus artillery and a garrison that included a provisional field hospital, embarked on a nine-day voyage

from Pearl Harbor. Rounds of daily calisthenics and debarkation drills helped to

pass the time. Amply supported but as

yet untested in combat, the Northern

Attack Force arrived off Makin Atoll on

the night of 19–20 November.6

Aerial photographs had revealed that

the Japanese defenses were concentrated around the seaplane base on the

lagoon shore, where several piers jutted

into the water. Two tank barriers crossed

the narrow island of Butaritari from

lagoon to ocean, and in between lay a

heavily defended area with pillboxes

and gun emplacements that Americans

called the Citadel. In the first landing at

0830, the 105th Infantry, followed by the

first and third battalions of the 165th

Infantry, came ashore at the western end

of the island. In the second, two hours

later, the remaining battalion of the

165th landed on the lagoon shore

between the tank barriers, splitting the

defenders.

Opposition to the landing on the

western beaches was sporadic and ineffective. Fortunately, most of the 800

defenders clung to the Citadel, and

most of the troops, despite unfavorable

tides that delayed the landing of supplies, were ashore by the end of the first

day. Company aidmen landed with their

units, and medics who accompanied the

Army engineers, coming in with the second and third waves, set up aid stations.

Then followed the battalion medical

sections, the collecting company platoons, the portable surgical hospital,

and the clearing company. 5

Whitehill, “Medical Activities in Middle Pacific,”

block 18a, pp. 5–10, file 314.7; Surg, 27th Inf Div,

Annual Rpt, 1943, encl. 4, pp. 1–2, file 319.1–2. Both in

HUMEDS, RG 112, NARA. Palletizing had been used in

the Aleutians, though not so extensively.

6

Samuel Eliot Morison, History of United States Naval

Operations in World War II, 15 vols. (Boston: Little,

Brown and Co., 1947–62), 7:86–90, 102–07. 

222 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Trouble developed on the beaches

along the lagoon shore, where the

Japanese had concentrated. Here the

invaders were peppered by small-arms

and automatic weapons fire as they

waded ashore. Not all the bullets came

from the shore. Snipers had holed up in

two wrecked ships, and American aircraft blasting at these impromptu forts

delayed the landing of the medics in the

later waves. Around the Citadel the

infantry began to take heavy casualties.

For a time a collecting platoon, a battalion aid station, and the stations of the

Army shore party and the Navy beach

party worked together to handle the

influx of wounded. Enemy fire was

heavy and accurate, and the medical

detachment of the 105th Field Artillery

Battalion was driven to emulate the

Japanese, digging a bunker and caring

for its casualties underground.7

During the first six hours of fighting

about 4 percent of the command were

killed or wounded. Most injuries were by

gunshot or shrapnel, either in the

extremities or in the buttocks of those

who failed to keep down when crawling.

Nothing could be done ashore but provide supportive measures to combat

shock, control hemorrhage, and immobilize fractures. Though evacuation was

usually swift—for which the crews of the

amphibious vehicles or small landing

craft used to transport troops from the

Navy flotilla to the shore received the

special thanks of the medics—little

effort was made to sort casualties, and

care was not uniform. Few vehicles went

ashore, and the LVTs (landing vehicle,

tracked), also known as “Alligators,”

moved only by day, for the transports

withdrew at night. The wounded were

moved mostly by litter from battalion

aid stations to collecting stations and

then to shore party aid stations. Some

went untreated, reaching the transports

in a dangerous condition from hemorrhage and shock, which personnel

belonging to Navy hospital ship platoons treated in sick bays and improvised wards in the vacant troop spaces.8

The succeeding days’ advance was

aided by tanks, and evacuation by jeep

ambulances, each equipped with welded

steel racks to hold up to four litters. The

Americans slowly pushed the enemy

back toward the northeastern tip of the

island, moving through dense foliage

and marsh in the face of tenacious

snipers. By D+1 the portable surgical

hospital was in operation, and by D+2

the jeep ambulances were shuttling

between the aid stations and the clearing station. Transports sailed with casualties, bound for Oahu, while Navy seaplanes flew a few critical cases to the

Ellice Islands, about 350 miles east and

600 miles south of Tarawa. By morning

of the fourth day all organized resistance had come to an end, and by 24

November the American combat forces

began to depart, leaving behind a small

garrison with medical support from the

1st Provisional Field Hospital. Army

engineers soon began to carve out air8

Interv, Capt Hilbert Ehrlich, 21 Dec 43, file 000.71;

Whitehill, “Medical Activities in Middle Pacific,” block

18a, pp. 21–26, file 314.7. Both in HUMEDS, RG 112,

NARA. See also Edmund G. Love, The 27th Infantry

Division in World War II (Washington, D.C.: Infantry

Journal Press, 1949), pp. 23–55.

THE FORTIFIED ISLANDS 223

7

Whitehill, “Medical Activities in Middle Pacific,”

block 18a, pp. 13–20, file 314.7; Ltr, Cmdr E. R. Hering,

Med Observer, Fwd Echelon, Galvanic, to CofS, V

Amphibious Corps, n.d., sub: Medical Situation,

Galvanic, Encl F to V Amphibious Corps Spec Staff Offs

Rpt on Galvanic, The Historical Unit (THU) Note

Cards, Historians files. Both in HUMEDS, RG 112,

NARA. 
fields, and evacuation by air became

standard, as in most places throughout

the Pacific.9

Despite the fierceness of the fight, the

cost of conquering Makin was not

great—66 dead, 152 wounded, and 33

sick and injured. By destroying enemy

gun emplacements, the pre-invasion

bombardment assured that the great

majority of wounds were caused by small

arms, hand grenades, and small-caliber

mortars, rather than by artillery. Gas

gangrene infections were apparently

absent. A small number of injuries,

some severe, were inflicted by swords,

reflecting the romanticism or desperation of the defenders. The enemy’s

whole garrison were either killed or captured; most fought to the death, a number committed suicide when their situation became hopeless, and one enemy

officer, taken captive while wounded,

resisted medical treatment, trying to

bite and kick the medical officer who

attended him.10

10Interv, Ehrlich, 21 Dec 43, file 000.71, HUMEDS,

RG 112, NARA.

224 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

9

Interv, Ehrlich, 21 Dec 43, file 000.71, HUMEDS,

RG 112, NARA; Department of the Navy, Bureau of

Medicine and Surgery, “The United States Navy

Medical Department at War, 1941–1945,” 1:177, files of

Bureau of Medicine and Surgery Archives (BMSA),

Washington, D.C. 

SHUTTLING LITTER CASUALTIES TO A CLEARING STATION
Overall, American performance during the Makin operation was mixed.

Both the complex tactical plan and the

medical plan proved to be weak in several respects. Dividing the forces caused

unnecessary problems throughout the

early part of the fight by increasing

injuries from friendly fire. Lack of combat experience among the medics

showed in a variety of ways—in an excess

of medical supplies dumped helter-skelter on the shores; in the haste of some

units to get ashore without regard to

prescribed times of landing; and in anxiety reactions, especially among the officers, after brief exposure to combat. On

the other hand, the emergency work of

the portable surgical hospital and evacuation by jeep ambulances over the flat

and relatively open terrain were

markedly successful. The Alligators

saved many lives by providing the essential link between the beach and the

landing craft and transports beyond the

reef. 

Individual medics had much to be

proud of, particularly on the first day

when they worked with only the supplies

they carried on their backs. Yet success

depended greatly upon the fact that few

casualties had to be moved or treated.

The events at Makin gave no indication

of what might happen in fights against

strong Japanese garrisons.11

At Tarawa Atoll the marines faced a

far more numerous and better prepared

enemy, entrenched in almost indestructible fortifications behind a protecting

coral reef that blocked the approach of

landing craft. About 3,000 well-trained

Japanese soldiers held the island of

Betio. Surviving the initial bombardment, they directed heavy fire against

the marines, who approached the beach

aboard Alligators and other amphibious

vehicles. Many of the amphibians were

destroyed, leaving the marines to reach

shore as best they might. Once there,

they had to fight their way, destroying

bunkers and pillboxes as they went. In

four days of savage combat some 3,000

became casualties, and of these about a

third died. Further sharp but limited

fighting was needed to conquer the rest

of the bloody atoll.12

To the south, the marines quickly

overcame the tiny garrison on

Apamama, where most of the 23

Japanese soldiers took their own lives.

But the struggles at Makin and especially at Tarawa were a warning of serious

tactical and medical problems. Each

attack on a very small island was, in

effect, a frontal assault; heavy prelanding bombardment crippled but did not

destroy the defenders. Waters near the

islands were treacherous with reefs, and

the attackers faced the risk of incurring

many casualties who could neither

receive adequate treatment ashore nor

be evacuated to the ships in an acceptable time.13

Medical officers reviewing the reports

recommended that future invasions be

11See Surg, 27th Inf Div, Annual Rpt, 1943, encl. 4,

pp. 17–22, file 319.1–2; 147th Gen Hosp ETMD, 10 Dec

44, pp. 1–3, file 350.05. Both in HUMEDS, RG 112,

NARA.

12“Navy Medical Department at War,” 1:161–83,

BMSA. On the Marine medical experience, see the narrative account of the Gilbert Islands operation, The 2d

Marine Division and Its Regiments, prepared in 1984 by

the Reference Section, Historical Branch, History and

Museums Division, Marine Corps Historical Center,

Washington, D.C. The classic firsthand account of the

operation is Robert Sherrod, Tarawa: The Story of a Battle

(New York: Duell, Sloan and Pearce, 1944), which gives

a roster of Navy medical casualties (pp. 179–80). 13Statistics from Crowl and Love, Gilberts and

Marshalls, p. 156.

THE FORTIFIED ISLANDS 225
supported by medically equipped

amphibians, LSTs (landing ship, tank),

and at least three hospital transports for

each division. Jeep ambulances had

proved invaluable, and more of them,

better waterproofed, were needed.

Among the troops ashore, they noted

poor sanitary discipline as a problem for

both soldiers and marines. The casual

behavior of the troops, combined with

the piles of rapidly decaying enemy

dead (often carelessly entombed by bulldozers collapsing the captured

bunkers), brought a plague of flies and

an epidemic of bacillary dysentery to

both Makin and Tarawa in the aftermath

of the fighting. (Six percent of the

Makin garrison was hospitalized for this

cause.) On Makin dengue also became

epidemic. As General King admitted,

“Control [of mosquitoes] was very difficult, and little could be done.” Another

problem was the care of natives injured

by the fighting; overburdened medical

units proved inadequate, and the small

forces left as garrisons were unable to

treat the combination of war wounds

and tropical diseases that afflicted their

new civilian subjects. A separate and distinct medical organization would be

needed to handle civil populations that

could only grow greater as the war

moved westward.14

The lessons learned in the Gilberts

were harsh ones, especially when casualty rates there were compared with those

of other Pacific battles. Rates of wounded in action plus killed in action per

1,000 troops per day were 5.07 at Attu,

2.63 at Biak, but 12.77 for the Army in

14“History of OofSurg, USAFMIDPAC,” sec. 2, pp. 75

(quotation), 88–89, Ms 8–5.6 AA 30/2, CMH; Ltr,

Hering to CofS, V Amphibious Corps, n.d., Encl F to V

Amphibious Corps Spec Staff Offs Rpt on Galvanic,

THU Note Cards, Historians files, HUMEDS, RG 112,

NARA.

226 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

TARAWA CASUALTIES ON THEIR WAY TO OFFSHORE MEDICAL CARE
the Gilbert Islands and 39.65 for the

marines. By supplying airfields for landbased air support, the newly conquered

Gilberts contributed crucially to the

next campaign, where Admiral Nimitz’

command quickly demonstrated that it

had learned much from the struggle just

completed.15

The Marshalls

Lying halfway between Hawaii and

New Guinea, the 700-mile-long archipelago of the Marshalls, containing natural

and developed harbors, airfields, and a

seaplane base, presented a tempting target. All of its thirty-four atolls and two

thousand islands are flat, with none rising more than 30 feet above sea level.

Most supported coconut, breadfruit,

and pandanus trees, and some a thriving

tropical undergrowth as well.16

Some Japanese strongholds in the

islands could be bypassed and neutralized. But the atolls of Kwajalein,

Eniwetok, and Majuro had to be taken.

Heavily garrisoned Kwajalein would

require two simultaneous assaults, causing General Holland Smith to divide his

ground troops into four landing forces.

The newly formed 4th Marine Division

and the 7th Infantry Division, recently

arrived in Hawaii from the Aleutians,

were ordered to cooperate in seizing the

islands of Kwajalein, the world’s largest

atoll.

The division surgeon, Colonel Potter,17

and the 7th Medical Battalion commander Colonel Kamish, approached the

problems of the new assault with their

Alaskan experience as well as the knowledge recently gathered in the Gilberts to

guide them. The collecting companies

would be broken down into platoons,

one to support each battalion landing

team and the clearing company

equipped with additional equipment to

function as a 200-bed division hospital in

case of need. A portable surgical hospital

was to go ashore at Eniwetok. Backup at

Kwajalein would be provided by the 31st

Field Hospital, with three platoons and a

headquarters section. Except for the

clearing companies and the hospital platoons, whose heavy equipment was to be

secured to pallets in waterproof wrappings, all medical personnel would carry

their initial supplies on their backs.

Overall responsibility for the casualties that occurred between the beach

and the reef fell to the medical section

of the 708th Amphibian Tank Battalion.

In each of the four landing groups

established by Admiral Turner the Navy

designated one amphibian to act as an

ambulance, once its original load of

assault troops had been discharged on

the beach. Each amphibian ambulance

was assigned a physician or highly qualified technician and three enlisted

medics. Flying the red cross, these LVTs

were to pick up casualties from the

17Potter’s later career was a distinguished one. Only

thirty-four years old at the time of the Marshalls campaign, he served with the Medical Corps until 1969,

retiring as a major general after serving as the United

States Army, Europe, surgeon and the Brooke Army

Medical Center commander.

THE FORTIFIED ISLANDS 227

15Percentage rates based on statistics from the following sources: Stetson Conn, Rose C. Engelman, and

Byron Fairchild, Guarding the United States and Its

Outposts, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1964), p. 295; Robert

Ross Smith, The Approach to the Philippines, United States

Army in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1953), p. 577; and Crowl and Love, Gilberts and

Marshalls, pp. 125, 156. 16Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 3–4, file 314.7, HUMEDS, RG 112,

NARA.
water and from disabled vehicles,

administer first aid, carry them across

the reef, and then transfer them to Navy

landing craft for ferrying to the transports. If conditions offshore proved less

serious than anticipated, the ambulances were to remain on the beach and

work there. The 7th Medical Battalion’s

executive officer was assigned as medical control officer to the naval control

vessel that guided each landing. Posted

at the line of departure, he was to maintain contact with the beachmaster, the

amphibians, and the transports, to coordinate the movement of casualties and

supplies.18

Training for the new campaign was rigorous. In Hawaii the medics, like line

troops, took long road marches, qualified

in swimming, studied security measures,

fired small arms, and learned the rudiments of jungle fighting. Unit field problems prepared them to work with the battalion landing teams that they were to

support. Doctors and clearing platoon

personnel polished their specialties in

the hospitals of Oahu, and the enlisted

men drew fatigue details to give the collecting platoons as much time as possible

to follow their own, more field-oriented

training programs. Finally, in memory of

the epidemics that had followed the earlier battles, training of all personnel heavily emphasized sanitation.19

By the third week of January 1944 the

assault forces were ready. Setting out

from Oahu, the Northern and Southern

Attack Forces and the Majuro Attack

Group headed for the Marshalls. Majuro

proved to have been abandoned by the

enemy, and the American flag was raised

on the morning of the thirty-first.

Occupation of the various islands of the

atoll followed without incident, and the

medics found little to do but conduct

sanitary surveys of the fortunate natives

who, like the soldiers, had been spared a

battle. Kwajalein was another matter. 

On 31 January the convoys bearing

the Northern and Southern Attack

Forces arrived at the huge atoll to begin

Operation FLINTLOCK. The two landed

almost 50 miles apart, reflecting the size

of Kwajalein, whose eighty islands surround a 655-square-mile lagoon. Flat,

and covered with palm trees, the islands

resemble the Florida Keys in size, topography, and climate. At the northern end

of the atoll, Roi and Namur, two islands

linked by a sand spit, contained an airfield and controlled the northern

anchorages and entrances into the great

lagoon; Kwajalein Island was similarly

sited and armed at the southern end.

The native inhabitants, ill-treated and

forced to labor for the Japanese, proved

to be well disposed to the Americans.

The seizure of Roi-Namur fell to the

marines of the Northern Attack Force,

that of Kwajalein to the infantry.20

On the first day a few outlying islets

fell quickly and with little resistance.

Then on the morning of D+1, following

a lethal naval bombardment, amphibians carried the whole assault wave of

the 7th Division across the reef to

Kwajalein. Soldiers of the 32d and 184th

Regimental Combat Teams swarmed

20S. L. A. Marshall, Island Victory: The Battle of

Kwajalein Atoll (Washington, D.C.: Infantry Journal

Press, Penguin Books, 1944), pp. 49–52. 

228 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

18Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 10–15, file 314.7; Notes on OofSurg,

USAFICPA, ETMD, 4 Apr 44, encl. 5, pp. 1–2,

Historians files. Both in HUMEDS, RG 112, NARA. See

also “History of OofSurg, USAFMIDPAC,” sec. 2, pp.

75–79, Ms 8–5.6 AA 30/2, CMH. 19Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 16–18, file 314.7, HUMEDS, RG 112,

NARA.
ashore on Red Beaches 1 and 2 at the

western end of the 21

⁄2-mile-long island.

At the northeastern end were barracks,

warehouses, and headquarters buildings; at the center, an airstrip neared

completion. The coral island was flat

and sandy, and the pre-invasion bombardment had left a cratered moonscape piled with rubble.21

Opposition to the landing was light,

but resistance stiffened as the 184th

Regimental Combat Team advanced

along the lagoon side of the island and

the 32d Regimental Combat Team

along the ocean side. Debris blocked

the troops’ vision, and the enemy

fought back from pillboxes, bunkers,

and networks of trenches camouflaged

with palm fronds. Disorganized but

tenacious defense gave the battle the

character of urban warfare. “You often

see Kwajalein described as a ‘jungle’

battle,” wrote historian S. L. A.

Marshall, “but . . . what happened there

possessed nearly all of the attributes of

house-to-house fighting,” with bitter

skirmishes around ruined buildings and

endless bloody work to be done in clearing out snipers. Frenzied resistance also

occurred on nearby islands. Marshall

told the story of an aidman, Pfc. Vonnie

W. Gray, on the islet of Gehh, who

crawled forward under fire to dress the

arm of a wounded soldier. While he

worked, an explosion flung another

into the air, who landed with right leg

shattered and bleeding. Gray went to

his aid, working calmly under intense

fire, “an example of courage that stimulated and enriched every fighting man

who saw it. The troops would talk about

it for days to come.”22

By nightfall on 4 February Kwajalein

Island had fallen, and two days later the

mission of the Southern Force was complete, at a cost of 142 dead, 845 wounded, and 2 missing. Enemy losses were

high—almost 5,000 dead; Japanese and

Korean prisoners of war totaled 206.

Meanwhile, the marines of the

Northern Force had seized Roi-Namur

and nearby islets, losing 313 dead and

502 wounded to the enemy’s 3,500

killed.23

Medical Support

Two collecting companies and one

clearing platoon of the 7th Medical

Battalion plus four shore party medical

sections supported the two regimental

combat teams that fought on the large

island, while collecting platoons alone

handled the casualties on nearby islets.

The medical battalion headquarters was

set up about 200 yards inland, midway

between the two landing beaches.

Ambulances were landed from the first

day, establishing motor evacuation, and

by D+4 clearing stations were receiving

wounded.

Offshore, the suppression of enemy

fire by a murderous opening barrage

and the presence of many amphibians

brought welcome changes. No carnage

like that at Tarawa occurred in the water.

Amphibian ambulances evacuated from

the beaches. On D+1 a platoon of the

22Quotations from Marshall, Island Victory, pp. 103

and 44. See also Heinl and Crown, Marshalls, pp.

100–07. 23Heinl and Crown, Marshalls, pp. 53–58, 108–14.

Whitehill, “Medical Activities in Middle Pacific,” block

18b, p. 92, file 314.7, HUMEDS, RG 112, NARA, gives

the total Army wounded as 1,001.

THE FORTIFIED ISLANDS 229

21Robert D. Heinl, Jr., and John A. Crown, The

Marshalls: Increasing the Tempo (Washington, D.C.:

Historical Branch, G–3 Division, Headquarters, U.S.

Marine Corps, 1954), pp. 26–27, 55–58.
31st Field Hospital landed on

Ennylabegan, an islet adjacent to

Kwajalein, while the other platoons

worked aboard ships, apparently for the

first time in the Pacific war. By D+5, however, the entire hospital was together

again on the islet. Unusual was the work

of two surgical teams that went ashore on

another islet, Enubuj, to support field

artillery units firing against Kwajalein.

Lacking American wounded, the surgeons treated enemy captives who had to

pass through the division headquarters

on the island.24

Evacuation for this workmanlike

operation was efficient and unremarkable. At the front, litter squads assigned

to the assault companies quickly

removed the wounded to the aid stations. Collecting platoons provided

relief litter-bearers to battalion medical

sections. Hauls were short and beds

were ready at the collecting and shore

party aid stations; surgeons estimated

the facilities could have handled three

times the number of wounded with no

loss of efficiency. As jeep ambulances

became available, movement of the

wounded became even smoother, quicker, and less wearing. The amphibian

ambulances proved invaluable in transporting casualties to the control ship,

from which they were transferred to

LCTs (landing craft, tank) and subse230 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

24Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 29–51, file 314.7; Notes on Rpt, 31st Fld

Hosp, 1 Mar 44, sub: Recent Mission in the Marshall

Islands, pp. 1–3, Historians files. Both in HUMEDS, RG

112, NARA. See also “History of OofSurg, USAFMIDPAC,” sec. 2, pp. 77–79, Ms 8–5.6 AA 30/2, CMH. 

LITTER-BEARERS REMOVING A KWAJALEIN CASUALTY FROM THE FRONT LINE
quently to transports. At high tide the

LCTs evacuated the wounded directly

from the beaches; at other times they

were usually obliged to wait beyond the

reef. For some casualties the entire trip

from front line to transport or hospital

ship took three hours and for others as

many as fifteen; the average was a bit less

than six. Relatively quick evacuation

became a key to the low mortality rate

that distinguished the battle for

Kwajalein. 

In turn, the ships (including the Navy

hospital ships USS Solace and USS Relief)

on hand for the operation evacuated to

Oahu, a 2,100-mile voyage that took

eight to twelve days. By the end of

March airfields in the Marshalls had

been cleared and completed, and air

evacuation of the few casualties from the

garrison forces began. Some complaints

about the evacuation process were

heard: More hospital ships would have

been welcome, and too many transfers

from one craft to another had taken

place in the inshore waters. Yet by and

large, considering the complexity of the

operation and the many medical units

working independently on islets (the

Southern Attack Force captured twentysix islands, of which twelve were occupied by the enemy), the process had

been effective and the cooperation of

the two services outstanding. Carefully

prepared and veteran troops were

another part of the equation; light casualties were the third. When an observer

commented that the evacuation chain

could easily have handled three times as

many casualties, he paid tribute both to

THE FORTIFIED ISLANDS 231

HOSPITAL SHIP FITTED WITH HANGING COTS, to handle the overflow of evacuees
the consequences of a well-fought battle

and to the careful preparations by the

Joint Staff for misfortunes that never

occurred.25

In the aftermath of the fight, the new

emphasis on sanitary measures paid dividends. Details led by officers of the

Sanitary Corps sprayed latrines and

decomposing bodies with sodium arsenite or paradichlorobenzene and buried

the enemy dead in mass graves, some

containing 1,200 bodies. A few cases of

sickness occurred, providing work for a

station hospital that arrived on

Kwajalein and for a provisional station

hospital on one of the nearby islets, but

epidemics did not break out. One section of the provisional hospital devoted

its attention chiefly to the Marshallese

natives, meeting a need that had first

been recognized during the fight for the

Gilberts. On Oahu a senior medical officer of the U.S. Public Health Service

joined the Joint Staff planners at Nimitz’

headquarters to arrange for the care of

civilians during future operations.26

Eniwetok

Meanwhile, the 22d Marines

Regimental Combat Team and the

106th Infantry, 27th Division, gathered

to assault Eniwetok Atoll, some 350

miles northwest of Kwajalein. During a

five-day battle (17–22 February 1944)

the marines and soldiers seized the principal islands of Engebi, Eniwetok, and

Parry. Heavy opposition met the landings on Parry, costing the marines, as

Betio had, about 25 percent in casualties. Working from bunker to bunker,

the Americans destroyed an enemy garrison of 2,600, only 66 of whom survived

the attack. Total American casualties for

the campaign numbered 262 killed, 757

wounded, and 77 missing.27

With one exception—a medical

detachment with the 104th Field Artillery

Battalion that supported the marines on

Engebi from a nearby islet—Army medical units ashore were concentrated on

Eniwetok Island. As usual, company aidmen landed with their units, and battalion aid stations, collecting platoons, and

shore party medical sections followed

close behind. Evacuation imitated the

pattern established on Kwajalein. The

first casualties were littered to the beach;

then, after coming ashore, jeep ambulances took over the task of evacuating

the wounded from the battalion aid stations to the beach. Amphibians carried

casualties to the waiting transports. The

Solace, anchored off Eniwetok from 19 to

24 February, received the seriously

injured from the transports, to be ferried

back to Oahu. On the transport USS

Wharton, where an entire deck had been

set aside as a hospital, an Army clearing

company and a portable surgical hospital

worked side by side with the Navy surgeons and corpsmen. 

After the battle, these same units

moved to Parry Island to care for the

garrison and the native population,

while elements of the 36th Field

27Statistics from Crowl and Love, Gilberts and

Marshalls, p. 365. Morison, Naval Operations in World

War II, 7:304, gives different figures. See also Love, 27th

Infantry Division, pp. 59–111; “Navy Medical

Department at War,” 1:221–23, BMSA.

232 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

25Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 51–54, file 314.7; OofSurg, USAFMIDPAC, “Organization in Pacific Ocean Areas,” 28 Jan 44,

p. 16, Historians files; Notes on OofSurg, USAFICPA,

ETMD, 4 Apr 44, encl. 5, pp. 6–8, Historians files. All in

HUMEDS, RG 112, NARA. 26Notes on Prov Sta Hosp No. 2 Annual Rpt, 1944, p.

6, Historians files; Whitehill, “Medical Activities in

Middle Pacific,” block 18b, pp. 43–44, file 314.7. Both

in HUMEDS, RG 112, NARA. 
Hospital did the same on Engebi. The

customary outbreak of dysentery followed the victory, and was suppressed by

the same methods as on Kwajalein.

Despite bitter fighting, medical personnel had met with few surprises. The

Central Pacific Area forces had

learned—seemingly, had mastered—the

art of amphibious warfare. Yet there

were dangers even in success. The

bloody Gilberts campaign had stimulated thought and innovation. By contrast,

“the relative ease with which the

Marshall Islands campaign had been

executed influenced the thinking in the

Medical Section as it undoubtedly did in

other sections and divisions of the Joint

Staff to the end that an optimistic attitude had been adopted in the development of the plans for the Marianas, or

FORAGER Operation.” As a result,

“casualty estimates proved to be too low”

for the complex and desperate struggle

that lay ahead.28

Operation FORAGER

Quick if sometimes costly victory in

the Gilberts and Marshalls heartened

the Joint Chiefs to advance the Central

Pacific Area’s schedule for Operation

FORAGER in the Mariana Islands. On 12

March the Chiefs approved an attack

against the islands of Saipan and Tinian,

under Japanese mandate since World

War I, and against Guam, an American

mandate that had fallen to the enemy in

the opening days of World War II.

The Marianas are of both volcanic

and coral origin, an arc 425 miles long

that lies about 1,000 miles from the

nearest American base on Eniwetok and

about 1,300 miles from Tokyo. Relatively

large, the islands are diversified in form

and appearance, with swamps and sugarcane fields, fair-sized towns, and precipitous mountains. The new assault

would be a huge effort, involving

106,000 U.S. forces, including 50,000

soldiers. The Marianas could not fail to

evoke a fanatical defense, if only

because American planes operating

from Saipan and Tinian could threaten

the Philippines and Japan itself.

In preparation for the coming campaign U.S. forces seized undefended or

lightly defended islands on approaches

to the Marianas; constructed air and

naval bases; and, by constant bombardment, neutralized the enemy bastion at

Truk in the Caroline Islands to the

south. Saipan and Tinian were assigned

to the V Amphibious Corps, consisting

of the 2d and 4th Marine Divisions and

the 27th Infantry Division. Guam was to

be assaulted by the III Amphibious

Corps, formerly the I Marine

Amphibious Corps, consisting of the 3d

Marine Division and 1st Marine

Provisional Brigade then staging on

Guadalcanal.29

The Office of the Chief Surgeon

faced formidable problems in supporting so vast an operation against distant

reef-encircled islands of difficult terrain.

Invasion planning began shortly after

the completion of the Marshalls cam29Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 5–7, file 314.7, HUMEDS, RG 112,

NARA; Philip A. Crowl, Campaign in the Marianas,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1960), pp. 28–29. Unless otherwise noted,

the combat narrative for the Marianas campaign is

drawn from the latter source. 

THE FORTIFIED ISLANDS 233

28OofSurg, USAFMIDPAC, “Organization in Pacific

Ocean Areas,” 28 Jan 46, p. 19 (quotations), Historians

files; Whitehill, “Medical Activities in Middle Pacific,”

block 18b, pp. 60–74, file 314.7. Both in HUMEDS, RG

112, NARA.
paign. For the Saipan and Tinian operations, the theater allocated the Army’s

31st Field Hospital and the 96th and

97th Portable Surgical Hospitals to assist

the Navy medics supporting the

marines. Three new medical units,

called corps evacuation hospitals, were

established to provide the marines thirdechelon backup, but no similar organizations were provided to the soldiers of

the 27th Division, who were seemingly

destined for a reserve role. The division

had its own 102d Medical Battalion, with

support from the 38th Field Hospital

and the 98th Portable Surgical Hospital.

Finally, Admiral Nimitz alerted the 77th

Infantry Division on Oahu to be ready

for possible movement to Guam as the

reserve. The division was supported by

its own 302d Medical Battalion, the 36th

Field Hospital, and the 95th Portable

Surgical Hospital (Map 9).

Floating support would be unusually

strong. Four hospital ships were provided, and the transport USS Bolivar was so

extensively modified as to be, in effect, a

fifth. An array of smaller craft, including

LSTs, were fitted out to play the same

role temporarily. Because of the great

distances involved, casualties would be

carried by sea to the Marshalls and

retained in holding units until air evacuation could be instituted to Hawaii.

Penicillin, which had appeared in small

quantities in the Pacific theaters late in

1943, was stockpiled to be shipped by air

to the front.30

Prewar Navy experience in Guam provided a wealth of precise information on

the disease environment of the coming

campaign. The accidents of history and

the topography of the islands had determined which vectors were present and

which were not. The malaria-bearing

Anopheles was absent from the entire

Marianas chain, but the Aedes, which

transmitted dengue, was abundant.

Insect control units were assigned to the

invasion forces, but shipping shortages

delayed them, a fact that would cost the

garrison forces dearly. On Guam sanitary

conditions among the inhabitants were

poor, especially in the capital, Agana.

Venereal diseases and yaws were common

among the native population, a lightskinned people of mixed racial stock who

had endured Spanish, American,

German, and now Japanese occupation.

On Saipan the military and medical picture was complicated by a civilian population of 30,000, of whom 90 percent were

said to be Japanese or Korean civilians—

the first substantial group of enemy

nationals to be met in the Pacific war.

Experience with epidemics in earlier

campaigns led to improvements in preventive medicine techniques. Equipment

was developed to permit airplane spraying of DDT; burial details were trained,

with special squads set aside to spray

corpses with sodium arsenite; and sanitary precautions were urged upon all

troops. Again, field exercises and hospital training prepared the medics for their

new task.31

Between 29 and 31 May 1944 a flotilla

of 110 transport vessels set out from

31Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 12–15, 66–67, file 314.7; Surg, Saipan

Island Cmd, Annual Rpt, 1944, pp. 4–5. Both in

HUMEDS, RG 112, NARA. See also “Navy Medical

Department at War,” 1:300–01, BMSA.

234 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

30Combined Operations Headquarters (London),

Bulletin Y/41, U.S. Operations Against Saipan and

Guam in the Marianas, Sep 44, p. 27, file 370; Army

Service Forces (ASF) Monthly Progress Rpt, 31 Jan 45,

sec. 7, pp. 5–6, THU Note Cards, Historians files;

Whitehill, “Medical Activities in Middle Pacific,” block

18d, pp. 13–14, 96–97, file 314.7. All in HUMEDS, RG

112, NARA. See also “History of OofSurg, USAFMIDPAC,” sec. 2, pp. 79–81, Ms 8–5.6 AA 30/2, CMH.
Pearl Harbor across the intervening

3,200 miles of ocean. A number of miscellaneous units, assigned by the surgeon general, traveled with the expedition to support the Saipan garrison,

including a sanitary company and teams

THE FORTIFIED ISLANDS 235

SAIPAN I

TINIAN I

AGUIJAN I

ROTA I

GUAM

0 30

Miles

ARMY MEDICAL SUPPORT

OPERATION FORAGER

June–September 1944

Note: Not all inclusive.

PHILIPPINES

MARIANA IS

Iwo Jima

Guam

PALAU IS

CAROLINE IS

JAPAN

Enlarged

Area

102d Medical Battalion

31st and 38th Field Hospitals

96th, 97th, and 98th Portable Surgical Hospitals

Corps evacuation hospitals

176th and 369th Station Hospitals

148th General Hospital

743d Sanitary Company

302d Medical Battalion

36th Field Hospital

95th Portable Surgical Hospital

289th Station Hospital

96th and 97th Portable Surgical Hospitals

(as of 24 Jul)

MAP 9
of experts on various topics of medical

interest. Hospitalization would be handled by the 148th General Hospital and

the 369th and 176th Station Hospitals, a

total of over 2,200 beds, plus a civilian

annex. The Army also was to supplement Navy facilities on Guam with the

289th Station Hospital.

In spite of the medical array carried

by the fleet, however, conditions aboard

the transports were poor. Space was so

limited that a unit larger than a platoon

could neither be briefed or instructed at

one time nor participate in PT, and the

troops, stacked five deep, slept in miserably hot and humid quarters or on deck

under blankets and shelter halves. Yet

the Army units reached their destination with no worse consequences than

an outbreak of diarrhea.32

Saipan

Northernmost of the three islands to

be conquered, and the most heavily

defended, Saipan was garrisoned by

some 32,000 enemy forces, almost double the American intelligence estimates.

Strategically placed artillery commanded the approaches to the island by sea,

and two functioning airports added to

its strength. Two major enemy weaknesses would affect the outcome of the campaign and the number of American

casualties: The Japanese did not believe

that the Americans were ready to strike

so far to the west, and plans for defense

in depth had been made but had not

been implemented when the invasion

came. The defenders would attempt to

defeat their enemies on the beaches,

despite the ample space and rugged

topography that Saipan afforded them;

by the time they retreated to the hills,

they would already be a broken force.33

Yet the fight for the beaches was brutal. Initial air strikes by carriers devastated the defending aircraft, and the naval

bombardment lasted from 11 to 15 June.

But neither was sufficient to destroy the

shore defenses. The marines, crossing

the reef on the fifteenth, were caught by

fire from Japanese artillery, mortars, and

automatic weapons. Prevented by cliffs

from landing anywhere but on the

island’s western side, the Americans were

invading at the enemy’s strongest point,

manned by a garrison four battalions

overstrength. By evening the landing was

a success, but only half the planned

beachhead had been secured and onetenth of the 20,000 assault troops had

been wounded. Moreover, reports from

submarines and aircraft patrolling off

the Philippines indicated that a large

Japanese fleet had begun to move

toward Saipan.

Hence, the 27th Division, the task

force reserve, landed on D+1 (16 June).

Two regiments, the 105th and 165th

Infantry, went ashore to assist the 4th

Marine Division in attacking Aslito airfield, on the southern tip of Saipan. By

the eighteenth the original schedule of

the Marianas campaign had been so

delayed that Nimitz was obliged to postpone the invasion of Guam. Meanwhile,

elements of the 27th Division fighting in

southern Saipan showed a marked lack

of combat efficiency. Dissatisfied, the

33On intelligence estimates, see Rpt, Lt Col John

Iemp, 11 Jul 44, sub: Observer Report on the Marianas

Operation (Forager), pp. 6–7, file 350.09, HUMEDS,

RG 112, NARA. Iemp was a special observer sent by the

Army chief of staff. 

236 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

32Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 14, 20–22, file 314.7, HUMEDS, RG 112,

NARA; “History of OofSurg, USAFMIDPAC,” sec. 2, pp.

80–81, Ms 8–5.6 AA 30/2, CMH.
corps commander, Holland Smith, now

a lieutenant general, relieved the division commander. Under new leadership, the soldiers then joined in the final

drive against the Japanese redoubts in

the mountainous center and the northern end of the island.34

By 20 June all elements of the 27th

Division were ashore. Savage fighting

scattered the landscape with dead and

wounded, and the maps with grim nicknames—Death Valley, Harakiri Gulch.

Just before daybreak on 7 July the 105th

Infantry, bivouacked between the shoreline and the cliffs on the coastal

Tanapag Plain, woke to a wild counterattack. Some 3,000 Japanese overran the

American positions, decimating the 1st

and 2d Battalions. Only at the regimental command post in Tanapag village was

the attack at last halted, in house-tohouse fighting.

Notable in the 3d Battalion, 105th

Infantry, was the courage of the regiment’s dentist, Capt. Ben L. Salomon,

DC, who had volunteered to care for the

wounded in place of an injured battalion surgeon. Seeing his aid station overrun, Salomon seized a rifle to cover the

escape of his wounded. Then he took

over a machine gun whose crew had

been killed. “He seemed to be having

the time of his life,” the division historian related. “He fired so fast and well that

witnesses say he piled up the enemy in

front of his gun until he no longer had

a field of fire.” Two days later Salomon’s

body was found, “still slumped over the

machine gun, riddled with bullets.”35

Yet for a time matters were grim. By

overrunning the perimeters of two battalions the enemy isolated the

Americans from their supplies and cut

their routes of evacuation. At a time

when the battered units took over 900

casualties, the Japanese controlled the

roads to the collecting stations. When

Maj. Edward B. McCarthy, commander

of the 2d Battalion, 105th Infantry,

assembled a party to seek help for his

wounded, American artillery mistakenly

zeroed in, driving the infantrymen into

the ocean for safety. Some walking

wounded got through; moving in the

opposite direction, a few litter-bearers at

great personal risk slipped into the aid

stations, and a single bold driver forced

his jeep ambulance through in midafternoon. Others followed when an

American counterattack cleared the

way, and Alligators nosed up to the nearest beach to carry off the wounded. As

usual in such situations, litters disappeared from the point of severest pressure with the wounded who lay on them,

and aidmen had to improvise others

from blankets and poles. Night had fallen before all who needed care were

removed from the front.36

By 9 July Saipan was secure. The

Japanese had ceased to exist as an organized force; their commander committed suicide after ordering the final attack,

which he was too sick to lead in person.

Once the enemy forces on the northern

end of the island were flushed out and

destroyed, the marines departed to

attack Tinian, and the infantry remained

on Saipan to mop up stragglers.

The victory had been costly. Of

71,034 American officers and enlisted

36Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 50–52, file 314.7; Rpt, CO, 102d Med Bn,

20 Jul 44, sub: Operational Report, p. 7, An C to Rpt,

Surg, 27th Inf Div, 1 Aug 44, sub: Forager Operational

Report, file 370. Both in HUMEDS, RG 112, NARA. 

THE FORTIFIED ISLANDS 237

34On the Marine-Army controversy, see Crowl,

Marianas, pp. 199–201. 35Love, 27th Infantry Division, p. 457.
men committed to the battle, 14,111

(about 20 percent) were listed as killed,

wounded, or missing—roughly the same

casualty rate as at Tarawa. Losses included 3,674 soldiers and 10,437 marines.

The defenders were virtually exterminated, and hundreds of the Japanese

civilians who had made the island their

home wrote a grim epilogue to the

struggle by leaping to their deaths from

the northern cliffs. Persuaded that the

Americans would torture and kill them,

much of the civil population had

retreated with their armed forces, taking

heavy casualties. Because farmers on

Saipan fertilized with nightsoil, the

earth was heavily seeded with the spores

of tetanus and the bacilli that cause gas

gangrene. Wounded civilians, lacking

inoculations, were often infected.

American medics were too few to care

properly for internees until the battle

was over, and internment camps quickly

became overcrowded and filthy. In all,

some 28,000 civilians were interned in

the Marianas, most on Saipan and

Tinian, and their sufferings added to

the human toll of the fighting.37

The Medical Problem

With its tens of thousands of dead

and wounded, the Saipan battle was

marked by recurring medical crises. The

marines landed first, under conditions

of great danger and confusion, and

Navy medics faced the task of bringing

some degree of medical order to the

beachhead. The task was far from easy,

especially in the first three days. Marines

who had survived the enemy’s devastating bombardment of the landing craft

huddled for almost thirty hours under

an artillery barrage ashore. The beach

resembled a massacre; wounded, dead

and dying lay everywhere. Navy aidmen

carrying seabags of medical supplies

were the first to reach them, administer

first aid, and attempt to remove them

from the beach for treatment. But early

evacuation was haphazard and slow.

When battalion aid stations were set up,

litter-bearers set out to retrieve survivors. Hospital corpsmen took losses of

their own; in the 4th Marine Division

alone, 161 medics were wounded.

The Navy beach party medical sections came ashore next, one for each

battalion landing team. Composed of

one medical officer and eight hospital

corpsmen each, these sections constituted the link between medical care ashore

and afloat. Digging in above the high

water mark, they set up casualty evacuation stations that were quickly overwhelmed by the wounded. One such station treated over 1,000 troops in four

days. Jeep ambulances speeded evacuation from the front lines, but were themselves hit time and again by enemy fire.

When a Japanese fleet threatened the

invasion, the transports were ordered to

sea, and a potential medical crisis developed. While the Battle of the Philippine

Sea took shape, medical personnel

ashore struggled to make do minus their

backup. LSTs were not fully equipped

for complex surgery, and only first aid

was available on the beach. Enemy

artillery and mortar fire continued to

harass the beaches, causing casualties to

pile up in aid and evacuation stations.

On D+3 (19 June), however, the hospital

ships arrived, and the transports

returned a few days later. The sea battle

238 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

37Statistics from Crowl, Marianas, p. 265; see also

Morison, Naval Operations in World War II, 8:170–212.

On civilians, see ASF Monthly Progress Rpt, 31 Jan 45,

sec. 7, pp. 6–7, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA.
ended in an American victory that permanently impaired the ability of the

Japanese Navy to fight in the air.38

On Saipan the medical crisis was over.

The 27th Division had brought ashore

its organic medical personnel and collecting platoons of the 102d Medical

Battalion. The worst confusion had

passed, and during the next few days the

remaining Army medical organization

landed without incident. Among the

new arrivals were the rest of the medical

battalion, the 98th Portable Surgical

Hospital, the 38th Field Hospital, and

one platoon of the 31st Field Hospital,

the second and third remaining aboard

the transport USS Storm King to work on

evacuees. The 96th and 97th Portable

Surgical Hospitals, which were designated to support the marines, came ashore

on 20 June (see Map 9).

Collecting company platoons

advanced with the infantry regiments,

and the clearing company, after working

for a few days in a small village on southern Saipan, joined the 165th Infantry.

Aid stations came under hot fire.

Casualties held overnight had to be lowered into foxholes for safety, doctors

worked by flashlight under cover of a

blanket or raincoat, and volunteers

from the division band helped to fill

gaps in the ranks of litter-bearers. The

98th Portable Surgical Hospital worked

near the clearing station, performing

emergency stabilizing surgery, often

under blackout conditions; the heaviest

influx of casualties at all facilities began

about 1400 hours and continued long

into the night. The portables were

extremely busy, treating about 2,700

casualties and performing some 225

operations; on occasion, four tables

were at work simultaneously. Medical

units worked within the perimeters of

the organizations they supported.

Defense was needed; on one occasion

three Japanese soldiers burst into a

clearing station, throwing hand

grenades. The 38th Field Hospital did

most of its work in a partly demolished

Japanese hospital at Aslito airfield, functioning in effect as an evacuation facility

and having a patient load that sometimes approached 1,000. The advance

echelon of the 369th Station Hospital—

a unit designated for garrison duty—

gave welcome assistance, as did the 98th

Portable Surgical Hospital late in the

campaign.39

Of all the Army hospitals on Saipan,

however, the 31st Field Hospital had the

most varied experiences. When their

work was done on shipboard, the two

platoons from the Storm King came

ashore. The 31st’s three platoons worked

separately. Setting up near the V

Amphibious Corps headquarters at

Charan-Kanoa, one platoon treated civilians and prisoners of war (POWs) from a

nearby internment camp—although

with great difficulty, given the lack of

interpreters, who were fully occupied at

the camp interviewing POWs. In the

beginning “disposition of patients . . .

was chiefly by death”; then as wounds

healed, the injured were discharged to

stockades or civilian internment camps,

where civil affairs doctors continued

38“Navy Medical Department at War,” 1:243–47,

BMSA.

THE FORTIFIED ISLANDS 239

39Ibid., 1:265–67, BMSA. See also ASF Monthly

Progress Rpt, 31 Jan 45, sec. 7, pp. 4–5, THU Note

Cards, Historians files; Rpt, 38th Field Hosp, 4 Sep 44,

sub: Observer’s Report [on] Forager Operation, pp.

1–5, file 350.09; Rpt, Surg, 27th Inf Div, 1 Aug 44, pp.

1–3, file 370; Rpt, CO D, 102d Med Bn, 18 Jul 44, pp.

2–4, An C to ibid; Whitehill, “Medical Activities in

Middle Pacific,” block 18d, pp. 24–31, 37–43, file 314.7.

All in HUMEDS, RG 112, NARA. 
treatment. The other two platoons

worked near the 102d Medical Battalion,

where they received large numbers of

casualties from the banzai charge of 7

July. For a time beds were filled to overflowing; casualties lay everywhere on the

ground on litters or blankets. The Navy

and portable hospital surgeons who

arrived to help had to cope with the clutter of bodies and insufficient operating

tables. Nevertheless, from 7 to 9 July,

under air raids and shrapnel falling from

antiaircraft fire, surgery went on around

the clock.40

The 38th Field Hospital, too, had its

adventures. All of its elements dug in,

for all were targets of enemy attack. No

component was properly defended,

leading the hospital commander to urge

that defense platoons be assigned to

hospital units, not only to guard against

the enemy but to assist with the diggingin chores that took medical personnel

away from their charges, often at times

when their services were badly needed.41

Psychiatric cases made up about 6 percent of the more than 5,000 casualties

suffered by the 27th Division from all

causes during FORAGER. Under the guidance of the division psychiatrist, working

at the 38th Field Hospital, all were initially recorded as “combat fatigue” cases

41Ibid., p. 31, file 314.7; Rpt, 38th Field Hosp, 4 Sep

44, pp. 3–4, file 350.09. Both in HUMEDS, RG 112,

NARA.

240 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

40Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 25, 30–31, 42–46 (quotation, p. 44), 53,

file 314.7, HUMEDS, RG 112, NARA.

WOUNDED NATIVE CHILDREN ON SAIPAN
and received treatment that by now had

become standard. On admission those

who were able ate hot food, took a cool

shower, and shaved; then, once in bed,

they were visited by the psychiatrist and

sedated with sodium amytal. As usual,

symptoms mimicked many serious disorders—manic depression, schizophrenia,

and Parkinsonism. Most stayed in the

hospital only four or five days. Those

who did not respond in thirty-six to seventy-two hours were evacuated to the

hospital ships. Despite the unfortunate

location of the hospital—in an abandoned village between a battery of heavy

artillery and Aslito airfield, where sudden blasts caused the more acute cases to

“literally jump off their cots”—202 of 272

patients were returned to duty by the

end of the battle.42

Overall, the Saipan campaign proved

to be more difficult and far more expensive than American commanders had

anticipated. Unexpected enemy

strength made a serious impact upon

the medical units and their overworked

personnel. Total bed capacity of all

Army and Marine installations was a bit

over 2,000, including expansion beds.

But by 9 July the total patient census had

reached 200 per day. The 31st Field

Hospital had a peak expansion capacity

of over 1,000 and a peak daily census of

the same. The medical system, especially its field hospitals, struggled to provide

care. Numerous combat casualties led

the 38th Field Hospital’s commander to

recommend that the semi-evacuation

hospital of 400 beds, with an expansion

capacity of 350, or the larger “750 bed

evacuation hospital be used instead of

the field hospital for this type of medical

coverage.”43

These were not the dimensions of a

disaster. But the figures recorded a system straining at its upper limits, and

implied a maximum burden on the

medics who were themselves enduring

much of the danger that had faced

their patients on the front lines.

Overcrowded facilities for the troops

also meant too rapid evacuation for

some casualties, too quick return of

others to the line, and generally insufficient care for civilians and prisoners

of war. The flood of wounded exhausted the supply of whole blood, and continued to do so even when division personnel began to donate their own.

Blood banks had to be set up on shipboard to provide whole blood for the

troops invading Tinian. On Saipan

many wounded made do with plasma;

many who received some whole blood

ought to have received more.44

Serious problems also developed in

evacuation. On land one difficulty was

the late arrival of the jeep ambulances,

which were not unloaded until four or

five days after the landing of the personnel who were to use them. Overburdened

litter-bearers were further hampered by

the need to move injured civilians and

42Rpt, Maj Albert D. Pattillo, OofSurg, 27th Inf Div,

20 Jul 44, sub: Report of Psychiatric Casualties in the

27th Infantry Division During the Saipan Operation,

pp. 1–3 (quotations, p. 1), An B to Rpt, Surg, 27th Inf

Div, 1 Aug 44, file 370, HUMEDS, RG 112, NARA. 

43Rpt, CO, 38th Field Hosp, 21 Jul 44, sub:

Operational Report, Saipan Campaign, p. 6 (quotation), An D to Rpt, Surg, 27th Inf Div, 1 Aug 44, file 370;

Whitehill, “Medical Activities in Middle Pacific,” block

18d, pp. 14, 43–44, 53, 55, file 314.7. Both in HUMEDS,

RG 112, NARA. 44Comments and Recommendations, pp. 1–3, in Rpt,

Surg, 27th Inf Div, 1 Aug 44, file 370; Whitehill,

“Medical Activities in Middle Pacific,” block 18d, pp.

47–58, file 314.7, HUMEDS, RG 112, NARA. See also

Douglas B. Kendrick, Blood Program in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1964), p. 594. 

THE FORTIFIED ISLANDS 241
prisoners of war. Alligators, halftracks,

and tanks were sometimes used to evacuate the wounded from the areas of hottest

fighting, but most evacuation during the

tense early days and after the enemy

counterattack was done by hand, and

some units, especially the hard-pressed

31st Field Hospital, were acutely short of

bearers for brief periods.

But the pressure on shipping caused

the greatest difficulty. The Joint Staff

planners could not have foreseen how

many casualties had to be taken off the

island—almost 2,000 the first day—nor

the absence of most transports for three

days during the sea battle. The reliance

upon transports for all complex surgery,

pending the arrival of the hospital ships,

left the severely wounded ashore without

proper treatment for about twenty-four

hours. After hospitals were ashore and

ships were ready to receive casualties, a

critical period ensued, lasting roughly

from 26 June to 9 July, when an influx of

wounded, sick, and injured, including

civilians and prisoners, taxed all facilities. Because the number of casualties

exceeded holding capacity both afloat

and ashore, about 10,000, even some

with only light wounds, left with ships

departing the combat area—a loss of 14

percent of the total Army and Marine

assault force. However desirable for the

wounded themselves from a purely medical viewpoint, such figures suggested

that the medical system afloat and

ashore was unable to preserve the fighting strength of the forces.45

Mix-ups in sorting casualties among

the ships compounded evacuation problems. Apparently, the Navy did not put a

medical officer aboard the control vessel,

the point where evacuees were transferred from landing craft to larger ships.

Under the intense pressure of combat,

many casualties were not triaged or properly distributed among the available

ships. Certain craft had been designated

to treat the lightly wounded and return

them to the line, but they were often

mixed with the seriously wounded. Lack

of effective medical regulation mingled

Americans with injured civilians and prisoners of war, and left some ships empty

while others were filled to overflowing.

Some medically equipped LSTs lacked

identifying marks, creating confusion

that combined with the haste or ignorance of coxswains to compel multiple

transfers of casualties from ship to ship.

Planners had looked to the smaller

assault craft and the amphibians to evacuate from the beaches to the LSTs and

from the LSTs to the transports and hospital ships. But the reef surrounding

Saipan halted many of the landing craft,

forcing additional transfers; some wounded were shifted five times from smaller to

larger craft, undergoing stress and pain at

every move. The arrival of the hospital

ships on D+3 eased the situation, but the

number proved to be too few, leading a

December 1944 study by the Joint Chiefs

to recommend that two such vessels be

allotted for each assault division.46

About nine-tenths of the casualties

evacuated from Saipan went by sea.

Evacuation by tactical aircraft began on

24 June, when Aslito, now renamed Isley

airfield, became operational. Evacuees

46Rpt, CO, 102d Med Bn, 20 Jul 44, p. 4, An C to Rpt,

Surg, 27th Inf Div, 1 Aug 44, file 370; Rpt, 38th Field

Hosp, 4 Sep 44, p. 7, file 350.09. Both in HUMEDS, RG

112, NARA. See also “Navy Medical Department at

War,” 1:252, BMSA.

242 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

45ASF Monthly Progress Rpt, 31 Jan 45, sec. 7, p. 5,

THU Note Cards, Historians files; Whitehill, “Medical

Activities in Middle Pacific,” block 18d, pp. 47–58, file

314.7. Both in HUMEDS, RG 112, NARA.
were flown to Kwajalein in seven hours,

as against five days by water. Here they

rested a few days before moving on to

Oahu. Poor planning, however, characterized the early days of air evacuation:

No flight surgeon screened the casualties; no attendants rode the planes; and

no oxygen was available, resulting in

marked dypsnea and cyanosis when

planes flew above 4,000 feet. After several evacuees perished en route, rules were

adopted that excluded from air evacuation those who suffered from head,

chest, and abdominal wounds. Medics

trained in flight medicine accompanied

the planes, and oxygen masks and containers arrived on Saipan. Conditions

steadily improved, as did the importance

of air evacuation, though it remained an

adjunct to the sea until 17 August, when

the Air Transport Command’s Pacific

Wing took over medical flights from the

Marianas. Now C–54s, staffed with corpsmen and flight nurses, bore the wounded in conditions of relative safety and

comfort, and the number of air evacuees

quickly came to equal or exceed the

number carried by ships.47

Unloading supplies at Saipan was a

difficult process, slowed by the barrier

reefs and by the fact that transports, to

avoid enemy air and submarine attacks

after dark, stood out to sea at nightfall.

The withdrawal of all ships during D+2

to D+5 slowed the work further. The

102d Medical Battalion lost 5–10 percent of its initial supplies—tents, beds,

blankets, and mosquito nets, among

other things—either in transit to the

beach or in the confusion of the dumps.

Meanwhile, the great number of casualties overwhelmed the system and exaggerated the materiel losses.

By D+3, however, the division medical

supply dump was in operation, and when

the transports returned a few days later,

the system began to work fairly well. Until

then, units and individual medics made

do with the supplies they carried with

them. Throughout the initial disorder

and later stabilization, the technique of

lashing packages to wooden pallets covered with waterproof cloth or paper

proved its utility. Protected from the wet,

supplies were located on the beaches

more easily than in separate containers,

and were hauled to inland dumps by tractors rather than carried by labor details.

Palletizing had been tried in the

Aleutians, the Gilberts, and the Marshalls,

but became the norm in the Marianas; at

Saipan the 27th Division palletized 80 to

90 percent of its supplies, leading even

the marine commander to comment on

the advantages of a system his own service

had hitherto been slow to employ.

Resupply was standardized as well. The

USASOS provided automatic block shipments of special medical maintenance

units, each meant to supply 2,000 troops

for fifteen days. Some imbalances

occurred, with excesses of a few items and

shortages of others, simply because the

course of events could not be foreseen.

No supplies were brought for civilian

care, but the large amounts of captured

Japanese materiel took up the slack.48

47Whitehill, “Medical Activities in Middle Pacific,”

block 18d, p. 56, file 314.7, HUMEDS, RG 112, NARA;

“History of OofSurg, USAFMIDPAC,” sec. 2, p. 82, Ms

8–5.6 AA 30/2, CMH.

48ASF Monthly Progress Rpt, 31 Jan 45, sec. 7, pp. 3–4,

THU Note Cards, Historians files; Rpt, 38th Field Hosp,

4 Sep 44, p. 6, file 350.09; Rpt, Surg, 27th Inf Div, 1 Aug

44, pp. 3–4, file 370. All in HUMEDS, RG 112, NARA.

See also Charles M. Wiltse, Medical Supply in World War

II, Medical Department, United States Army in World

War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1968), pp. 473–74.

THE FORTIFIED ISLANDS 243
The battle of Saipan shared with

other Central Pacific campaigns the

characteristic that most casualties resulted from battle, not disease. Yet the aftermath brought one serious outbreak.

Saipan was free of malaria, and dysentery was adequately controlled. But

dengue was endemic when the rainy season arrived, multiplying the opportunities for mosquitoes to breed. The number of cases among American troops—

soldiers, sailors, and marines—rose

sharply. By 11 August 300 cases had

been reported; by 8 September, 3,500.

The relative smallness of the island,

however, permitted quicker and more

effective control measures than General

Headquarters, SWPA, had been able to

impose on many areas of New Guinea.

The 743d Sanitary Company undertook

survey and control work in populous districts. Unit commanders were made

responsible for eliminating mosquitoes

in their own areas. Planes sprayed the

island with a 5-percent solution of DDT,

a new insecticide then coming into use

in combat theaters. The rigorous control program broke the epidemic; new

cases fell from a high of 426 on 15

September to only 44 on the thirtieth.

But earlier action might have prevented

the outbreak entirely.49

Overall, Saipan evades neat judgments. A bold, desperate, often confused but ultimately decisive struggle, it

compelled the American forces to

respond heroically to not only their own

shortcomings but also the enemy’s

49OofSurg, USAFPOA, ETMD, 26 Oct 44, encls. 4

and 5, THU Note Cards, Historians files; Rpt, Capt

James A. Rooney, OofSurg, 27th Inf Div, n.d., sub:

Report of Medical Inspector—Saipan Operation, pp.

2–4, An A to Rpt, Surg, 27th Inf Div, 1 Aug 44, file 370.

Both in HUMEDS, RG 112, NARA.

244 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

UNLOADING SUPPLIES ON A SAIPAN BEACH
unexpected strengths. The medical side

of the battle fitted the general picture,

as the veteran medics endured much,

cared for overwhelming numbers of

casualties, faced constant danger, and

coped with situations that often seemed

close to getting out of hand.

The results of the campaign were

epochal. The enemy’s defense perimeter had been pierced, his fleet had

been seriously and permanently damaged by the loss of naval aircraft, and

his homeland lay within reach of the

new long-range American bombers.

Acknowledging a crushing setback, the

Japanese government of Hideki Tojo

resigned on 18 July, the day the

American victory was announced.

Meanwhile, the campaign for the

Marianas moved on.

Tinian and Guam

Although Tinian’s 40 or so square

miles was guarded from the sea by

rugged cliffs in the south and by a hilly

region in the north, most of the island

was an undulating grassy plain checkered with fields of sugarcane. The land

was perfect for the construction of air

bases, of which the Japanese had already

built three. The garrison was comparatively small, about 8,300 troops.

Assigned to the invasion were the 2d

and 4th Marine Divisions, with the 27th

Infantry Division in reserve.

With Saipan in their grasp, the

Americans proceeded at their leisure to

study and soften up its neighbor, only

3.5 miles away. Army artillery joined

Navy guns in battering defensive positions, discovered by overflights of reconnaissance planes. On 24 July marine

assault forces landed on the narrow

rocky beaches of the northwest coast,

seemingly the least favorable of the

island’s three possible landing areas. In

consequence, they achieved complete

surprise. The marines secured the island

in about a week. Except for some

artillery units, the 27th Division was not

needed.

Several Army medical units originally

attached to the 27th Division for the

Saipan landing were assigned by the V

Amphibious Corps to participate in the

conquest of Tinian. Their contributions,

however, were limited by a typhoon that

stirred up heavy swells on the sea and

kept both Marine and Army units,

including the 31st Field Hospital, away

from the fight. Limited to their own

medical personnel, the 2d and 4th

Marine Divisions on Tinian were fortunate that a low casualty rate enabled

them to care for their own. In the first

four days LSTs, with two portable surgical hospitals on board, evacuated about

300 casualties before rising seas prevented further movement by sea. But by that

time captured airfields on Tinian made

air evacuation possible, and beginning

on 28 July, C–47s flew evacuees to

Saipan.

Saipan’s facilities, strengthened by

those medical units that had remained

on the island due to the storm, nevertheless provided useful support to the

fighting forces. In effect, only first aid

had to be done on Tinian. Chief losers

from this division of labor were enemy

civilians hurt in the action, for the

understaffed and undersupplied Navy

medical units supporting the marines

were unable to aid them properly until

the fighting was over. Captured

Japanese equipment and supplies satisfied some of their needs, however, and

on 9 August a 100-bed Navy facility was

dispatched from Saipan expressly for

THE FORTIFIED ISLANDS 245
their care. The buildup of Tinian as a

major air base for attacks by very heavy

bombers on the Japanese mainland

ensured that medical facilities would

increase as well, and an Army station

hospital of 1,000 beds soon arrived to

support the air force units stationed

there.50

The last phase of FORAGER was the

assault on Guam, largest of the Marianas

and a possession of the United States

since the time of the Spanish-American

War. The task of its reconquest fell to

General Geiger’s III Amphibious Corps,

which organized the assault around

three division-strength units: the 3d

Marine Division, the 1st Marine

Provisional Brigade, and the 77th

Infantry Division in reserve.

An island of two distinct parts, Guam

comprises a high coral plateau in the

north, with sharp bluffs falling away to

the beaches. The waist of the island, low

and swampy, includes the capital of

Agana. To the south, a rough and mountainous landscape rises, with peaks 1,000

feet high, but the beaches are more accessible than in the north. Because of the

impassable reefs on the eastern shore,

landings were planned for the west. Here

lies Apra Harbor and Orote Peninsula,

with an enemy airfield that formed the

first objective of the campaign.

Anticipating strong resistance from

the 18,500 defenders, the Americans

seared the 34-mile-long island with the

most intense bombardment of the

Pacific war. On 21 July the marines went

ashore. By evening the beaches had

been cleared. Soldiers of the 305th and

306th Regimental Combat Teams, 77th

Division, landed to take over perimeter

defense, while the marines sought to

clear the enemy from Orote Peninsula.

Five days of severe fighting, marked by

fierce enemy counterattacks, secured

the region. Now the 3d Marine and 77th

Divisions pursued the enemy into the

northern part of the island, the soldiers

advancing along the eastern shore, the

marines in the west. Trackless jungle,

insects, rain, and deep mud created a

combat environment reminiscent of the

Southwest Pacific; the 77th suffered 200

casualties in three days. But the hardused enemy was beginning to disintegrate, and the Chamorro natives greeted the Americans as liberators. The final

drive began on 6 August, with all the

major American landing forces as participants. Two days later the soldiers had

seized Mount Santa Rosa, the last

Japanese stronghold, and on the tenth

General Geiger declared Guam secure.51

Throughout, Guam was primarily a

Navy show, as the loss statistics of

marines and soldiers demonstrated. The

work of the two medical services reflected this fact. Supporting the 77th

Division was its own 302d Medical

Battalion, as well as the 95th Portable

Surgical Hospital and the 36th Field

Hospital. The Army’s 289th Station

Hospital also arrived while the fighting

was in progress but did not set up until

the battle was over; the unit provided

support mainly for naval garrison forces.

By comparison, the marines brought

two large hospitals with them, plus the

organic medical units that supported

their two division-sized forces.

The performance of the Army medical personnel was professional and with50Whitehill, “Medical Activities in Middle Pacific,”

block 18d, p. 98, file 314.7; Rpt, 38th Field Hosp, 4 Sep

44, pp. 12–13, file 350.09. Both in HUMEDS, RG 112,

NARA. See also “Navy Medical Department at War,”

1:278–82, BMSA. 51Crowl, Marianas, pp. 329, 405, 437.

246 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
out surprises. During the first few days

medical units stayed on the beach or

close to it. Battalion aid stations were set

up along the natural lines of drift to

intercept the walking wounded, as close

to battalion command posts as possible

and often within their defensive perimeters. Collecting platoons landed with the

rear elements of the battalion teams, but

soon recombined into collecting companies because the combat elements

remained coherent during the fighting

on Guam. Thus Company A, 302d

Medical Battalion, supported the 305th

Regimental Combat Team; Company B,

302d Medical Battalion, the 306th

Regimental Combat Team; and

Company C, 302d Medical Battalion, the

307th Regimental Combat Team. The

third echelon—the 302d’s clearing company and the 95th Portable Surgical and

36th Field Hospitals—landed on 24 and

25 July. The field hospital went into

immediate operation at Agat, and the

clearing company and the portable followed the northward advance, keeping

7–8 miles behind the collecting stations.

Together, these units handled all emergency surgery cases from the front. In

early August two of the three field hospital platoons joined the northward movement. The third platoon remained at

Agat as backup, admitting 1,125 casualties, two-thirds of them medical, between

the 8 and 14 August (see Map 9).52

52Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 74–81, file 314.7, HUMEDS, RG 112,

NARA; “History of OofSurg, USAFMIDPAC,” sec. 2, pp.

81–83, Ms 8–5.6 AA 30/2, CMH; “Navy Medical

Department at War,” 1:290–94, BMSA. 

THE FORTIFIED ISLANDS 247

AID STATION MEDICS CARING FOR 77TH DIVISION TROOPS ON GUAM
As at Saipan, reefs delayed the movement of supplies ashore, and both Army

and Navy medics labored under shortages of supplies and equipment for the

first few days. Evacuation ashore was

affected by the slow arrival of vehicles. A

variety of technical problems faced the

Seabees in moving such large items

ashore; once on the beach, however, the

difficulties that developed were all too

familiar. Supplies were lost by breakage

in transit, by pilferage, and by the confusion that resulted from dumping

materiel of all sorts on the narrow strips

of sand. Looting was a serious problem;

supplies were stolen both aboard ship

and, on the beach, by those apparently

in search of alcohol. Even boxes that

had been well constructed and waterproofed were broken open, their contents scattered and, ultimately, soaked

by rain. A fifth of the 302d Medical

Battalion’s cots disappeared, compelling

medics to put many of their sick and

wounded on the ground. Such heavy

items as ward tents, a kitchen range, and

a washing machine also vanished. Some

losses were inevitable, but on Guam the

scale of theft was such as to interfere

with the proper functioning of the medical units.53

In evacuation, Guam presented fewer

problems than Saipan, not because

organization was better but because the

number of wounded was smaller.

Casualties, which totaled only about twofifths the number at Saipan, reached the

clearing station or the hospitals usually

thirty to ninety minutes after leaving the

aid stations. The beaches were not so

heavily crowded with wounded awaiting

transport, and the handling of the

wounded was more efficient. Seven LSTs

had been set aside, two equipped with

surgical teams and five to evacuate medical cases. The chief problem in using

these large landing craft was the reef;

often medical officers preferred routing

casualties by amphibious vehicles direct

to the transports, rather than sending

them via the LSTs. Two transports and

two hospital ships received casualties

from Guam and subsequently brought

them to rear area bases instead of using

air evacuation.54

Lt. Col. John C. Ivins, MC, the 77th

Division surgeon, complained about

the lack of a third echelon ashore, that

is, an evacuation hospital to receive

casualties from the field hospital platoons, provide complex treatment, and

transfer evacuees to the ships. The

attempt to make do without such a hospital apparently reflected a literal-minded attempt to apply the methods appropriate for atolls to combat on the largest

island of the archipelago, greater in

area than all the others combined. The

field hospital platoons had to follow the

troops, provide treatment, receive casualties at the beach, and evacuate as well,

“an added burden,” said Ivins, “on personnel and transportation that was

already overworked.”55

As the prevalence of medical casualties indicated, sickness also marred the

conclusion of this Central Pacific Area

campaign. Most of the enemy dead were

left unburied; again insect control

53Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 82–83, file 314.7, HUMEDS, RG 112,

NARA; Crowl, Marianas, pp. 358–59.

54Whitehill, “Medical Activities in Middle Pacific,”

block 18d, pp. 87–89, file 314.7, HUMEDS, RG 112,

NARA; “Navy Medical Department at War,” 1:294–97,

BMSA. 55Surg, 77th Inf Div, Quarterly Rpt, Oct–Dec 44, p. 1,

THU Note Cards, Historians files, HUMEDS, RG 112,

NARA.

248 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
details had failed to land with the assault

forces. Flies and mosquitoes, already

common, multiplied in the disorder

that accompanied the fighting, and

plagues of dysentery and dengue struck

the victorious forces. At one point in

October, when the 77th Division was

preparing for new operations, its surgeon counted hospital admissions for

dengue and fevers of unknown origin at

250 a day. The medics were not exempt;

more than half the complement of the

289th Station Hospital fell ill with

dengue. Skin diseases were ubiquitous,

from a combination of high humidity,

excessive sweating, contaminated soil,

and lack of laundry and bathing facilities. On this large jungled island, troops

of the supposedly healthy Central

Pacific experienced conditions that

were the norm in the theaters to the

south.56

Civilian sick were another serious burden to medical personnel. Originally

inclined to treat the natives well, the

Japanese, as the war drew to a close, had

requisitioned their labor on defensive

works. Chamorros were forced into

camps typified by minimal food, insufficient shelter, and miserable sanitary

conditions. Hundreds died; others were

ill when liberated. Though internment

removed the Guamanians from the battlefields and spared them many wounded, the Navy medical service fell heir to

its sick. But here, as at Saipan and

Tinian, shipping priorities had prevented early movement of facilities to serve

civilians. Medics of the III Amphibious

Corps were obliged to scrape together

captured Japanese supplies and borrow

from the 77th Division and the hospital

ships offshore.57

Yet Guam, despite the difficulties that

arose, was a comparatively easy victory.

Total American losses were less than half

those at Saipan: some 7,800 casualties, of

whom 2,124 were killed in action or died

of wounds. Most of the blood was shed by

the marines, who lost 6,716 to the Army’s

839 and the Navy’s 245. Of the Japanese

garrison of 18,500, few survived.58

Summing up the costs of the bitter

and decisive campaign for the Marianas,

the Americans counted nearly one-fifth

of their total force either dead or

wounded—24,518 out of an estimated

128,000 soldiers, sailors, and marines.

Of the estimated 53,255 Japanese who

had defended the islands, only 2,847

survived as prisoners; the rest, except for

a few stragglers hiding in the jungle, had

perished. The differences among the

three Central Pacific Area campaigns

are suggested by the loss ratios of the

two forces. On Saipan, 1 American was

killed in action to every 8.4 Japanese; on

Guam, 1 to every 14.8; and on Tinian, 1

to every 23.8. Overall, the average was

almost precisely 1 to 11.59

Planning for the campaign had been

less than satisfactory, in part because the

easy victory in the Marshalls had made

the projections of the Joint Staff’s

Logistics Division and the latter’s medical section overly optimistic. Low estimates of casualty rates resulted in hospitals and hospital ships being overloaded,

not only at the scene of the fighting but

56Ibid., pp. 1–2, THU Note Cards, Historians files;

Whitehill, “Medical Activities in Middle Pacific,” block

18d, pp. 84–85, file 314.7. Both in HUMEDS, RG 112,

NARA. See also “History of OofSurg, USAFMIDPAC,”

sec. 2, pp. 81–82, Ms 8–5.6 AA 30/2, CMH.

57“Navy Medical Department at War,” 1:300–06,

BMSA. 58Crowl, Marianas, p. 437. 59ASF Monthly Progress Rpt, 31 Jan 45, sec. 7, p. 3,

THU Note Cards, Historians files, HUMEDS, RG 112,

NARA.

THE FORTIFIED ISLANDS 249
also back through the chain of evacuation as far as the United States. Hardly

an aspect of the evacuation story could

be cited that did not reveal failures of

foresight and unnecessary suffering

inflicted on the wounded. The failure to

provide insect control units to accompany the landings was apparently a product of the very fact that made the campaign a success. Striking so far to the

enemy rear compelled the fleet to carry

immense quantities of every kind of supplies, and priorities excluded the units

that might have imposed successful preventive medicine from the beginning.

In reviewing accounts of the Marianas

campaign, the Army Service Forces

headquarters drew the conclusion that

each assault division needed one 400-

bed evacuation hospital, a mobile field

hospital, and two hospital ships; that

some mobile medical units should land

with the first waves if any possibility

existed that enemy action might compel

the transports to retire; that sanitary

details equipped to cope with flies and

mosquitoes should land in the first week

of battle; that special provision must be

made for large numbers of civilian casualties; and that frontline medical installations, which had been subject to attack

throughout the Marianas fighting, needed improved security.

Despite all failings, the epic struggle

had carried the American forces beyond

the atolls, prepared them for the assault

on the Philippines, taught valuable

lessons in amphibious warfare, and

brought the day of victory measurably

closer. By the end of the year the

Seventh Air Force headquarters would

be established on Saipan and the air

assault against Japan would be under

way. The Marianas would become a center of military hospitalization, with

16,500 Army beds alone, many times the

number on Oahu. As the forces prepared for new battles, the support system as well grew rapidly over the great

Pacific distances.60

60Rpt, Col Robert F. Bradish, CO, 821st Hosp Ctr,

Tinian, n.d., sub: Status Notes as of 12 June 1945, THU

Note Cards, Historians files; ASF Monthly Progress Rpt,

31 Jan 45, sec. 7, pp. 1–3, THU Note Cards, Historians

files; Ltr and 1st End, OofSurg, 7th Air Force, to Surg,

PACUSA, 1 Jul 46, and Surg, PACUSA, to CSurg, USAFPAC, 11 Jul 46, encl. 1, p. 2, bound in Surg, 7th Air

Force, Annual Rpt, 1946, file 319.1–2. All in HUMEDS,

RG 112, NARA. See also “History of OofSurg,

USAFMIDPAC,” sec. 2, pp. 82–83, 88–100, Ms 8–5.6 AA

30/2, CMH. 

250 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
While the battlefront advanced, an

increasingly complex medical organization developed in the Central, South,

and Southwest Pacific Areas to support

the fighting forces. By mid-1944 base

commands, each with a medical complement for its garrison and many with

elaborate rear area complexes of general and station hospitals to receive casualties, were the norm. Organization differed between MacArthur’s Army-dominated and Nimitz’ Navy-run areas. But

patterns of evacuation, hospitalization,

supply, and preventive medicine also

showed broad similarities.

SWPA: Unity Replaces Conflict

During 1943 the buildup of medical

personnel in the Southwest Pacific Area

was steady, rising from about 13,000 to

more than 33,000. Yet the increase of

about 254 percent did not quite keep

pace with that of the theater as a whole,

where Army strength rose from about

118,000 to more than 329,000 in the

same period, or about 280 percent.

Since the dispersion of forces grew with

the campaigns in New Guinea and nearby islands, most units operated below

strength throughout the year.1

The process of determining appropriate bed strength for the theater

underscored the divided state of medical leadership. In early 1943 General

Headquarters, SWPA, provided fixed

bed strength equal to 9 percent of

troop strength. The consensus was that

this figure was inadequate. Carroll

wanted 11 percent; Rice preferred 12

percent; and Brig. Gen. Charles C.

Hillman, MC, of the Office of the

Surgeon General, after inspecting conditions in the theater in March 1943,

urged 15 percent. On 24 September,

however, a War Department radiogram

fixed the authorization at 10 percent,

with equipment for a 50-percent

expansion in case of need and with 400

mobile beds per division. This implied

a total of 33,540 fixed beds, with more

to follow as the troop buildup continued. Carroll, as the USASOS chief surgeon, intended to put 35 percent of

the beds in Australia and 65 percent in

New Guinea and nearby islands,

reflecting the advance of the front.

The basic justification for the array was

not battle losses—only 6 to 7.5 percent

of the theater’s beds were expected to

War II, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1963), pp. 350, 354.

CHAPTER VIII

Growth of the Medical System

1

John H. McMinn and Max Levin, Personnel in World 
be occupied by battle casualties resulting from the planned offensives of

1944. All of the remaining beds would,

the chief surgeon estimated, be used by

the victims of disease and nonbattle

injuries.2

The commitment of beds meant provision of adequate medical personnel to

staff them. In fact, however, medical

strength in the Southwest Pacific Area

followed a variable course. While combat forces increased to more than

700,000 during 1944, medical personnel

grew to only 62,000 by the end of the

year, never reaching the authorized goal

of 10 percent of command strength. By

mid-1944 medical strength had briefly

attained at least numerical parity to the

number of medical personnel available

in the European theater—9 percent—

but thereafter gradually declined,

shrinking to 7.9 percent of troop

strength by the end of the war.3

The surgeon general’s intervention in

the matter of bed strength reflected his

long-standing dissatisfaction with the

medical setup in the Southwest Pacific

Area. MacArthur’s medical organization, faced with its endemic problems of

distance and dispersion, could ill afford

the conflict that had developed between

Carroll and Rice.4 As complaints from

medical officers reached Washington,

Surgeon General Kirk deemed it necessary in mid-1943 to dispatch investigators to General Headquarters, SWPA, to

uncover the true situation.

One investigator, Colonel Wilson,

who was chief of the Hospitalization and

Evacuation Branch, Plans Division,

Army Service Forces (ASF), assessed the

problem to be a lack of centralized

direction. Many of the officers he interviewed concurred on the need for a

chief surgeon who had excellent previous training, good judgment, and

unbounded energy. During the same

period Brig. Gen. Hugh J. Morgan, MC,

chief of Medical Services, Office of the

Surgeon General, saw and reported that

disorganization at the top was directly

affecting frontline service to the troops.

“The closer one approaches the fighting

front,” he wrote, “the more urgent

become the administration [sic] and

professional problems of the Medical

Department.” Indeed, its “poorly organized and poorly operated medical services in the Advanced Areas” constituted

“Medical Department failure.”5

Opportunity beckoned that

December, when General Carroll, physically exhausted by his extended tour,

returned to the United States to become

commanding officer of Vaughan

General Hospital in Hines, Illinois. In

5

Memo, Col William L. Wilson to Gen Kirk, 20 Oct

43, sub: [Observations and Facts Obtained During Visit

to SWPA], pp. 1–10, file 333 (Visit of Col Wilson to

SWPA) 1943; Memo, Wilson to Ex Off, [OSG], 1 Nov

43, sub: Visit to Southwest Pacific Area, p. 1, file 333

(Visit of [Col Wilson] to SWPA) 1943; Comments and

Recommendations, Medical Department, USAFFE, pp.

1 (quotations), 2–3, attached to Exh 1 of Ltr, Brig Gen

Hugh J. Morgan, OofSurg, USAFFE, to Brig. Gen. Percy

J. Carroll, CSurg, USAFFE, 12 Aug 43, file 333 (Brig

Gen Hugh J. Morgan) SWPA. All in HUMEDS, RG 112,

NARA.

252 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

2

CSurg, USASOS, SWPA, Annual Rpt, 1943, pp.

35–41, 45, file 319.1–2, Historical Unit Medical

Detachment (HUMEDS), Record Group (RG) 112,

National Archives and Records Administration

(NARA), Washington, D.C. Part of Carroll’s rationale

for the 11-percent figure arose from geography. Units

were so subdivided that mobile medical support, as

determined by T/O&E, was inadequate and had to be

supplemented with fixed beds, which depleted the theater’s holding capacity. 3

On the problems of the expansion, see ibid., 1944,

pp. 1–7, 151–67, file 319.1–2, HUMEDS, RG 112,

NARA; McMinn and Levin, Personnel, pp. 368–70. 4

See Chapter II on the early controversy between

Carroll and Rice.
January 1944, as a consequence of

Morgan’s and Wilson’s reports, central

control of medical activities was partially

achieved when General Denit, the energetic surgeon of the Atlantic Base

Section in North Africa, became simultaneously Chief Surgeon, USAFFE, and

Chief Surgeon, USASOS. This eliminated one source of confusion by allowing

Denit to supervise all aspects of Army

medicine, except in the task forces. But

another remained.6

Surgeon General Kirk offered to have

Rice relieved also, but Denit, to his later

regret, opposed the move, believing that

Rice, an old friend, “could be utilized.”

In time, however, he came to agree with

Carroll’s estimate of the headquarters

surgeon as a marplot, whose chief function was to interfere. Relying upon past

friendship to establish a “most harmonious and helpful relationship,” the new

chief surgeon soon realized that he had

“made a serious mistake by saying . . .

[Rice] should not be brought home at

the same time with Carroll.” According

to Denit, Rice still advised the supreme

commander as he saw fit while evading

the responsibility for practical problems

that had to be met and for operations

that went awry. “[Rice’s] status as G.H.Q.

surgeon which he claims to have an

order for places me in a very anomalous

position,” Denit complained. “There is

still confusion in the minds of the Sixth

Army, & the Fifth Air Force.”7

Nevertheless, Rice continued to

regard himself as the true theater chief

surgeon until September 1944, when he

was appointed surgeon of the newly

established Eighth Army. Following his

reassignment, the title of Surgeon,

General Headquarters, SWPA, was terminated. As the war entered its last year,

the theater medical service achieved at

last a measure of the unity it had long

needed.

One area still remained, however,

where the chief surgeon’s voice was

heard dimly, if at all: the task forces. By

the end of the war Denit had begun to

sound much like his predecessor,

Carroll, on this subject. In each task

force the commander determined his

own medical needs, often, in Denit’s

opinion, setting them too low in order

to make space for line units and their

equipment. “I sometimes got a chance to

review and comment,” Denit noted, “but

no amount of pleading could change

things if the CG, task forces, ruled otherwise.” The medics faced other problems, apparently related to the chief surgeon’s standing, or lack of it, in the

headquarters pecking order. Engineer

units seemed to have no time to build

hospitals. The chief signal officer, who

had served with MacArthur on

Corregidor, enjoyed direct access to the

Supreme Commander and as a result, in

the embattled enclave or forward base,

local signalers took the high ground and

ruled hospitals out of the neighbor6

Interv, [Maj] Gen Guy B. Denit, 1 Mar 50, file

000.71, HUMEDS, RG 112, NARA; Interv, Mary Ellen

Condon-Rall with Percy J. Carroll, 26 Sep 80, U.S. Army

Center of Military History (CMH), Washington, D.C. 7

First quotation from Interv, Denit, 1 Mar 50, p. 1,

file 000.71; remaining quotations from Memo (handwritten), [Denit], n.d., pp. 3 and 1–2, file 320

(Organization of Medical Service) SWPA 1944. Both in

HUMEDS, RG 112, NARA. In loc. cit., see also Ltrs, Col

George W. Rice to Col John A. Rogers, 31 Jan 43, and

GROWTH OF THE MEDICAL SYSTEM 253

Maj Gen Norman T. Kirk to Rice, 2 Nov 43, file 201

Correspondence, Col George W. Rice, 1942–1944. For

further details on the organization of the SWPA medical service, see Blanche B. Armfield, Organization and

Administration in World War II, Medical Department,

United States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1963), pp. 407–50.
hood, complaining that X-ray machines

caused interference. “Hence the frog

ponds for hospital areas.”8

The Bases Advance

Despite such frictions the chief surgeon had gained new authority and

prestige, and needed both during 1944

to meet the complications of a changing

theater. The theater abandoned much

of its Australian base, with its widely scattered garrison forces. Planned complex

operations and medical personnel

shortages alike dictated fewer and larger

hospital units, with consequently greater

reliance upon an improved transportation network. Eventually, small station

hospitals were inactivated, their personnel absorbed by large general hospitals,

which in turn were organized into hospital centers. 

Meanwhile, new bases in western New

Guinea burgeoned. In November 1943,

to administer the bases and to handle

the movement of supplies and personnel to the forward area, the USASOS

established the Intermediate Section,

headquartered first at Base D (Port

Moresby) and then at Base B (Oro Bay)

on the north coast. A new Advance

Section, located at Lae and then at

Finschhafen in January 1944, controlled

the medical activities of Bases E (Lae)

and F (Finschhafen). In March the

Advance Section was disbanded and its

responsibilities absorbed by the

Intermediate Section. In preparation

for the coming invasion of the

Philippines, Base G was established at

Hollandia in June, at first directly under

the USASOS but two weeks later under

the Intermediate Section. At this juncture, the Intermediate Section became

the USASOS’s principal command post

and the chief surgeon’s main base,

though a rear section remained in

Australia until November. With the

Sixth Army tagged for the invasion, the

USASOS created another new organization, the Army Service Command, in

July to provide direct support.9

Far to the rear, the old Australian

bases were consolidated, reduced to

caretaker status, or closed down. A new

USASOS base section was created at

Brisbane in June 1944, specifically to

handle the complicated process. Supply

depots departed, and the 4th General

Hospital moved to Finschhafen, having

restored its 1,000-bed facility to the

Australian people, who had given it to

the Americans in 1942. Signs of the

times were transfers of soldier patients

to U.S. Navy or to Australian hospitals.

At the Army hospitals that remained in

the Australian base sections the main

medical problem was venereal disease,

reflecting the concentration in towns

and cities of troops once isolated in

remote areas. But the advent of penicillin in the Pacific in November 1943

soon helped to make this old military

affliction far less important than before.

The base sections too began to disappear, not only because the tide of battle

had moved north but because casualties

of the New Guinea fighting increasingly

were evacuated directly to the United

8

Denit comments quoted by Ashley W. Oughterson,

“From Auckland to Tokyo,” in B. Noland Carter, ed.,

Activities of Surgical Consultants, Medical Department,

United States Army in World War II, 2 vols.

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1962–64), 2:770.

9

CSurg, USASOS, SWPA, Annual Rpt, 1944, pp. 1–3,

HUMEDS, RG 112, NARA; Armfield, Organization and

Administration, pp. 412, 434–35. For more on the Army

Service Command, see Chapter X. 

254 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
States. Base Section 1 at Darwin closed,

and its troops departed gladly from a

place of tedious routine and tropical

heat. Base Section 3 at Brisbane was

changed and downgraded as well. It had

been the home of both the USASOS

headquarters and the Malaria Control

School; the theater’s main distribution

center for medical supplies; and,

because of its seven hospitals and 4,000

beds used by evacuees from New

Guinea, an important center of evacuation to the United States. But as the

medical units followed the troops

throughout 1944, along with the headquarters, the Malaria School was lost to

the Intermediate Section. In June

Section 3 was renamed Base Section

USASOS Brisbane, with control over the

remaining base sections, and in

February 1945 redesignated the

Australian Base Section, emphasizing

the fact that this large and once-active

organization had become a rear area.10

Even in New Guinea the southern

and eastern bases declined. Port

Moresby passed its peak in 1943, losing

its four station hospitals and turning

over American sick and wounded to

Australian facilities. In mid-1944 Base A

(Milne Bay) peaked and then rapidly

lost its importance; the 4,208 occupied

beds of June fell to 1,775 in December.

As the base declined to a supporting status during 1945, a single general hospital met all the needs that six station and

three large general hospitals had served

a year before. Base B (Oro Bay) also

began to shrink during the second quarter of 1944. Air activity moved away from

Lae, once the objective of a hard-fought

campaign; however, neighboring

Finschhafen, strategically located on the

tip of the Huon Peninsula, remained a

major base. Meanwhile, the western

bases grew rapidly, notably G

(Hollandia) and H (Biak); they mushroomed into immense centers of supply,

with port facilities and staging areas. By

the end of 1944 more than 280,000

troops were concentrated in the last

three. In February 1945, as USASOS

bases built up in the Philippines, the

New Guinea bases came under the

newly established New Guinea Base

Section that replaced the Intermediate

Section at Oro Bay.11

Such rapid growth, especially in the

disease environment of New Guinea,

meant serious problems for the medics.

The first six months of 1944 at

Finschhafen, for example, were marked

by repeated outbreaks of dengue and

malaria, which in the end were suppressed apparently as much by the

return of the dry season as by the imposition of rigorous control measures. The

effectiveness of strict Atabrine discipline

and efforts to destroy mosquitoes, however, became evident later in the year,

for both diseases were reduced to manageable problems. At Oro Bay the base

commander offered a prize in war

bonds to the unit that killed the most

rats; units offered their own prizes, the

winner in the 25th Ordnance Medium

11See “USASOS Bases in New Guinea,” pp. 41–42,

Historians files, and Quarterly Rpts (copies), 1944 and

Jan–Jun 45, for Surgs, Base D [Port Moresby], Base B

[Oro Bay], and Base E [Lae], file 319.1. All in

HUMEDS, RG 112, NARA. 

GROWTH OF THE MEDICAL SYSTEM 255

10See Quarterly Rpts, Oct–Dec 43, pp. 1, 6, and

Jan–Mar 44, p. 1, for Surg, Base 1; respectively, p. 1, and

p. 1, for Surg, Base 3; and pp. 10–12, and p. 5, for Surg,

Base 4 (copies); plus Oct–Dec 44, pp.1–2, and Jan–Mar

45, pp. 1–2, for Surg, Base 2 (copies), and p. 1, and p.

1, for Surg, Base 7 (copies). All file 319.1, HUMEDS,

RG 112, NARA. See also Diary (Extract), Australian

Base Sec, 15 Feb 45, file 323, HUMEDS, RG 112, NARA,

and Armfield, Organization and Administration, pp.

476–77.
Maintenance Company receiving a

chocolate cake. Presumably no commander, at this stage of the war, doubted

any longer that medical discipline was

essential and that the health of the base

was a command responsibility.12

As was customary in the Pacific, a long

supply line, materiel shortages, and

incessant rains combined to slow all construction, including that of hospitals. As

usual, medical personnel were obliged

to do most of their own construction

work, in default of assistance from the

overburdened engineers, whose first priority was airfields. Denit was scornful of

Australian prefabricated hospitals,

which he called “Australian cowsheds,”

but admitted that “they served their purpose, and as they had to be abandoned

quickly as the front moved, better construction would have been unwarranted.” In any case, theater priorities left

American-made prefabricated hospital

assemblies stranded on the docks and in

the warehouses of United States port

cities.13

The basic cause of shortages, both of

medical personnel and materiel, was the

course of the war, then surging toward

its climax in several widely separated

theaters. The end of 1944 and the opening of 1945 saw climactic battles in the

Pacific and in Europe, and the strain on

American resources in both troops and

supplies was heavy. As early as August

Surgeon General Kirk had expressed his

concern to Denit: “I don’t see . . . how

your Theater can do a good job—

although maybe it can—until V–Day

comes in Europe,” warning that “there

won’t be enough in the States to meet

both requirements.” Then as the Battle

of the Bulge raged in Europe, he again

wrote the chief surgeon, reporting that

“we are out of hospital units. We have

had a hell of a drain on us from the

U.K.”14

One result was to turn medical personnel at new bases into construction

laborers, just as their predecessors had

been when the war was new. At

Finschhafen as throughout New Guinea,

professors of surgery operated concrete

mixers and bulldozers, enlisted medics

hammered and sawed, and mosquito

control units spent their days at carpentry rather than fighting malaria. By the

end of March, with the epidemics in full

swing, the base had only 1,630 hospital

beds for 90,000 troops—1 bed for every

55 men and 9 out of every 10 beds occupied! But by the end of June three general, five station, and two field hospitals

were in operation, and bed strength had

risen to about 7 percent of the command. The units were housed in prefabricated buildings, most of Australian

manufacture, with tented expansion

wards and generously equipped with

cola machines and ice cream freezers.

Many were surrounded by beds of tropical flowers in settings framed by New

Guinea’s extraordinary natural beauty.15

14Ltr (copy), Maj Gen Norman T. Kirk, SG, to Brig

Gen Guy B. Denit, CSurg, USASOS, 28 Aug 44, p. 2

(first two quotations); ibid., 19 Dec 44, pp. 1–2 (third

quotation); Ltr (copy), Col Arthur B. Walsh, Dir, Plans

Div, OSG, to Denit, 23 Dec 44, p. 2. All in file 200 KirkDenit Correspondence, HUMEDS, RG 112, NARA. On

construction problems in the Southwest Pacific, see

Karl C. Dod, The Corps of Engineers: The War Against

Japan, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, United States Army, 1966), pp. 548–51. 15Surg, Base F [Finschhafen], Quarterly Rpts

(copies), Jan–Mar 44, p. 5, and Apr–Jun 44, pp. 6–7, file

319.1, HUMEDS, RG 112, NARA.

256 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

12See Surg, Base B [Oro Bay], Quarterly Rpts

(copies), 1944, file 319.1, HUMEDS, RG 112, NARA. 13Interv, Denit, 1 Mar 50, p. 3, file 000.71, HUMEDS,

RG 112, NARA.
PREFABRICATED BUILDINGS IN NEW GUINEA, used as a base dispensary, dental clinic,

and medical ward
Late in 1944 a new organization came

to Finschhafen, the 26th Hospital

Center, created around the nucleus of

the 4th General Hospital, lately at

Melbourne. Combining three or more

1,000-bed general hospitals, the center

unified administration, enhanced specialization in its component organizations, and economized on medical personnel. Improved efficiency was necessary; the patient census in Finschhafen

reached 7,122 in October, with few beds

to spare. Though that apparently represented the peak, casualties from the new

battlefields to the west continued to flow

into Finschhafen during late 1944 and

the first half of 1945. Planes delivered

them to the airfields nearby, and ships

converted into seagoing hospitals

docked and discharged their loads onto

sea ambulances, high-powered launches

that ferried them to shore. From

Finschhafen, casualties were evacuated

to Australia until May, but thereafter

directly to the United States.16

The base at Hollandia in western New

Guinea was set up in mid-1944 primarily

to prepare and support future operations in the Philippines. Base surgeon Lt.

Col. Everett King, MC, landed in May

with a small party to select hospital sites,

finding only the 36th Evacuation

Hospital, the 24th Medical Battalion of

the 24th Infantry Division, and the 9th

Portable Surgical Hospital at work in the

area. By 30 June King had developed

plans for the proposed 27th Hospital

Center to include four general, two station, and one field hospital—an aggregate of 3,650 beds. Actual expansion

came more slowly than King had forecast

but in the end was greater; for the

stream of casualties from the Philippine

campaign, some 8,930 beds were available by the end of 1944 and a total of

9,502 by the spring of 1945. Medical personnel built the Army’s largest overseas

facility, the 54th General Hospital, with

3,500 beds—cutting trees, leveling the

ground, mixing cement, and putting up

the “prefabs,” until a miniature city had

appeared in place of tropical jungle.17

Casualties were brought to the 27th

Hospital Center via LSTs, hospital ships,

and transports. Ambulance boats scurried between the ships in the bay and

the docks, bringing in new ones and carrying those in need of long-term care to

the hospital ships for transport farther

to the rear. The theater, having previously only two hospital ships, as of late

1944 boasted seven, with a total capacity

of 3,675 beds. The four more elaborate

hospital ships, which were both operated and staffed by the Navy, were intended to serve as large floating hospitals,

where definitive work was accomplished, and to appear as a luxurious

means of transporting the wounded to

further treatment ashore; they also functioned as mobile outpatient departments and mobile medical supply

depots. The three less elaborate hospital

ships—the USS Mercy, USS Hope, and

USS Comfort—were built, commanded,

and crewed by the Navy for the Army

and were staffed by Army medical personnel. All seven joined SWPA’s growing

fleet, consisting of several distinct types

17Surg, Base G [Hollandia], Quarterly Rpts (copies),

Apr–Jun 44, p. 4, Jul–Sep 44, pp. 1–3, Oct–Dec 44, pp.

3–4, and Jan–Mar 45, pp. 3–5; 27th Hosp Center

Quarterly Rpt, Jan–Mar 45, pp. 2–7. All file 319.1,

HUMEDS, RG 112, NARA.

258 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

16Ibid., Oct–Dec 44, p. 2, Jan–Mar 45, p. 2, and

Apr–Jun 45, p. 2, file 319.1; CSurg, USASOS, SWPA,

Annual Rpt, 1944, pp. 88–93, file 319.1–2; Ltrs (copies),

Kirk to Denit, 7 Oct 44, p. 1, and 25 Oct 44, p. 2, file 200

Kirk-Denit Correspondence. All in HUMEDS, RG 112,

NARA.
of seagoing craft. The Army itself

obtained a fleet of twenty-six converted

transports, with civilian crews provided

by the Transportation Corps and medical staffs by the Office of the Surgeon

General. Finally, every attack transport,

even if it was not designated a hospital

ship, by regulation had a small hospital

aboard, with bed strength equal to 3–5

percent of troop berths. Hospital ships,

whether Navy or Army, usually abided by

Geneva regulations. They were painted

white, with a broad green stripe and red

crosses; were registered with the enemy;

were subject to search by the enemy for

contraband of war; and sailed brilliantly

lighted at night. The troop transports

were camouflaged, blacked out at night,

and were subject to attack by enemy aircraft or submarines.18

Evacuation policy changed in 1944 as

direct flights from New Guinea to the

United States became more common.

In contrast to the limited scale of the

previous year, air evacuation rapidly

increased in response to the worldwide

expansion of transoceanic flights by the

Air Transport Command. In the

Southwest Pacific Area the seriously sick

and wounded passed through the Air

Transport Command’s Southwest

Pacific Wing headquarters, first at Lae

and then on Biak, on their way home.

Prior to November medical disposition

boards, which met at general hospitals,

were responsible for examining and

selecting casualties for evacuation to

the United States. Thereafter, commanders of base sections that had general

H. F. Fultz, “Forest Fires, Lightning, and the Moon,”

U.S. Navy Medicine 75 (Jul/Aug 84): 9–18; “History of

USS Comfort (AH 6),” file USS Comfort, Bureau of

Medicine and Surgery Archives, Washington, D.C.;

Melville J. Aston and Richard A. Kern, “The Wartime

Log of a United States Navy Hospital Ship to 30 June

1943,” U.S. Navy Medical Bulletin 46 (Nov 46): 1640.

GROWTH OF THE MEDICAL SYSTEM 259

18On hospital ships, see CSurg, USASOS, SWPA,

Annual Rpt, 1943, pp. 5, 59; Clarence McKittrick Smith,

The Medical Department: Hospitalization and Evacuation,

Zone of Interior, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1956), pp. 394–425;

THE USS COMFORT ARRIVES AT HOLLANDIA
hospitals issued the necessary movement orders.19

The last of the big New Guinea bases

opened on Biak Island in August 1944,

with Col. August W. Splitter, MC, as base

surgeon. The small field medical establishment grew rapidly to accommodate

the 51,000 troops crowding the island,

where their predecessors had struggled

against the fortified caves of the

Japanese. Again, the Philippine campaign provided the major stimulus for

growth; bed strength rose from about

1,000 at the end of September to 4,750

by the end of the year and to almost

8,900 in March 1945. The three general

hospitals on Biak were organized as the

28th Hospital Center; a station hospital

on nearby Owi Island provided additional strength. The major difference

from Hollandia and Finschhafen was

the fact that evacuation was almost

entirely by air from an island whose harbor was small and whose airfields were

large. On 23 November 1944 C–54s

began to carry evacuees directly to the

United States, via Guadalcanal, Canton

Island, and Honolulu (see Map 10). Only

when additional shipping became available following the end of the war in

Europe did water transport, reversing

the usual order of things in the Pacific,

replace the planes of the Southwest

Pacific Wing, whose headquarters by

260 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

19Surg, Base G [Hollandia], Quarterly Rpts

(copies), Apr–Jun 44, pp. 4–5, Oct–Dec 44, pp. 4–5,

Jan–Mar 45, pp. 3–6, and Apr–Jun 45, pp. 11–12, file

319.1; CSurg, USASOS, SWPA, Annual Rpt, 1943, p.

53, file 319.1–2. All in HUMEDS, RG 112, NARA. See

also Sheldon R. Uday, “The Army’s Largest Hospital

Overseas,” in Philip A. Schaefer, ed., 54th in Review: A

Resume of the Activities of the 54th General Hospital,

1943–1945 (Tokyo: Dai Nippon Printing Co., 1946);

Robert F. Futrell, “Development of Aeromedical

Evacuation in the USAF, 1909–1960,” USAF Historical

Studies No. 23 (Maxwell Air Force Base, Ala.: USAF

Historical Division, Air University, 1960), p. 357, copy

in CMH.

PORT DISPENSARY TENT ON BIAK ISLAND
then had moved on from the hot coral

island in Geelvink Bay.20

Overall, the conclusion can hardly be

escaped that the price of the great

advance of the bases during 1944, and

the care simultaneously provided to tens

of thousands of casualties, continued to

be paid by medical personnel whose

numbers, though constantly increasing,

were never large enough to do all that

was demanded of them. As Surgeon

General Kirk wrote Denit in November

1944, “I don’t know how in hell we are

going to be able to carry on this twoocean war with the doctors and nurses we

have.” Not occasionally but habitually

they were required to be their own engineers while caring for the sick and

injured. “To understand the injustice

placed upon hospital personnel (indirectly the patients) who are required to

establish their own hospitals,” wrote a

team of medical inspectors, “one need

but see the various medical specialists . . .

with their trained professional technicians pouring concrete, digging drainage

ditches, building mess halls and operating rooms, assembling and installing

heavy equipment—in shifts because at

the same time they must accept and treat

patients.”21

20Surg, Base H [Biak], Quarterly Rpts (copies),

Jul–Sep 44, pp. 1–5, Oct–Dec 44, pp. 7–8, Jan–Mar 45,

pp. 2, 7–9, and Apr–Jun 45, pp. 8–9, file 319.1,

HUMEDS, RG 112, NARA.

21Ltr (copy), Kirk to Denit, 24 Nov 44, p. 1 (first quotation), file 200 Kirk-Denit Correspondence; Rpt,

Training Div, OSG, [19 Sep 45], sub: Survey of

Effectiveness of ASF Trained Medical Department Units

and Personnel in SWPA and POA, p. 2 (remaining quotations), Historians files. Both in HUMEDS, RG 112,

NARA. On the experiences of U.S. Army hospitals, see

copy of Extracts From Historical Reports [Relating to]

Construction, Hospital Structures, and Utilities,

Jan–Mar 44 entries, Historians files, HUMEDS, RG 112,

NARA.

GROWTH OF THE MEDICAL SYSTEM 261

NEW CONCRETE FLOOR IN A STATION HOSPITAL WARD
Hollandia

Sarmi

Sansapor Manokwari

VOGELKOP

 PENINSULA

NETHERLANDS EAST INDIES

Morotai I

Halmahera I

Tanimbar Is

Noemfoor I

Biak I

Wadke I

Aroe Is NEW G

MOLUCCAS

Ceram I

A R A F U R A S E A

Geelvink 

Bay

P A C I F I C O C E A N

to U.S. via Ca

B

27th H

Base H and

28th Hospital Center

MAP 10
Rabaul

Aitape

Wewak

Port Moresby

Buna

Wau

Lae

Salamaua

Finschhafen

Arawe

Saidor

Madang

PAPUA

NORTHEAST

NEW GUINEA

AUSTRALIA

NEW IRELAND

NEW BRITAIN

Admiralty Is

Woodlark I

Kiriwina I

Goodenough I

UINEA

C O R A L S E A

BISMARCK 

SEA

Milne Bay

Oro Bay

NEW GUINEA BASES

December 1944

ELEVATION IN METERS

0 500 2000 4000 and Above

Miles

0 300

Sea evacuation

Air evacuation

anton or Guadalcanal

Base C

Base D

Base E

Base F and

26th Hospital Center

Base G and

Hospital Center

Base A

Base B and

Intermediate Section Headquarters
Persistent Problems

The net effect of all these changes was

to shift most of the Southwest Pacific

Area’s support structure, as well as its

combat forces, into the tropical disease

zone. The theater’s limited but real success in controlling malaria did not,

unfortunately, imply a similar success

against other medical problems of tropical warfare. The handling of at least two

others—neuropsychiatric (NP) conditions and scrub typhus—reflected

enduring shortcomings in theater medical organization and policy.

For reasons that went deep into contemporary medical beliefs and assumptions, neuropsychiatric casualties—the

nation’s leading cause of nonbattle disability separations—might almost be

called the definitive American military

medical problem of World War II.

MacArthur’s command had the worst

record of any theater in handling NPs.

During 1944 problems defined as psychiatric accounted for almost 33 percent of all evacuations to the United

States; intratheater evacuations also

were heavy. The reasons were depressingly familiar—jungle warfare, the tropical environment, the conviction of

many GIs that they would never see

home until the war ended. The number

of evacuees swelled because commanders used medical channels to eliminate

their undesirables. In addition, doctors

who lacked psychiatric training misdiagnosed NP disorders and, like the commanders, dispatched puzzling or incomprehensible cases to the rear.22

In the face of many difficulties,

General Headquarters, SWPA, had a

mixed record in prevention and treatment during 1944. Beginning in

February, a series of memos and circular

letters educated the average medical officer in his responsibilities and the nature

of the problem, especially in properly

diagnosing minor NP disorders. Nurses

and enlisted medics learned their own

jobs through lectures and by working

with psychiatrists. Each psychiatrist

trained two or three assistants by the

ancient medical practice of apprenticeship. In hospitalization, however, the

consolidation of hospitals caused the

command to backslide; station hospitals

designated to treat NPs during 1943

were merged into general hospitals,

where the emphasis of medical disposition boards on evacuation caused the

cure rate for minor cases to plummet

from 85 to 25 percent. Not until 1945

would dedicated psychiatric hospitals

reappear, and the cure rate return to or

exceed the levels of late 1943.23

In the field, on the other hand, division psychiatrists increased in number,

and the practice of holding cases well

forward continued to spread in irregular fashion, depending on the outlook

of unit commanders and the influence

and sophistication of the local surgeon

and psychiatrist. The patient with mild

to moderate stress reactions was likely to

recover, provided he was not sent to the

general hospitals and selected for evacucine in this respect are knowledgeably discussed by

Albert J. Glass, “Psychosomatic Medicine,” in W. Paul

Havens, Jr., ed., Infectious Diseases and General Medicine,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1968), pp. 675–712. 23See CSurg, USASOS, SWPA, Annual Rpts, 1944 and

1945, file 319.1–2, HUMEDS, RG 112, NARA.

264 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

22Frank A. Reister, Medical Statistics in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1975), pp. 34, 44. The underlying causes of the failures of American military medi-
ation out of theater. Once on that treadmill, he was lost to duty and dispatched

on crowded vessels, whose holding

capacity for such cases was never adequate (neuropsychiatric cases lacked the

priority for air travel until 1945). Yet better days for the theater lay just ahead. In

January 1945, a period of intense fighting when stress and danger were acute,

the rate for all psychoneuroses dropped

from about 26 per 1,000 troops to 8.3

and for psychoses from 17.3 to 5.7.

Growing comprehension among doctors, reinstitution of dedicated hospitals,

and pressure on commanders to cease

disposing of disciplinary problems

through medical channels all contributed to a further decline that continued until the end of the war.24

Assistance from experts in the United

States played an important role in

reducing to manageable proportions

another enduring problem of quite a

different sort—scrub typhus. This formidable illness first appeared in American

troops in the form of isolated cases

reported in northern Australia and the

Port Moresby area of New Guinea during 1942. Related both to louse-borne

epidemic typhus and to Rocky

Mountain spotted fever, scrub typhus

was better known to Japanese physicians, who called it tsutsugamushi fever,

than to Americans. Hundreds of cases

developed among Australians fighting

along the Kokoda Trail; mortality

among those afflicted varied greatly,

reaching almost 10 percent in some

areas. As Americans began fighting

north of the Owen Stanleys they too fell

ill, and cases reaching Port Moresby at

first baffled doctors. The number of

cases among soldiers in the Southwest

Pacific Area rose from 935 in 1943 to

4,396 in 1944 and to 5,663 in 1945. The

illness was more widespread than anyone had imagined before the war; the

fact that armies now were living and

fighting in some of the most remote and

least known regions of the Earth served

to reveal both its extent and its dangers.

The death rate, though 4 percent overall, was far higher in some cases, reaching 25 percent in one virulent outbreak

(among Army hospital personnel, ironically) on Goodenough Island. The long

period of nursing required was a serious

cause of ineffectiveness, not only among

the victims of the disease but also

among the troops in forward areas, who

sometimes had to be detailed to help

care for them.25

In the summer of 1943 the United

States of America Typhus Commission

had sent a team to New Guinea to study

scrub typhus. Its leader was Dr. Francis

G. Blake, dean of medicine at Yale

University. Blake and his colleagues

knew from prewar Japanese studies that

the illness was spread by the larva of a

mite—in common language, by a red

bug that burrowed into the skin. Unlike

epidemic typhus, tsutsugamushi fever

25Chris J. D. Zarafonetis and Myles P. Baker, “Scrub

Typhus,” in W. Paul Havens, Jr., ed., Infectious Diseases,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 112–15.

GROWTH OF THE MEDICAL SYSTEM 265

24CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 1, pp.

93–94, file 319.1–2; Ltr (copy), Capt Charles E. Test,

MC, 126th Sta Hosp, 7 Oct 44, sub: War Neuroses, pp.

1–9, Encl to Ltr (copy), Denit to Kirk, 24 Oct 44, file

200 Kirk-Denit Correspondence. All in HUMEDS, RG

112, NARA. See also S. Alan Challman and Henry A.

Davidson, “Southwest Pacific Area,” in Albert J. Glass,

ed., Overseas Theaters, Medical Department, United

States Army in World War II (Washington, D.C.: Office

of the Surgeon General, Department of the Army,

1973), 536–41. It should be noted that in the military

medical parlance of the time a psychosis simply meant

a psychiatric condition with severe symptoms that

proved impossible to alleviate. 
spread only from mite to man and not

from man to man. The disease killed,

however, in the same manner as louseborne typhus, by causing many small

hemorrhages throughout the body,

including the heart muscle and the

brain. No drug then known combated it.

Penicillin was useless, and DDT, the

other miracle compound put into common use during the war, proved ineffective against the mites.26

The need was for a careful systematic

program of prevention, based upon

knowledge of the vector. The Typhus

Commission had identified the vector as

a group of trombiculid mites living on

field mice in the kunai grass that typified many regions of New Guinea.

(Later evidence showed that grass and

ferns might also shelter these and other

rodents on which the mites lived—as

happened during the outbreaks on Biak

and Sansapor.) Americans began to

experiment with dipping clothes in a

miticide. Parallel efforts to develop a

miticide were already under way by the

Australian Army, acting for the

Combined Advisory Committee at

SWPA headquarters. In November 1943

the committee accepted the Australian

findings that two chemicals, dibutyl and

dimethyl phthalate, were most effective

for impregnating the clothing of troops

who must go into areas where the scrub

typhus was known or suspected to exist. 

But a systematic program of prevention was delayed. In 1944 General Denit

accepted the value of the miticide as

proven, while Colonel Hagins, the Sixth

Army surgeon, required a number of

field tests before agreeing. The impregnated clothing caused skin problems,

stiffened the cloth so as to cause chafing,

and reduced the evaporation of sweat. As

already noted, the Combined Advisory

Committee did not function properly in

this case; its members, uneasy over their

anomalous position, deferred to the field

commanders instead of seeking

MacArthur’s approval for a ruling that

embodied their own and Denit’s views.

The result was to delay adoption of a

standard method until after two major

outbreaks had occurred in American

forces, during July and August (Chart 3).

As Colonel Pincoffs of the committee

later remarked, “A committee is not usually as effective an executive agency as an

individual.”27

27Maurice C. Pincoffs, “History of Preventive

Medicine, SWPA,” pp. 14–15, Maurice C. Pincoffs

Papers, Medical Unit Historical Collection, U.S. Army

Military History Institute (MHI), Carlisle Barracks,

Pennsylvania.

266 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

26Ibid., pp. 116–17.

TYPHUS COMMISSION ENTOMOLOGIST

GATHERING MITES
Supply and Personnel

Throughout 1944 medical support

for every type of casualty suffered from

the slow and complicated supply procedures that prevailed within the theater.

Col. Alfonso M. Libasci, MC, the chief

medical supply officer, remained

responsible for an unending headache

caused by distance, weather, deficient

shipping, a burgeoning troop basis, theater bureaucracy, and a variety of other

factors. During the year he spent hundreds of hours in air travel, investigating

GROWTH OF THE MEDICAL SYSTEM 267

0

200

400

600

800

1000

July August September

1 8 15 22 29 5 12 19 26 2 9 16 23 30

Owi-Biak Epidemic

Sansapor Epidemic

Ratea

CHART 3—SCRUB TYPHUS ADMISSION RATE FOR U.S. ARMY FORCES, NEW GUINEA,

JULY–SEPTEMBER 1944

a

Reflects the number of cases per annum per 1,000 troops.

Source: Adapted from Cornelius B. Philip, “Scrub Typhus and Scrub Itch,” in Ebbe Curtis Hoff, ed., Communicable Diseases:

Arthropodborne Diseases Other Than Malaria, Medical Department, United States Army in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army, 1964), p. 288.
the situation at the widely scattered

bases, developing a new stock control

system, and supervising a buildup of

depots and the depot companies that

served and maintained them. 

Yet interbase distribution remained

poor. Requisitions often took five to

seven months to fill. Supplies intended

for one base arrived at another, requiring transshipment over hundreds of

miles in vessels that were too few and

unloading and reloading at poor, inadequate, and crowded docks. Even when

available in port, the shortage of service troops, poor roads, and bad weather hampered distribution. Everywhere,

the priority system favored combat

materiel over medical supplies, however critical, with the single exception of

antimalarials.

Repair was equally difficult. When

1944 opened, the 9th Medical Supply

Depot, now in Sydney, ran the only

maintenance section—a small one—in

the Southwest Pacific Area. Equipment

that medical units could not repair inhouse was hauled to a base depot and

then to Sydney. Here many items had to

be farmed out to civilian contractors.

Often weeks or months passed before

the original unit received the repaired

items. Libasci sought to meet the problem in three ways. He authorized immediate replacement by the depots; the

broken item, after repair, would then

return ultimately to depot stocks for

reissue. In April a second, larger, and

fully equipped shop opened at

Finschhafen, able to repair such complex items as X-ray machines and electrocardiographs. Finally, roving repair

teams went from base to base, fixing and

installing equipment as required and

bringing a new level of expertise to

improvisation of spare parts.

In the autumn a troubleshooter sent

by the surgeon general subjected the

whole system to a searching investigation. Col. Tracy S. Voorhees, JAGD, a

lawyer by training, had been instructed

by the secretary of war to oversee

administrative problems in the Army

Medical Department. In consequence,

he had become deeply versed in its

methods of operation and its problems,

and had already carried out an important survey of medical supply in the

European theater. Voorhees found the

harbor of Hollandia crowded with ships

waiting to be unloaded and the requisition system to the United States slow

and tangled in red tape. Libasci’s staff

was requisitioning supplies on a theaterwide basis, even though some supply

depots were 2,500 miles apart.

Although reforms were initiated at

Libasci’s urging, real relief for the theater’s problems, as the surgeon general

had suggested, awaited victory in

Europe and the freeing of shipping—

and more generally of the whole nation

and its war machine—from the burdens

of a two-ocean war.28

As noted above, lack of skilled personnel in the Southwest Pacific Area was

a persistent theme of complaint by medical officers. To offset the shortages that

he faced, General Denit did several

things: He sought to improve efficiency

by exploiting the theater consultants as

teachers; he transferred specialists to

28See Ltr (copy), Denit to Kirk, 18 Nov 44, p. 2, file

200 Kirk-Denit Correspondence; CSurg, USASOS,

SWPA, Annual Rpt, 1944, pp. 7–30, file 319.1–2; and

OofSurg, Intermediate Sec, USASOS, SWPA, ETMD

(copy), 15 Dec 44, p. 1, file 350.05. All in HUMEDS, RG

112, NARA. See also Charles M. Wiltse, Medical Supply

in World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1968), pp.

478–81.

268 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
forward bases; and he substituted

Medical Administrative Corps (MAC)

officers for physicians in posts, such as

assistant battalion surgeon, where a high

degree of clinical knowledge was seldom

needed. By doing so, he met a major

problem but created a lesser one. In

most units the MACs were accepted

without difficulty; however, in hospitals

friction developed over having them in

the position of executive officer or acting commander. Doctors were willing to

have only the day-to-day tasks of management shouldered by the administrative officers, who lacked medical knowledge and were usually younger.29

Women were essential to the medical

system as nurses, dieticians, and clerical

workers, but again a partial solution to

one difficulty begot others. Female nurses continued to provide skilled patient

care, and yet in some respects they were

also a source of internal disputes and illfeeling. Problems developed partly from

the nature of the war, with its repeated

invasions, and partly from the reluctance of General Headquarters, SWPA,

to allow women to go into forward locations. Fear of their mistreatment if captured by the enemy, practical problems

of housing and protecting them, traditional chivalry, and male chauvinism all

contributed to results that injured the

morale of both sexes in the SWPA medical service. 

GROWTH OF THE MEDICAL SYSTEM 269

29Rpt, Training Div, OSG, [19 Sep 45], sub: Survey . . . ,

pp. 5–6, Historians files, HUMEDS, RG 112, NARA.

SHED FOR MEDICAL SUPPLIES AT ORO BAY
In the early days of each new campaign, all the work normally done by

the nurses fell to the enlisted corpsmen

and technicians of the mobile medical

units. Yet none could win the officer

status that was accorded to women

nurses for such work, and as soon as

the firing quieted down the enlisted

men found themselves displaced or

made subject to a nurse’s orders.

“Thus, when the nurses move in,” said a

report, “the morale of the enlisted element immediately hits bottom.” The

fact that women officers were officially

untouchable and undatable by enlisted

men did nothing to assuage such feelings. But officers and commanders of

field hospitals were also reported to

prefer male to female nurses, either

because of chauvinism or resentment

toward personnel who occupied TO&E

slots but were absent on the day of battle. Meanwhile, nurses were deprived of

opportunities to practice their professions and do the work for which they

had volunteered. In turn, their disappointment and sense of exclusion led

to poor morale, psychological problems, and perhaps to some pregnancies, which provided a way out of the

theater.30

Despite Denit’s best efforts, trained

medical personnel in all categories—

from enlisted men to specialists—

remained in short supply. The chief surgeon was obliged to demand more and

more of his subordinates, to deny them

rotation unless replacements were in

hand, and to compel them to work long,

often excessive hours at the most varied

tasks. No doubt fatigue took some toll of

efficiency, and grumbling was common

among the stressed and overworked

who felt, with some reason, that they

were the stepchildren of the theater

they served. But in the end they bore the

burden, and because of them the necessary jobs were done.31

The Central and South Pacific Areas 

In the Central Pacific quite different

command problems developed and,

under Navy leadership, found their

own practical solutions. For soldiers,

preparations for the offensive that was

to begin in late 1943 brought into

being in September the new and higher headquarters, the United States

Army Forces in the Central Pacific Area

(USAFICPA), to which the Hawaiian

Department was now subordinate. The

implication was clear: Whereas previously the Army’s role had been to

defend and, through the military government, to administer only the

Hawaiian Islands, it would now become

actively involved in operations throughout the Central Pacific.32

As the USAFICPA commander, Lt.

Gen. Robert C. Richardson, Jr., was

responsible for the administration and

training of all U.S. Army ground and air

forces in the region, which now

stretched from the west coast of the

United States to the east coast of China.

Once trained, his forces were subordinated to Admiral Nimitz’ headquarters

or to the tactical commands—the V

31In October 1944 medical personnel in the

Southwest Pacific Area totaled 61,787. See McMinn and

Levin, Personnel, p. 368. 32Armfield, Organization and Administration, p. 383.

270 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

30Quotations from ibid., p. 6, Historians files,

HUMEDS, RG 112, NARA. See also Rpt, Maj Margaret

D. Craighill, MC, to AG, Wash., D.C., 8 Jun 45, sub:

Medical and Social Condition of Women in Military

Service in the Southwest Pacific Area, box 6, Margaret

D. Craighill Papers, MHI.
Amphibious Force or the V Amphibious

Corps—for employment in combat.33

Training, logistics, resupply, and the

construction, development, defense,

maintenance, and manning of bases all

fell under the USAFICPA. If the fundamental organizational problem for the

medics in the Southwest Pacific Area was

unity of direction, that in the Central

Pacific Area was the extraordinary

expansion of the theater across thirtyfive degrees of longitude in the course

of about a year. As the invasion forces

traversed thousands of miles of ocean

and conquered hundreds of islands,

hospitalization and evacuation had to

keep pace. At the same time, the troop

strength of the command grew rapidly,

increasing some 200 percent between

June and December 1943. By charging

the USAFICPA with the responsibility

for providing common supplies to

Marine and Navy units as well as to the

Army ground forces in the Gilberts campaign, Nimitz made the headquarters

his “logistical agency for the support of

offensive operations.” Many new bases

passed into the USAFICPA’s hands. In

March 1944 even Tarawa, hard won by

the marines, became an Army command

and, in May, Saipan.34

General King added to his many hats

by becoming Chief Surgeon, USAFICPA,

in August 1943. The veteran chief surgeon of the Hawaiian Department faced

challenges that were broad, complex,

and interrelated. The command’s area

had expanded some 30 percent during

1943, and medical facilities grew accordingly. By the year’s end the number of

beds was double that possessed by the old

department in 1942. Seven Army divisions staged in the area, and six moved

out to combat; hospitals had to be provided for task forces dispatched to the

Gilbert, Marshall, and Mariana Islands;

and the garrisons required medical support of a more lasting nature. Meanwhile,

many duties remained with the Hawaiian

Department, though care of the civilian

population had by now been returned to

the islands’ doctors and public health

officials. Port and quarantine regulations

still had to be enforced and training

areas, replacement depots, and prisonerof-war camps policed. 

Hawaii’s huge fixed hospital establishment remained and in fact grew. One

happy consequence of its amplitude,

when combined with King’s cordial relations with the Seventh Air Force surgeon, was to exclude from this theater

the conflict between soldiers and airmen over hospitalization that marred

many others. With units scattered on

many islands, the airmen maintained

their own dispensaries but did not seek

to turn them into hospitals, preferring

the treatment received in those of the

theater surgeon, especially in light of his

sympathetic attention to their special

needs. The one exception—the Hickam

Station Hospital at Hickam Field near

Pearl Harbor—was operated by the air

force, with personnel assigned by King.35

The chief surgeon’s office grew, decentralizing functions and expanding its staff

of consultants. One function—civilian

liaison—declined in significance as the

33“History of the United States Army Forces, Middle

Pacific and Predecessor Commands, During World War

II, 7 December 1941–2 September 1945,” pt. 2,

“Structural and Functional Development of the Army

Command,” 3:360–65, Ms 8–5.6 AA 2/1, CMH. 34Ibid., 3:367, Ms 8–5.6 AA 2/1, CMH.

GROWTH OF THE MEDICAL SYSTEM 271

35Armfield, Organization and Administration, pp. 384,

386; Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 3, pp. 20–30, file

314.7, HUMEDS, RG 112, NARA.
Hawaiian Islands became more secure,

and in March 1943 the military government ended, relieving the surgeon of

many duties which reverted to civilian

authorities. But other sections—personnel, operations and training, preventive

medicine, supply, and nursing—were

augmented with officers and enlisted

personnel (Chart 4).

A basic task of King’s expanded office

was to cooperate fully with the medical

section of the Logistics Division in

Admiral Nimitz’ headquarters that

planned medical support for the Central

Pacific offensives.36 The management of

large numbers of new personnel, the

training of medical units for combat, the

equipping of hospitals to accompany

task forces, the allocation of funds, and

the maintenance and movement of supplies especially preoccupied the chief

surgeon’s staff. 

King’s Operations and Training

Section directly supported the campaigns by ensuring that officers and

enlisted men received both basic medical training and advanced technical

training. Medical personnel trained with

tactical units at Koko Head crater, east of

Honolulu. Medical officers without previous field training went to the Service

Unit Officers Field Training School;

units not engaged in professional work,

to the Unit Jungle Training Center. The

thousand nurses who worked in the

Central Pacific Area trained vigorously

with road marches and swimming, as

well as in clinical courses offered by the

general hospitals. Schools and training

programs were established for technicians and laboratory assistants, and

King’s staff endeavored to build up the

understrength specialties, notably dentists, whose numbers roughly doubled

without reaching levels adequate to the

needs of the troops. A school for medical

administrative officers opened in

December 1944, with classes supplemented by weapons qualification and

jungle and amphibious training. Every

effort was made to prepare the officer

candidates realistically for war.37

At the chief surgeon’s office paper

work increased with the introduction of

more detailed reporting on the sick and

wounded. During the year the War

Department instituted the essential

technical medical data report, to a chorus of complaints that were later stilled

when its value as a planning document

and record of clinical and field experience became apparent. 

Through all the changes, the personality of the chief surgeon remained constant. Although preoccupied with planning for forthcoming operations, King

long tried to maintain his habit of reading and checking the work and correspondence of his entire office; he gave

up his penchant for one-man control

reluctantly, in the face of a constantly

growing workload. As far as possible he

still kept the lines of authority centralized in his own hands, dominating an

office that grew in numbers—at the end

of 1943 it included 29 officers, 3 warrant

officers, and 121 enlisted men—yet

became ever smaller in relation to the

burgeoning command it served.38

37Surg, CPBC, Annual Rpt, 1944, pp. 44–45, file

319.1–2; Whitehill, “Medical Activities in Middle

Pacific,” block 3, pp. 25–27, file 314.7. Both in

HUMEDS, RG 112, NARA. 38Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 20–21, 23–24, file 314.7, HUMEDS, RG

112, NARA; Armfield, Organization and Administration,

p. 386. By mid-1944 total Army strength in the Central

Pacific Area was about 296,000.

272 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

36For the Central Pacific campaign narrative, see

Chapter VII.
The search for a more efficient organization in the Navy theaters led to the

creation of logistical base commands. In

the summer of 1944 Nimitz ordered the

sweeping change, in view of experience

gained during the westward advance of

the battlefront. On 15 June the South

Pacific Area was redesignated the South

Pacific Base Command (SPBC), and

brought under the direct command of

Nimitz’ headquarters; on 1 July a new

headquarters, the Central Pacific Base

Command (CPBC), assumed responsibility for logistical support from the

USAFICPA; and on 1 August the

USAFICPA became the United States

Army Forces, Pacific Ocean Areas (USAFPOA), still under General Richardson. 

King, leaving most of the personnel

of his office in the CPBC quarters,

moved with a small staff of 9 officers

and 15 enlisted men—essentially, the

GROWTH OF THE MEDICAL SYSTEM 273

Dental Veterinary Personnel Nursing

Medical

Inspector Records Finance andSupply Consultants

Anti-Biological

Warfare

Battle Command

Post

Operations and

Training

Executive Officer

Deputy Chief Surgeon

Chief Surgeon

Source: Adapted from “History of the Office of the Surgeon, United States Army Forces, Middle Pacific and Predecessor

Commands, 7 December 1941–2 September 1945,” sec. 2, “Central Pacific Area,” p. 3, Ms 8–5.6 AA 30/2, CMH.

CHART 4—ORGANIZATION OF THE OFFICE OF THE CHIEF SURGEON, USAFICPA,

DECEMBER 1943
part of his staff that had been engaged

in operational planning—to set up the

USAFPOA chief surgeon’s office in a

separate building at Fort Shafter. Here

he served the last months of a tour of

duty that had lasted from before Pearl

Harbor to the opening battles of the

reconquest of the Philippines. He was

relieved on 17 November by Brig. Gen.

John M. Willis, MC. For the greater

part of a year Willis’ office remained

small, with many posts filled by officers

borrowed from the two logistical

commands.39

The Central Pacific Base Command,

inheriting the long-established medical

complex in the Hawaiian Islands and

adding later the Gilberts and the

Marshalls, had no such problems. On

10 August, a little more than a month

after becoming the CPBC surgeon, Col.

Paul H. Streit, MC, established the

Medical Service, an operating agency

under his own command that gave him

direct control of all medical units and

installations on Oahu (Chart 5). The

Medical Service took charge of the personnel and units that operated many

fixed hospitals, supply depots, two concentration centers—the command’s

term for training and processing centers—and a convalescent and reconditioning facility. It also controlled a variety of field organizations, including

mobile medical units, medical groups,

ambulance battalions, and so forth. On

an island that more than ever had the

character of a transient lodging, many

units passed through the base command for training on their way to the

tactical commands operating in the

western Pacific.40

In the South Pacific Area Brig. Gen.

Earl Maxwell saw his dual role as

USAFISPA and USASOS surgeon end

in the summer of 1944, when the theater, with its combat mission over, was

transformed into a logistical command.

He remained as Surgeon, SPBC, until

he was relieved on 30 November by

Col. Laurant L. LaRoche, MC. In May

1945 the SPBC surgeon’s office was

274 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

39Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 32–34, 37–38, file 314.7; CSurg, USAFPOA,

Annual Rpt, 1944, pp. 1–2, file 319.1–2. Both in

HUMEDS, RG 112, NARA. See also Armfield,

Organization and Administration, pp. 451, 455.

BRIG. GEN. JOHN M. WILLIS, MC

40Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 43–47, file 314.7; Surg, CPBC, Annual

Rpt, 1944, pp. 1–4, file 319.1–2; Rpt, Col Harry D.

Offutt, 1945, sub: Close-Out Report of Medical

Service, Central Pacific Base Command, pp. 1–2,

Historians files. All in HUMEDS, RG 112, NARA.

Colonel Streit later rose to the rank of major general

in the Medical Corps.
transferred to the Philippines to help

plan the invasion of Japan. Meanwhile,

Colonel Koontz, surgeon of the New

Caledonia Island Command, took on

the additional duties of base command

surgeon and served out the remainder

of the war in these roles. Care of combat troops undergoing rehabilitation,

logistical support of three combat

infantry divisions (the 37th, 93d, and

Americal), inspection of foodstuffs procured from New Zealand, and evacuation of casualties from the active theaters were the most important duties

remaining in the South Pacific, where,

in the days of the Guadalcanal fighting,

bitter and decisive struggles had been

the order of the day.41

41Whitehill, “Medical Activities in Middle Pacific,”

block 3, pp. 71–82, file 314.7, HUMEDS, RG 112,

NARA. Maxwell was promoted to brigadier general on

19 January 1944.

GROWTH OF THE MEDICAL SYSTEM 275

General

Hospitals

Station

Hospitals

Field and Portable

Surgical Hospitals

Medical

Laboratory

Medical Supply

Depots

Medical Department

Concentration Centers

Ambulance

Battalion

Sanitary

Companies

Veterinary

Units

Dental

Clinics Consultants

Executive Officer

Deputy Surgeon

Surgeon

Source: Adapted from Rpt, Col. Harry D. Offutt, 1945, sub: Close-Out Report of Medical Service, Central Pacific Base

Command, p. 6, Historians files, HUMEDS, RG 112, NARA.

CHART 5—ORGANIZATION OF THE MEDICAL SERVICE, CPBC, AUGUST 1944
The Medical Picture

To the soldiers wounded in more

recent island battles, the base commands

meant primarily evacuation to hospitals

for definitive treatment of their injuries

or illness. For them the transition must

have been extraordinarily abrupt; a few

days on ship and aircraft moved them

from primitive jungles to a world of abundant food, of tolerably sophisticated science, and sometimes of urban amenities

and female nurses as well. Their wounds

or illnesses were the price—often a high

one—they paid for such a journey, and

the medical skill required to repair the

ravages of war was great.

Evacuation from the Central Pacific

Area more than doubled during 1943,

and included over a 1,000 evacuees from

the Southwest Pacific Area who passed

through the Hawaiian Department on

their way to the mainland. Air evacuation from Oahu began in January, at first

by tactical aircraft and later by the planes

of the Air Transport Command’s Pacific

Wing. The total for the year was exactly a

dozen casualties, all critical cases! But

major changes were already under way.

The meager record of air evacuation had

reflected many factors, including the

lack of an urgent need in a theater with

little combat and the lack of planes suitable for long-distance transport. 

But with the opening of the Gilbert

Islands campaign the necessity of moving the seriously wounded quickly over

some 2,000 miles of ocean to Oahu

made long-distance evacuation a necessity. The Central Pacific Combat Air

Transport Service was organized, drawing units and planes from the Army,

Navy, and Marine Corps. The Navy’s PBY

amphibious planes evacuated from battle sites until airfields could be put into

operation and utilized by Army and

Marine transports. The Air Transport

Command’s large C–54A aircraft covered the longest leg. In November 1943

Tarawa casualties began to reach Hickam

Field, and out-of-theater evacuation

soon followed. Air evacuation rapidly

established itself as a crucial element of

medical support for the Pacific Ocean

Areas. Critical improvements in techniques, equipment, and personnel were

contributing factors. The big planes

were equipped with brackets for holding

litters, and trained flight nurses based at

Tarawa accompanied the wounded on

the long jump to Hawaii. Flight surgeons

were substituted for untrained medical

officers, one of whom at an earlier time

had spent an entire trip being airsick

while his single patient looked on sympathetically from his stretcher.42

Precise measurement of the effects of

the new system are difficult, for reorganization of the USAFICPA chief surgeon’s office contributed to a lack of

adequate statistics for 1944, the year

when the evacuation system was suddenly overburdened by increased numbers

of casualties. As the theater vastly

expanded in area, in excess of 22,000

evacuees had to be moved much farther.

The proportion of air evacuation greatly

increased, comprising virtually all

intratheater movement in the South

and Central Pacific Base Commands

and about 50 percent of that to the

United States. The impact of the campaigns on the hospitals was great: In the

aftermath of the Marianas fighting,

when the USAFPOA headquarters was

compelled to reduce its evacuation poli42Ibid., block 8, pp. 4–6, file 314.7, HUMEDS, RG

112, NARA; Futrell, “Aeromedical Evacuation,” pp.

399–401, copy in CMH.

276 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
cy from 120 to 90 days, hospital beds

were emptied at the cost of straining

transportation, losing combatants, and

finding replacements.43

Sheer distance remained the single

greatest difficulty, whether evacuation

was viewed as a problem in treatment,

transport, or time. During Operation

FORAGER the Navy planned to evacuate

by surface craft from the Marianas to

Kwajalein and then by air to Oahu (six

Navy and five Army planes were assigned

the task). Incidental aircraft were also to

be exploited, while surface craft were to

evacuate from Kwajalein both to Hawaii

and to the South Pacific Area. As matters turned out, however, the Army had

to assign ten C–54s, rather than five, and

some Saipan Island casualties were carried by Seventh Air Force transports

without benefit of medical care during

flight. When the battle wounded crowded the wards of the Oahu hospitals,

Kwajalein provided a new evacuation

route to Guadalcanal. Neuropsychiatric

cases, which rose to 25 percent of total

evacuations during 1944, presented a

special problem; precautionary measures had to be adopted to enable them

to travel by air, by sedating heavily those

who needed restraint. By the end of

1944 out-of-theater evacuation had followed the same pattern, though at a

slower pace—78 percent of casualties

moved by air. Emergency cases and

43Whitehill, “Medical Activities in Middle Pacific,”

block 8, pp. 8–12, file 314.7, HUMEDS, RG 112, NARA.

GROWTH OF THE MEDICAL SYSTEM 277

USAFPOA HEADQUARTERS, FORT SHAFTER, where the chief surgeon’s office was located
those requiring treatment in the United

States received first priority, based on

decisions made by disposition boards at

each hospital. An Air Transport

Command surgeon also screened evacuees to ensure that they could endure

the trip.44

At the general hospitals on Oahu soldiers with wounds and illnesses contracted in the active theaters trickled in during 1943, but treatment of the troops

training on the island and of civilian

patients was more typical. One hospital

reported its most interesting case—a

young soldier, accidentally shot through

the bowels during target practice, whose

life was saved, despite gross fecal contamination, by the use of penicillin.

Another hospital cited the treatment

and ultimate recovery of a civilian stung

during swimming by a dangerous jellyfish! For such rear area medical installations, the war began in earnest with the

arrival of the first battle casualties from

the Gilberts. At North Sector General

Hospital “the receipt of these casualties

seemed to cause a general pick up [sic]

in morale and a feeling that . . . [its personnel] were taking a greater part in the

war effort than they had realized.”45

The creation of the Central Pacific

Base Command and its medical service

tightened medical organization in the

Hawaiian group. A single center was

established at the 22d Station Hospital

for neuropsychiatric cases, not only for

their own treatment but to prevent “contagion” of the other troops. During 1944

a convalescent and reconditioning center expanded from 400 to 1,000 beds,

and a special section for diseases of the

chest was set up at the 147th General

Hospital and a center for neurosurgical

cases at the 218th General Hospital.

Experience in the treatment of tropical

diseases, such as malaria and filariasis,

increased with the return of casualties

from the forward areas. But the primary

concern was the battle wounded, for

whom at least 2,500 beds were available

at all times. Peaks followed the surges of

combat, with notable influxes during

February, July, August, and December

1944. In fact, as the CPBC surgeon

emphasized, the command received all

types of casualties, medical as well as surgical, nonbattle as well as battle.46

During 1944 the development of new

medical complexes on captured islands

left the Hawaiian facilities little to do for

casualties but to receive the overflow of

the forward bases. (During the Marianas

fighting a station hospital on Kwajalein

expanded to 1,300 beds, filling newly

erected air force barracks with the

wounded.) Indeed, the number of beds

in the Central Pacific Base Command

fell by about 2,100, the net result of a

sharp reduction in facilities on the outer

islands of the Hawaiian group, where

invasion clearly was no longer a threat,

and of many departures for the tactical

commands and island garrisons. But by

the end of the year the Pacific Ocean

Areas included the Marshall, Gilbert,

and Mariana Islands, and General Willis, 44Ibid., pp. 12–15, file 314.7, HUMEDS, RG 112,

NARA. During 1945 evacuations increased by 88 percent, to 41,857. However, this may be partly the effect of

better statistics collected after December 1944. 45204th Gen Hosp Annual Rpt, 1943, app. 6, p. 6, and

North Sector Gen Hosp Annual Rpt, 1943, pp. 17, 28

(quotation), in CSurg, USAFICPA, Annual Rpt, 1943,

file 319.1–2, HUMEDS, RG 112, NARA.

46Surg, CPBC, Annual Rpt, 1944, pp. 6 (quoted

word), 19–20, file 319.1–2, HUMEDS, RG 112, NARA.

In neuropsychiatric admissions during World War II

the Pacific Ocean Areas stood third after the Southwest

Pacific Area and the Mediterranean theater. See

Reister, Medical Statistics, p. 44.

278 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
as the USAFPOA chief surgeon, provided technical guidance and direction for

Army hospitals in all. Hospitals of various types were formed from those existing in the Hawaiian Islands to accompany the task forces and to provide for the

needs of the garrisons after the battle.47

Various subordinate commands—the

United States Army Forces in Tarawa,

Kwajalein, Eniwetok, and so forth—were

established under the USAFICPA in

1944. The creation of Army and Navy

island commands determined which service took responsibility for the hospitals

there, but did not preclude the hospitals

of one service from being assigned to

the other service’s command. In the

Marianas, for example, Saipan became

an Army base; Guam and Tinian, Navy

bases. On Saipan the original base development plan included a general and

two station hospitals, all Army, but

Guam was to have an Army station hospital as well. The growth of Tinian as a

major air base devoted to strategic

bombing was paralleled by a great multiplication of general and station hospitals in the Marianas. By the year’s end

the USAFPOA had over 14,000 fixed

beds, a trifle less than its authorization

of 6 percent of troop strength.48

The opening of combat in September

1943 gave new importance to preventive

medicine in what had been a comparatively healthy theater, concerned mainly

with the problems caused by wartime

population pressures in Hawaii. When

the USAFICPA was established, its medical inspector’s section developed the

command’s preventive medicine program; a single officer served as epidemiologist and medical intelligence chief,

devoting much time to acquiring data

on the Japanese-held islands from

sources in Hawaii, an effort that apparently duplicated those of the surgeon

general’s medical intelligence operation. In the successor commands the

medical inspector’s section remained

part of the CPBC surgeon’s office,

whereas at the USAFPOA headquarters

two officers carried out preventive medicine as additional duties. Col. Charles

T. Young, MC, took over some aspects of

the program in addition to his work as

47See Chapter VII.

48“History of the Office of the Surgeon, United States

Army Forces, Middle Pacific and Predecessor

Commands, 7 December 1941–2 September 1945,” sec.

2, “Central Pacific Area,” p. 22, Ms 8–5.6 AA 30/2,

CMH; Rpt, Lt Col Lamar C. Bevil, 15 Apr 44, sub: Brief

of the Central Pacific Area, p. 3, bound in “Brief of

Pacific Ocean Areas,” file 319.1, HUMEDS, RG 112,

NARA; John B. Flick, Forrester Raine, and Robert

Crawford Robertson, “Pacific Ocean Areas,” in Carter,

ed., Surgical Consultants, 2:663–64. The XXI Bomber

Command launched its first raid against Tokyo from

Tinian in November 1944.

GROWTH OF THE MEDICAL SYSTEM 279

147TH GENERAL HOSPITAL UPPER

RESPIRATORY WARD
consultant in medicine, and Col. Elbert

Decoursey, MC, commander of the 18th

Medical General Laboratory, was designated epidemiologist and sanitation

officer. 

But the theater still lacked a formal

preventive medicine organization, a fact

duly noted by Brig. Gen. James S.

Simmons, MC, the active chief of the

Preventive Medicine Service, Office of

the Surgeon General, who conferred

with General King about the problem in

early autumn 1944. In November Lt.

Col. Thomas G. Ward, MC, became

chief of a newly formed Preventive

Medicine Section in the Office of the

Chief Surgeon, USAFPOA.49

Ward established a section that replicated in many ways the structure of

Simmons’ service in Washington.

Traditional concerns for venereal disease, sanitation, immunization, and the

gathering of health statistics were supplemented by special attention to tropical diseases, industrial hygiene, and

medical intelligence. A specialist, Lt.

Col. Paul A. Harper, MC, was brought in

from the South Pacific Area in late

November to be theater malariologist,

as USAFPOA subordinate commands

planned advances into regions where

the disease was endemic. Control of

insects increasingly meant the systematic application of DDT. Venereal disease

had never been much of a problem in

the theater, and was chiefly interesting

for the variety of approaches on different islands. On American Oahu houses

of prostitution were closed in 1944, with

a reported drop in infections. On

French-mandated islands garrisoned by

U.S. forces, civil authorities operated

houses of prostitution, but the women

had to undergo regular examinations

conducted by American medical officers. Either way seemed to work, if carefully administered, although some cases

of infection inevitably escaped the

examiner’s eye. The Hawaiian experience suggested that, from the medical

officer’s point of view if not the young

soldier’s, suppression was somewhat

more satisfactory, for the cheapness and

convenience of brothels increased the

number of sexual contacts, which in

turn was reflected in the incidence of

venereal disease. The difference, however, was not very great.

Nutrition presented a question of

potentially greater importance. Rations

were balanced in theory, but parts of

them remained so unpalatable that the

troops, because of selective eating,

developed deficiencies, a difficulty

solved by requiring vitamin pills as a supplement. Water supply continued to be

a problem on some islands, as local

sources were still of poor quality.

Lacking adequate supplies of halazone

(chlorine) tablets, the theater attempted to solve the problem by sending

water with the assault forces and establishing filtration plants as soon as possible after victory was won.50

In many respects, Ward’s Preventive

Medicine Section apparently did little but

systematize the procedures already under

49Office of the Surgeon (OofSurg), United States

Army Forces in the Pacific Ocean Areas (USAFPOA),

“History of Preventive Medicine,” p. 1, file 314.7; Office

of the Surgeon, United States Army Forces in the

Middle Pacific, “History of Preventive Medicine,” pp.

23–31, file 314.7; Whitehill, “Medical Activities in

Middle Pacific,” block 12, pp. 1, 10–11, file 314.7;

CSurg, USAFPOA, Annual Rpt, 1944, p. 9, file 319.1–2.

All in HUMEDS, RG 112, NARA. 

50OofSurg, USAFPOA, “History of Preventive

Medicine,” pp. 43–47; Whitehill, “Medical Activities in

Middle Pacific,” block 12, pp. 1, 18–20. Both file 314.7,

HUMEDS, RG 112, NARA.

280 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
way—spraying corpses with sodium arsenite, for example, and impregnating uniforms with miticides to guard troops

against scrub typhus. Epidemiology teams

were sent into forward areas; a dengue

team brought aerial DDT spraying to

Saipan; and in the 1945 campaigns dysentery epidemics were halted by identifying

the cause and applying control methods.

The many problems encountered in the

conquered islands suggested the need for

a school of preventive medicine, which

was eventually set up on Okinawa in mid1945.

Excluding the assault phases of the

various campaigns, disease caused over

80 percent of the theater’s noneffectives

during 1944, despite the lack of serious

illnesses and a continuing low venereal

disease rate. A tropical climate, crowding and stress, and poor conditions on

transports were all contributors, and

served to underline the continuing

importance of preventive medicine.51

Supply

Medical supply presented daunting

challenges as the theater grew and as

assault forces, in ever greater numbers,

moved from the West Coast and Hawaii

over constantly increasing distances to

strike at enemy-held islands. To equip a

large invasion force with medical supplies required initial approval by the

War Department, requisitions to the San

Francisco Port of Embarkation, and

endless conferences with the units

involved to establish a basis of issue for

every item. Then a detailed plan was

prepared, called a combat project, and

forwarded once again through area

headquarters to the War Department

for final approval. Proposals to reform

this tedious process were often heard,

and a new procedure was adopted by

the Army in December 1944.

Implementation, however, proved no

less time-consuming than the combat

project method, and the war ended

without comprehensive reform.52

Combat units arrived in theater minus

essential medical supplies. Assemblages

forwarded from the mainland had similar gaps, caused by spot shortages in the

mainland depots. Since the units could

not be sent into combat without equipment, medical supply officers in Hawaii

had to replace any shortfalls within

schedules set by the plan of attack and

hoped to recoup them later through requisitions from the mainland. The danger

of attack during the early years of the war

led to a program of dispersing supplies

on the outer islands of Hawaii; when

American forces shifted to the attack, the

supplies had to be concentrated again, at

the chief surgeon’s order, to economize

on time, personnel, and facilities.

Preparation for each combat operation

was a complicated affair—checking

equipment, deleting nonessential items,

palletizing and waterproofing, preparing

thirty-day 3,000-man medical maintenance units for resupply, repacking medical chests into canvas packs, and so forth. 

Despite the complications introduced by combat, Colonel Voorhees

reported in his October 1944 study “the

outstanding fact . . . that Medical Supply

[in the Central Pacific Base Command]

has been and is thoroughly adequate.” 51OofSurg, USAFPOA, “History of Preventive

Medicine,” pp. 43–47, file 314.7; Whitehill, “Medical

Activities in Middle Pacific,” block 12, pp. 14–15, 24, file

314.7; CSurg, USAFPOA, Annual Rpt, 1944, pp. 6, 9,

file 319.1–2. All in HUMEDS, RG 112, NARA.

52Whitehill, “Medical Activities in Middle Pacific,”

block 6, p. 3, file 314.7, HUMEDS, RG 112, NARA.

GROWTH OF THE MEDICAL SYSTEM 281
Both King’s thoroughness in directing

the Hawaiian Department during the

early years of the war and the long period of preparation for combat facilitated

the creation of a system “more satisfactory . . . than [in] other theaters.” As

with hospitals, the arrangements in

Hawaii designed to guard against attack

had ceased to be necessary, and it was at

Voorhees’ suggestion that the chief surgeon acted to consolidate supplies in

the Hawaiian Supply Depot. The main

weakness uncovered was the absence of

a chief supply officer in the chief surgeon’s office. King promptly appointed

Maj. Donald E. Remund, MAC, and

Willis, King’s replacement, Maj. Louis F.

Williams, MAC, from the Office of the

Surgeon General.53

The rapid growth of the hospital system imposed supply requirements only a

little less pressing than those of the

assault forces earlier. Looking to future

operations that would involve the combat of large forces, the Army planned to

install some 8,000 fixed beds in the

Marianas—about 5,000 of them on

Tinian, where Army engineers were constructing airfields for heavy bombers to

attack Japan. The location of the islands

and the ample facilities for air evacuation made them ideal; however, hospitals

demanded complex supplies, many provided by the engineers who built the hospitals but some issued by the medical service. Fluorescent lighting fixtures for

operating rooms in Quonset huts were

developed by the engineers in conference with members of the chief surgeon’s office and constructed in the field

for all island commands, using materials

on hand. Field expedients, cooperative

action by the two technical services, and

the coordinating effect of a single island

command all contributed to the development of the new medical complexes.54

A variety of limited improvements in

supply were recorded during 1944, most

coming in response to Voorhees’ report

and action by the theater headquarters.

A shift from automatic resupply to requisition by the Central Pacific Base

Command made for a more responsive

system, one capable of adapting to the

new phase of the war. But the 3,700

miles that separated Oahu from the

Marianas complicated the process of

establishing a closely-knit supply network. Duplication, overages, and occasional shortfalls could be minimized but

not eliminated, and the chief supply

officer, despite hopes that had attended

his appointment, depended mainly on

informal contacts in his dealings with

the nearly autonomous island commands. More valuable than improvements in organization was the increased

capability of mainland depots to assemble and ship virtually complete hospital

units by mass-production methods that

rendered hand assemblage in Hawaii

out of date. And the matured wartime

productive capacity of the United States

made up for organizational failings in

enabling the forces under Nimitz’ tactical commanders to be supported across

many thousand miles of sea.55

Voorhees’ report to Surgeon General

Kirk on the Pacific supply situation as a

whole emphasized the problems caused

by the multiple commands in the

region, with no coherent system for

redistributing excess stocks. Confirming

the gut feeling of many SWPA medical

54Dod, Corps of Engineers, p. 493. 55Wiltse, Medical Supply, pp. 468–81.53Ibid., pp. 1 (quotations), 28–36, file 314.7,

HUMEDS, RG 112, NARA; Wiltse, Medical Supply, p. 481.

282 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
officers, Voorhees found that excesses

had piled up in the two Navy-run theaters, in part at least because the great

overseas distances had produced critical

shipping shortages. Stocks had accumulated in rear areas, in some cases abandoned there by fighting units that

expected to be issued new supplies in

the combat zone. Lack of a unified command structure prevented the transfer

of excess supplies and supply personnel

to the areas of greatest need. The time

was fast approaching when a greater

degree of unity would become essential

to the forces that were converging for

climactic battles in the western Pacific.56

Personnel 

Perhaps the most striking fact about

medical personnel in the Central Pacific

Area during 1944 was that little growth

occurred during a time of increasingly

heavy combat—primarily because the

USAFICPA and CPBC headquarters,

after organizing and training their

forces, sent them to the amphibious

commands to do their fighting. Army

medical strength in Admiral Nimitz’

command was, however, large and growing. In the autumn of 1944 Army medics

totaled about 34,500 to support 429,000

troops; by contrast, MacArthur’s command had about 52,000 medics to support 706,000 soldiers. The proportion of

medical personnel to troops was nevertheless about the same, 87 per 1,000 in

the Southwest Pacific Area and 81 per

1,000 in the Pacific Ocean Areas.57

The absorption of the former Central

and South Pacific Area headquarters

meant that the USAFPOA chief surgeon

became responsible for the proper utilization of medical personnel, but by the

end of 1944 the necessary records still

had not been completely forwarded.

Despite this gap, General Willis’ office

gradually built up an alphabetical index

file for the whole of the Pacific Ocean

Areas, containing a card for each

Medical Department officer, male and

female, with military service and professional experience. As new medical officers were assigned to the theater, the

commander of the Replacement Depot

submitted their names and qualifications

to the chief surgeon, who offered his recommendations on their assignments.

Additionally, Willis sometimes suggested

changes in the assignments of officers

already in the theater. Promotion lists

came first to the chief surgeon, who

scanned the names to verify eligibility

and competence and then forwarded

them to the command’s adjutant general with his recommendations. Such an

assessment was absolutely necessary, for

the promotion of a medical officer

implied having a certain level of professional medical and military competence.

Introduction of the military occupational specialty (MOS) system during

1944 added a new wrinkle: Every officer

received an MOS number and letter classification. The three top medical officer

categories were 3100 (General Duty),

3139 (Internal Medicine), and 3150

(General Surgery). These specialities

accounted for over 80 percent of doctors

assigned to non-hospital units and 60

percent to hospital units in the theater,

based on the fact that some officers held

more than one MOS classification. As a

control device, the system remained

somewhat crude because the fine points

of medical competence, such as board

qualification and certification, were not

56Armfield, Organization and Administration, p. 454. 57McMinn and Levin, Personnel, p. 368.

GROWTH OF THE MEDICAL SYSTEM 283
included. But the MOS system did help

to reveal some interesting peculiarities of

the theater medical setup in midwar.

Psychiatrists represented 3.8 percent of

the total MOS specialists in hospitals—a

welcome fact in a theater where NP evacuations were high through 1944. A critical shortage was in orthopedic surgeons,

numbering only forty-one, even though

the theater had sixty-six hospital units.58

In contrast to the reluctance displayed by General Headquarters, SWPA,

the Army commands in Navy theaters

tended to move their female nurses

rapidly into forward areas, though not

during actual combat. The tradition

established in the South Pacific Area

continued through the reorganizations

of 1944. The Army garrison force on

Saipan received its first Army Nurse

Corps officers in August, shortly after

the island had been declared secure.

Here, like many of their patients, some

60 percent fell ill during the dengue

outbreak that followed the conquest. As

usual, they performed creditably under

difficult conditions. Throughout the

year the tendency was for nurses to

move toward the front, which created at

least a potential problem for the Oahu

hospitals. Understaffed, they drew nurses from hospital units staging and training in the Hawaiian Islands; as the units

moved on, the nurses accompanied

them, to be replaced by others newly

arrived from the mainland. But as the

center of gravity for the Central Pacific

Area shifted westward, the CPBC director of nursing—who served on the

USAFPOA chief surgeon’s staff in the

same capacity as an added duty—anticipated shortages and hoped for rotation

back to Oahu of nurses who had worked

twenty-eight months or longer in forward areas.59

Medical consultants were preoccupied with the qualifications of personnel from the standpoint of improving

the quality of medical service in the

Pacific. Active and energetic was Col.

Ashley W. Oughterson, MC, a Yale clinical professor who served as surgical consultant on the USAFISPA and then

USAFPOA chief surgeon’s staff; he visited every medical unit in the command

and established “broad policies and . . .

guiding principles” for combat surgery,

embodying his view of the war in a diary

that was both caustic and compassionate. The psychiatric consultant, Lt. Col.

M. Ralph Kaufman, MC, established

schools of military neuropsychiatry in

areas were divisions were undergoing

rehabilitation or were being readied for

combat. The Central Pacific Area

lacked a dental consultant, although

Col. Harry M. Deiber, DC, the CPBC

dental surgeon, functioned in essentially that role. Like the chief nurse, Deiber

also served on the USAFPOA chief surgeon’s staff as an extra duty. His main

task was the difficult administrative one

of shuffling a consistently understrength group of officers to provide

support to an increasingly scattered

command.60

Despite many difficulties the mood of

the medics in the Pacific theaters was

upbeat as the winter campaigns of

1944–45 moved closer. Against most bitter resistance the fighting forces had

58CSurg, USAFPOA, Annual Rpt, 1944, pp. 7–8, file

319.1–2, HUMEDS, RG 112, NARA.

59Ibid., p. 10, file 319.1–2, HUMEDS, RG 112, NARA.

60Ibid., pp. 11–12 (quotation, p. 11), file 319.1–2,

HUMEDS, RG 112, NARA. Selections from

Oughterson’s diary have been published in his chapter,

“From Auckland to Tokyo,” in Carter, ed., Surgical

Consultants, 2:767–887.

284 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
achieved major triumphs, and combat

and support forces alike had matured

into veterans. The problems of the medical service were mainly those of success,

and so comparatively easy to bear. The

long confusion over authority in the

Southwest Pacific Area had been

brought to an end; the course of combat

had reduced the South Pacific to a communications zone and Hawaii, once

threatened by the enemy, to a base in

the distant rear of operations. 

With great difficulty, the problems of

fighting in the environment of diseaseridden jungled islands had been met if

not mastered. Now combat loomed on

large islands with heavy populations, as

well as on small dots of rock and coral

that a desperate enemy would defend to

the death—a prospect that promised to

summon every reserve of skill and

courage in a medical service that had

learned the art of saving lives in the

midst of war.

GROWTH OF THE MEDICAL SYSTEM 285
While the Allies struggled against the

Japanese on the islands of the Pacific,

their forces also fought in the Burmese

jungles to reopen land access to the

embattled Republic of China. In Burma,

in mountainous lands remote from

Allied bases, medical personnel confronted jungle warfare and in China the

disease environment of an ancient civilization still living in the sanitary equivalent of the Middle Ages. 

Seven months before Pearl Harbor

the United States began to aid Chinese

leader Generalissimo Chiang Kai-shek

with lend-lease supplies and technical

advice. The American Military Mission

to China, an advisory group, was dispatched to the provisional capital of

Chungking. The supplies followed a tortuous course through the Burmese port

of Rangoon, ultimately arriving in

unconquered southern China via the

Burma Road. Two junior medical officers accompanied the mission, but

direct support to those who moved the

supplies was the province of an

American medical missionary, Gordon

S. Seagrave, whose hospital at Namhkam

was close both to the Burma Road and

to the Chinese border. 

A surgeon of limited ability but wide

experience, with a hard-driving, impatient personality, Seagrave began to

treat the coolie roadbuilders and the

drivers of the lend-lease trucks that

careened down the precipitous muddy

track. Finding that the drivers carried

venereal disease, while the coolies were

scourged by malaria, he set up a system

to provide care at small nurse-operated

hospitals. He visited these medical outposts regularly in an ambulance to dispense medicines, check the progress of

patients, and carry serious cases back to

Namhkam for fuller treatment.1

Pearl Harbor intensified America’s

involvement. During the second week of

December the United States and China

became cobelligerents. After the

Combined Chiefs of Staff created a

China theater of operations, a U.S.

Army task force, headed by Maj. Gen.

(later Lt. Gen.) Joseph W. Stilwell, was

dispatched to China. In February 1942

Stilwell, traveling with an advance party,

1

Gordon S. Seagrave, Burma Surgeon (New York: W.

W. Norton and Co., 1943), pp. 115–18, 134; Charles F.

Romanus and Riley Sunderland, Stilwell’s Mission to

China, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1953), pp. 13–17,

27–29; Robert G. Smith, “History of the Attempt of the

United States Army Medical Department To Improve

the Efficiency of the Chinese Army Medical Service,

1941–1945,” 1:1–4, file 314.7, Historical Unit Medical

Detachment (HUMEDS), Record Group (RG) 112,

National Archives and Records Administration

(NARA), Washington, D.C.

CHAPTER IX

The China-Burma-India Challenge
flew to Chungking, where on 4 March

he established the command called the

United States Army Forces, China,

Burma and India (USAFCBI). At the

suggestion of Chiang Kai-shek, the

Supreme Commander, Stilwell became

his chief of staff and commanding general of the Chinese forces in Burma.

Stilwell’s staff surgeon was Col. Robert P.

Williams, MC, a tough practical-minded

Regular Army officer who would later

wear one star.

Meanwhile, in December 1941 the

Japanese had invaded Burma and in a

few months’ time cut China’s last land

link to the Western Allies. As a desperation measure, American pilots began to

fly the “Hump,” taking supplies from

British bases in India across the

Himalayas to China. Stilwell’s original

mission to equip, train, and advise the

Chinese forces was followed by another—to reopen a land route from India

to China. The Army’s medical mission

developed in this context. Medical personnel would support the campaigns in

the jungled mountains of northern

Burma while attempting to improve the

medical service of the Chinese Army. As

a result, the Medical Department would

come to know the Chinese military perhaps more intimately than any other

branch of the U.S. Army, for American

surgeons and hospitals would go into

combat with Chinese units that lacked

medical support of their own.

Medics would also, to their sorrow,

come to know the China-Burma-India

(CBI) theater, established on 6 July 1942.

Larger than the continental United

States, the theater was marked by

extremes of climate and terrain. Modern

sanitation was unknown, and almost

every tropical disease flourished there.

With the theater at the bottom of the War

Department’s priority list, supplies were

often inadequate, and their distribution

was impeded by antiquated transport systems and pervasive graft, speculation,

and theft. In time, partial answers would

be found for many of the daunting problems of preventive medicine that the CBI

presented. But the struggle would not be

an easy one, and the victory once

attained would be little appreciated by a

world intently watching the decisive battles in the Pacific Ocean and in Europe.2

2

Romanus and Sunderland, Mission to China, pp.

50–80, 193; James H. Stone, “United States Army

Medical Service in Combat in India and Burma,

1942–1945,” 1:1–2, 18, Ms 8–6.2 AG, files of U.S. Army

Center of Military History (CMH), Washington, D.C.;

Smith, “Chinese Army Medical Service,” 1:4–7, 17, file

314.7, HUMEDS, RG 112, NARA.

THE CHINA-BURMA-INDIA CHALLENGE 287

BRIG. GEN. ROBERT P. WILLIAMS, MC

(Rank as of 27 May 1949)
The Burma Campaign

On 6 March 1942 the Burmese capital

of Rangoon fell to the Japanese, despite

the efforts of two British Indian

brigades. The British units and a swarm

of hapless refugees retreated northward

from the burning city, along the

roadbed of the all-important railroad

that connected Rangoon, via Mandalay,

to the northern terminus of Myitkyina

and the eastern terminus of Lashio. In

turn, Lashio was the point of origin of

the Burma Road. The Chinese offered

assistance to the crumbling Allied cause.

Two of Chiang Kai-shek’s field armies

entered Burma, and the Allies established a new defensive line at Toungoo,

north of Rangoon. 

Seeking to rally the retreating forces,

Stilwell set up his own headquarters at

Maymyo, in the hill country near

Mandalay. Colonel Williams arrived at

Lashio on 19 March. He found that the

Chinese Army medical service, supposedly well supplied with manpower at all

levels, from battalion to army headquarters, was in fact a mere skeleton. The

100,000 Chinese soldiers, spread over

some 3,000 square miles of Burmese

jungle and rice fields, were supported by

only five graduate doctors and nine

ambulance trucks. Chinese medics were

hopelessly ill trained and poorly

equipped. Supplies, including 150 tons

of Red Cross material, were scattered

among Calcutta, Lashio, and Karachi.

Additional Chinese and American medical units were said to be on the way, but

the time of their arrival was unknown.3

Some help was available. The British

were already providing medical aid to

China, including several Burmese units,

supplies, volunteer medics of the

Friends Ambulance Unit, and some

beds in local hospitals. Additionally, the

British asked Seagrave to support the

Chinese 6th Army, and organized his

people as a civilian mobile surgical hospital. On learning of Stilwell’s arrival, he

volunteered to serve under Colonel

Williams, and on 21 April was sworn into

the U.S. Army as a major in the Medical

Corps. At Seagrave’s request, Williams

divided the hospital unit, providing support to both the Chinese 5th and 6th

Armies. Other medical officers arrived

to help Seagrave. Capt. Donald M.

O’Hara, DC, a dentist, came directly

from the States and Capt. John H.

Grindlay, MC, a skilled surgeon with a

background at Harvard and the Mayo

Clinic, from the American Military

Mission to China.

Such aid was welcome but insufficient, as hard fighting on the Toungoo

front demonstrated. On 10 April

Seagrave recorded a daily round that

featured hideous wounds, determined

good spirits, and unrelenting work with

inadequate means:

I found that Grindlay and O’Hara had been

scrubbing out the operating room themselves with cresol. Grindlay found pieces of

amputated fingers and toes in the plaster of

Paris and wound refuse on the floor! No

sooner had we finished lunch than the

Friends brought in another thirty-five

patients. One of them had his enlarged

spleen shattered by a shell fragment. Insects

were so numerous that they kept dropping

into the wounds of the abdominal cases.4

Repeatedly bested by the Japanese,

the Allies retreated toward the north.

3

Stone, “Medical Service in India and Burma,” 1:2–3,

7–8, 15, Ms 8–6.2 AG, CMH.

4

Ibid., 1:5–6, 17, Ms 8–6.2 AG, CMH; Seagrave,

Burma Surgeon, pp. 139–41, 151–52, 160–62, 172–73

(quotation). The plaster of Paris was used to make

casts.

288 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Colonel Williams was forced to improvise an evacuation system, using a few

hospital trains from the British and a

hospital ship, the Assam, that plied the

Irrawaddy River. For a time in March he

even had air evacuation—ten C–47s. His

first requests were for American field

units—a medical regiment, three field

hospitals, and three medical battalions.

He wanted to provide small mobile units

as spot support to the Chinese Army

and, through the medical battalions,

hoped to organize the chaotic evacuation system as well.5

But when the Japanese crossed the

Irrawaddy River in April, the Allied

forces withdrew in great confusion,

swamping the inadequate means of

moving wounded. Undoing much work,

the fragile medical system buckled

under the strain. Patients who could

walk took to the roads unhealed, while

others were abandoned to die untended. Cholera, smallpox, and dysentery

broke out among the refugees, civilian

and military. Exhaustion, hunger, and

enemy bombs and gunfire joined with

disease to mark the trails leading into

the mountains with abandoned carts,

bundles of once-prized possessions, and

human bones, sometimes in great mass5

Stone, “Medical Service in India and Burma,”

1:8–13, 16, Ms 8–6.2 AG, CMH.

THE CHINA-BURMA-INDIA CHALLENGE 289

DR. GORDON S. SEAGRAVE (left) AND CAPT. JOHN H. GRINDLAY and Burmese nurse scrubbing

for surgery
es, where whole encampments perished

together.6

For a time Colonel Williams personally delivered supplies to Seagrave’s hospital section. Then on 18 April the final

collapse began, and within ten days the

front had ceased to exist. The British

and the Chinese 5th Army retreated

toward India, the 6th toward China.

Joining the flight of General Stilwell’s

headquarters toward Imphal, Williams

served as the headquarters detachment

medical officer throughout an epic

march. Despite stress and danger, the

headquarters detachment was well supplied with medical support, for

Seagrave’s section made up almost 40

percent of the group—doctors, members of the Friends Ambulance Unit,

Burmese nurses, and servants. 

All had their work cut out for them.

Seagrave took daily sick calls, until felled

by illness himself. When the motorized

vehicles—jeeps, sedans, and trucks—had

to be abandoned, most of the party

marched afoot; the sick rode ponies. For

part of the journey they rafted down a

jungle river, the Uyu, where monkeys

screamed in the trees and tiger spoor

showed on the sandbars. Food and medical supplies arrived by parachute drops

into clearings, or through the canopy of

dense jungle foliage. The Burmese nurses, tireless walkers despite their fragile

appearance, cheerfully nicknamed

Stilwell “Granddaddy” and Williams

“Second daddy,” and maintained the

pace better than many of the Americans.7

Complaints were futile, for no one

could fall behind and live. On one occasion Stilwell observed Seagrave wrapped

in a blanket and shaking with a malaria

chill. He stopped and asked:

“What’s the matter, Seagrave, got fever?”

“No, sir, I got wet and felt a little cold so

was warming up.”

“How are your feet?”

“Better, sir.”

“You are lying.”

“Yes, sir.”

The hard-used party ended the trek by

climbing the steep forested ridges of the

Chin and Naga Hills. When Williams

protested that some could not keep up,

Stilwell replied, “Dammit, Williams, you

and I can stand it. We’re both older than

any of them. Why can’t they take it?” In

the end they did. With medical aid at

hand and Stilwell to drive them, they

reached Imphal without a single loss.8

Here the leaders reviewed the wreckage of a failed campaign. Thousands of

Chinese soldiers had perished during

the retreat, and the condition of the

Indian refugees was pitiable. The British

command attempted to put the best

face possible upon the disaster, but

Stilwell refused to mask facts. “I claim we

got a hell of a licking,” declared Vinegar

Joe. “We got run out of Burma, and it’s

humiliating as hell.”9

Attempting to bring order out of the

chaos, Colonel Williams reunited the

6

Ibid., 1:16–19, Ms 8–6.2 AG, CMH.

7

Seagrave, Burma Surgeon, pp. 177–81 (quotations, p.

180), 207–19.

8

Ibid., pp. 220–35 (first quotation, p. 221).

Commenting on Williams, who was fifty-five at the time,

Seagrave noted on p. 208: “He is ten years older than I

am, but he can walk circles around me.” Second quotation as cited in Barbara W. Tuchman, Stilwell and the

American Experience in China, 1911–1945 (New York:

Macmillan Co., 1970), p. 296. 9

Quotations as cited in Eric Larrabee, Commander in

Chief: Franklin Delano Roosevelt, His Lieutenants, and Their

War (New York: Harper and Row, 1987), p. 537. See also

Romanus and Sunderland, Mission to China, pp. 138–48;

Jack Belden, Retreat With Stilwell (New York: Alfred A.

Knopf, 1943), pp. 259–368; Joseph W. Stilwell, Stilwell

Papers, arr. and ed. Theodore H. White (New York:

William Sloane Associates, 1948), pp. 95–106.

290 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Seagrave hospital and ordered it to

India’s Assam Province to aid the British

in caring for the refugees, mostly laborers who had worked in Burma or served

the British administration there. In light

of the crisis just endured, he now knew

that before an effective reconquest of

Burma could begin, the Chinese Army

medical service must be completely

reorganized and retrained. The defeat

had left both Williams, who would

become Chief Surgeon, USAFCBI, in

July, and Stilwell free of illusions about

the job that faced them in the theater.

They had learned positive lessons as

well; they knew the terrain from walking

it and the people who had been their

companions in misfortune.10

Preparing To Counterpunch

Substantial numbers of American air

and service forces arrived in the CBI

during the months that followed the fall

of Rangoon. Their missions were to

expand and protect air communication

with China; to begin constructing the

Ledo Road, which was to replace the

Japanese-held section of the Burma

Road; and to reorganize, train, and supply the Chinese armies for the reconquest of Burma.

General Stilwell established a rear-echelon headquarters at New Delhi in July

and kept an advance echelon in

Chungking—the latter an ugly bomb-battered provincial town that was crowded

by refugees and the wartime government

of China. At the end of 1942 Stilwell

ordered Colonel Williams to the forward

headquarters, assigning him the task of

guiding medical training and care for the

Chinese forces in China. At Chungking

the chief surgeon set up his office on the

rocky palisades that overhung the confluence of the Yangtze and the Chia-ling

Rivers. For the Chinese troops in India, a

vacated prisoner-of-war camp at Ramgarh

became a training ground; the Seagrave

hospital, the remnants of the Chinese

field medical units, and the 98th Station

Hospital, a small unit of fifty beds, provided support. Here Chinese medical

personnel heard lectures and received

technical training as they performed

hands-on work among the patients.11

Meanwhile, the American military

structure that was to support and assist

the Chinese took form, with its own medical system. Col. John M. Tamraz, MC,

became surgeon of the United States

Army Services of Supply (USASOS) and

Col. Hervey B. Porter, MC, the surgeon

of the Tenth Air Force (one of the two

tactical air commands in the theater). Lt.

Col. Thomas C. Gentry, MC, served as

surgeon of Brig. Gen. Claire L.

Chennault’s American Volunteer Group

(Flying Tigers), a force of volunteer

pilots that predated America’s entry into

the war and was later absorbed by the

theater air forces.

In New Delhi Colonel Tamraz concentrated on the problems of medical

supply and hospitalization, support for

the Ledo Road construction crews, and

the care of air force service personnel in

India. As in the Pacific theaters, his sub10Stone, “Medical Service in India and Burma,”

1:19–21, Ms 8–6.2 AG, CMH; Seagrave, Burma Surgeon,

pp. 240–41.

11Stone, “Medical Service in India and Burma,” 1:27,

39, 69–72, Ms 8–6.2 AG, CMH; Blanche B. Armfield,

Organization and Administration in World War II, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 508–09, 514. See

also Romanus and Sunderland, Mission to China, pp.

192–221.

THE CHINA-BURMA-INDIA CHALLENGE 291
ordinates were dispersed in order to support similarly fragmented small garrison

and service units in the Indian port

cities, along the line of communications,

and among the Assam airfields. With

bed strength keyed to U.S. forces, the

hospitals were obliged to support the

Chinese as well—a built-in deficit that

the War Department, in response to theater protests, corrected too late to provide adequately for the bitter fighting of

1943–44.12

Like Williams a long-service Regular

Army officer, Tamraz apparently proved

less able than the theater surgeon to

adapt to his new responsibilities.

According to his historical officer, Lt.

James H. Stone, he displayed a preoccupation with routine, a fixed attention to

niggling detail, and a suspicion of his

superiors that did little to improve an

inherently difficult situation. The two

headquarters echelons were 2,100 miles

apart—enough to ensure that the

USASOS surgeon would act with considerable independence and also in substantial isolation both from Williams

and from the front. Stone recorded that

“on a quiet day the disappearance of a

routine memorandum could provoke

[Colonel Tamraz] as much as a telegram

reporting that a supply ship had been

sunk. The arrival of a Regular Army

friend from peacetime days was as

notable as the opening of a new supply

depot in Calcutta.” Tamraz traveled

much, but seemed to draw from his

inspection trips chiefly enjoyment of his

status as a USASOS celebrity, returning

unenlightened about the problems of

his subordinates.13

The CBI’s medical difficulties were

varied, and began with basics: the disease environment of India and the

effects of jungle warfare. In 1943 the

theater counted among its 75,000

American soldiers over 8,000 admissions

for malaria, almost 7,000 for alimentary

disorders, about 2,600 for venereal disease, and 1,150 for dengue. Though

malaria control units arrived in the early

part of the year, control could not be sat- 12Stone, “Medical Service in India and Burma,”

1:27–61, Ms 8–6.2 AG, CMH; Armfield, Organization

and Administration, pp. 509, 512, 514. On the American

Volunteer Group, see Russell Whelan, The Flying Tigers:

The Story of the American Volunteer Group (New York:

Viking Press, 1943). Other doctors, nurses, and technicians associated with the group are listed in the appendixes to Whelan’s volume.

13James H. Stone, comp. and ed., Crisis Fleeting:

Original Reports on Military Medicine in India and Burma

in the Second World War (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1969), pp.

135–39 (quotation, p. 137).

292 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

COL. JOHN M. TAMRAZ, MC
isfactorily established over vast areas, in

part heavily populated by an infected

people and in part covered with almost

impenetrable jungle. DDT did not

become available until the end of 1944,

about a year after theaters with a higher

priority status for supplies; Atabrine was

available only in the combat zone, forward of Ledo, and was viewed with suspicion by Williams until he became convinced of its effectiveness in 1944. A rigorous full-scale anti-malaria campaign

was not undertaken until late 1944,

when it had become evident that the

1943 rate of 183 per 1,000 troops per

year had been reduced to only 166 by

previous efforts.14

Psychiatric problems were common

in the theater, for the unfamiliar and

often hostile environment demanded

radical adjustments from the Americans

who served there. But the theater had

only four psychiatrists at the end of 1943

and twenty-one at the end of the war,

serving by then almost 200,000 troops.

Because all the psychiatrists worked at

general hospitals, stress reactions in forward units received treatment so late

and so far from the front lines as to be

useless. In short, preventive psychiatry

did not exist during the time when it was

most needed. A psychiatric consultant

did not arrive in New Delhi until

January 1945, and endeavored to

14Herrman L. Blumgart and George M. Pike,

“History of Internal Medicine in India-Burma Theater,”

p. 35, file 314.7–2, HUMEDS, RG 112, NARA; Armfield,

Organization and Administration, pp. 533–34; John W. H.

Rehn, “China-Burma-India Theater,” in Ebbe Curtis

Hoff, ed., Communicable Diseases: Malaria, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 347–98. 

THE CHINA-BURMA-INDIA CHALLENGE 293

ANTI-MALARIA EFFORTS IN INDIA’S ASSAM PROVINCE
upgrade service and provide care farther forward. The lack of statistics, however, makes any assessment of his success

or failure impossible.15

In 1944 the number of cases of diarrheal diseases was serious enough to

impair efficiency, probably three times

the officially recorded 16,562 cases.

Even the recorded cases served to give

the CBI the highest rate for all theaters

in World War II. The rate peaked at 326

per 1,000 troops per annum in July, and

did not decline significantly until the

following year (Chart 6). Such ills were

pervasive in India and seemingly unconquerable, given the climate, crowding,

local mores, and native food-handlers.

The burden on the Veterinary Corps

officers who inspected the Army’s food

and supervised slaughterhouses was a

heavy one. Immunizations successfully

kept the serious diseases of cholera,

typhoid, and typhus from endangering

American troops, and a rigorous antiVD program, inaugurated by Williams at

the end of 1942 and aided late in the

war by the introduction of penicillin

treatment, ultimately reduced the level

of infection to the lowest for any theater

of operations. Nevertheless, both medical and command leadership in the CBI

were generally sluggish in guarding the

health of the Army there. As the Army’s

official history of the theater concludes,

“Preventive medicine did not come into

its own in [the CBI] until the winter of

1944–45.”16

The major responsibility of the

USASOS headquarters was to construct

a new land route to China—the Ledo

Road—from India’s Assam Province

through the northern Burma jungles to

a junction with the old Burma Road.

Work began in March 1943 and ended

triumphantly in January 1945, when the

first truck convoy set out for China. To

achieve this remarkable feat of engineering—building a roadway through

jungle and mountains in the midst of

war and in the face of an active enemy—

required the labor of thousands of

Americans and tens of thousands of

Chinese and Indians. 

Battalion and regimental medical

detachments provided first-echelon care.

Colonel Tamraz established a complex of

fixed hospitals and battalion aid stations

in the Ledo base area. Operating the aid

stations was the responsibility of the 151st

Medical Battalion. Spaced a hard day’s

march apart, the stations were small,

each containing a few enlisted medics

and sometimes a doctor who worked for

a time and then moved on. Living in

bashas (bamboo huts), the medics

endured heat, rain, insects, and boredom, compensated in part by the natural

setting of green mountains and the distant snow-capped Himalayas. How much

pleasure the homesick and the lonely

15Donald B. Peterson, “China-Burma-India Theater,”

in Albert J. Glass, ed., Overseas Theaters, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1973), pp. 830–31; John R.

Mays, “History of Neuropsychiatry in the India-Burma

Theater in World War II,” pp. 2–5, 12–14, 17, file

314.7–2, HUMEDS, RG 112, NARA. Mays, apologizing

for the lack of meaningful statistics, indicates that a statistical section organized in the theater surgeon’s office

began to function satisfactorily only in June 1945.

16Frank R. Philbrook and John E. Gordon, “Diarrhea

and Dysentery,” in Ebbe Curtis Hoff, ed., Communicable

Diseases Transmitted Chiefly Through Respiratory and

Alimentary Tracts, Medical Department, United States

Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1958), pp.

376–78; Charles F. Romanus and Riley Sunderland,

Stilwell’s Command Problems, United States Army in

World War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1956), pp.

287–88 (quotation).

294 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
derived from their surroundings is 

another matter. Probably most would

have agreed with Sgt. Robert W.

Fromant’s sentiments, written on the

evening of 13 August 1943: “The sun was

out most of the day and tonite [sic] the

moon is beautiful. Oh for home, a car &

freedom.”17

Medical support for the Army Air

Forces meant providing fixed hospitalization for the crews and ground personnel

of the Tenth Air Force, as well as supplies

for the dispensaries maintained by air

force personnel at bases in India. On 10

March 1943 the theater activated the

Fourteenth Air Force in China under

Chennault, who was promoted to major

general on the fourteenth. Here too

Chennault sought to establish a dispensary at every base, and in October the

USASOS surgeon established the 95th

Station Hospital at Kunming. Meanwhile,

in August the theater command Army

Air Forces, India-Burma Sector—comprehending the Tenth Air Force, the Air

Service Command, and the Air Forces

Training Command—was established at

New Delhi, with its medical section successively headed by Colonel Porter, in

October by Col. William F. DeWitt, MC,

and in May 1944 by Col. Clyde L.

17Fromant’s log in Stone, comp. and ed., Crisis

Fleeting, pp. 32–34 (quotation).

THE CHINA-BURMA-INDIA CHALLENGE 295

50

100

150

200

250

300

350

DecNovOctSepAugJulJunMayAprMarFebJan

1944

1943

1945

Ratea

a

Reflects the number of new admissions plus secondary diagnosis cases per annum per 1,000 troops.

Source: Adapted from Herrman L. Blumgart and George M. Pike, “India-Burma Theater of Operations,” in W. Paul Havens, Jr.,

ed., Activities of Medical Consultants, Medical Department, United States Army in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1961), p. 712.

CHART 6—DIARRHEA AND DYSENTERY INCIDENCE IN U.S. ARMY FORCES, CBI, 1943–1945
Brothers, MC, a former Tenth Air Force

surgeon. The air surgeon’s staff was minimal, and various air organizations,

including the Air Transport Command’s

India-China Wing and the XX Bomber

Command, set up in 1944 to initiate the

strategic bombing of Japan from bases in

mainland Asia, were outside of his commander’s authority. These organizations

dealt directly with the air surgeon in

Washington and the theater surgeon in

Chungking.

So fractured a system seemed unlikely to offer harmony among the many air

surgeons, the theater surgeon, and the

USASOS surgeon. If anything, the multiplication of theater headquarters loosened central authority. Instead of a twosided conflict between the Army Air

Forces and the theater, the result

appears to have been free-form competition among the various air surgeons

for medical materiel and hospital space,

both of which were in short supply.

Relationships with the USASOS headquarters were defined by a variety of

makeshift agreements. Only in the fall

of 1944, when the offices of theater surgeon and USASOS surgeon were consolidated and increased numbers of hospitals received, did friction diminish

and more centralized control bring

greater orderliness to the support of the

theater’s airmen.18

Medical supply was poorly handled by

the theater, though the complications

that underlay the problem were not of its

making. Supplies for American troops

arrived from the United States in the

familiar form of medical maintenance

units. American-sponsored Chinese

troops in China received lend-lease supplies from the United States through the

China Defense Supply Program, established by Congress; Chinese troops in

India were supplied by the British under

lend-lease agreements, which the United

States managed on behalf of China.

Secondary suppliers included the

Chinese Army Medical Administration

and China’s National Health

Administration and National Red Cross

Society. Nongovernmental aid came

from the United States via the American

Red Cross, the Bureau of National Aid to

China, and the United China Relief.

Colonel Williams had some success coordinating his multiple sources, to a great

extent through personal contacts with

their representatives, but less in maintaining liaison with his own subordinate

commands. 

In December 1942, while Colonel

Tamraz was away on an inspection tour,

the chief surgeon transferred the

USASOS supply officer from New Delhi

to Kunming. When Tamraz returned, he

appointed his dental officer to the

vacant slot. Inexperienced and lacking

supervision from the USASOS surgeon,

the new supply officer performed poorly, allowing critical stocks to dwindle

without requisitioning replacements,

probably through misunderstanding of

a War Department order that terminated the automatic system in September

1943. The following month Tamraz

relieved him and requested a supply

expert from the United States, who,

18Surg, 14th Air Force, Annual Rpt (copy), 1943, pp.

1–3, file 319.1–2; Surg, 10th Air Force, Annual Rpts

(copies), 1943, p. 1, and 1944, p. 1, file 319.1–2; James

H. Stone, “The Hospitalization and Evacuation of Sick

and Wounded in the Communications Zone, ChinaBurma-India and India-Burma Theaters, 1942–1946,”

pp. 156–59, file 314.7–2; Surg, China Air Svc Cmd,

Annual Rpt (copy), 1944, pp. 1–2, file 319.1–2. All in

HUMEDS, RG 112, NARA. See also Mae Mills Link and

Hubert A. Coleman, Medical Support of the Army Air Forces

in World War II (Washington, D.C.: Office of the

Surgeon General, USAF, 1955), pp. 876, 902–07;

Armfield, Organization and Administration, p. 525.

296 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
arriving in December, found inventories

far below authorized levels. But distance

and time—two of the theater’s most persistent enemies—prevented him from

restoring safe levels until mid-1944.19

Such mismanagement was especially

unfortunate because of the theater’s

many built-in problems, including its

geographical remoteness and its position

at the bottom of the War Department’s

priority list. Because gasoline and ammunition took precedence, medical supplies

failed to reach China in sufficient quantities; in January 1944 the supply depot at

Kunming complained that it had

received none since November 1943.

The Allies were also a problem. The

British filled only 25 percent of their

obligations to the Chinese armies, compelling the diversion of American supplies to their use. The Chinese consumed

medical supplies at a rate of 228 percent

of the expected norm, and by December

1943 they had exhausted even stocks of

some common items like iodine. In 1944

failure to fill air force requisitions led to

complaints to the air surgeon in

Washington. He turned to the surgeon

general, who dispatched Colonel

Voorhees, his troubleshooter, in June to

inquire into the problem. 

Colonel Voorhees in turn catalogued

a list of failings that included unqualified people in key positions, an unsatisfactory requisitioning system, failures in

depot operations, lack of centralized

authority, and absence of any clear definition of responsibilities. Voorhees also

proposed solutions that, in combination

with the overhauling of the theater command itself, resulted in marked

improvements during 1944.20

While the supply system expanded in

space and declined in quality, the job of

reconquering Burma languished.

Lacking troops, time, and Allied agreement on objectives, Stilwell put aside his

first plans for a counteroffensive in

1942. In the spring of the following year,

however, the Allies agreed to invade

Burma in the fall, clear the Japanese

from northern Burma, construct the

Ledo Road, and eliminate Japanese air

bases in order to protect and shorten

the air route to China. The American

and British air forces would undertake a

supporting campaign to win control of

the skies. Meanwhile, at the Ramgarh

training center Stilwell organized three

Chinese divisions into the so-called XForce; at the same time, twenty-seven

divisions were organized at Kunming

and designated the Y-Force.

Williams, then still in India, conceived of somewhat grandiose plans,

whereby medical support for the XForce would be via an elaborate system

modeled on a contemporary U.S. Army

corps. When these failed to materialize,

a new plan was devised in 1943, tailored

to the theater’s deficient resources.

Tamraz’ USASOS headquarters would

continue to support the road-building

operations slated to proceed concurrently with the fighting, and would also

provide for evacuation and fixed hospitalization. Combat forces would meet 19James H. Stone, “Organization and Development

of Medical Supply in India and Burma, 1942–1946,” pp.

1–3, 39–41, 56–60, file 314.7–2; Memo (copy), Col

Tracy S. Voorhees et al. to CG, USAF, CBI, 25 Jul 44,

sub: Medical Supply in CBI, p. 1, in Medical Supply,

CBI, Extracts, file 333. Both in HUMEDS, RG 112,

NARA. See also Romanus and Sunderland, Mission to

China, pp. 13–14, 26.

20Stone, “Medical Supply in India and Burma,” pp.

106–33, file 314.7–2; Memo (copy), Voorhees et al. to

CG, USAF, CBI, 25 Jul 44, p. 2, in Medical Supply, CBI,

Extracts, file 333. Both in HUMEDS, RG 112, NARA.

THE CHINA-BURMA-INDIA CHALLENGE 297
first- and second-echelon medical

needs, with Chinese units reinforced by

U.S. Army medics to handle complex

surgery. Later, as the reconquest

advanced deep into Burma, mobile hospitals requisitioned from the United

States would support the fighting forces,

and the USASOS fixed hospitals would

become a fourth echelon.

However, the lack of personnel and

units ensured that medical support

would be both unconventional and

sparse. Fixed hospitals included not

only two general hospitals but also three

evacuation hospitals. Attempts to use

evacuation hospitals in the customary

manner, as mobile units, failed because

tentage was lacking, construction in the

war zone was difficult, and casualties

were too many. Williams sought field

hospitals to support the fighting forces,

but of the twenty-five he requisitioned

he received only five during 1943.

Judging the Southwest Pacific Area’s

portable surgical hospitals appropriate

for the primitive jungled regions of

northern Burma, he requested eighteen

but received six, and those only after the

campaign had been under way for

months. Even when the portables

moved to the front, they had an abundance of pediatricians, general practitioners, and obstetricians, but a minimum of trained surgeons. 

So many improvisations and so much

hope and guesswork went into medical

planning that a knowledgeable officer

wrote that the medical service “resembled a suit of clothes worn by a stepchild

in an old fairytale,” a patchwork made

from the leftovers of theaters that were

richer and better endowed.21

With such resources, the Americans

sought to support an ally that lacked

almost everything. As Williams and

Tamraz both discovered, reforming the

Chinese Army medical service was a disheartening job. The problem began

with leadership and supply. Pay was

abysmal and racketeering pervaded the

officer corps. The ration was wholly

inadequate, and vitamin and protein

deficiencies were common. Disease ran

rampant: In one Chinese division in

India a survey found that 90 percent of

the personnel suffered from deficiency

diseases, half from chronic dysentery,

and a quarter from malaria. Peasant

conscripts were profoundly ignorant of

sanitation and their army made no

effort to enlighten them.

Medical personnel held low status in

the military hierarchy; a line officer who

failed to do his duty might be given a

stethoscope and made a doctor. Life was

cheap in the Chinese forces, at least

partly because manpower was abundant

in China while almost everything else an

army needed was scarce. Any soldier

who appeared moribund was simply

abandoned to die, his rifle—more valuable than the soldier himself—given to

another. Not surprisingly, a Chinese

army on the march left “a wake of

exhausted and sick and dying soldiers

behind.”22

Those who reached treatment centers

were only a little better off. In hospitals

Chinese patients threw uneaten food

under their beds, spit where they

pleased, and urinated just outside the

door. Their preventive medicine consisted of devices for warding off demons—

21Stone, “Medical Service in India and Burma,”

1:39–54, 62 (quotation), Ms 8–6.2 AG, CMH. 

22Smith, “Chinese Army Medical Service,” 1:11–20

(quotation, p. 19), file 314.7, HUMEDS, RG 112,

NARA.

298 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
for example, pinning a piece of paper

money to their sleeves in the belief that

evil spirits did not disturb the wealthy.

Exploitation by their own leaders sometimes extended beyond death. One division commander received $15 (Chinese)

for each coffin that had to be built; after

paying off the commander and the hospital superintendent, $2 remained to

buy a dead soldier’s coffin—and the

more who died, the greater the profit.

One shocked American medical liaison

officer summed up what he saw: “The

Chinese Division Medical Service was

appalling. There wasn’t any.”23

Complicating a difficult situation was

the fact that China possessed an elaborate premodern theory of medicine, as

intricate as the humoral theory that had

prevailed for thousands of years in the

West and as deeply embedded in the culture. With time at a premium, Williams

could hardly hope to educate Chinese

personnel wholesale in Western medicine, dentistry, and veterinary science.

Instead, using as a model the courses

given by the Medical Field Service School

at Carlisle Barracks, Pennsylvania, the

Americans sought to produce a practical

system of field medicine, where line personnel as well as medics could be given a

rudimentary understanding of evacuation, first aid, and preventive medicine.

Williams hoped to form medical detachments for all infantry and artillery units

in the X-Force, and a field hospital company for each division. 

Crowning the system of training was a

fairly elaborate six-month professional

course at Ramgarh for junior medical

officers, providing a new medical corps

of doctors who were given four months

of intensive classroom work and two

months of internship. Similar centers

were later established for Y-Force troops

at Kunming and later, when Z-Force was

created, at Kweilin. All had dental sections—an attempt to supply a need for

which the Chinese Army made no provision at all. Veterinary medicine, which

was essential for an army that depended

on animal transport but provided its

beasts of burden little or no care, was

also taught at Ramgarh.24

The work of American and—increasingly, as time went on—of Chinese

instructors constituted a major achievement by the theater command and its

chief surgeon. If the Chinese were to

bear the brunt of the fighting, the

Americans had to enable them, as far as

possible, to fight a modern war on equal

terms. The training mission was not subsidiary but fundamental; the medical

side of it provided elementary but crucial knowledge in a theater where pervasive disease made ignorance tantamount

to self-destruction. To effectively help

others to help themselves was often a

thankless and demanding job, requiring

tact and understanding of cultural differences in a society where saving face

was paramount.25

As the time for the planned attack

drew close, the X-Force gathering at

Ledo was the better prepared in medical

terms, though most of its field units were

either en route to the theater or unready

for combat. The Seagrave hospital, however, was ready to provide support; the

USASOS base hospitals had opened and

the 151st Medical Battalion was ready to

take charge of evacuation; and adequate

23Ibid.

24Stone, “Medical Service in India and Burma,”

1:66–84, Ms 8–6.2 AG, CMH. 25Stone, comp. and ed., Crisis Fleeting, pp. 74–75,

82–83.

THE CHINA-BURMA-INDIA CHALLENGE 299
supplies were on hand. In the Y-Force,

on the other hand, medical units included only two field hospitals, whose platoons could support no more than six of

the twenty-seven divisions. Nevertheless,

need for a coordinated attack—the YForce was to clear the Japanese from

Salween River valley that runs south

from China into Burma—demanded

that the troops move anyway, with the

hope that any new personnel reaching

India could be flown across the Hump in

time to join the fighting troops in the

field. Perhaps significantly, the military

plan for the forthcoming battle in northern Burma was code-named STEPCHILD.

26

Northern Burma

For reasons of his own, Chiang Kaishek held the Y-Force immobile until

May 1944 and the battle for Burma was

fought by the X-Force and by British,

Indian, and West African troops under

England’s Lt. Gen. William J. Slim. The

fight was two-sided. While the Allies

attacked in the north, the Japanese

attacked in the south and in the center,

against Imphal. Their entanglement in

India enabled Stilwell to amass a great

advantage in men and air power and

made his victory possible. From beginning to end, Allied control of the air was

decisive, for without it neither supply nor

evacuation would have been possible.27

The struggle that was to drive the

Japanese from northern Burma began

in October 1943, when the Chinese 38th

Division’s 3d Battalion, 112th Regiment,

providing security for the Ledo Road

construction, collided with Japanese

troops just beyond the town of

Shingbwiyang. Surprised by the enemy,

the Chinese bogged down, taking heavy

losses. The Seagrave hospital split into

three sections and gave basic support to

three Chinese battalions, which quickly

became isolated from one another. 

A period of several months’ stalemate

followed, marked by frustration among

the American leadership and by heavy

patrol action in the jungle. Medics

learned to practice their art under jungle conditions. Lacking orthopedic

equipment, they devised fracture tables

of bamboo and parachute ropes to suspend casualties in traction while the

doctors worked. A camp stove, a bamboo frame, and a tarpaulin formed a

hutch for warming the wounded who

were chilled or in shock. Evacuation

from one Seagrave unit to Shingbwiyang

involved a litter carry of no less than 25

miles, and the Americans viewed with

amazement the Chinese litter-bearers

who could cover the distance at a jog

trot, pausing only twice for rest.28

Provisional surgical teams drawn from

USASOS hospitals reinforced Seagrave,

learning much of frontline service in the

process. One such team of two officers

and twelve enlisted men departed the

comparative comfort of the 73d

Evacuation Hospital at Ledo on 20

October, rode by truck to Shingbwiyang,

and then hiked forward over a steep slippery trail that was soaked by frequent

rains and marked by the skeletons of

refugees who had perished in 1942.

Aided by Nepalese porters and protected

26Stone, “Medical Service in India and Burma,”

1:60–61, Ms 8–6.2 AG, CMH. 27Ibid, 1:97–98, Ms 8–6.2 AG, CMH; Field Marshal

Viscount William J. Slim, Defeat Into Victory (New York:

David McKay Co., 1961), pp. 214–44. On operations in

northern Burma, see Romanus and Sunderland,

Command Problems, pp. 129–293.

28Stone, “Medical Service in India and Burma,”

1:101–02, 105–07, Ms 8–6.2 AG, CMH.

300 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
by Chinese soldiers, the trekkers, after a

journey of three weeks, reached

Seagrave’s surgery at Wang Ga. Then

they moved forward again, finding the

Chinese 3d Battalion, 112th Regiment,

at last dug into a defensive position at

Ngajatzup, from which its officers

refused to budge. 

Here the only Medical Department

casualty, T. Sgt. 4 Ronald M. Brown, was

killed in an ambush. The Chinese abandoned his body, along with several of

their own wounded, despite the plea of

an American medical liaison officer that

he be allowed to kill the helpless men

painlessly with lethal doses of morphine.

Then for three months the remaining

members of the team worked in a

dugout within the battalion perimeter,

on a wooded hilltop surrounded by a

defensive system of trenches, booby

traps, and sharpened stakes. 

Medical supplies as usual were airdropped. Parachutes were turned into

sheets, blankets, towels, and lining for

the dirt walls of the medical dugout.

Gasoline cans of boiling water served as

sterilizers, and flashlights illuminated

nighttime operations. The medics dissolved dry plasma in distilled but unsterile water, and made no attempt to sterilize dressings or surgical drapes. Yet casualties, despite febrile reactions to the

plasma, survived; most wounds healed

without infection, though two abdominal

cases died. Basic medicine and antiseptic

surgery, aided by doses of oral sulfathiazole, enabled the Chinese to survive a

lengthy siege in a jungle environment. In

January 1944 a Chinese regiment of the

22d Division broke through, and the

team members returned to well-merited

decorations for their service under fire.29

The advance resumed as the Chinese,

under Stilwell’s direct leadership, began

to move down a chain of valleys, at

whose southern end lay the town of

Mogaung, which was on the railroad

line connecting Mandalay with

Myitkyina. The commander now had in

the field some 50,000 Chinese in two

well-trained and competently led divisions, while a third continued to train at

Ramgarh. A British deep-penetration

force, the famous Chindits under Maj.

Gen. Orde C. Wingate, operated behind

enemy lines. The invaders had valuable

allies in Shan and Kachin tribesmen,

who loathed the Burmese and supported the Allies.

Stilwell also had an American unit of

3,000 troops, under Brig. Gen. Frank D.

Merrill. The 5307th Composite Unit

(Provisional), code-named GALAHAD,

was a volunteer regiment soon to gain

renown as Merrill’s Marauders.

Operating on the left flank of the

Chinese, the Marauders struck at the

Japanese rear. They traversed jungle

trails that plunged into deep valleys and

climbed precipitous slopes, carrying

their supplies on mules and horses and

replenishing by airdrops.30

American medical units that had

arrived in the theater during late 1943

supported the Chinese—the 25th Field

Hospital; the 42d, 43d, and 46th Portable

Surgical Hospitals; the 13th Medical

Battalion; and the 803d Medical Air

Evacuation Transport Squadron. The

portables, long awaited, proved a key to

the creation of a functional field medical

system under Burmese conditions. As on

the islands of the Pacific, they assumed

29Ibid., 1:104–05, 107, 109–12, Ms 8–6.2 AG, CMH.

30Ibid., 1:127–28, 145, Ms 8–6.2 AG, CMH; idem,

comp. and ed., Crisis Fleeting, p. 294; Romanus and

Sunderland, Command Problems, pp. 129–31, 196.

THE CHINA-BURMA-INDIA CHALLENGE 301
many roles besides that of rendering

frontline surgery. They functioned at

times as collecting stations, as clearing

stations, as holding units at jungle

airstrips, and as medical supply points.

The USASOS headquarters by late 1943

probably disposed of over 10,000 beds

deployed from Karachi to Ledo, including expansion beds. The main forward

concentration at Ledo—the 20th

General Hospital and the 14th, 48th(-),

and 73d Evacuation Hospitals—had

3,250 authorized beds (see Map 11).

Linking the fixed hospitals to the front

was the 151st Medical Battalion.31

But the system did not reach all who

needed it. Because evacuation followed

the main axis of the advance, units on

the extreme left and right had great difficulty in sending out their casualties.

GALAHAD, during its deepest jungle

marches in the late winter and early

spring of 1944, lacked any medical service at all except that of its own battalion

detachments. And Chinese forces on

the right flank fared only a little better.

A surgical team accompanying the

Chinese 22d Division’s 1st Battalion,

65th Regiment, marched through deep

jungle, over 3,000-foot ridges, drawing

its supplies from occasional airdrops,

which were seldom sufficient. On one

occasion, when resupply failed for three

weeks, surgeons were reduced to borrowing knives and saws from the native

Kachins. Indeed, the Kachins made success and even survival possible; they provided food, shelter, guides, and litterbearers, and without them the

American medics on the far right flank

would have been “absolutely helpless.”32

As the Chinese began to advance, a

pattern of treatment and evacuation

quickly emerged. Casualties passed

through the hands of Chinese battalion

and regimental detachments to

American surgical teams and then, often

via Seagrave detachments, to the 25th

Field Hospital. They were moved by litter,

or by litter jeep when roads were available, to forward airstrips, where a holding unit—called an air clearing station—

cared for them until evacuated to

Shingbwiyang or, for the most serious

cases, to Ledo. Seagrave’s evacuation policy was about ten days; that of the field

hospital, six weeks.33

As the Chinese gained confidence

under Stilwell’s aggressive leadership,

their performance in the field improved

markedly, as they pressed the Japanese

down the Hukawng and Mogaung

Valleys. Anvil to the Chinese hammer,

the Marauders fought four battles, at

Walawbum, Shaduzup, Inkangahtawng,

and Nhpum Ga. Hard fighting, combined with months of marching through

steamy leech-ridden jungle and over

towering ridges, brought them close to

exhaustion.

Medicine and Marauders

Although the fate of the Ledo Road

rested on the Chinese armies, the

adventures of the Merrill’s Marauders

formed the American epic of the

Central Burma Campaign. In their long

trek to Myitkyina all of the pressures of 31Stone, “Medical Service in India and Burma,”

1:122, 133–34, 144, Ms 8–6.2 AG, CMH; Romanus and

Sunderland, Command Problems, pp. 142, 285. The 151st

Medical Battalion had been trained for desert; the 13th

Medical Battalion, for the Arctic. The latter unit was

redesignated 13th Mountain Medical Battalion on 7

November 1944.

32Stone, “Medical Service in India and Burma,”

1:131, 144–45 (quotation), Ms 8–6.2 AG, CMH. 33Ibid., 1:141–44, Ms 8–6.2 AG, CMH.

302 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
THE CHINA-BURMA-INDIA CHALLENGE 303

jungle war beset the regiment—exhaustion, disease, the invisibility of the

enemy. As a Marauder who became the

unit’s eloquent historian wrote, “It

would not be enough to say that . . . [the

march] was the worst experience I have

ever been through. It was so incomparably the worst that at the time I could

hardly believe in the rest of my life at

all.”34

A volunteer outfit of mixed and dubious antecedents, the Marauders to their

own misfortune were the only American

force under Stilwell’s command—

indeed, the only American land combat

force between North Africa and New

Guinea. From the beginning they were a

hard-luck crew, nursing real and imagined grievances and cultivating the air of

desperation and rascality that caused

journalists to award them their sobriquet. 

Formed as a result of transient enthusiasm for deep-penetration forces

engendered by Wingate, the regiment

was divided into three battalions and

each battalion into two combat teams.

The Marauders were to depend upon

air supply and evacuation, on the model

of Wingate’s Chindits; artillery support

was lacking. Even when they arrived in

India in late 1943, the soldiers, many

drawn from other tropical theaters, had

a malaria rate of 4,084 per 1,000 per

year; only Atabrine discipline enabled

them to fight. Yet they were not without

experience. Their training under

Merrill was rigorous, and when Stilwell

first saw them at the Burmese town of

Shingbwiyang on 21 February 1944, he

34Charlton Ogburn, Jr., The Marauders (New York:

Harper and Brothers, 1959), p. 5.

EVACUATING CHINESE CASUALTIES ON A C–47
INDIA

TIBET

NEPAL

CEYLON

Indian Ocean

Bay of Beng

New Delhi

Agra

Calcutta

Bombay

Karachi

Gaya

Ramgarh

181st General Hospital

Provisional Hospital

100th Station Hospital

97th Station Hospital

Advance Medical Depot 1

99th Station Hospital

48th Station Hospital (-) 112th 

MAP 11

ILLUS

MA

LIV
BUR MA ROAD LEDO ROAD BURMA

BHUTAN

THAILAND

FRENCH

INDOCHINA

CHINA

a l

Andaman Sea

Gulf of Thailand

Rangoon

Ledo

Imphal

Mandalay

Kunming Kueilin

Chabua

Lashio

Myitkyina

CBI FIXED HOSPITALS AND DEPOTS

December 1943

Scale 1:18,600,000

Note: Evacuation hospitals used as fixed facilities.

 Station Hospital

Advance Medical Depot 2

111th Station Hospital

14th Evacuation Hospital

48th Evacuation Hospital (-)

73d Evacuation Hospital

20th General Hospital

Advance Medical Depot 3

95th Station Hospital Advance Medical Depot 4

Provisional Hospital

S 93A

P 11

VE
viewed them with approval: “Tough

looking lot of babies.”35

Medical support appeared adequate.

Under regimental surgeon Maj. Melvin

A. Schudmak, MC, the medics shared the

hardships of the Marauders, enduring

constant rain, eating their own animals

when airdrops failed to materialize, and

suffering skin diseases, malaria, dysentery

(one outbreak cost battalion members an

average weight loss of 25 pounds, per

man), and scrub typhus. Clearly inadequate to the Marauders’ needs were the

chlorine purification tablets that formed

their only means of combatting polluted

water. No means of preventing scrub

typhus could be provided them, for no

vaccine existed. Compounding their suffering was a sense of heartless misuse and

indifference by Stilwell, whom they felt

ought to have understood as a commander in a theater that was neglected by

Washington.

Rapid motion preserved the

Marauders from some diseases—they left

their own wastes behind, though they

may have infected one another with

malaria—but the effects of exhaustion

multiplied throughout their march of

700 miles. Marked by symptoms of dizziness, lack of muscle tone, anorexia, and

nausea, the attrition of the trail was inexorable despite adequate salt and vitamin

intake. Merrill himself eventually went

down with a heart attack. Atabrine discipline slipped as morale deteriorated and

exhaustion increased; perhaps some

Marauders saw malaria as the only ticket

out of the jungle.

Clashes with the enemy left the medics

many wounded to care for, while the

nature of deep penetration ensured that

no regular chain of evacuation could be

maintained. On occasion, the lightly

armed special operations force was obliged to fight as line infantry. Early in April

a Japanese attempt at counter-envelopment trapped the 2d Battalion for ten

days on a barren hilltop near Nphum Ga;

artillery fire hammered the defenders,

who could not reply in kind. Medical and

sanitary problems were acute, as always

during a siege. Water was scarce and polluted by feces, dead animals, and human

corpses; the stink of decay hung over the

perimeter and a plague of flies beset its

defenders. When relief arrived, casualties

had to cross 6 miles of mountain trail by

foot, litter, or horseback to a rest camp at

Hsamshingyang, where casualties, some

of whom had been wounded ten to

twelve days before, slept on the ground

or in parachute tents. By then dysentery

was rampant, and impossible to control

with sulfaguanidine or paregoric.36

Throughout the march medical treatment was elementary and evacuation

prolonged. Battalion medical detachments moved with the Marauder

columns; cared for the sick; collected

the wounded and gave first aid; and,

during fights, set up aid stations. When

the march resumed, casualties walked if

they could, rode pack animals, or were

carried in litters until they recovered or

3613th Mountain Med Bn Annual Rpt (copy), 1944,

pp. 9–10, file 319.1–2; 896th Clearing Co [Seagrave hospital] Annual Rpt (copy), 1944, pp. 3–5, file 319.1–2;

Rpt Extracts on Activities of U.S. Army Medical

Department Units Assigned to Northern Combat Area

Command During the Northern and Central Burma

Campaigns, “Hospitalization,” p. 2, Historians files. All

in HUMEDS, RG 112, NARA. See also Stone, “Medical

Service in India and China,” 1:150, Ms 8–6.2 AG, CMH;

idem, comp. and ed., Crisis Fleeting, pp. 305–21. It

should be noted that Stilwell used the Chindits with

similar ruthlessness and similar effects.

306 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

35Stone, “Medical Service in India and Burma,”

1:119–21, Ms 8–6.2 AG, CMH; idem, comp. and ed.,

Crisis Fleeting, p. 295 (quotation).
until air evacuation came to the rescue.

Stabilizing emergency surgery was provided briefly by a small surgical team of

the 13th Medical Battalion and, on the

final leg of the march to Myitkyina, by a

Seagrave hospital team. Lack of consistent surgical support was probably

responsible for the fact that more

Marauders than Chinese had wound

infections when they were hospitalized.

Wingate’s forces included several

experimental helicopters, and the first

American medical evacuation by rotarywing craft was carried out in April by Lt.

Carter Harman, a pilot of 1st Air

Commando that supported the Chindits.

However, all air evacuation of Marauder

casualties apparently was left to light

planes that landed in jungle clearings or

on the sandbars of jungle rivers. Singleengined L–1s and L–5s shuttled them to

landing fields, where they were transferred to two-engine C–47 ambulance

planes of the 803d Medical Air

Evacuation Transport Squadron. At each

stop the air clearing stations cared for

those in transit; local troops might staff

them, or the 13th Medical Battalion, or,

farther to the rear, the 151st Medical

Battalion. At each station a medical officer and a handful of enlisted men—

nursing orderlies, drivers, litter-bearers,

laborers—provided minimum shelter in

a ward tent and elementary supportive

care. At the end of the long and tortuous

route out of combat were the wards of

the 20th General Hospital or the 73d

Evacuation Hospital at Ledo.37

Attrition along the trail was compounded when the weary Marauders

were ordered to cross still another range

of mountains, descend into the valley of

the Irrawaddy, and lay siege to

Myitkyina. Though their depleted numbers—now reduced to about 1,300—

were strengthened with Chinese units,

the siege destroyed the 5307th as an

effective force. 

The reason was not a lack of medical

support, which was more adequate than

on the long campaign down the

Hukawng and Mogaung Valleys and on

the hard march to Myitkyina. On the

march the old problems continued—

exhaustion, limited medical care, and

near-impossible evacuation. But the

Marauders of the 1st and 3d Battalions,

which had Chinese units attached, benefited from the latter’s American surgical support. When the Allies closed in

on Myitkyina and the Chinese seized the

airfield, the closeness of the forces and

the availability of air evacuation and supply both meant better days for the

Marauders. Seagrave’s medics, though

concentrating on the Chinese, served all

the injured, working under the fierce

midsummer sun of the tropics or under

torrential rains that marked the onset of

the monsoon.

Thus on 19 May Seagrave’s surgeons

laid litters across packing boxes under

“the scorching sun and squalls of rain.”

During downpours his Burmese nurses

held open umbrellas over the casualties

and the attending surgeons. A company

of Chinese litter-bearers bravely scoured

the field for the wounded. The next day

hospital personnel draped parachutes

over bamboo poles to form impromptu

operating pavilions. The rain continued,

impeding air evacuation and aggravating

shock in the wounded, who were cold

and wet. The 42d Portable Surgical

Hospital also took American casualties;

THE CHINA-BURMA-INDIA CHALLENGE 307

37Stone, comp. and ed., Crisis Fleeting, pp. 323–25;

Peter Dorland and James Nanney, Dust Off: Army

Aeromedical Evacuation in Vietnam (Washington, D.C.:

U.S. Army Center of Military History, 1982), p. 9.
SEAGRAVE HOSPITAL FIELD AND CAMP AREAS IN MYITKYINA
on the twenty-fourth a surgical team from

the 25th Field Hospital arrived, and on

10 June the 58th Portable Surgical

Hospital pitched its tents. As the ring

around Myitkyina drew tighter, Seagrave

found himself treating American, Indian,

British, and Kachin wounded, as well as

Japanese prisoners of war. Allowing for

the circumstances, care was able; the

progress of the Chinese in giving first aid

marked a radical improvement in their

medical system. Seagrave lost only 3.8

percent of the 4,000 Chinese casualties

who passed through his unit, a figure that

compared favorably with American hospitals treating their own troops in the

Pacific and Europe.38

Evacuation was a mixed bag, with

some scenes drawn from the twentieth

century and others reminiscent of the

Civil War. On the battlefield the wounded made agonized journeys to the hospitals over rutted roads in jeeps or in jolting

springless oxcarts; many arrived in shock.

But evacuation from Myitkyina was

incomparably easier than on the jungle

march, even though the first ambulance

plane, landing on 18 May, was hit by

enemy fire and the flight surgeon, flight

nurse, and two technicians were wounded. The fact that supply depended entirely upon cargo planes meant that space

for returning wounded was always available, even if the dedicated ambulance

planes were full. Almost 4,000 casualties—Chinese, American, and British—

were flown out of northern Burma during May alone, and for the three months

from mid-May to early August three-quarters were said to be evacuees from

Myitkyina. In consequence, a delay of

four to five days between wounding and

reaching hospitals at Ledo that had

apparently typified the campaign was

reduced to one to two days. 

But as the siege progressed, serious

conflicts developed between medical

and line officers over evacuations.

Colonel Williams, as chief surgeon,

warned that medical officers were evacuating casualties whose only problem was

exhaustion and that line officers, seeking to keep every man they could, sometimes removed tags from those marked

for evacuation and ordered them back to

duty. A basic reason for the conflict was

the condition of the Marauders. For

them, by the end of May “the terms ‘sick’

and ‘well’ were meaningless.” Fifteen to

thirty a day were reporting to sick call

with scrub typhus, while dysentery was

ubiquitous. Of GALAHAD’s 2d Battalion,

once 564 strong, 12 were left in action

on the thirtieth. By the following day all

but 13 enlisted men and 1 officer of the

3d battalion had been tagged for evacuation. Several hundred survivors of the 1st

Battalion struggled on into June. As the

3d Battalion surgeon reported, “I have

never seen so many physically unfit men

gathered in one unit.”39

Stilwell found 2,600 American

replacements, throwing service troops

and technicians into the battle. “These

green soldiers,” wrote his political adviser, “were flown into Myitkyina during

the monsoon rains and stepped off the

transports into a nightmare.” They were

called NEW GALAHAD; OLD GALAHAD was

dying—“just shot,” said Stilwell. Of its

original 3,000, the regiment had suffered about 2,400 casualties in the

THE CHINA-BURMA-INDIA CHALLENGE 309

38896th Clearing Co [Seagrave hospital] Annual Rpt

(copy), 1944, p. 7, file 319.1–2, HUMEDS, RG 112,

NARA; Stone, comp. and ed., Crisis Fleeting, pp. 346–47

(quotation, p. 346).

39Stone, comp. and ed., Crisis Fleeting, pp. 349–55

(first quotation, p. 354; second quotation, p. 365).
course of the Central Burma Campaign,

nearly 2,000 of whom were victims of

disease (Table 4). At the end of a May

only about 600 of the original force

remained. The last survivors of OLD

GALAHAD were evacuated by 4 June.40

Even when the ill and wounded were

back in Ledo, the demands of the interminable siege pursued them. The fixed

hospitals were overwhelmed, and a convalescent facility, long needed, had only

begun to take patients when the casualties from Myitkyina flooded in. The period of the monsoon and the climactic

battles passed amid a “kaleidoscopic

scene of mud, shortages, malaria, overtaxed equipment, rain, disappointments, heat, language difficulties, shifting priorities, jungle fighting, plans discarded, landslides, and homesickness.”41

The strain on the system was extraordinary. The theater counted only 8,800

authorized hospital beds, yet in June

1944 12,530 were in use, 7,130 by

Americans and 5,400 by Chinese. Tamraz

attempted to meet the situation by reducing rear-area facilities and creating new

hospitals or expanding old ones at

Ramgarh and elsewhere to absorb the

influx from the fighting lines. But while

the medical service demanded beds,

Stilwell’s headquarters pressed for the

immediate return to the front of all soldiers capable of fighting. For both reasons, U.S. troops newly released but in

need of rest and recuperation instead

were marked for duty and flung into the

replacement system. Soon they found

themselves back in Myitkyina—a new

item for the Marauders’ endless list of

grievances against the theater commander and the world in general.42

As the siege went on, and throughout

the campaign, the Allies were fortunate

in the failures of the Japanese medical

service. Enemy soldiers suffered from

the same diseases, but the incidence was

higher. Malaria was all but universal,

and supplies of quinine were very low in

40Quotations from Louis Allen, Burma: The Longest

War, 1941–1945 (New York: St. Martin’s Press, 1984), p.

368. See also Stone, “Medical Service in India and

Burma,” 1:192, 194, Ms 8–6.2 AG, CMH. 41Stone, “Medical Service in India and Burma,”

2:254, Ms 8–6.2 AG, CMH.

42Romanus and Sunderland, Command Problems, p.

286. 

310 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

TABLE 4—5307TH COMPOSITE UNIT (PROVISIONAL) CASUALTY PROFILE, 4 JUNE 1945

Battle Casualties Nonbattle Casualties

Killed in Action 93 Deaths 30

Wounded in Actiona 293 Amebic dysentery 503

Missing in Action 8 Scrub typhus 149

Malaria 296

Psychoneurosis 72

Miscellaneousb 950

Total 394 Total 2,000

a

The figure for wounded in action, which does not account for the lightly wounded who were treated on the line of march and

retained with the unit, and the figures for diseases represent the number of cases that were evacuated. Total official casualties

equaled 80 percent of the force. bMostly fevers of unknown origin.

Source: Adapted from Stone, “Medical Service in India and Burma,” 1:194, Ms 8–6.2 AG, CMH.
northern Burma. Sanitation was poor,

never more so than in besieged

Myitkyina, and diarrhea and dysentery

were common. And, unlike the Allies,

Japanese soldiers suffered from malnutrition, with all its attendant ills.43

Myitkyina fell at last on 3 August, after

a siege of seventy-eight days. The

Marauders’ story was over. Sickness and

exhaustion, not enemy weapons, had

destroyed OLD GALAHAD. Accounts by veterans praised most of their doctors,

though the regimental surgeon may have

been an exception. The real difficulties

lay elsewhere. The starved resources of a

neglected theater formed a great part of

the story, as did the attrition of jungle

warfare. Fighting in the CBI differed

markedly from the Pacific. Except for

guerrilla forces, Allied troops on the

islands did not attempt to survive and

fight for long periods deep behind

enemy lines, and after 1942 the sea

became their highway for resupply and

reinforcement. Air supply, the only equivalent in the towering forested mountains,

provided no equivalent support. 

But climate, terrain, theater priorities, and deep penetration alone did not

explain the ruin of the unit. The

Marauders were called upon to act as

the symbol of American will in a theater

where the Chinese and British predominated, neither with any strong inclination to the combat in northern Burma

that Stilwell’s mission demanded.

Hence, the commander was constrained, for political reasons, to keep

his one American unit fighting beyond

the limits of its strength. As the

Marauders’ historian rightfully suggested, the familiar tag on the sick that read

“FUO, meaning Fever of Unknown

Origin, . . . might as well have read AOE,

or Accumulation of Everything.”44

The Central Burma Campaign

The new troops who filled the

Marauders’ ranks were reorganized into

the 2d and 3d Battalions of the 475th

Infantry, while the 1st Battalion was

formed in India from GALAHAD veterans

as they were released from hospitals. The

regiment was joined by the newly arrived

124th Cavalry. Together, these became

the American combat units of the 5332d

Brigade (Provisional), or MARS Task

Force, which was supported by three

portable surgical hospitals and the 18th

Veterinary Evacuation Hospital. The

Seagrave hospital, though formally activated in October 1944 as the 896th

Clearing Company, retained its large

civilian complement to help its uniformed personnel provide for the

Chinese divisions. 

While the American forces were reorganized and the monsoon blew itself out,

Stilwell prepared for autumn operations.

Initially, the Central Burma Campaign,

from the American and Chinese standpoints, served to screen the roadwork by

pushing back the Japanese; to the British,

it aided the reconquest of their Burmese

colony and secured their northern flank.

Early Allied goals rapidly expanded in

response to early successes.

In mid-October the British 36th

Division advanced, strengthened with

Chinese elements that were supported by

the American 45th and 60th Portable

Surgical Hospitals and by elements of the

43Rpt, Mil Intel Div, WDGS, 28 Dec 44, sub: The

Japanese Medical Record in Burma, 28 Dec 44, file

350.09, HUMEDS, RG 112, NARA. 44Ogburn, Marauders, p. 232.

THE CHINA-BURMA-INDIA CHALLENGE 311
13th Medical Battalion. The main

Chinese forces moved out with support

from three other portables, Seagrave’s

896th Clearing Company, and the

remainder of the medical battalion. For

the time being, the new American

brigade, with its three portables,

remained at Myitkyina to complete its

training. By this time conditions along

the chain of evacuation had greatly

improved. Disease incidence declined

with the onset of the dry season. Beds

emptied as battle casualties returned to

duty, and fixed hospitals, newly arrived in

the theater, began work. No less important, air evacuation was now a “going concern,” with a medical air evacuation

squadron, established air clearing stations, and a force of light liaison planes.

Medically as well as militarily, this would

be an entirely different campaign.45

Improved mobility on the ground was

another plus. During operations in

northern Burma, the capture of

Mogaung had reconnected the Allies

with the railway corridor that ran from

Rangoon to Mandalay, Myitkyina, and

Lashio. During the last phases of the

Mogaung Valley offensive, American

planes had dropped jeeps that were fitted

with flanged wheels to evacuate casualties

on the tracks, and occasional use of these

devices had aided evacuation there and at

Myitkyina. Rail evacuation became standard in the Central Burma Campaign,

and a major supplement to the air evacuation that still dominated the theater. 

Cooperation between the British and

American medical services also grew

steadily. Even in northern Burma

American aircraft had evacuated many

British casualties. Now ambulances of the

13th Medical Battalion moved British

wounded to the battalion’s clearing station or to portable surgical hospitals. The

151st Medical Battalion operated an air

clearing station for British and Chinese

casualties at Sahmaw, where C–47s shuttled to and from airfields in India. And

Indian units established a chain of air

clearing stations, where the wounded

waited at impromptu airstrips, some in

dry rice paddies, to be evacuated by

American aircraft. 

Supplies, too, arrived by air, and a hospital supporting the Chinese at Shwegu

underwent a “bombardment” of packages of rice and horse-feed, dropped by

supply planes unable to land in the

rough country through which the

Chinese 22d Division marched to the

Irrawaddy. The importance of air evacuation reflected, as usual, the harsh countryside of dense wet jungle and mountain ridges through which the Allies

advanced. On the ground the portables

again proved themselves indispensable,

keeping up with the troops and working

in the most varied locations: in a field of

smashed gliders, where the British had

made a deep penetration landing; in

jungle clearings; in buildings perilously

close to the front lines, where bullets riddled the walls; and in ancient temples.46

Medics found plenty of work, for the

Japanese fought sharp delaying battles.

Yet their campaign featured planned

withdrawals before forces they could no

longer hope to best in the field. The

Chinese invested the strategic and heavily defended town of Bhamo, on the east

bank of the Irrawaddy, and hard fight46Ibid., 2:281–88 (quoted word), Ms 8–6.2 AG, CMH.

See also Annual Rpts (copies), 1944, for 13th Mountain

Med Bn, pp. 2–3, 10; 44th Port Surg Hosp, pp. 2–3;

45th Port Surg Hosp, pp. 1–2; and 58th Port Surg Hosp,

p. 2. All file 319.1–2, HUMEDS, RG 112, NARA. 

45Stone, “Medical Service in India and China,”

2:275–81 (quoted words, p. 277), Ms 8–6.2 AG, CMH.

312 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
ing developed in December 1944 along

the Bhamo–Namhkam road and at

Namhkam, where Americans of the

5332d Brigade battled for control the

ridges overlooking the Burma Road.

Bhamo fell in December, and Namhkam

in January 1945, bringing Seagrave back

to the site of his original mission hospital. The attacking forces now began to

meet forward elements of the Y-Force,

which had belatedly moved against

Japanese forces in south China. 

The result was to open both the Ledo

Road, renamed Stilwell Road in

February, and portions of the old Burma

Road running north from Lashio. On 27

January a truck convoy assembled at

Myitkyina and rolled across the Chinese

border a few days later. Seagrave’s surgical teams continued to work, in effect as

a mobile evacuation hospital, when the

Chinese and the MARS Task Force

moved against Lashio. In turn, Lashio

fell in March. With British forces

advancing in the south, a general collapse of Japanese power in Burma was

under way.47

Yet the reconquest proceeded without one of the commanders most

responsible for its success. A crisis in

command—rooted in longstanding conflicts between Chiang Kai-shek and his

American chief of staff—had resulted in

Stilwell’s recall late in October 1944 and

the abolition of the CBI. By President

Roosevelt’s decision, the oversized and

undersupported theater was divided in

October into two: India-Burma, of

which Williams became both chief surgeon and USASOS surgeon; and China,

where Col. George E. Armstrong, MC,

formerly Williams’ deputy, assumed

both hats.48

In May 1945 the British forces under

General Slim recaptured Rangoon and

effectively brought the Burma campaign

to an end. Medically, the struggle in central Burma had been far less taxing than

that in northern Burma. The portable

surgical hospitals worked close to the

line regiments; available beds in the

896th Clearing Company and the 25th

and 44th Field Hospitals allowed the

lightly wounded to be held in the for48Charles F. Romanus and Riley Sunderland, Time

Runs Out in CBI, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1959), pp. 8–15;

Armfield, Organization and Administration, pp. 542, 546.

Armstrong later became surgeon general of the Army,

serving from 1951 to 1955.

47896th Clearing Co [Seagrave hospital] Annual Rpts

(copies), 1944, pp. 8–9, and 1945, pp. 1–3, file 319.1–2,

HUMEDS, RG 112, NARA.

THE CHINA-BURMA-INDIA CHALLENGE 313

COL. GEORGE E. ARMSTRONG, MC
ward zone. Air evacuation cleared serious cases even in the absence of a medical battalion to manage evacuation

from the 5332d Brigade, and the fixed

hospitals faced no such overload as in

the earlier campaign. Though the environment remained hostile, the numbers

of sick never became so overwhelming,

in part because a malaria control organization now existed, at least in the

5332d Brigade. Nor did the tactical situation, in a winning battle marked by few

retreats and no enemy envelopments,

preclude evacuation and replacement.49

In brief, a time of improvisation and

crisis had given way to one of experience and sure-handed competence.

Between the fall of Myitkyina and that of

Rangoon, however, a critical situation

developed in China that demanded an

American response.

The Chinese Puzzle

Problems had marked the American

experience in wartime China from the

early years of the war. In January 1943

Stilwell established the Chinese

Training and Combat Command at

Chungking, and Williams took on the

responsibility of developing medical

support for the twenty-seven divisions of

Y-Force, which was intended to operate

in extreme southern China and northeast Burma. In January 1944, when the

Z-Force was set up to train and ready

thirty additional divisions at Kweilin for

service against the Japanese in southeast China, he assumed responsibilities

here also. 

Both Y- and Z-Forces, however, were

under Chinese rather than American

command. Williams’ freedom of action

was correspondingly limited, and supplies, because of the armies’ remoteness

from the Indian bases, were even more

difficult to obtain than in Burma. But

his greatest problem was to impress

upon the Chinese Army the importance

of maintaining the health of soldiers

and upon civilian authorities the importance of maintaining the health of the

local populace in those areas where the

armies concentrated.50

Although Stilwell established a number of training centers in southern

China, the prototype for teaching the

Chinese the rudiments of military medicine opened in April 1943 at the

Kunming training center. Manned by

American personnel, the medical school,

despite poverty and language barriers,

provided both clinical and tactical

instruction to hundreds of Chinese medical officers and enlisted men during its

bare seven months of existence. Few

instructional aids existed; few could be

obtained from India, in view of priorities

for flights over the Hump. Manikins and

charts found in temples had to be

pressed into use for illustrating lectures

on physiology, anatomy, and first aid.

Similar training was conducted at the Tali

Medical School, and the two institutions

graduated about 1,000 students in all.51

American instructors traveled from

one Chinese unit to another, to spread

their teaching to soldiers in the field,

and Americans went on campaigns serv49Stone, “Medical Service in India and China,”

2:330–31, 385–88, Ms 8–6.2 AG, CMH. DDT was introduced into the theater in 1944, but apparently was not

widely used until 1945. The vast area and dense jungle

canopy made aerial spraying ineffective.

50Smith, “Chinese Army Medical Service,” 1:42–43,

file 314.7; Surg, Chinese Tng and Combat Cmd,

Annual Rpt (copy), 1944, pp. 2–5, 13–14, file 319.1–2.

Both in HUMEDS, RG 112, NARA. 51Smith, “Chinese Army Medical Service,” 1:47–56,

file 314.7, HUMEDS, RG 112, NARA.

314 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
ing as unit advisers on medicine and

health. Williams attempted to detail at

least one doctor, one enlisted medic,

and one veterinary enlisted man to each

Chinese division and army. To them fell

the difficult task of improving, through

diplomacy and tact, the medical and

sanitary practices of a civilization far

more ancient and deeply rooted than

their own. Those who were wise enabled

the I Kuan (medical officer) to gain face

with his commander through quiet

instruction and open support; those

who were not wise merely aroused

resentment by their overbearing ways.52

Evacuation had to be organized as

well. Collecting posts, division dressing

stations, and division and army field hospitals were few in number, inadequately

equipped, and thinly staffed. One solution was to assign American field and

portable surgical hospitals, and by mid1944 Williams had been able to provide

three of the former and ten of the latter

to the Chinese Army. The portables

gained the respect of the troops by

working far forward, not only saving

lives but also enhancing morale among

soldiers who now saw (possibly for the

first time) evidence both of a commitment and an ability to save their lives if

they were wounded.53

In April the long-delayed fight to

reopen the Chinese portion of the

Burma Road began as Chiang’s forces

crossed the Salween River. Chinese and

American medical units were highly integrated. Some portable surgical hospitals

were split in two, to provide two surgical

teams and double the number of Chinese

divisions they could support. Chinese collecting companies brought casualties to

the portables, which often evacuated in

turn to Chinese field hospitals. 

Service with Y-Force in the southern

China battlefields was brutal and picturesque. Five portables and 140 pack

animals crossed the Salween on a suspension bridge and then climbed rain-slick

trails into a range of hills that rose to

11,000 feet beyond. Some pack animals

fell into the valleys, and bulls had to be

rented and turned into beasts of burden.

Weary Americans, exhausted by climbing, heat, and wet, slept in grass huts or

within the walls of ancient temples. Here

too, in a temple yard, the 32d Portable

Surgical Hospital set up on the night of 6

September as the battle for Tengchung, a

strategic walled city, raged around it.

Casualties were heavy, and American

medics were short of plasma. Those in

shock seldom survived; all cases of combined chest and abdominal wounds died

without exception. Candles illuminated

the operating room, and continuous rain

prevented resupply by air.54

Three field hospitals working on the

Salween front divided into separate platoons, each of which supported a

Chinese hospital and received its most

serious cases. Litter hauls by hard-working coolies were incredibly long, one

being recorded of 85 miles; American

surgeons by stabilizing severe cases

saved an untold number of them who

had to make the long journey to the

rear. By the end of 1944 American hospitals had admitted close to 20,000

Chinese, more than 13,000 of them battle casualties. Almost 5 percent died in 52Ibid., 1:57–58, file 314.7, HUMEDS, RG 112,

NARA. 53CSurg, USFCT, Annual Rpt (copy), 1944, pp. 4–6;

CSurg, USAFIBT, Annual Rpt (copy), 1944, pp. 4–5.

Both file 319.1–2, HUMEDS, RG 112, NARA.

5432d Port Surg Hosp Annual Rpt (copy), 1944, pp.

3–8; 34th Port Surg Hosp Annual Rpt (copy), 1944, pp.

2–4. Both file 319.1–2, HUMEDS, RG 112, NARA.

THE CHINA-BURMA-INDIA CHALLENGE 315
the hospital, as compared to 3.8 percent during the siege of Myitkyina, a

reflection of many factors, including an

even more difficult supply situation

and the long litter hauls from the

front.55

While the Chinese made progress on

the southern front, the Z-Force trained

at Kweilin for an anticipated offensive

against the Japanese on China’s southeast coast. Under the leadership of

Colonel Armstrong a medical school

had opened at Kweilin on 1 November

1943, drawing its American faculty from

the X- and Y-Forces. Because of inadequate equipment and supplies, the faculty, as before, had to improvise. But the

history of X- and Y-Forces, like that of ZForce, was suddenly transformed by a

Japanese offensive that opened in the

summer of 1944. 

Stung by air attacks launched from

Chinese bases, the enemy struck back,

driving the Chinese in retreat westward

toward Kunming. Threatened by envelopment, the Kweilin Training Center

and its medical school closed, never to

reopen; the town fell to the Japanese in

November 1944. The Americans had

trained some 500 Chinese medical officers, 400 veterinary officers and enlisted technicians, and 24 dental officers.

Hopes entertained by Williams of supplying Z-Force with American hospitals

had meantime gone glimmering, as

massive offensives in the decisive theaters of Europe and the Pacific

absorbed the medical resources available to the War Department. The

forces engaged in Burma and along the

Salween had their own needs and could

offer no help.

The result was another medical

nightmare, reminiscent of Burma in

1942. The retreating Chinese forces

were demoralized, their medics lacked

adequate training, and most supplies

available in the theater remained in

storage at Kunming, rather than reaching the troops. American liaison officers sent into the field without supplies

could neither treat the wounded nor,

lacking vehicles, organize an effective

system of evacuation. On 1 October

Williams recalled his officers, whom he

could ill afford to lose. Halted in

December by Chinese ground forces

and American airmen, the Japanese

55Surg, Chinese Tng and Combat Cmd, Annual Rpt

(copy), 1944, pp. 21–24; CSurg, USFCT, Annual Rpt

(copy), 1944, pp. 4–6. Both file 319.1–2, HUMEDS, RG

112, NARA.

316 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MEDICS ADMINISTERING PLASMA TO A

Y-FORCE CASUALTY
prepared to renew the offensive in the

spring of 1945.56

Meanwhile, on 27 October General

Hsu Hsi Lin, director general of the

Chinese Army Medical Administration,

approached Armstrong, suggesting that

medical training be reconstructed

around a system of schools that had

been established by the Chinese themselves at Kweilin and Kweiyang.

Receiving little support from the

Chinese Army, and eclipsed by the Yand Z-Force training centers, these

schools had been limping along.

Armstrong willingly provided them such

support as he could muster, sending two

platoons of the 27th Field Hospital to

Kweiyang to operate a 300-bed hospital

with personnel of the Chinese school.

Together American and Chinese doctors made ward rounds, held staff conferences, and assisted one another in

surgical duties. Strictly advisers, the

Americans were limited in their ability

to effect reforms but encouraged by a

doctor draft launched that same

October, which began to raise the caliber of the Chinese personnel.

The newly created Chinese Training

and Combat Command undertook to

train a new 100,000-man army to resist

56Surg, Chinese Combat Cmd, Annual Rpt (copy),

1945, pp. 1–2, file 319.1–2; Smith, “Chinese Army

Medical Service,” 1:121–38, file 314.7. Both in

HUMEDS, RG 112, NARA.

THE CHINA-BURMA-INDIA CHALLENGE 317

FRONTLINE SURGERY ON A CHINESE CASUALTY. A C–47 passes overheard after having dropped

supplies by parachute.
the Japanese advance. Armstrong

assigned at least one American medical

officer to each division. He pulled all

available hospitals into southeast China

to meet the threat, moving eleven from

western Yunnan Province and air-shipping another direct from Burma. Each

hospital was split into sections in order

to support as many combat units as possible. As they had along the Salween, the

Americans took the most serious cases.

Units that had been stripped of equipment and personnel for jungle warfare

in northern Burma had to be reconstituted and provided motor transport for

conventional combat in China. With few

larger American hospitals to serve as

backup, the portables had to be capable

of handling complex surgical and medical problems as well, and had to do it

without special equipment that was

denied the theater by the surgeon general’s office. As usual, theater forces

went into battle armed with expedients

and hope.57

Fortunately, the Japanese, too, were

grappling with the severe pressure of

crushing defeats in the Pacific and of

failed supply lines, the result of U.S. submarine attacks. When the Chinese

launched a counteroffensive in April

1945, they won back some air bases and

stopped the enemy’s renewed drive on

Kweiyang in May and June. At the battle

of Chihchiang casualties were heavy; a

Chinese base hospital, staffed by both

American and Chinese personnel,

worked beside the 34th Portable Surgical

Hospital, receiving 150 casualties a day

for several weeks. In the base hospital two

Americans performed all surgery in an

operating room run by American enlisted technicians. American trucks transported the overflow of evacuees 60 miles

to the Chihchiang air base. Ultimately,

three more portables and an American

field hospital platoon arrived to support

the Chinese combat forces. Despite inadequate equipment, the mortality rate for

the battle wounded at the Chihchiang

hospitals reached a low of 1.95 percent,

or about half that recorded for

Americans in World War II—a tribute

either to excellent surgery, poor evacuation, or both.58

The Chinese, tasting victory, now prepared a new thrust against Canton and

Hong Kong, only to have the war end

with startling suddenness in the late

summer of 1945. The efforts of

American medical personnel to train,

equip, advise, and support the Chinese

Army were never subjected to the

supreme test of a large-scale offensive.

Yet their work in many bitter and ultimately thankless campaigns had provided support for the small complement of

U.S. forces, while assisting the British

Army and radically changing the practice of many Chinese units from the

early days when casualties were abandoned without food or treatment.

Against that dismal background and in

light of almost heart-breaking shortages

and problems imposed by geography

and the disease environment of south

Asia, the provision even of minimal care

was no small accomplishment.

58If many casualties die before reaching the hospitals,

the hospital death rate is correspondingly low. The

China theater by this time had five helicopters and performed what later would be called medevac missions,

but the new device was not yet of statistical significance.

See Surg, Chinese Combat Cmd, Annual Rpt (copy),

1945, p. 2, file 319.1–2; Smith, “Chinese Army Medical

Service,” 2:218–19, file 314.7. Both in HUMEDS, RG

112, NARA. See also Romanus and Sunderland, Time

Runs Out, pp. 276–90.

57Surg, Chinese Combat Cmd, Annual Rpt (copy),

1945, pp. 3–5, file 319.1–2, HUMEDS, RG 112, NARA.

318 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
While the Allies reconquered Burma

and suffered setbacks in China, the climactic battles of the war against Japan

took shape in the Pacific. By September

1944 General MacArthur’s forces had

conquered Morotai Island in the Moluccas that lie southeast of Mindanao, while

Admiral Nimitz’ forces had seized the

Palaus that lie due east. After extensive

debate, the Joint Chiefs of Staff dropped

several proposed operations and agreed

to a quick attack on the Philippines. The

first target was the large central island of

Leyte, followed by Luzon, various smaller

islands, and Mindanao.

Leyte

The largest amphibious operation of

the Pacific war to date, the attack on Leyte would employ an entire field army of

more than 200,000 troops and a flotilla of

more than 700 ships. Counting personnel

staging for future operations, some

258,000 Americans would be on Leyte by

the end of the fighting. Army units from

the Pacific Ocean Areas (PAO) brought

their medical support with them, and the

Sixth Army surgeon set standards for the

invasion force once ashore. 

Overall logistical responsibility for the

operation belonged to MacArthur’s service forces, and General Denit prepared

to call upon all the medical resources of

the Southwest Pacific Area (SWPA) to

support the effort. He summarized his

duties:

transportation on troop and cargo transports of battalion medical troops; portable

surgical, field and evacuation hospitals, surgical teams, and surgeons; arrangements for

care of casualties suffered by air attack en

route; establishment of evacuation by sea

and air after the landings; planning for initial supplies; refrigeration for whole blood;

and establishment and maintenance of isolated installations equipped to accomplish

all categories of definitive surgery.

His consultants also provided instruction in the newest advances of military

medicine; in March 1944 a senior officer

was assigned to instruct all units, but

especially those in the forward areas, in

the use of penicillin.1

CHAPTER X

Large-Unit War: The Philippines

1

CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 1, p. 12

(quotation), file 319.1–2; Rpt, Col I. Ridgeway Trimble,

MC, OofCSurg, USASOS, 25 Dec 45, sub: Notes on

Surgery in Southwest Pacific Area and Western Pacific

Area, August 1944–November 1945, p. 14, Historians

files. Both in Historical Unit Medical Detachment

(HUMEDS), Record Group (RG) 112, National

Archives and Records Administration (NARA),

Washington, D.C. See also M. Hamlin Cannon, Leyte:

The Return to the Philippines, United States Army in World

War II (Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1954), pp. 26, 367.

The officer assigned to teach the use of penicillin, Col.

Frank M. Glenn, MC, became surgical consultant to the

Sixth Army shortly after the Leyte landings.
The kind of warfare that impended—

with large American units engaged on

extensive landmasses amid a heavy population of friendly civilians—resembled

the European fighting of 1944 more

than the Pacific campaigns to date.

Hence, a strong medical establishment

was necessary. The Sixth Army’s six divisions were organized into two corps, the

X from the Southwest Pacific Area and

the XXIV from the Pacific Ocean Areas,

plus a two-division reserve. Both corps

were to land on northeastern Leyte, with

the aim of establishing air and logistical

bases—especially airfields in the broad,

flat Leyte Valley on the western side of

the island—to cover and support the

reconquest of the Philippines.2

The medical organization of the huge

task force followed what were by now

standard procedures. At sea the Navy

assumed responsibility for the health of

the troops, though on many ships Army

medical personnel carried out the actual work. SWPA personnel staged and

sailed from bases 700–2,000 miles away

on Biak, Noemfoor, Hollandia, Aitape,

and Manus. The X Corps was transported and sustained by the U.S. Seventh

Fleet, the XXIV Corps by the U.S. Third

Fleet. MacArthur’s VII Amphibious

Force provided forty casualty-converted

LSTs (landing ship, tank), including

twenty-three with surgical teams, to support the early phases of the landing;

four carried surgical specialty teams—

orthopedic, ophthalmic, thoracic, and

genitourinary. Shore parties and beach

parties were to be established as usual,

with serious cases dispatched to the ship

best equipped to handle them.

At the landing seventeen surgically

equipped LSTs would provide care, disgorging the troops and equipment they

carried and then beaching themselves

to enable vehicles to drive aboard with

the wounded. Converted APAs (transport, attack) would receive the seriously

injured offshore. For both attack forces,

hospital ships—vulnerable because of

their Geneva markings and lack of armament—would arrive later. Once the

Sixth Army went ashore, responsibility

would devolve upon its ranking medical

officers: Colonel Hagins, the Sixth Army

and task force surgeon; Col. Charles

McC. Downs, MC, the X Corps surgeon;

and Colonel Potter, the XXIV Corps surgeon, who had served earlier in the war

as the 7th Infantry Division surgeon at

the invasion of Attu.3

Supporting the X Corps were the

36th and 58th Evacuation Hospitals;

the 1st, 2d, and 3d Field Hospitals; the

16th, 19th, and 27th Portable Surgical

Hospitals; the 135th Medical Battalion;

two amphibious medical companies of

the 2d Engineer Special Brigade’s 262d

Medical Battalion; a medical supply

platoon; and no less than nine antimalaria units—three assigned to survey

and six to control. Three separate collecting companies and three separate

clearing companies also were at the

3

Rpt, U.S. Seventh Fleet, n.d., sub: Amphibious

Operations Invasion of the Philippines, October 1944

to January 1945, p. 1, file 370.5, HUMEDS, RG 112,

NARA; Department of the Navy, Bureau of Medicine

and Surgery, “The United States Navy Medical

Department at War, 1941–1945,” 1:356–57, files of

Bureau of Medicine and Surgery Archives (BMSA),

Washington, D.C.; Cannon, Leyte, p. 28. On Attu, see

Chapter V.

320 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

2

Cannon, Leyte, p. 26; Walter Krueger, From Down

Under to Nippon: The Story of the Sixth Army in World War

II (Washington, D.C: Combat Forces Press, 1953), pp.

141–53; Robert L. Eichelberger, in collaboration with

Milton Mackaye, Our Jungle Road to Tokyo (New York:

Viking Press, 1950), pp. 165–80. Unless otherwise

noted, the tactical narrative on Leyte is drawn from

these sources.
36TH EVACUATION HOSPITAL AT PALO, LEYTE, occupying the San Salvador Cathedral
corps’ disposal. By comparison, the

XXIV Corps was much less well

endowed; it lacked evacuation hospitals

and had fewer collecting and clearing

companies and anti-malaria units.

Attached to the Sixth Army, the 135th

Medical Group was to direct evacuation

from Leyte and provide ambulance service to the X Corps, while the 71st

Medical Battalion would evacuate the

XXIV Corps. The remainder of the

262d Medical Battalion, plus additional

portables and malaria control and survey units, would operate directly under

army control.4

Finally, the Army Service Command

(ASCOM), an organization new to the

Pacific, made its appearance in July

1944, with the mission to support the

Sixth Army by bridging the gap between

the tactical command’s area of responsibility and that of the USASOS.

Numbering about 45,000, the command

contained engineer, quartermaster,

medical, and other service units. Its

medics controlled five general and nine

station hospitals, intended to back up

the mobile units. In effect, the command worked as a mini-USASOS to

organize rear-area support. When the

USASOS arrived, ASCOM personnel

would pass to its control, forming the

complement of the first major logistical

base in the Philippines at Leyte’s capital

of Tacloban.5

Systematic plans were made for evacuation as well. Transports and hospital

ships (and planes, once airstrips were

built) would remove the seriously

wounded from Leyte, returning

MacArthur’s forces to the Southwest

Pacific Area and Nimitz’ to the Pacific

Ocean Areas—although military planners hoped to establish a sixty-day evacuation policy as soon as possible. To this

end, mobile units provided about 4,900

beds to receive casualties, while the

ships offshore formed a floating reserve

of 3,000–5,000 beds; ASCOM, once

established ashore, would offer another

7,650 fixed beds. The resources proved

ample in numbers, but other factors

would cause the Sixth Army to remain

dependent on the ships longer than the

planners anticipated.6

Discipline against disease was tight.

The troops were ordered to wear full

clothing, impregnated with miticide to

protect them against scrub typhus.

They also were instructed in measures

to control flies and avoid schistosomiasis, as well as given Atabrine to suppress

malaria, salt tablets to guard against

heat exhaustion, and halazone tablets

to purify drinking water. The presence

of a friendly civilian population of

some 900,000 was duly noted:

Prophylactic kits were issued against

venereal disease, and medical personnel were ordered to care for civilian

patients to the extent permitted by military needs. Special Philippine civil

affairs units had already been established under the field commanders,

with orders to contact civilian doctors

and nurses and arrange as quickly as

possible to relieve the suffering of the

innocent victims of the battles that now

impended. But no medical units were

earmarked for civilians alone, an omis4

Rpt, Surg, X Corps, 9 Mar 45, sub: Medical Service

History, Leyte Campaign, X Corps, pp. 2–3, file 210–26,

box 4153, Entry 427, RG 407, NARA. 5

CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 1, p.

18, file 319.1–2, HUMEDS, RG 112, NARA. 

6

See Quarterly Rpts (copies), Oct–Dec 44, for Surg,

Sixth Army, pp. 13–14, 126th Gen Hosp, pp. 1–2, and

49th Gen Hosp, pp. 1–3, plus Jan–Mar 45, for 133d Gen

Hosp, pp. 1–2, file 319.1, HUMEDS, RG 112, NARA.

322 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
sion that in time would have a serious

impact on the field forces.7

The Landings

On their 3,000-mile voyage from the

Hawaiian Islands, POA troops of the III

Amphibious Force endured crowded

quarters, bad ventilation, unrelenting

heat, and boredom—the usual precursors of an invasion. On 20 October 1944

the immense fleet approached eastern

Leyte over a glassy sea. Small ranger

forces, supported by the 10th Portable

Surgical Hospital, had already landed

and secured several offshore islands. As

the first waves of assault craft reached

the beaches, the X Corps began to land

to the north, near Tacloban, while the

XXIV Corps went ashore to the south,

near Dulag.

In the north opposition was light, and

Tacloban, with its airfield, fell to the 1st

Cavalry Division the next day. Here the

president of the Philippines proclaimed

his temporary capital; General

MacArthur established his headquarters; and in November the USASOS

began to build a major installation, Base

K, and in January 1945 a new advance

base to organize a growing logistical

establishment. 

Meanwhile, the tide of battle in the

north moved on, as the X Corps’ 24th

Infantry Division entered northern

Leyte Valley. In the XXIV Corps area

Japanese units centered around a complex of airfields. Despite stout resistance, elements of the 7th Division

slogged through swamps and mud to

seize Dulag, while others struck south to

Abuyog, from which a very poor road

crossed the rugged mountains to the

west coast of the island. Problems in

evacuation developed early, in part

because the XXIV Corps had originally

been loaded for a campaign on the

small island of Yap, northeast of the

Palaus, and was short of vehicles needed

for the Leyte fighting.

Throughout the first few days division

medics in both regions provided casualties with initial care. Most of the wounded at this stage were victims of enemy

bombs—almost continuous air raids battered the invaders for their first twelve

days ashore—though a substantial number were hurt by friendly fire. The Navy

offered higher-echelon treatment on its

hospital LSTs, but here serious problems developed. When shallow water

prevented most LSTs from beaching,

casualties had to be transferred to small

boats or amphibians, and the regulating

system that was to have sent serious cases

to teams of specialists broke down under

the conditions of combat.

In the beginning most things seemed

to go well for the medics ashore on

Leyte. By 26 October the hospitals were

getting established; in the X Corps sector Colonel Hagins took control of the

hospitals, the 135th Medical Battalion,

and the separate medical companies as

the Sixth Army area organized to the

rear of the fighting (see Map 12).

Departing from earlier SWPA policy,

General Denit allowed female nurses

into Leyte on the twenty-ninth, and contingents were soon at work in field and

evacuation hospitals. By the time of the

Leyte operation penicillin had become

plentiful not only in hospitals but also in

clearing companies, where the wounded

received it intravenously before underLARGE-UNIT WAR: THE PHILIPPINES 323

7

Rpt, Surg, X Corps, 9 Mar 45, pp. 8–11, file 210–26,

box 4153, Entry 427, RG 407, NARA; Surg, X Corps,

Quarterly Rpt (copy), Oct–Dec 44, p. 42, file 319.1,

HUMEDS, RG 112, NARA.
going surgery. Though ruthless enemy

attacks on clearly marked hospital ships

reduced their usefulness, and though

minor problems appeared, maturity and

competence marked the initial effort.8

Soon, however, enduring problems of

the campaign surfaced. Delayed by the

long high-level debate over strategy, the

invasion had come at the opening of the

October-to-January wet season.

Engineers found great difficulty in building and maintaining roads and in building or upgrading the airfields that had

been the original reason for invading

Leyte. As the attack forces moved inland,

324 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

8

Rpt, Seventh Fleet, n.d., pp. 1–4, file 370.5;

Quarterly Rpts (copies), Oct–Dec 44, for Surg, X Corps,

pp. 23–24, and Surg, Sixth Army, pp. 11–12, 28, file

319.1; OofSurg, USAFFE, ETMD (copy), 23 Dec 44, p.

28, file 350.05. All in HUMEDS, RG 112, NARA.

SIXTH ARMY MEDICAL SUPPORT

LEYTE

26 October 1944

0 30

Miles

XXX Corps Boundary

16th, 19th, and 27th Portable Surgical Hospitals

58th Evacuation Hospital

36th Evacuation Hospital

262d Medical Battalion (-)

135th Medical Group

135th Medical Battalion (-)

893d Medical Clearing Company

400th Medical Collecting Company

7th, 51st, and 52d Portable Surgical Hospitals

394th Medical Clearing Company

644th and 645th Medical Collecting Companies

262d Medical Battalion (-)

69th Field Hospital

76th and 165th Station Hospitals

71st Medical Battalion (-)

XXX

X CORPS

XXIV CORPS

DINAGAT

LEYTE GULF

CAMOTES SEA

Panaon

 Strait

BOHOL

BILIRAN

Carigara Bay

PANAON

Tacloban

Palompon

Ormoc

Burauen

Dagami

Dulag

Abuyog

Tanauan

Palo Jaro

Carigara

Baybay

Wright

La Paz

S U R I G A

O

S

T

R

A I T

SAMAR

MAP 12
increasing distance combined with heavy

rains and enemy fire to slow evacuation

time. In some areas the expedients used

recalled the Indian Wars; the wounded

were dragged from the wettest spots on

travois pulled by water buffalo. While first

aid was almost always available, such conditions meant that a casualty might wait

up to thirty hours for surgical care. The

results would show up in the statistics of

the campaign: 5.6 percent of the wounded would die, compared to 4 percent in

the European theater; the ratio of killed

to wounded would stand at 1:2.94, higher

than in any prior SWPA operation; and

gas gangrene would appear in 1 percent

of the wounded. Trench foot would

become a serious problem, for the first

time since Attu.9

Meantime, the crisis of the campaign

passed offshore. Even as Japanese

planes—including the first suicide craft,

or kamikazes—battered the invaders

and their ships, ominous intelligence

was received of the approach of a major

Japanese fleet. Navy transports withdrew from the southern beaches, compelling diversion of surgical LSTs from

the north. On 23–25 October, in one of

the great naval battles of the war, the

Seventh Fleet and elements of the

Third narrowly repulsed the Japanese

attack directed at the beachhead,

wrecking much of the remaining

strength of two enemy fleets. Ashore,

the Americans made progress, but won

no decision. Even though by 2

November they had secured four of

Leyte’s five airfields and controlled the

Leyte Gulf, they still faced a harsh fight

against reinforced Japanese Army

forces and the wild sodden terrain.

Decisions by the Imperial General

Headquarters ensured that the decisive

struggle for the Philippines on land as

well as on the sea would take place on

Leyte and that casualties sustained there

by both sides would be correspondingly

heavy. The remaining Japanese port of

entry for its reinforcements was the west

coast town of Ormoc. The X Corps

moved against it from the north, crossing the mountains to enter the Ormoc

Valley, while the XXIV Corps pushed

toward Baybay, intending to turn north

once it reached the west coast. Severe

fighting resulted in harsh country that

was covered with dense jungle and

drenched by incessant rain. Typhoons

swelled the rivers, turning the trackless

terrain into quagmires, where some

wounded drowned. The wettest areas

had to be negotiated by amphibians, and

long litter hauls became commonplace. 

Field and evacuation hospitals were

difficult to transport, while their replacements, the fixed hospitals, were often

consigned to morasses because various

headquarters preempted the few dry

spots. “Today . . . I lost the site of my convalescent hospital to an air strip [sic],”

complained Lt. Col. Paul O. Wells, MC,

the Base K surgeon, “and the site of a

500 bed station [hospital] to an ordnance dump!” Ships piled up offshore;

the Army Service Command found great

difficulty in unloading one-third of the

daily cargo it had anticipated; hospital

assemblies remained aboard, and the

general hospitals, in particular, had trouble marrying equipment to personnel.

The major exception, the 133d General

Hospital, arrived on 25 November

aboard four LSTs; unit personnel carried

9

Army Service Forces Monthly Progress Rpt, 31 May

45, sec. 7, pp. 18–19, Historians files; “Central

Philippine Operation: Medical Aspects of Leyte-Samar

Campaign,” p. 5, file 370.2. Both in HUMEDS, RG 112,

NARA. See also “Navy Medical Department at War,”

1:357, BMSA.

LARGE-UNIT WAR: THE PHILIPPINES 325
their own materiel ashore, set up the

hospital in the customary quagmire, and

opened for business the next day.10

But few had the happy experience of

traveling with their gear, and in general

the Sixth Army’s experience with fixed

hospitals in combat was not a happy

one. Some, working lamely with inadequate equipment, functioned far below

their proper level. Many station hospitals disappeared, merged with other

units, and few played significant parts in

the campaign. On the other hand, too

few mobile hospitals had been provided.

On 24 November, thirty-four days after

the landing, only 2,400 beds were in

operation out of more than 8,500 present on Leyte; on 29 December only

4,900 of 11,800 were functional.11

More than ever, the Army found itself

depending upon the LSTs and other

floating hospitals, which held the

wounded close to the fighting and provided them care the medical service

ashore could not always give. The dedicated hospital ships served mainly to

evacuate casualties who could not be

treated adequately at Leyte. Praising the

Navy, Hagins declared that, without its

help, “the level of medical and surgical

care on Leyte would certainly have been

sub-standard.” The other effect of inadequate bed strength was to compel the

evacuation of the lightly wounded, who

ought to have been hospitalized on

Leyte and returned to their units but

who instead recovered in distant New

Guinea or Saipan. Indeed, by the time

some evacuees arrived at their destination, they were fit to return to duty.12

The medical problem for troops in

the forward areas was defined by evacuation more than by any other factor.

Each corps was charged with evacuating

casualties to the ships until such time as

the Sixth Army could assume responsibility (as matters turned out, 25 October

for the X Corps and 14 November for

the XXIV Corps). But as the fighting

moved inland, transportation even to

the forward hospitals grew more difficult. Jeep (1

⁄4-ton) ambulances proved

useless in marshy areas, and too few of

the higher-built 3

⁄4-ton ambulances and

tracked vehicles, such as Weasels, had

been provided. Units working along the

coasts were luckier; their wounded were

evacuated by landing craft or amphibians in comparative safety and much

greater comfort than those who had to

traverse inland Leyte.

Nevertheless, soldiers wounded in the

fighting on the west coast endured difficult times. The whole island bulk lay

between them and the fleet in Leyte Gulf;

Japanese planes harried the 7th Division

and strafed the offshore craft as well. In

the Ormoc corridor an Army surgeon

saw a party of fifty casualties who had

been three days in transit without food.

At night DUKWs carried some back to

Baybay to receive emergency treatment

at an advanced aid station, set up by the

7th Medical Battalion. Those who needed hospital care had to be evacuated by

ambulance over the rough and twisting

road to Abuyog, a trip that usually lasted

12As quoted in Cannon, Leyte, p. 194. See also

“Central Philippine Operation,” p. 9, file 370.2,

HUMEDS, RG 112, NARA. 

326 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

10As quoted in Blanche B. Armfield, Organization and

Administration in World War II, Medical Department,

United States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the Army,

1963), p. 478. See also 133d Gen Hosp Quarterly Rpts

(copies), Oct–Dec 44, pp. 1–2, and Jan–Mar 45, p. 1, file

319.1, HUMEDS, RG 112, NARA, and compare with similar reports for the 44th, 49th, and 126th Gen Hosps. 11“Central Philippine Operation,” pp. 1, 9, file 370.2,

HUMEDS, RG 112, NARA.
two days. Not until early December did

hospitalization become available on the

west coast and the long trip over the

mountains come to an end.13

Air evacuation got off to a slow start.

Enemy attacks slowed the improvement

of the Tacloban airfield, which Army

planners had expected to ready quickly

for service. Evacuees awaiting flights

piled up in air holding stations until 4

November. Thereafter a regular system

developed; the wounded were routed

through evacuation hospitals to airfields, where C–54s loaded casualties

from the XXIV Corps for the Marianas

and C–47s those from the X Corps for

SWPA bases. By Christmas almost 4,500

had been evacuated by air, two-thirds to

POA bases (which may have reflected

the XXIV Corps’ poorer holding facilities on Leyte). Only in the mopping-up

phase of the campaign did the airfields

at last begin to function as expected.

Then, with shipping diverted to other

battlefields, the planes began to carry

almost all of the remaining casualties of

Leyte’s last battles.14

Supply, no less than evacuation,

reflected not only the problems of a campaign mounted from two different theaters but also the difficulties imposed by

the situation at Leyte itself. Intended

originally to fight on Yap, the XXIV

Corps was short of supplies, as it was of

medical units generally. Anticipating a

sixty-day campaign, Sixth Army planners

provided the comprehensive list of medical materiel needed in combat only for

that period; the troops actually carried

much less, a five-day supply for the assault

units and a thirty-day supply for all others. Resupply was by medical maintenance units, which provided only some

700 of the more than 3,000 items needed

for balanced operations. 

Conditions at the beachheads complicated the picture. Heavy Japanese air

strikes, including attacks from kamikazes,

helped to disrupt and confuse unloading. Once on Leyte, enemy counterattacks, lengthening supply lines, and

floods and swollen streams made difficult

the task of hauling food, ammunition,

and medicines to the troops inland.

When slow progress against the enemy

compelled General MacArthur to commit first his reserve divisions and then

other units as well, the supply system was

obliged to support still more troops fighting in ever more remote locations. 

Those in very isolated areas depended on airdrops. While some 70 tons were

delivered in this way, and even delicate

items like bottled plasma and whole

blood generally survived, the problems

were evident. The 1st Cavalry Division,

fighting in the mountains between

Leyte and Ormoc Valleys, lived for a

time on short rations, as did Filipino

guerrillas, who were operating as auxiliaries. A member of the 11th Airborne

Division recorded that

for many days, three men had only one K

ration among them. . . . We were shorter of

food than we had ever expected to be; our

ammunition had to be counted by rounds

rather than by clips; we suffered awaiting

LARGE-UNIT WAR: THE PHILIPPINES 327

13Edmund G. Love, The Hourglass: A History of the 7th

Infantry Division in World War II (Washington, D.C.:

Infantry Journal Press, 1950), p. 258; Surg, Sixth Army,

Quarterly Rpt (copy), Oct–Dec 44, pp. 11–14, 19–20,

file 319.1, HUMEDS, RG 112, NARA. 14OofSurg, USAFFE, ETMD (copy), 23 Dec 44, pp.

11–12, file 350.05, HUMEDS, RG 112, NARA. For summary accounts of evacuation, see Quarterly Rpts

(copies), Oct–Dec 44, file 319.1, loc. cit., for Surg, Sixth

Army; Surg, X Corps; Surgs, 77th and 96th Inf Divs; 36th

and 58th Evac Hosps; 1st Field Hosp; and 27th and 30th

Port Surg Hosps. See also Sixth United States Army,

“Report of the Leyte Operation, 17 October 1944–25

December 1944,” pp. 262–64, U.S. Army Center of

Military History Library (CMH–L), Washington, D.C.
medical supplies from the skies which did

not come; and we hated with a bitter hatred

the gods that made the weather, the pilots

who wouldn’t fly, and the powers that sent us

into the mountains in the first place.15

Such experiences notwithstanding,

most medical supply shortages, except

for isolated units, lasted only a few

hours. Blood plasma, morphine

Syrettes, penicillin, and critical equipment were available in most cases where

they were needed. Ample quantities of

most items had been shipped; most

medical supplies were comparatively

light and could be delivered by persistence or by a daring pilot in the necessary quantities. But during the heavy

fighting of the late autumn the supply

lines became dangerously tenuous, a

problem that could only be eased by an

improvement in the tactical situation.

In December the 77th Infantry

Division staged a new invasion.

Supported by the 95th Portable Surgical

Hospital, the unit landed almost unopposed south of bomb-shattered Ormoc

on the west coast, splitting the enemy

forces. In a foretaste of the battle for

Manila, a fierce house-to-house battle

virtually destroyed what remained of the

town. The northern and southern pincers now closed on the Ormoc Valley,

where the Japanese made a desperate

last stand. Jeep ambulances evacuated

most frontline stations, while artillery

liaison planes served isolated areas.

Small boats evacuated from clearing stations along the coast. The paratroopers

fighting in the mountains sought to rely

on cub planes, which were fitted up as

makeshift ambulances with sheets of plywood and mattresses that bumped the

pilots in the nape of the neck during

flight. But such planes were too few, and

many wounded had to be held for days,

or else littered by special teams over the

mountains and through the jungles.16

Despite many difficulties, reinforcements were not the only good news for

the invading forces that December. The

weather improved and unloading of the

transports in Leyte Gulf proceeded.

Many hospitals that had been mobile

only in theory at last became mobile in

fact, finally moving away from the sodden bases where they had been detained

for so long by inadequate transport,

heavy rain, and tactical stalemate. To

support the divisions on the west coast,

the 69th Field Hospital and the 165th

Station Hospital moved to the Ormoc

area, soon to be joined by the 645th

Medical Collecting Company. All were

needed. Not only did the 77th Infantry

and 11th Airborne Divisions require

support, but, once the pincers closed,

the X Corps as well began to send casualties down the valley from the north. 

With transport functioning and the

enemy confined to a shrinking region in

the west, other improvements in the situation followed naturally. As hospitals

were able to deploy their expansion

beds, fewer patients were lost to evacuation from the island. Whole blood had

been available in sufficient quantities

16Flanagan, Angels, p. 44; Surg, Sixth Army, Quarterly

Rpt (copy), Oct–Dec 44, p. 20, file 319.1, HUMEDS, RG

112, NARA; [77th Division Association], Ours To Hold It

High: The History of the 77th Infantry Division in World

War II (Washington, D.C.: Infantry Journal Press, 1947),

pp. 148–59.

328 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

15Quotation from Edward M. Flanagan, The Angels: A

History of the 11th Airborne Division, 1943–1946

(Washington, D.C.: Infantry Journal Press, 1948), p. 55.

On the supply situation, see Sixth Army, “Leyte

Operation,” p. 264, CMH–L; Quarterly Rpts (copies),

Oct–Dec 44, for Surg, Sixth Army, pp. 36–37, Surg, X

Corps, pp. 45–46, 56, and Surg, 7th Inf Div, p. 1, plus

Jan–Mar 45, for 126th Gen Hosp, pp. 9–12, file 319.1,

HUMEDS, RG 112, NARA.
from the beginning of the campaign,

but now began to arrive by air direct

from San Francisco via Guam. Disease

was not a serious threat on Leyte, for the

island was not heavily malarial; the POA

troops were not seeded with the disease;

and scrub typhus was adequately controlled by the preventive measures

worked out in earlier campaigns.

Dengue rates were high, however, reaching 68 per 1,000 troops per year in the

Sixth Army. Infectious hepatitis and

schistosomiasis appeared, the latter for

the first time in the Southwest Pacific

Area, and an outbreak of amebic dysentery raised medical concerns. But no

epidemics occurred, and the winding

down of the fighting brought further

improvement in a picture that was

already comparatively bright.17

The winding down of the fighting

meant better days, too, for the hardused civilian population of Leyte. A

poor people in the main, most of the

915,000 inhabitants of the island had

lived simply before the war in thatched

dwellings. They worked the fields, harvesting rice, sugar cane, corn, and

copra. The war had brought the

Japanese and, in the hills, quarrelsome

factions of guerrillas who seemed to

hate each other more than the enemy.

All had levied upon the people, a burden that grew as more Japanese troops

began to enter the island early in 1944.

With the American landings, small

Philippine civil affairs units (PACU),

which were attached to the Sixth Army,

had begun to assume responsibility for

their care, pending the reestablishment

of a civilian government by the

Philippine Commonwealth.18

One of the most pressing needs was

for medical care, long neglected under

Japanese administration. Each 49-man

Philippine civil affairs unit had a medical section of 1 officer and 5 enlisted

men, whose duty was to establish a functioning public health system in the

unit’s area of control—on average,

about 12 square miles. The medical officer set up quarantine procedures, provided for malaria control, and launched

an immunization program to protect

against cholera, smallpox, and other illnesses, relying greatly on local civilian

doctors, nurses, and pharmacists. Most

PCAU members were Filipinos, and

their work entailed coordination with

the Civil Affairs Section, Sixth Army; the

task force surgeon; and the representatives of the civil government.

But to expect so few to care for so

many, in a war zone where fighting went

on for months, was plainly unrealistic.

As a result, much of the burden fell on

the field forces, which alone had the

manpower and supplies to meet the

17CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 1, p.

101, file 319.1–2; Surg, Sixth Army, Quarterly Rpt

(copy), Oct–Dec 44, pp. 28, 33–34, file 319.1. Both in

HUMEDS, RG 112, NARA. See also Malcolm S.

Ferguson and Frederik B. Bang, “Schistosomiasis,” in

Ebbe Curtis Hoff. ed., Communicable Diseases Transmitted

Through Contact or by Unknown Means, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1960), pp. 65–72. The following unit histories also proved useful in developing a picture of the campaign: Francis D. Cronin, Under the

Southern Cross: The Saga of the Americal Division

(Washington, D.C.: Combat Forces Press, 1951), pp.

219–64; Orlando R. Davidson, J. Carl Willems, and

Joseph A. Kahl, The Deadeyes: The Story of the 96th Infantry

Division (Washington, D.C.: Infantry Journal Press,

1947), pp. 45–76; [77th Division Association], Ours To

Hold It High, pp. 139–211; B[ertram] C. Wright, comp.,

The 1st Cavalry Division in World War II (Tokyo: Toppan

Printing Co., 1947), pp. 71–100.

18Cannon, Leyte, pp. 198–203; “Leyte: Historical

Report of the 24th Infantry Division Landing Team, 20

October 1944–25 December 1944,” pp. 146–50,

CMH–L.

LARGE-UNIT WAR: THE PHILIPPINES 329
emergency. No sooner had the

Americans landed than people made

homeless by the naval bombardment

began to return, stunned and sometimes injured, to the ruins of their

towns. Food, shelter, and medical care

had to be provided. Both Potter and

Hagins devoted units entirely to assisting civilians, including the 644th

Medical Collecting Company, which

operated a 50-bed civilian hospital in a

San Jose church; the 394th Medical

Clearing Company, which established a

100-bed facility in a Dulag elementary

school; and the 893d Medical Clearing

Company, which ran a similar hospital at

Palo. Four days after the invasion, the

Sixth Army had about 45,000 people

under its care, the population of more

than fifty communities.19

At this time, of course, the army’s own

lines of supply were short and the floating hospitals were available offshore for

its wounded. Nevertheless, such a burden of noncombatants would have

made operations difficult, and civil

affairs proved its value by opening shelters, mainly in school buildings that had

survived in Tacloban and elsewhere.

Hospitals were improvised in the same

area, at Carigara on the north coast and

at Baybay on the west coast. Because

supplies for civilians were inadequate,

the Philippine civil affairs units continued to provide food, medical supplies,

and supervision for the hospitals long

after the battlefront had moved on.

A relatively dense population and

casual fraternization between soldiers

and civilians ensured that in protecting

Filipinos from disease the civil affairs

units would be protecting soldiers as

well. Cooperation between the Sixth

Army’s malaria units and civilian authorities was close, and soldiers and civilians

worked together to control flies and

reduce amebic dysentery. In January

and February 1945 a sharp rise in venereal disease rates began. The army was

learning in the Pacific, as in contemporary Europe, the special advantages and

problems of fighting in the towns and

fields of one’s allies—above all, that the

health of soldier and civilian were really

inseparable and that, in consequence,

civil affairs was everybody’s business.20

For practical purposes Leyte was in

American hands by Christmas, though

bitter mopping-up campaigns remained

to be fought. On 26 December control

passed from General Krueger’s Sixth

Army to the Eighth Army under General

Eichelberger. Thus a bloody, often frustrating, ultimately decisive battle moved

toward its conclusion. Mopping up was a

dangerous, rough, inglorious task, but by

May 1945 most of the remaining

Japanese soldiers, their numbers variously estimated at 5,000 to 28,000, had been

killed. Despite contemporary claims that

43 Japanese to 1 American had died, a

proportion MacArthur termed “unsurpassed in the history of war,” American

casualties numbered more than 18,000,

20Surg, X Corps, Quarterly Rpt (copy), Oct–Dec 44,

pp. 42–44, file 319.1; CSurg, USAFWESPAC, Annual

Rpt, 1945, pt. 1, pp. 95–99, file 319.1–2; “Central

Philippine Operation,” pp. 6–7, file 370.2. All in

HUMEDS, RG 112, NARA. See also Unit Histories,

PCAU 1 and 2, Sep 44–Jul 45, files PCAU 1–0.1 and

PCAU 2–0.1, box 22416, Entry 427, RG 407, NARA;

Armfield, Organization and Administration, pp. 480–81.

330 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

19See Quarterly Rpts (copies), Oct–Dec 44, for Surg,

Sixth Army, p. 12, Surg, X Corps, pp. 42–44, and Surg,

7th Inf Div, p. 1, file 319.1; OofSurg, USAFFE, ETMD

(copy), 23 Dec 44, p. 4, file 350.05; and “Central

Philippine Operation,” p. 1, file 370.2. All in HUMEDS,

RG 112, NARA. See also Unit Histories, Philippine Civil

Affairs Units (PCAU) 1 and 2, Sep 44–Jul 45, files PCAU

1–0.1 and PCAU 2–0.1, box 22416, Entry 427, RG 407,

NARA.
including 15,500 from Army ground

troops alone, of whom 3,500 died.

Estimates of Japanese dead vary widely,

but apparently about 75,000 died, with

fewer than 1,000 taken prisoner.21

In every sense Leyte was a major battle, which completed the ruin of the

enemy’s fleet, decimated its remaining

air force, and severely weakened its

army forces defending the Philippines.

But new tests for the victorious

Americans lay ahead on Luzon.

Luzon

The attack on Luzon aimed at

Lingayen Gulf, where the Japanese had

landed in their own invasion of 1941.

The reason was the same excellent

beaches, giving ready access to the

Central Plains at whose southern end lay

the capital city of Manila. Secondary

assaults, both airborne and amphibious,

were planned to keep the enemy off balance, and Eichelberger’s Eighth Army

was to seize Mindanao and certain islands

in the central Philippines at the same

time. But Krueger’s Sixth Army, now

comprising the I and XIV Corps, was to

stage the invasion of Luzon from the

north, and the effort would be a huge

one, involving 191,000 troops in a flotilla

of 850 vessels. Preceded by the seizure of

sites for airfields on Mindoro Island,

which was defended only by Japanese aircraft and a few ships, the landing on

Luzon was set for 9 January 1945.22

LARGE-UNIT WAR: THE PHILIPPINES 331

21Quotation from CSurg, USAFWESPAC, Annual

Rpt, 1945, pt. 1, p. 11, file 319.1–2, HUMEDS, RG 112,

NARA. Statistics from Cannon, Leyte, pp. 367–68. In late

December enemy troops remaining on Leyte numbered about 15,000. See Stanley L. Falk, Decision at Leyte

(New York: W. W. Norton, 1966), p. 312.

SHELL-TORN CHURCH AT DULAG, LEYTE, used as an evacuation hospital

22Robert Ross Smith, Triumph in the Philippines,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1963), p. 29. Unless otherwise noted, the tactical narrative on Luzon is drawn from this source. See

also Krueger, From Down Under to Nippon, pp. 211–19.

The Sixth Army’s I Corps comprised the 6th and 43d

Infantry Divisions; its XIV Corps, the 37th and 40th

Infantry Divisions. The 25th Infantry Division, 11th

Airborne Division, 158th Regimental Combat Team,

and 13th Armored Group were assigned to the Sixth

Army reserve.
Medical planning reflected the experience, unity, and matured professionalism of the SWPA system. Almost every

line unit could count on more medical

support than ever before. Each division

was backed up by its own organic units.

The I Corps possessed in addition three

evacuation hospitals (the 29th, 54th,

and 92d), four field hospitals (the 5th,

23d, 37th, and 43d), the 70th Medical

Battalion, two amphibious companies

from the 3d Engineer Special Brigade’s

263d Medical Battalion, nine portable

surgical hospitals, and an array of separate collecting and ambulance companies, anti-malaria units, and a medical

supply platoon. Backing the XIV Corps

were two large evacuation hospitals (the

7th and 21st), two field hospitals (the

24th and 41st), the 135th Medical

Battalion, two amphibious companies of

the 4th Engineer Special Brigade’s

264th Medical Battalion, and a similar

melange of smaller units. At army level

the 135th Medical Group stood ready to

organize evacuation, once the headquarters came ashore and the battalions

passed to the group’s control.

Early evacuation and treatment of

casualties would again be the job of the

Navy, which would provide eighteen

medically equipped LSTs, including six

with surgical teams on board—one to

each invasion beach. After the beachhead had been won, the Army Service

Command would land with support that

included depot companies, malaria survey and control units, sanitary compa332 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

UNLOADING A CASUALTY AT THE 7TH EVACUATION HOSPITAL, VILLASIS, LUZON
nies, a medical laboratory, a general dispensary, and station hospitals.

Establishment of a new USASOS installation, Base M, would follow. The

prospect of good roads in the broad

Central Plains of Luzon encouraged the

provision of many ambulance companies. The anticipated distances between

hospitals also caused planners to dedicate three squadrons of radio-equipped

L–5 artillery liaison aircraft to evacuation. The engineers were instructed to

build airstrips as requested by army,

corps, and division surgeons. A few helicopters were also available, and would

do good service before the campaign

was over.23

Intelligently adapted to the changed

conditions of warfare, the medical plan

featured an amplitude of forces unusual

for the Pacific—some 10,000 medics of

all sorts, more than the entire invasion

force in some lesser campaigns. By early

1945 the multiple commands of the

Pacific theaters and the widely separated

lines of attack were converging as

American forces neared the enemy

homeland. To assist the Luzon operation, Admiral Nimitz supplied naval

forces; medical troops staged and

embarked from bases throughout the

South and Southwest Pacific Areas,

some from as far away as New

Caledonia. In the early days of the new

year troopships moved toward the rendezvous points, until the invasion fleet

was over 40 miles in length. 

As the ships entered Philippine

waters on 9 January, kamikazes dove out

of cloud cover, smashing into vessels and

sinking seventeen. Despite such harassment, the attack began as scheduled.

The landing craft, after circling, formed

lines and then made for the shore. “I felt

as though I was going to take an important exam,” said Capt. George Sharpe,

MC, a battalion surgeon. “Shells were

screeching overhead. . . . The boat

struck the beach and we plunged forward in water up to our waists.” Ashore,

resistance was light, and by nightfall

some 68,000 troops had poured into a

beachhead 15 miles wide. The enemy

kept up a harassing fire with artillery

and mortars, causing light casualties,

who were quickly evacuated to the ships.

Medical units gave most of their attention to injured civilians. Again, as at

Leyte, the limited resources of the

Philippine civil affairs units obliged the

field forces to care for hundreds of casualties from the first hours ashore.24

Although the Japanese had withdrawn

into the highlands, they represented an

implied threat to the landing area.

Hence, General Krueger sent the I Corps

into the hills, where stiff resistance from

an enemy dug into a maze of ridges and

ravines caused 200 battle casualties a day.

Moving the wounded to treatment

entailed long litter hauls over treacherously steep hills, bare along the ridge

lines but thick with rainforest in the inter- 23CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 1, pp.

17, 40, file 319.1–2; Quarterly Rpts (copies), Jan–Mar

45, for Surg, Sixth Army, pp. 9–10, 135th Med Group,

pp. 2, 5–7, and Surg, I Corps, p. 36, file 319.1; “Seventh

Amphibious Force Command History, 10 January

1943–23 December 1945,” pp. 71–72, file 314.7 (7th

Amphibious Force) SWPA. All in HUMEDS, RG 112,

NARA. See also “Navy Medical Department at War,”

1:375–76, BMSA; Sixth United States Army, “Report of

the Luzon Campaign, 9 January 1945–30 June 1945,”

3:56, 155–56, CMH–L.

24Quotations from George Sharpe, Brothers Beyond

Blood: A Battalion Surgeon in the South Pacific (Austin,

Tex: Diamond Books, 1989), p. 115. See also Surg, Sixth

Army, Quarterly Rpt (copy), Jan–Mar 45, pp. 10–12, file

319.1, HUMEDS, RG 112, NARA; “Navy Medical

Department at War,” 1:374–78; Krueger, From Down

Under to Nippon, pp. 225–27.

LARGE-UNIT WAR: THE PHILIPPINES 333
vening valleys. Weary litter-bearers were

supplemented with Filipinos and

infantrymen pulled from the line. Medics

used metal litters welded to ordinary

ones as sleds for moving casualties down

slopes and Stokes litters, secured to cable

systems, for crossing over precipitous valleys. To the rear of the collecting companies, Sixth Army ambulances carried the

wounded back over freshly bulldozed

roads to mobile hospitals at San Fabian

(Map 13). On 15 January the Sixth Army

surgeon assumed control of the medical

service ashore, and the 135th Medical

Group began to coordinate both on- and

offshore evacuation, including beach

clearing stations and holding units at

airstrips. Three days later air evacuation

to Leyte commenced, using C–47s that

departed from an airstrip at Magdalan.25

Meanwhile, the XIV Corps pushed

south with deliberate speed through the

Central Plains toward Clark Field and

Manila. Except for small delaying forces,

the enemy was absent. The countryside

featured broad flatlands, good roads,

and fields of rice dotted with small

towns and hamlets. The cultivated landscape spoke of long human residence,

and a medical officer, driving down a

concrete road, marveled: “It does not

seem possible that it is the same war that

was being fought in New Guinea. The

medical support is in no way similar.

Here advancement has been speedy and

one has had civilized communities to

deal with all along the way.”26

The main injuries were incurred in

marching; medics doctored hundreds of

bruised and blistered feet. Some divisions outran their hospitals, which

proved to be less mobile in fact than in

name; evacuation hospitals sometimes

bypassed the field hospitals that they

were supposed to back up. Divisional

units and portables hugged the moving

front, leapfrogging when necessary to

keep up. Coordinated by the 135th

Medical Battalion, evacuation was swift

and smooth, and ambulances surpassed

previous SWPA experience both in numbers and in ease of operation. 

But as the distance from the hospitals

and the Lingayen base increased—by

the end of January one field and four

evacuation hospitals were operating 120

miles from the beach and the ASCOM

hospitals there—air evacuation became

a necessity. By now the XIV Corps was

fighting its first serious battle of the

campaign, around Clark Field and Fort

Stotsenburg, where some 30,000

Japanese struggled fiercely to hold onto

the complex. Ambulance hauls were too

long; serious surgical cases needed

quicker treatment. In early February

Hagins, who recently had been promoted to brigadier general, ordered his

small planes into service. They were

more than ever necessary, because by

then the battle for Manila had begun.27

Manila

While two divisions—the 37th

Infantry and 1st Cavalry—moved against

Manila, supported by three evacuation

hospitals, two Eighth Army elements

also invaded Luzon. On 28 January the

27Sixth Army, “Luzon Campaign,” 3:157, CMH–L.

Hagins was promoted on 4 January 1945.

334 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

25OofSurg, USAFFE, ETMD (copy), 20 Apr 45, pp.

55–57, file 350.05; Quarterly Rpts (copies), Jan–Mar 45,

for Surg, Sixth Army, pp. 11–17, Surg, 43d Inf Div, p. 4,

and Surg, 25th Inf Div, pp. 1–4, file 319.1. All in

HUMEDS, RG 112, NARA. See also Sixth Army, “Luzon

Campaign,” 3:156–57, CMH–L. 2629th Evac Hosp Historical Rpt, 6 Feb 45, p. 3, file

319.1–2, HUMEDS, RG 112, NARA.
XXX

I CORPS

XIV CORPS

A

g

n

o

R i v e r

70th Medical Battalion

263d Medical Battalion(-)

29th and 54th Evacuation Hospitals

23d and 43d Field Hospitals

6th, 11th, 15th, 55th, 56th, 57th, 61st, 62d, 

and 63d Portable Surgical Hospitals

604th, 608th, and 895th Medical 

Clearing Companies

409th, 424th, and 505th Medical 

Collecting Companies 

135th Medical Battalion

264th Medical Battalion(-)

21st Evacuation Hospital

24th Field Hospital

20th, 21st, 24th, 31st, 33d, and 38th

Portable Surgical Hospitals

607th and 894th Medical 

Clearing Companies

408th and 410th Medical 

Collecting Companies

LINGAYEN

GULF

Santo

 Tomas

San

Fabian

Binalonan

 Santa

Barbara

Aringay Baguio

Rosario

San Jacinto

Dagupan

Lingayen

San Carlos

Bayambang

Aguilar

Sual

Villasis

ELEVATION IN FEET

0 1000 2000 and Above

0 10

Miles

SIXTH ARMY MEDICAL SUPPORT

LUZON

13 January 1945

XXX Corps Boundary

MAP 13
XI Corps landed on the west coast near

Subic Bay, with five hospitals in support,

and headed inland to seal off the Bataan

Peninsula; two days later elements of the

11th Airborne Division landed south of

the capital city and advanced swiftly

north. The Manila Naval Defense Force,

against the orders of the Japanese Army

commander, prepared to defend to the

death the objective of these converging

forces.28

Once known as the pearl of the

Orient, Manila, with its population of

about 1 million, sprawled over 100

square miles, bisected by the Pasig

River. To the north lay important

American objectives, including Santo

Tomas University and Old Bilibid,

where thousands of Allied captives were

confined, while to the south lay the residential and business districts and the

magnificent 400-year-old walled city

called Intramuros. As the XIV Corps

approached, the defenders blew up

bridges and set whole sections of the

city ablaze. On 4 February the

Americans entered Manila, liberating

1,275 captives at the prison as flames

threatened to envelop it, and on the

next day a dash by the 1st Cavalry

Division liberated 2,500 internees at the

university as well. Finally, on the twentythird 11th Airborne Division paratroopers, accompanied by a medical officer

and several aidmen, jumped into the

prison camp south of Los Banos to rescue the prisoners.29

In the city itself a month of pitiless

combat left the 20,000 defenders and

100,000 civilians dead, either massacred

by the Japanese or killed by American

artillery. Strange scenes were recorded

in a city where liberation and destruction arrived hand in hand. A medical

administrative officer found crowds celebrating their deliverance while the city

burned: “It was about 2100 hours. The

further we got into the town the more

brilliant was the orange illumination.

Crowds of people lined the streets. From

the balconies flags were draped. . . .

Behind this scene of ‘victory’ the masses

of giant flames rose high. The streets

were as brilliantly lit by the reflection as

Times Square in peace time [sic].”30

While the battle raged, the medics

had three basic duties—to support the

attackers, to assist the innumerable civilian victims of the fighting, and to aid the

liberated prisoners, whose condition

was fragile at best. The divisions in

Manila, besides their organic units, were

backed up by three evacuation and two

field hospitals, plus separate collecting

and clearing companies and parts of two

medical battalions. Portable surgical

hospitals moved frequently, some setting up in as many as six locations to

keep abreast of the fighting. 

The services of all units were badly

needed. When the 37th Division stormed

the Legislative Building, the clearing station of the 112th Medical Battalion

became a “Grand Central of unloading

ambulances, badly wounded soldiers,

30Quotation from 29th Evac Hosp Historical Rpt, 6

Feb 45, p. 6, file 319.1–2, HUMEDS, RG 112, NARA.

See also Krueger, From Down Under to Nippon, pp.

235–70; Stanley A. Frankel, The 37th Infantry Division in

World War II, ed. Frederick Kirker with John MacDonald

(Washington, D.C.: Infantry Journal Press, 1948), pp.

291–96; Wright, comp., 1st Cavalry Division, pp. 125–40.

336 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

28On the Eighth Army’s contribution to the Luzon

campaign, see John F. Shortal, Forged By Fire: General

Robert L. Eichelberger and the Pacific War (Columbia, S.C.:

University of South Carolina Press, 1987), pp. 105–13.

After landing, the XI Corps came under the Sixth

Army’s control. 29Surg, 11th Airborne Div, Quarterly Rpt, Jan–Mar

45, pp. 1–3, HUMEDS, RG 112, NARA; Flanagan,

Angels, p. 89. 
and battered Filipino civilians.” In

Manila’s northern suburbs divisional

medics had the difficult task of evacuating across the sluggish Calumpit River

under fire from the east bank, where the

enemy occupied houses and a church

tower. M. Sgt. James B. Underwood

dragged casualties off the muddy banks

and maneuvered them into small

dugouts that he pushed to safety, swimming amid geysers of muddy spray

thrown up by mortar rounds. In eight

trips he brought out twenty-eight, most of

them wounded, a few dead.31

On 7 February the 71st and 29th

Evacuation Hospitals arrived, and the

54th two days later. These units handled

most of the 2,724 American wounded

during the first half of the month. The

71st set up just north of Manila in an old

slaughterhouse; the 29th entered Manila

proper, where it worked in the Philippine

Constabulary Academy for seven weeks,

admitting close to 5,000 casualties in all,

military and civilian; a mile and a half

away the 54th took enemy artillery

rounds during its first week working in

the Santolan Tuberculosis Colony, treating internees liberated from Santo

Tomas, Old Bilibid, and Cabanatuan prisons. Although members of the 54th

31Frankel, 37th Infantry Division, pp. 266–67, 294

(quotation).

LARGE-UNIT WAR: THE PHILIPPINES 337

TRANSPORTING CASUALTIES ACROSS MANILA’S PASIG RIVER
inhabited marble halls and airy, spacious

rooms, patients and staff alike lacked

such essentials as water and workable toilets—as did everyone in Manila.32

The other medical workhorses of the

battle for Manila were the separate

clearing companies. Soon after

American forces entered the capital, the

893d Medical Clearing Company moved

with PCAU 5 to Santo Tomas. Unlike

other prisoners, who had been quickly

evacuated from camps endangered by

the fighting, internees here remained

on the university grounds. The clearing

company set up a small hospital in the

Education Building and received its first

patients the evening of 6 February.

While the Philippine civil affairs unit

provided the first decent meal tasted by

the prisoners in many months, the

medics worked with patients who were

profoundly malnourished and suffered

from deficiency diseases, including

scurvy. Enemy shells fell on the university, frightening away potential civilian

laborers, though casualties from street

fighting just outside the compound

were carried in for emergency treatment. Latrines were not functioning,

because the city water supply had failed.

Garbage and debris littered the

grounds, and clearing company drivers

trucked it away themselves, risking

death in the streets during return journeys with water and food.33

By mid-February the Japanese were

confined to areas south of the Pasig.

Progress in the fighting throughout

Luzon was reflected in the establishment

of the Luzon Base Section in the capital

city. A USASOS unit, the section used its

21st Evacuation Hospital to provide additional medical support. Opening at New

Bilibid, 20 miles south of Manila, the

hospital first served internees from Los

Banos, but later began to take battle

casualties from divisions fighting in

southern Luzon. Casualties from the

11th Airborne Division also were treated

by the 41st Field Hospital, which worked

in Manila at Quezon City; and the 5th

Field Hospital took over from a clearing

company at Old Bilibid, treating a mixed

array of Allied nationals and American

Army nurses lately released, plus many

Filipino civilians.34

Comparison is inevitable to conditions in conquered Germany a month or

two later. There the high numbers of

recovered military prisoners, slave laborers, and concentration camp inmates

burdened the medical system greatly

after the fighting had slacked off and

the number of wounded had fallen. In

the smaller foretaste at Manila, however,

severe fighting coincided with the recovery of prisoners and the heaviest casualties among friendly civilians in the

Pacific war. American medical facilities

were hard put to handle the burden,

although assistance from Filipino health

care workers of all sorts provided early

and welcome assistance, and evacuation

removed many military casualties from

the scene. The most difficult days came

34See Quarterly Rpts (copies), Jan–Mar 45, for 21st

Evac Hosp, pp. 2–3, 41st Field Hosp, pp. 1–2, 5th Field

Hosp, pp. 1–2, and Surg, Sixth Army, pp. 20, 23, 26, file

319.1, HUMEDS, RG 112, NARA.

338 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

32Rpt (copy), CO, 71st Evac Hosp, 11 Aug 45, sub:

History of the 71st Evacuation Hospital, 11 January

1945–30 June 1945, pp. 1–5, file 319.1; Quarterly Rpts

(copies), Jan–Mar 45, for 29th Evac Hosp, pp. 1–2, and

54th Evac Hosp, pp. 1–4, file 319.1; Rpt, Capt David G.

Asherman, Med Dept Info Svc Field Off, OofCSurg,

USASOS, 17 Feb 45, sub: Report of Activities—Manila,

pp. 1–12, file 370 (Manila). All in HUMEDS, RG 112,

NARA. 33893d Med Clearing Co Quarterly Rpt, Jan–Mar 45,

pp. 1–2, file 319.1, HUMEDS, RG 112, NARA.
in March, when the Leyte hospitals were

full and some of the Sixth Army installations were “filled far beyond their rated

capacity.” But that month, too, brought

the end of fighting in Manila and the

beginning of reconstruction.35

Moving the wounded out of the city

was primarily the job of the separate collecting companies and amphibious medical battalions, which maintained the

holding stations at airstrips from 8

February, when air evacuation from the

capital region began. Thus the 409th

Medical Collecting Company worked

both at the Rosales strip in the city,

where L–5s landed, and at the Quezon

City strip northeast of the capital, used

by C–47s to evacuate from Luzon. For a

time the 264th Medical Battalion operated a convalescent hospital in a battered

tuberculosis sanitarium; late in February

the 227th Station Hospital took over, and

the battalion moved to the Quezon

airstrip to take on evacuation duties

there. The arrival of the 49th General

Hospital on 1 March, however, signaled a

new stage in the treatment of casualties

at Manila, where the end of the battle

initiated the transformation of the devastated city from battleground to base.36

LARGE-UNIT WAR: THE PHILIPPINES 339

WARD OF THE 49TH GENERAL HOSPITAL, set up in the Manila Jockey Club

35Sixth Army, “Luzon Campaign,” 3:158, CMH–L.

The peak in evacuations on and from Luzon came in

April, in response to rapidly increasing numbers of disease victims and fresh battle casualties from the mountains. On conditions in conquered Germany, see

Graham A. Cosmas and Albert E. Cowdrey, The Medical

Department: Medical Service in the European Theater of

Operations, United States Army in World War II

(Washington, D.C.: U.S. Army Center of Military

History, 1992), pp. 550–78.

36See Quarterly Rpts (copies), Jan–Mar 45, for Surg,

Sixth Army, p. 23, 409th Med Collecting Co, p. 2, 49th

Gen Hosp, pp. 2–3, 227th Sta Hosp, pp. 1–2, and 264th

Med Bn, pp. 1–2, file 319.1, HUMEDS, RG 112, NARA.

See also Sixth Army, “Luzon Campaign,” 3:158, CMH–L.
Manila Bay

Unlike the Americans in 1942, the

Japanese 14th Area Army commander,

General Tomoyuki Yamashita, did not

intend to have his 275,000 troops bottled up on the peninsula of Bataan.

Instead, he meant to defend three

mountainous areas in northern, west

central, and southern Luzon. Americans

had already encountered elements of

one defending force, the Shobu Group,

when they fought in the foothills after

their Lingayen invasion, and another,

the Kembu Group, near Clark Field.

MacArthur, anticipating a possible

replay of 1942, had ordered the Eighth

Army’s XI Corps to land on the west

coast of the Philippines near Subic Bay,

open the bay to Allied shipping, and

move rapidly southward to seal off

Bataan. Dug in athwart the route of

advance were some 2,700 troops from

the Kembu Group, in defenses hidden by

impenetrable jungle growth.

The landing was easy, for some prime

targets had already fallen to Filipino

guerrillas. But when the Americans

entered the hills, heading for Bataan,

they ran afoul of the Japanese in a

rough, tangled region called the ZigZag

Pass. As the attack began, casualties

quickly mounted. In three days (3–5

February) the 34th Regimental Combat

Team, 24th Division, lost almost half as

many infantrymen as it had during seventy-eight days of combat on Leyte. The

battalion surgeon toiled “in a caldron of

dirt and sweat and noise and tattered

flesh, . . . a stranglehold upon his jangled nerves.” Mortar and shell wounds

filled the 18th Portable Surgical

Hospital, set up on the main road near

the western entrance to the pass. Trucks,

jeeps, and ambulances brought in more;

some supply vehicles dumped out

rations on the road to make room for

the wounded. At the portable a surgeon

“patched up one man whose heart

pulsed uncovered in his split-open

chest.” The 38th Infantry Division

moved in, and the fight was renewed

and extended. Supported by the 64th

Portable Surgical Hospital, the 149th

Regimental Combat Team, 38th

Division, outflanked the pass, sending

back its wounded by litter and by

carabao cart until its own medics were

able to hack a landing strip out of the

jungle.37

Victory against a tenacious foe cost

the XI Corps 1,400 casualties, and

ZigZag was not cleared until 15

February—a bloody and ironic

reminder to the Americans of how long

a small force could hold up a large one

in such country, and at what price.38

Almost undefended, Bataan itself fell

easily, but substantial casualties were

incurred in reconquering Corregidor.

The attack had some tactical justification, for the isolated enemy garrison

there could harass ships entering

Manila Bay. But sentiment also played a

large part in the decision to recapture

the fortress, and a desire to do so with

maximum drama may have influenced

the choice of means: a coordinated

parachute drop and amphibious assault.

Drop zones were small, and surrounded

by ruins caused by naval and air bombardment. Winds were unexpectedly

brisk, and the troopers of the 503d

Parachute Infantry were scattered, one

340 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

37Quotations from Richard J. H. Krebs [Jan Valtin],

Children of Yesterday (New York: Reader’s Press), pp.

327–28. See also Quarterly Rpts, Jan–Mar 45, for Surg,

Sixth Army, pp. 19, 22–23, and 18th Port Surg Hosp,

pp. 1–2, file 319.1, HUMEDS, RG 112, NARA. 38Smith, Triumph in Philippines, p. 330.
in every four suffering injuries on 16

February as a result of landing “on, in,

and among buildings and trees away

from the two fields [or drop zones].”

Their medics jumped with them.39

With the advantage of numbers and

surprise, the Americans confronted an

entrenched and determined enemy.

Further casualties quickly mounted from

hits on landing craft as the 3d Battalion,

34th Infantry, came ashore. For the first

thirty-six hours of fighting, the injured

paratroopers and battle wounded of the

503d Regimental Combat Team were

cared for at the regimental aid station,

the only medical unit available on the

island until the 18th Portable Surgical

Hospital arrived from Bataan on the second day of the battle. Col. Frank J.

McGowan, MC, the Eighth Army’s surgical consultant, reached Corregidor on 18

March and combined the 503d’s medics

with those of the portable hospital.

McGowan began to operate on the many

compound fracture cases left by the

jump; however, because of a lack of water

and plaster, he was unable to make casts.

Under the flood of wounded, plasma ran

out as well. Calls for help were soon

answered. Two volunteers loaded plasma

into a tank destroyer and, in the midst of

machine gun fire intermittently beating

39Quotation from ibid., p. 344. See also Frank J.

McGowan, “Eighth U.S. Army,” in B. Noland Carter,

ed., Activities of Surgical Consultants, Medical

Department, United States Army in World War II, 2

vols. (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1962–64), 1:571.

LARGE-UNIT WAR: THE PHILIPPINES 341

MANILA BAY CASUALTIES DISEMBARKING FROM AN LST AT CORREGIDOR
on the vehicle’s armor, ran it from the

beach along a winding road and over

unsafe bridges to reach Topside, a

plateau 400–500 feet above Manila Bay.

Then they made the trip again for water,

counting 200 bullet scars on the steel

when the second trip was done.40

Utilizing underground passageways,

the Japanese infiltrated at night, retaking positions they lost during the day.

But the Americans made progress in a

punishing contest, dynamiting tunnel

entrances and calling in napalm and

artillery strikes on the defenders. As

their losses mounted, the Japanese

resorted to their usual suicide tactics. A

fierce counterattack in the predawn

hours of 19 February was followed by

scattered banzai charges that cost them

heavily. Another 40 killed themselves by

blowing up an ammunition dump, sending a score of American casualties into

the portable with severe blast injuries.

Worse was to come. 

On 26 February, a little before noon,

the Japanese detonated an underground arsenal at Monkey Point “amid

scenes of carnage on both sides.” A mile

away one soldier was hurt by falling

debris; flying rock struck a destroyer

2,000 yards offshore. “Bits and pieces of

American and Japanese troops splattered the ground; rock slides buried

alive other men of both forces.” Medics

worked for nearly two hours to clear the

150 American wounded, and a medical

officer admitted: “As soon as I got all the

casualties off, I sat down on a rock and

burst out crying. I couldn’t stop myself

and didn’t even want to. I had seen

more than a man could stand and still

stay normal. . . . When I had the cases to

care for, that kept me going; but after

that it was too much.”41

In ten days of battle the Americans

suffered more than 1,000 casualties,

including 210 killed. The 18th Portable

Surgical Hospital received a well-earned

Presidential Unit Citation. Over the rubble flew the American flag, not quite

three years after it had been lowered in

surrender. The other fortified islands in

Manila Bay fell soon after Corregidor. In

this mostly symbolic victory for the

Americans, 4,500 Japanese died and 20

surrendered.42

The Mountain Campaigns

Yamashita’s decision to withdraw his

main forces to the mountains of Luzon

meant, paradoxically, that some of the

hardest fighting followed attainment of

the campaign’s main strategic objectives. The medical problem on Luzon

now resolved itself into aiding the construction of bases—MacArthur planned

airfield complexes in the north and a

major hospital center and a landing

craft assembly plant on Batangas Bay,

south of Manila—while providing support for the fighting units. Meanwhile,

the Sixth Army’s fighting forces were

reduced, not only by the demands for

manpower to construct and defend new

bases but also by a shift of emphasis

41Smith, Triumph in Philippines, pp. 346–48 (quotations). 42Ibid., pp. 349–50.

342 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

40Rpt, Capt Robert M. Atkins, Supply Off, 503d RCT,

3 Mar 45, sub: Historical Record of Regimental Supply

Section, 503d Regimental Combat Team, From 16

February to 2 March 1945, pp. 1–2, file INRG–503–4

(503d Prcht Inf Regt—S4 Rpt, Corregidor, 16 Feb–2

Mar 45), box 21305, Entry 427, RG 407, NARA;

Quarterly Rpts (copies), Jan–Mar 45, for Surg, Sixth

Army, p. 22, and 18th Port Surg Hosp, pp. 3–6, file

319.1, HUMEDS, RG 112, NARA; Krebs, Children of

Yesterday, pp. 352–53; McGowan, “Eighth U.S. Army,” in

Carter, ed., Surgical Consultants, 1:571–72.
toward reconquest of the southern

Philippines by the Eighth Army.

As a result, the remaining battles on

Luzon were fought by American forces

that were well supplied but either

numerically inferior or not greatly superior to enemy units. To deal with the

Shimbu Group, General Krueger sent the

XIV Corps into the mountains east of

Manila to recover dams that supplied a

substantial part of the city’s water. The

fighting fell to the 1st Cavalry Division’s

2d Cavalry Brigade and to the 6th

Infantry Division (two regiments from

the I Corps in the Central Plains and one

regiment from the XI Corps on Bataan).

The 30,000 Japanese defenders of the

beautiful but desolate highlands were, as

usual, strongly entrenched in caves, with

bunkered entrances, and were armed

with mortars and artillery. Up to 14

March, when the XI Corps took command of the action, the XIV Corps suffered 1,335 casualties, of whom 295 died.

The action was no less bitter thereafter.

During the week of 15–22 March each of

the four regiments in the line lost 50 to

60 a day; in 10 days the 2d Cavalry

Brigade lost 60 killed and 315 wounded,

against 500 known Japanese dead.43

As the Americans and their guerrilla

allies moved deeper into the hills, fighting an endless series of small-unit actions,

evacuation became ever more difficult.

In response, portable surgical hospitals

worked close to the front, moving often;

four moved from four to ten times, and

the least active moved three times to

keep up with the troops. In May torrential rains fell, washing out the trails and

the few roads, and exhausted litter-bearers had to be supplemented with other

medics and Filipinos. Even with the

portables working well forward, some

casualties took twenty hours to reach surgical care. A few helicopters were available, transporting wounded from the

front to division clearing stations that

functioned, in effect, as small field hospitals, and L–5s helped to move the wounded back to Manila. There the evacuation

hospitals—fixed hospitals now in all but

name—awaited them. Casualty classification was the job of the 135th Medical

Battalion, which established a thirty-day

policy for the Sixth Army and routed

more serious cases to the hospitals of the

Luzon Base Section.

Not until 13–14 May did the most

important dam fall, and pockets of

enemy resistance continued to cause

trouble until the end of June. But the

enemy was near the end of his resources.

In the mountains the familiar rule of

Pacific warfare—that isolated forces

could not survive under jungle conditions—resumed its course. Cut off from

resupply, many Japanese perished from

starvation and disease, and those who survived the campaign were little more than

a nuisance at its end. Manila regained an

adequate water supply, improving health

there and aiding the city’s redevelopment

as a major port and Allied base. Similarly

bitter actions in southern Luzon completed the ruin of the Shimbu Group as an

effective fighting force.44

43Ibid., pp. 373, 384.

44Surg, Sixth Army, Quarterly Rpts (copies), Jan–Mar

45, pp. 24–27, and Apr–Jun 45, pp. 6–18; 135th Med

Group Quarterly Rpt (copy), Apr–Jun 45, pp. 2–3. All file

319.1, HUMEDS, RG 112, NARA. See also Sixth Army,

“Luzon Campaign,” 3:158, CMH–L; [6th] Division

Public Relations Section, The 6th Infantry Division in

World War II, 1939–1945 (Washington, D.C.: Infantry

Journal Press, 1947), pp. 108–22; Wright, comp., 1st

Cavalry Division, pp. 144–56. The original strength of the

Shimbu Group was more than 50,000, counting the forces

south, east, and northeast of Manila. Of these, some

2,000 were captured during the fighting and 6,300 surrendered at the end of the war. All the rest perished.

LARGE-UNIT WAR: THE PHILIPPINES 343
Fighting in the North

Meanwhile, in northern Luzon the I

Corps faced the largest of the enemy

forces, the Shobu Group. With 110,000

troops and control of the fertile

Cagayan Valley, General Yamashita

hoped to put up a stout resistance. In

early March the Americans moved

against him, intending to break into the

valley through the rugged Caraballo

Mountains by way of Balete Pass. Aiding

the original three infantry divisions—

25th, 32d, and 33d—were five regiments

of guerrillas organized and commanded

by Col. Russell W. Volckmann. In some

areas the campaign advanced quickly.

The town of Baguio fell on 26 April to

the newly arrived 37th Division, and the

25th Division, advancing along Highway

5, the best road in northern Luzon, was

able to execute flanking movements and

take Balete Pass on 25 May. 

But elsewhere precipitous mountains,

deep gorges, and forest thickets gave the

defense a great advantage. The 32d

Division, already battered in earlier

fighting on Leyte and Luzon, climbed

and fought its way up a narrow carabao

track called the Villa Verde Trail, coursing over 6,000-foot ranges. The unit was

forced by the terrain into one frontal

attack after another. Evacuation and supply were difficult. The division secured

the trail by 28 May, but at the cost of

physical and psychological exhaustion. 

Medical support was, for the Pacific,

conventional—only the size of the

344 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

LITTER-BEARERS EVACUATING WOUNDED FROM THE LUZON HILLS
forces was remarkable. Fragmentation

of units was inevitable in mountain

country, and medical units followed suit,

dividing as they had since the early days

of the war. Before Baguio the 33d

Division fought in companies over a

wide front. Hence, battalion aid stations

split in two; collecting companies, reinforced with clearing company personnel, set up provisional clearing stations,

sometimes with portable surgical hospitals nearby and sometimes alone. On

the Villa Verde Trail, on the other hand,

the front was narrow and the 32d

Division’s clearing station and a

portable leapfrogged each other as the

division advanced. With heavy casualties

and short distances the rule, medical

support sometimes was uncommonly

plentiful; on occasion, an entire collecting company backed up a single rifle

battalion.

The vertical terrain, the narrow trails,

the jungle, and the heavy rains spelled

trouble for litter-bearers. Infantrymen

and native laborers were called upon to

lend a hand. Igorot tribesmen provided

essential aid. Snipers harassed them all,

and some aid stations had to provide

smoke screens to shield approaching litter parties. Farther to the rear, consolidated litter-bearer trains moved at night

under armed guard. Near Baguio, horse

packtrains captured from the Japanese

were pressed into service, and engineer

bulldozers plowed new trails through

trackless countryside. 

Rather than attempt to move in such

country, field and evacuation hospitals

usually set up in school buildings, outside the combat zone. Even the I Corps’

separate clearing and collecting companies stayed well back of the front lines,

the former providing additional hospital beds, the latter managing rear-area

evacuation, including both ambulances

and holding stations at airfields the

engineers carved out exclusively for

medical use. Collecting companies also

ran convalescent hospitals. Beyond the

corps area, evacuation was easy, for a

network of good roads stretched into

the Central Plains, and aircraft helped

to speed the wounded to hospitals at

Lingayen and elsewhere. Evacuation

hops, mainly by L–5s or the larger

C–64s, were relatively short and a pilot

might make twenty runs a day. Since all

Sixth Army hospitals, except the 43d

Field Hospital, were in the Central

Plains or at Manila, ASCOM hospitals

received the severely wounded.45

Once the American forces broke into

the enemy’s main larder in the Cagayan

Valley, a rapid advance began that transformed the medical problem into one of

keeping up. To support the fast-moving

37th Division, the division surgeon was

obliged to uproot his office every two

days. Division clearing companies still

worked in platoons, each supported by a

portable surgical hospital, but were

unable to hold their casualties for long.

Evacuation routes stretched out; for

weeks after the breakthrough, ambulances carried the wounded on journeys

LARGE-UNIT WAR: THE PHILIPPINES 345

45See Quarterly Rpts (copies), Jan–Mar 45 and

Apr–Jun 45, for 70th Med Bn, Surgs, 25th, 32d, 33d,

and 37th Inf Divs, and Surg, I Corps, file 319.1,

HUMEDS, RG 112, NARA. See also Sixth Army, “Luzon

Campaign,” 3:158, CMH–L; Krueger, From Down Under

to Nippon, pp. 321–29; Eichelberger, Our Jungle Road,

pp. 246–58; Frankel, 37th Infantry Division, pp. 305–63;

Harold W. Blakely, The 32d Infantry Division in World

War II (Madison, Wis.: Thirty-Second Infantry Division

History Commission, 1957), pp. 203–76; 33d Infantry

Division Historical Committee, The Golden Cross: A

History of the 33d Infantry Division in World War II

(Washington, D.C.: Infantry Journal Press, 1948), pp.

225–37. First put into service in April by the 3d Air

Commando Group, the C–64 carried four litter or

seven sitting evacuees.
that reached 100 miles, through the valley and over Balete Pass to the 36th

Evacuation Hospital. As soon as possible, air evacuation began at captured

airfields, the first opening on 15 June.

Large enough for C–47s and C–54s, the

three fields seized during the month

quickly took the place of the long trek

through the pass. Field hospitals, too,

moved into the valley; the 91st set up in

mid-June at Bayombong and the 43d at

Cauayan, only two days after the infantry

passed through. By the end of the

month the 43d relocated to the town of

Tuguegarao, now the medical center of

the valley, with an airfield, the advance

headquarters of the 70th Medical

Battalion, and a growing medical supply

depot. The fate of the enemy wounded,

meanwhile, was grimly symbolized in

the discovery of 200 dead Japanese in

two Bayombong school buildings that

had been used as hospitals. All had been

killed by their own comrades to prevent

them falling into the hands of the

Americans.46

The main feature in easing the Allied

medical burden was the rapid collapse

of organized resistance in the lowlands.

Neither the main forces in the Cagayan

Valley, nor a task force operating on the

46Surg, 37th Inf Div, Quarterly Rpt, Apr–Jun 45, p. 4,

file 319. 1, HUMEDS, RG 112, NARA. In loc. cit., see

also similar reports for 70th Med Bn, 424th Collecting

Co, 637th Clearing Co, 43d and 91st Field Hosps, and

24th Port Surg Hosp.

346 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

IGOROT WOMEN LITTER-BEARERS IN THE MOUNTAINS OF NORTHERN LUZON
northwest coast to cut off Japanese

escape routes, nor airborne troopers

who dropped near Aparri at the point

where the valley exits to the sea, suffered

heavy battle casualties. Guerrillas

cleared the coast, and the troopers met

only a few enemy stragglers, as the

Japanese withdrew into the mountains

to continue resistance there. 

As a whole, the Luzon campaign illustrated how well the medical service performed in the most diverse struggle of

the Pacific war to date. Serious deficiencies in care occurred along the front

lines, in large part because of the difficulty of reaching casualties quickly. But

the characteristics of the Luzon campaign were the size of the forces

engaged and the fierce continuous

fighting. Hence, the most important

aspect of medical care was the effectiveness of surgery, and this might best be

measured by the incidence of gas gangrene infection—one half of 1 percent

on Luzon as against 1 percent on Leyte.

The influence of the chief surgeon

was an important factor. Denit pulled

surgical teams, each consisting of one

general surgeon, one orthopedist, and

six surgical technicians, from the general hospitals and assigned them to the

field and evacuation hospitals to

improve the caliber of surgery near the

front. Abundant supplies of penicillin,

plasma, and whole blood—25,000 pints,

including some from the United States

by way of the Navy’s blood bank on

Guam—were received. Surgical consultants worked effectively, visiting field

units to provide instruction and controlling the assignment of specialists.

Finally, light-plane evacuation had obvious significance for speedy surgical

intervention and hence for reduced risk

of infection. Consultants traced mishandled cases back to the units responsible,

and provided correction on the spot.47

The change in the character of the

fighting, however, raised questions about

some traditional ways of doing things.

The jeep ambulance, essential in most

Pacific campaigns to date, proved to be

inferior to the light plane in the mountains and less useful than the conventional ambulance in the Central Plains of

Luzon, where roads were good. The

greatest change, however, was the declining usefulness of the portable surgical

hospital, hitherto a key unit in the Pacific

fighting. Wherever the ground was open,

the portables lost much of their reason

for being. As the surgeon of the 24th

Division remarked, they were “difficult to

fit into the chain of evacuation,” and he

combined his two portables to form an

extra clearing platoon. In the Central

Plains many portables served as surgical

teams attached to the collecting companies of medical battalions.48

Perhaps traditions formed in earlier

campaigns were part of the problem.

Accustomed to attempt daring procedures, surgeons in portables had trouble

adjusting to a more normal situation,

where they did only emergency stabilizing procedures and sent their patients

to larger hospitals for definitive care.

Yet, in remote jungled regions, the

portables continued to serve admirably

47Rpt, Trimble, 25 Dec 45, pp. 25–28; Rpt, Lt Col

Frank M. Glenn, MC, OofCSurg, USASOS, n.d., sub:

Notes on Surgery in the Forward Area of the Southwest

Pacific, p. 10. Both in Historians files, HUMEDS, RG

112, NARA. See also Douglas B. Kendrick, Blood

Program in World War II, Medical Department, United

States Army in World War II (Washington, D.C.: Office

of the Surgeon General, Department of the Army,

1964), pp. 618–22. 48“Leyte: Historical Report of 24th Infantry Division,”

pp. 134–35 (quotation, p. 134), CMH–L; Rpt, Glenn,

n.d., p. 10, Historians files, HUMEDS, RG 112, NARA.

LARGE-UNIT WAR: THE PHILIPPINES 347
as independent units, operating in the

kind of terrain they were designed for.

As late as May 1945, officer and enlisted

medics backpacked equipment to perform major surgery on a five-day’s walk

into the mountains of Luzon.49

Despite all obstacles, evacuation both

on and from Luzon was an overall success. The struggles of the litter-bearers

on mountain trails demonstrated that,

as ever, the first step was the hardest.

Once off the line, however, the wounded were moved with speed and skill.

Under the 135th Medical Group, four

medical battalions—the 70th, 135th,

263d, and 264th—played key roles. At

the corps level, they provided coordination and liaison among ambulance companies, collecting companies, and air

and sea holding stations. 

Air evacuation had never been more

important. More helicopters might have

made a significant contribution, but as

matters stood the single-engine L–5s

remained the most important device for

transporting the casualty to the surgeon,

especially in rough and jungled terrain.

Ambulances and aircraft made more

than 160,000 trips with casualties—

ambulances, 130,000; C–47s, 12,000;

L–5s, 18,000; and C–64s, 1,100. (Many

of these trips, of course, carried the

same evacuees on different legs of their

journey.) Small planes were important,

not only for moving the sick and wounded to hospitals but also for redistributing them to installations with available

beds and to facilities with specialists

skilled in handling particular injuries.50

Sea evacuation was in the hands of the

two medical battalions, the 263d and

264th. Working through liaison personnel in hospitals and holding stations, the

battalions evacuated the seriously ill and

wounded to Leyte and, when hospitals

there were full, to Biak. Hospital LSTs

and medically equipped APAs and hospital ships carried them on slow journeys;

increasingly, however, airplanes made

similar trips with greater speed. In either

case, the basic organization of the

effort—liaison personnel, holding stations, medical battalions—was the same.

Of the 37,716 casualties removed from

Luzon between 9 January and 30 June

1945, 25,761 or 68 percent traveled by air

and 11,955 or 32 percent by water. Both

forms of evacuation declined after May, as

the growth of hospital complexes in the

Philippines allowed more cases (even the

more serious ones) to be retained there.51

The Reconquest Completed

While the Luzon campaign raged to

the north, the soldiers of General

Eichelberger’s Eighth Army moved

rapidly to open the sheltered water

route through the islands to the south.

His veterans conquered the islands of

Palawan, Panay, Negros, Cebu (where

fighting was especially bitter), and

Bohol, as well as the Zamboanga

Peninsula of the primitive southern

island of Mindanao. The campaigns

were marked by speed, tactical skill, and

comparatively low casualties. However,

when the Eighth Army launched a drive

51See Quarterly Rpts (copies), Jan–Mar 45, for Surg,

Sixth Army, pp. 34–35, 135th Med Group, pp. 5–8, 54th

Evac Hosp, p. 2, and Surg, I Corps, pp. 34–35; ibid.,

Apr–Jun 45, for 70th Med Bn, pp. 3–6, 135th Med

Group, pp. 1–4, and Surg, Sixth Army, pp. 4, 25–26, and

an. 2. All file 319.1, HUMEDS, RG 112, NARA.

49Rpts, Trimble, 25 Dec 45, pp. 26–27, and Glenn, n.d.,

pp. 10–11, Historians file, HUMEDS, RG 112, NARA. 50M. J. Musser, Jr., and Emmett C. Townsend, “Use of

Small Air Planes for Medical Evacuation on Luzon,”

Bulletin of the U.S. Army Medical Department 4 (Aug 45):

191–96.

348 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
against the remainder of Mindanao, its

forces encountered a more difficult test.

Mindanao was almost as large as

Luzon. Its harsh topography is dominated by a volcanic mountain range, with

peaks rising to 9,000 feet. The interior

was heavily jungled, although grasslands,

coconut groves, and nipa palms covered

the coastal plains. Roads were few and

poor. But a lively guerrilla movement

under Col. Wendell W. Fertig, a U.S.

Army reservist, already controlled much

of the island’s outback. The main

Japanese defenses had been laid out

around the capital of Davao, the shores of

Davao Bay, and roads leading back to the

interior along which the enemy hoped to

conduct a fighting retreat. Declining to

meet such defenses head on,

Eichelberger instead landed elements of

the 24th and 31st Infantry Divisions at

Illana Bay on 17–22 April. A Medical

Administrative Corps officer recorded his

impressions of the landing: “Dawn is not

far off. Light begins to creep into the sky.

The black silhouettes of the sailors, busy

about the ship, take form. . . . The vast

convoy glides steadily forward in battle

formation. Flags have all been raised to

full mast.” In the wake of the naval bombardment the 24th Division swarmed

onto an undefended shore; the medical

flag went up at the 263d Medical

Battalion, and a few injured began to

gather for treatment. As the push inland

began, a Japanese sniper shot the 21st

Infantry commander in the back; an

ambulance driver then killed the

sniper—perhaps the first enemy blood of

the campaign drawn by a medic.52

Approaching Davao overland, the

Americans took the enemy in the rear

and seized the town in ten days. So far

the main medical problem was keeping

up with the speed of the advance, chiefly

along navigable rivers. Now, however,

began a month-long struggle that

recalled northern Luzon, except that the

enemy’s forces were less formidable and

less ably led. Near Davao the Japanese

were entrenched in fortified caves and

concealed dugouts. As the 24th Division

assaulted these positions, two field and

two evacuation hospitals were inundated

with casualties and had to use expansion

beds for the overflow of not only the

wounded but also, increasingly, the sick. 

Ample whole blood and penicillin

saved many lives, but delivering it was

sometimes a hair-raising adventure. A

party of medics made a daring midnight

jeep-run to deliver whole blood to a

portable. “Quite blinded” by the lights

in the closed operating tent, they found

doctors and corpsmen working over a

man hit by mortar fire; surgical technicians lay in exhausted sleep on the dirt

floor, “too tired to find their own quarters.” The dangerous trip seemed something of an anticlimax, for volunteers

had already given their own blood to the

wounded. But when the medics set out

to return to their unit, the Japanese

ambushed them on the jungle road.

Their own wounded got the blood they

had brought for others.53

Evacuation from the island was rapid.

Large airstrips were seized or built and,

beginning on 27 April, C–47s were able

to relieve the burden on local units by

carrying some 3,800 wounded to Leyte.

53Ibid., 8 Jun 45, sub: Report of Activities—V–5, sec.

2, pp. 3–5 (quotation, p. 4), file 370 (Mindanao),

HUMEDS, RG 112, NARA.

52Rpt, Capt David G. Asherman, Med Dept Info Svc

Field Off, OofCSurg, USASOS, 13 May 45, sub: Report

of Activities—V–5 [Mindanao Task Force], sec. 1, pp. 3

(quotation), 5, file 370 (Mindanao), HUMEDS, RG

112, NARA.

LARGE-UNIT WAR: THE PHILIPPINES 349
But land evacuation, from the 24th and

31st Division units advancing across the

interior, was marked by all the scenes of

exhaustion, tedium, and danger of the

earlier Pacific battlefields. Distances

were long, roads poor, bridges blown,

with the terrain changing to a series of

steep ridges that had narrow and winding paths in dense jungle growth. As the

downpours of May swelled streams and

brought rivers above their banks, the

wounded moved by small boat, by

artillery caterpillar and trailer, and by

water buffalo. Many medics believed that

only the L–5 kept the system working. 

Nevertheless, despite all efforts, collecting companies often had to serve as

de facto hospitals, and portables again

became holding units—as they had on

New Guinea—keeping the wounded for

as much as two weeks. Though battle

casualties began to fall off after 10 June,

when effective Japanese resistance

ceased, medical cases mounted rapidly

and refilled the beds vacated by the

wounded.54

54Surg, Eighth Army, Annual Rpt (copy), 1945, encl.

9, pp. 4–5, file 319.1–2; Quarterly Rpts (copies),

Apr–Jun 45, for Surg, X Corps, pp. 2–3, 8–9, Surg, 24th

Inf Div, pp. 3–4, 26, 30th Evac Hosp, p. 2, and 99th Evac

Hosp, pp. 7–9, file 319.1. All in HUMEDS, RG 112,

NARA. See also “Report of the Commanding General,

Eighth Army, on the Mindanao Operation,” pp.

162–64, CMH–L.

350 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

PULLING A MINDANAO LITTER CASUALTY ACROSS A DEEP RAVINE
The Impact of Disease

Indeed, on both Luzon and Mindanao

the health record of the Army left much

to be desired. The Filipino population, in

poor shape after years of occupation

marked by food shortages and neglect of

public health, formed a reservoir of disease. The people were friendly, mingled

freely with their liberators, and shared

their food with them. (The troops had

field rations to eat, but native dishes were

an overwhelming temptation on grounds

of taste.) Diarrheal diseases spread in

response to swarming flies, poor sanitation, and contaminated food and water.

American troops counted almost 10,000

cases of infectious hepatitis, probably

spread by feces. Venereal disease

increased rapidly, for the local women

were both attractive and needy, the soldiers too long continent, and the usual

measures of control unenforceable while

fighting raged. 

The environment contributed its own

ills. American forces recorded some

2,000 cases of dengue, as well the usual

distressing skin infections. The exhaustion and stress of continuous combat

made all other problems worse.

Psychological causes accounted for about

20 percent of the total casualties among

combat divisions of the Sixth Army. As

had now become usual, medics held such

cases in the clearing stations or in rest or

casual camps near the front, sharply

reducing personnel losses suffered in earlier campaigns. Indeed, in the last year of

the war preventive neuropsychiatry at last

came into its own despite a continuing

shortage of specialists in the field.55

Malaria, not a significant hazard since

1943, returned in strength during the

Luzon and southern Philippines campaigns. Both on Luzon and on

Mindanao the disease was well established. Yet a major source of illness lay in

the bodies of the veterans themselves.

Atabrine discipline, as ever, proved hard

to enforce in combat, and weariness and

unrelenting danger speeded relapses

among those who already carried the

infection. As the Sixth Army surgeon

remarked, “It is not unlikely that a good

many troops deliberately evaded the taking of atabrine in the hope that an

attack of malaria would take them to the

comparative luxury of a hospital.”

Indicative, too, was the rapid decline of

the disease after the fighting ended in

June. On Mindanao the incidence

began to rise about 22 May and continued through June. About a third of

those afflicted admitted not taking

Atabrine, either because it could not be

obtained on remote patrols or because

they hoped to gain a few days’ rest in a

hospital. As on Luzon, the breakdown of

malaria discipline was progressive, growing worse as combat was prolonged.56

Such conditions helped to make medical care during the Philippine campaign a paradox. The medical service

was well endowed, capable, and experienced, and yet the Sixth Army had the

worst disease record since the Seventh

Army on Sicily, more than a year before.

The comparison is suggestive, for in

both cases Americans fought campaigns

of European intensity and scope in a hot

climate and a malarious region with a

variety of insect-borne diseases.

55On preventive neuropsychiatry, see, for example,

Surg, 41st Inf Div, Quarterly Rpt (copy), Jan–Mar 45,

pp. 10–15, file 319.1, HUMEDS, RG 112, NARA.

56Quarterly Rpts (copies), Apr–Jun 45, for Surg,

Sixth Army, p. 22 (quotation), and Surg, X Corps, pp.

6–7, file 319.1, HUMEDS, RG 112, NARA.

LARGE-UNIT WAR: THE PHILIPPINES 351
Preventive medicine, facing conditions

that were partly primitive, partly urban,

and wholly disordered by war, regressed

even as surgery and evacuation had an

excellent record.57

General MacArthur declared the

Mindanao campaign over on 20 June

and, ten days later, the Luzon campaign.

The Eighth Army inherited the mopping up on Luzon, which proved to be a

formidable task against mountain

redoubts defended by so able a tactician

as General Yamashita. Commenting on

what he called the “illegitimate child

known as ‘mopping-up,’” Eichelberger

had remarked at Leyte: “The only difference between a big fight and moppingup is that when victory is obtained

nobody can call it that.” Nevertheless,

the numbers of both wounded and sick

declined sharply, as the Philippine battleground became a staging area for the

invasion of Japan.58

Amid the scenes of victory and reconstruction, the tragedy of Bataan and the

medical disasters of the early years of

the war in the Philippines faded from

view. And yet from guerrillas and liberated prisoners Americans were learning

much about the struggle to survive that

had gone on behind enemy lines—and,

in areas controlled by the Japanese, still

continued. While the medical establishment of the armed forces had been

growing to unprecedented size and

sophistication, medicine of the most

primitive sort had often been the sole

reliance of Allied personnel under

enemy control.

57Surg, Sixth Army, Quarterly Rpts (copies), Jan–Mar

45, pp. 21, 28–33, and Apr–Jun 45, pp. 20–25, file 319.1,

HUMEDS, RG 112, NARA. Despite the similar environment, the Eighth Army’s record was better than the

Sixth’s because its campaigns were shorter and enemy

resistance was less intense.

58Jay Luvaas, ed., Dear Miss Em: General Eichelberger’s

War in the Pacific, 1942–1945 (Westport, Conn.:

Greenwood Press, 1972), p. 172. A brief account of the

development of the Philippines as a medical center for

the western Pacific will be found in Chapter XIII.

352 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Despite the crushing defeats suffered

in 1942 at Bataan and Corregidor, forces

loyal to the United States and the prewar government retained control of

many remote and mountainous areas in

the Philippines. After an initial period

of fairly benevolent rule, the Japanese

regime that dominated the rest of the

islands adopted policies that encouraged armed resistance, and its occupation forces embarked on campaigns of

repression that sometimes degenerated

into reigns of terror, marked by rape,

looting, and torture. Inevitably, such

behavior drove many to join the existing

guerrilla forces and caused new bands

to spring up. 

The Guerrillas

For three years a twilight army, ultimately numbering some 200,000 men

and women, survived without regular

sources of medical supplies or skilled

treatment. The guerrillas’ lives were far

from easy, and the combination of jungle living, lack of medicines, insufficient

food, and constant uncertainty broke

down the health of many. Especially

hard hit were the Americans who joined

the movement. Lt. Donald D. Blackburn

and Major Volckmann, two Americans

who refused to surrender on Bataan,

evaded capture and fled into the jungle

only to fall violently ill with nausea and

diarrhea. Then malaria caused them to

run “the full gamut of misery, shivering

and shaking so hard that their teeth

chattered.” They became jaundiced;

Volckmann developed beriberi. A camp

of Americans in hiding, where they

found temporary refuge, was disorderly,

squalid, and swept by recurring outbreaks of dysentery. Problems of health,

order, and command among the dispirited remnants of these defeated forces

were inextricably entwined from the

beginning.1

Resistance to Japanese rule took form

spontaneously in a patchwork of groups,

whose commanders might be Filipino or

American soldiers, local leaders or malcontents, or mere bandits. Such groups

numbered in the hundreds. For medical

care, most guerrillas continued to

depend upon the aid of courageous and

sympathetic civilians. A hospital might

mean an abandoned house or a grove of

trees; treatment, the surreptitious aid of

a local doctor or nurse. Some physicians

made horseback visits after dark to the

mountain strongholds of guerrilla units.

CHAPTER XI

Behind the Lines

1

Philip Harkins, Blackburn’s Headhunters (New York:

W. W. Norton and Co., 1955), pp. 49–61 (quotation, p.

49).
The National Psychopathic Hospital

near Manila provided medical treatment to guerrillas who came to its doors,

and sympathetic staff members diverted

quinine and other critical supplies to

resistance leaders. Japanese medical

supplies were captured in raids. Supply

from Australia was slow to develop and

never abundant, but small quantities of

quinine, sulfa drugs, and bandages

arrived by submarine.

The essence of guerrilla life, however,

was making do with little, and most

fighters continued to depend on expedients. A nurse later recalled making

surgical dressings by boiling old clothes

and using coconut shells for spoons and

dishes and sections of bamboo for

drinking cups. Ultimately, guerrilla survival during the early years was a

Darwinian process. The unfit died, and

the survivors endured hunger, disease,

and infection with a tenacity they could

not have imagined in their previous lives

as civilized people.2

As the war turned against Japan and

the resistance movement spread and

matured, some larger units (especially

during 1944) developed fairly elaborate

medical establishments. No overall pattern existed, despite the efforts of

General Headquarters, SWPA, to learn

about the resistance, provide supplies,

extract information, extend recognition

to reliable commanders, and foster

unity on a regional basis. The resistance

leaders who hammered together coherent organizations, however, thought in

terms of conventional military structures and sought to model their forces

on the prewar Philippine Army. The

best of these mature organizations were

ready, when the Americans landed, to

join the fight against the Japanese as

important auxiliary forces.3

The largest single group developed on

the southern island of Mindanao. On the

big primitive island, with its complex of

tribes and religions, General

Wainwright’s order to surrender was

obeyed erratically at best. Thousands of

Philippine Army soldiers and probably

100–200 Americans—officers, enlisted

men, and civilians who resided on the

island before the war—simply disappeared into the hills. Armed resistance

began as a folk movement to which the

Americans, many of them ignorant of the

languages and customs of the place, at

first could contribute little. Many died in

the jungle of malaria or starvation; others

were killed by wild pagan tribes or by the

Moros—Moslem inhabitants of the

mountains, who loathed the Christian

lowlanders and had never fully accepted

American, or even Spanish, rule.

Some Americans found friendly villages and hid out, content to escape the

war; others joined refugee camps in the

rainforests. Colonel Fertig called one

such camp a “wet hole in the jungle,”

where twenty or thirty onetime soldiers

and sailors lived a precarious existence.

Other USAFFE soldiers joined in the

3

For a comprehensive discussion of groups and leaders, see General Headquarters (GHQ), Far East

Command (FEC), “The Guerrilla Resistance Movement

in the Philippines,” Intelligence Series, vol. 1, pts. 1 and

2, U.S. Army Center of Military History Library

(CMH–L), Washington, D.C.

354 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

2

Ibid., pp. 321–25; Alice R. Clarke, “Guerrilla Nurse:

The Story of a Nurse Who Served With the Philippine

Army,” American Journal of Nursing 45 (Aug 45): 598–600;

Russell W. Volckmann, We Remained: Three Years Behind

Enemy Lines in the Philippines (New York: W. W. Norton

and Co., 1954), pp. 120–28; Jesus A. Villamor, They Never

Surrendered: A True Story of Resistance in World War II

(Quezon City, P.I.: Vera-Reyes, 1982), pp. 117–19. See

also documents in file 275–3, box 367, Philippine

Archives, Record Group (RG) 407, National Archives

and Records Administration (NARA), Washington, D.C.. 
BEHIND THE LINES 355

disorder of the time, helping themselves

to food and women by using their

weapons in the anarchy that followed

the breakdown of the colonial administration. The first coherent bands

emerged for reasons that the founders

of feudal Europe would have understood—the need to establish local security, to obtain food, or to settle grudges.4

Some Americans emerged as leaders

of these groups. Because the United

States had guaranteed the postwar independence of the Philippines, Americans

were able to stand apart from the struggle

of factions and individuals for power.

Many possessed useful military and organizational skills. Colonel Fertig was a mining engineer who had come to the island

during the thirties. Firm, aloof, with a

gray-streaked red goatee that became his

trademark, he proved able to master difficult logistical and administrative problems. As he began to consolidate the

resistance, soldiers “sick from malaria,

hunger and exposure, were drawn to the

beacon” of his leadership.5

4

Quotation from John Keats, They Fought Alone, (New

York: J. B. Lippincott Co., 1963), p. 77. See also Larry A.

Schmidt, “American Involvement in the Filipino

Resistance Movement on Mindanao During the

Japanese Occupation, 1942–1945” (M.A. thesis, U.S.

Army Command and General Staff College, Fort

Leavenworth, Kans., 1982), pp. 74, 79, copy in CMH–L.

GUERRILLAS AND AN INFANTRYMAN CARRYING A CASUALTY through a sniper-infested

area on Luzon

5

Schmidt, “Resistance Movement on Mindanao,” p.

92, copy in CMH–L.
At first almost ignored by the

Japanese, the guerrillas under Fertig’s

leadership developed an impressive organization. Administrative districts were set

up, each with a controlling military unit;

civil government was reestablished and

civil law prevailed, subject to military law

in case of conflict. Soon more than 90

percent of Mindanao had become, in

effect, an Allied enclave behind enemy

lines. General Headquarters, SWPA, estimated a force of about 38,000 guerrillas

under Fertig’s command, plus seventy

radios and four airfields, and in February

1943 recognized his organization as the

10th Military District. In 1944 Mindanao

became a focal point for the distribution

of supplies to guerrillas on the northern

islands. 

Fertig’s staff was elaborate, with G–1

through G–5 sections, and an adjutant

general, an engineer, a quartermaster,

and a signal officer. His medical organization, on the other hand, was loose.

Filipino doctors were awarded officer

rank, and each continued to work in his

own district; small hospitals were established in secure areas to handle severe

cases. Many people under Fertig’s control continued, as in the past, to depend

largely upon practicantes, irregular healers that an American called “the local

witch doctors.”6

Even trained physicians had little to

work with. One of Fertig’s subordinates

termed a field hospital “just a quiet place

to die, because there’s almost no medicine and damn few surgical tools. . . .” A

single trained Filipino surgeon practiced

on Mindanao, but equipment was not to

be had. Lt. Jack Hawkins, USMC, who

escaped from the Davao Penal Colony

and joined the guerrillas, later recalled

that maintaining the health of his soldiers was a problem “impossible of solution. . . . I remember one poor fellow

who came to our headquarters with his

right arm black to the shoulder with gangrene. Doc Munoz, our guerrilla surgeon had to remove it. There was no

anesthetic.”7

Fortunately, during much of the occupation, fighting was at a minimum, for

the guerrillas, in line with SWPA policy

that desired intelligence above all,

sought to evade rather than engage the

Japanese. As the threat of an American

invasion grew, however, the Japanese

garrison lost its tolerance of the guerrillas and launched campaigns to exterminate them. Enemy pressure then compounded all the medical problems that

were rooted in the environment of

Mindanao.

Disease was pervasive, especially vivax

malaria, which affected virtually the

entire organization to some degree. The

guerrillas controlled the Del Monte

Plantation, where the director of

forestry in the prewar government had

planted 11 million cinchona trees.

Fertig’s men boiled cinchona bark or

6

Quotation from Interv (telephone notes), Albert E.

Cowdrey with James L. Evans, MD, 18 Aug 89,

Historians files, Historical Unit Medical Detachment

(HUMEDS), RG 112, NARA. See also GHQ, FEC,

“Guerrilla Resistance Movement,” vol. 1, pt. 1, p. 85,

CMH–L; M. Hamlin Cannon, Leyte: Return to the

Philippines, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1954), p. 16.

7

First quotation from Keats, They Fought Alone, p. 205.

Keats’ book is informative but not strictly history; though

composed with Fertig’s assistance, and perhaps based

upon his unpublished memoirs, it contains lengthy conversations that apparently were made up either by Keats

or by Fertig himself and may or may not represent what

was actually said at the time. However, in Interv, Cowdrey

with Evans, 18 Aug 89, Historians files, HUMEDS, RG

112, NARA, Evans termed it substantially accurate.

Second quotation from Jack Hawkins, Never Say Die

(Philadelphia, Pa.: Dorrance and Co., 1961), p. 167.

356 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
ground it into powder to make a pill—

primitive expedients, and not very effective. More dangerous to life were respiratory diseases. Influenza was a common

illness, and the pneumonia that followed it frequently fatal; tuberculosis

was widespread and life-threatening.

Guerrillas in flight from Japanese

patrols treated their own injuries as best

they could, using picric acid from the

detonators of Japanese mines on tropical ulcers. Scarcely believable stories

were told of some desperate expedients—an Australian named Jock

McLaren, for example, performed an

appendectomy on himself with only a

mirror and a razor blade; five days later

he escaped a Japanese patrol, carrying

his appendix in a bottle.8

SWPA medical support, like Japanese

pressure, increased as the war went on.

During 1943 and 1944 supplies arrived

by submarine every three months or so.

Medicines, including sulfa drugs and

Atabrine, were an essential part of the

cargoes delivered to obscure points on

the long Mindanao coastline. Overall,

quantities were small. One writer has

calculated the total of supplies delivered

by submarines at only 6 pounds per man

per year for the Mindanao guerrillas,

and medical supplies apparently constituted only about 8 percent of an average

cargo.

Yet SWPA’s contribution to medical

supply on Mindanao was absolutely

essential on qualitative grounds. During

1944 medical supplies were second only

to ordnance in priority, and were neither heavy nor bulky. Much arrived that

the guerrillas could not provide themselves, no matter how ingenious they

might be. Submarines also took chronically sick Americans to Australia, perhaps the most tenuous evacuation route

of the Pacific war.9

A submarine also brought Fertig, in

November 1943, the man who was to be

his friend, housemate, and force surgeon until early 1945. Capt. James L.

Evans, MC, was the stock record officer

at the 3d Medical Supply Depot in

Brisbane when he joined the staff of

SWPA’s Allied Intelligence Bureau as

medical adviser. A 32-year-old general

practitioner, and a ham radio operator

by hobby, he selected and forwarded

medical supplies to guerrilla units, until

his varied talents caused Brig. Gen.

Charles A. Willoughby of MacArthur’s

staff to send him to Mindanao in

November 1943. He arrived on the huge

USS Narwhal, which was loaded for the

trip with 90 tons of supplies that included 1.2 million tablets of Atabrine and

800,000 of quinine. Evans quickly

learned to admire Fertig and became

both the force surgeon and commanding officer of the radio section, giving

about half his time to each.10

As signalman, Evans made technical

improvements that resulted in roundthe-clock radio communications with

Australia. As a doctor, he performed the

varied duties of a general practitioner of

the time, including simple surgery. And

as staff surgeon, he established clinics to

serve the local people, sought to regularize the loose medical organization,

and was gratified to see improved care

bring the double benefit of enhanced

morale among the fighters and warmer

9

Ibid., pp. 179–80, 184, copy in CHM–L; Interv,

Cowdrey with Evans, 18 Aug 89, Historians files,

HUMEDS, RG 112, NARA. 10Interv, James L. Evans, 29 Jun 56, file 000.71,

HUMEDS, RG 112, NARA.

BEHIND THE LINES 357

8

Schmidt, “Resistance Movement on Mindanao,” pp.

129–30, copy in CMH–L.
relations with the civilians. The medical

statistics of the operation, however,

remained a mystery. Evans’ efforts to

obtain written reports on sanitation and

disease brought in a sheaf of missives in

broken English and a variety of local

dialects. He later recalled: “I even once

got a monthly sanitary report written

with wry appropriateness on half a roll

of toilet paper.”11

He became an able and professional

observer of guerrillas and their ways, a

taste that later caused him to specialize

in psychiatry. Viewing their fears and

phobias, he noted in himself a horror of

being bombed, but none of the jungle;

in another guerrilla, terror of a Japanese

attack by land, but none of being

bombed. One American seemed to fear

the possibility of appendicitis more than

the enemy. Another hoarded Atabrine

against the time when, in flight in the

jungle, he might not be able to obtain

more. Yet Evans rejected the notion,

then popular, that psychopathic personalities were especially drawn to irregular

warfare. A measure of objectivity and

even of intellectuality was needed to

accept and triumph over conditions of

life at which the flesh rebelled. A selfselected group, Fertig’s men had

refused to surrender. Evans considered

them, by and large, a stable and closely

bonded lot, capable of effective action

in the most difficult circumstances.12

His most important contribution to

Fertig’s guerrillas may have been neither as doctor nor communications specialist, but rather as a medical supply

expert. Evans developed a list of requirements that was, in effect, a medical

maintenance unit tailored to guerrilla

needs. Included were chemotherapeutic

agents against malaria and yaws and a

surgical kit, wrapped in a canvas roll,

that met one of the most persistent and

critical deficiencies of the resistance

forces. The size of every item was

designed to fit through a submarine’s

hatch. Once General Headquarters,

SWPA, accepted the list, Evans could

requisition as many units as he needed,

use them to supply the loose regional

medical organization, and even provide

some help to the civilians on whose

goodwill survival ultimately depended.13

Other guerrilla leaders made do with

medical organization as loose as Fertig’s,

but with no Evans at the center. On central Luzon the guerrillas, led by Col.

Marcus V. Augustin, whose nom de

guerre was Marking, assembled a secret

medical detachment to care for the sick

in their mountain hideouts, where the

chief complaints were skin diseases and

malaria. Not a real unit, the detachment

was composed of civilians, former

Philippine Army medical officers, and

nurses who provided part-time assistance while carrying on their normal

occupations. Marking’s guerrillas

picked up medical supplies, including

instruments, from submarines. Then

the medical detachment members,

dressed as laborers, carried the items

into Manila, where many worked, and

they established in the mountains a military hospital that later moved to the

Pasig River when the battle for the capital was raging. Here the detachment, no

longer secret, drew supplies from the

43d Infantry Division’s 118th Medical

Battalion and treated both wounded

13Ibid.; Interv, Cowdrey with Evans, Historians files,

HUMEDS, RG 112, NARA. See also Keats, They Fought

Alone, pp. 300–36.

358 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

11Ibid.

12Ibid.
guerrillas and injured civilians. When

the fighting ended, the Filipinos transferred their remaining casualties to a

U.S. Army evacuation hospital.

This pattern—a part-time medical

organization that turned into a functional unit only after the American

forces arrived at Lingayen—apparently

was repeated in other groups. Some

arrangements were even more casual.

Thus a professor from the College of

Medicine, University of the Philippines,

later claimed to have aided the obscure

(and by SWPA unrecognized) FilipinoAmerican irregular troops on Bataan.

Yet the professor continued to teach

throughout the war, and his “unit” never

entered combat. But other and tighter

organizations existed on Luzon; several

recognized medical units, for example,

served with future Philippine President

Ramon Magsaysay’s Zambales Military

District. The Communist-led Hukbalahaps, whom Magsaysay would later

defeat in a postwar civil conflict, were

also well organized and effective. They

divided the region of Luzon that they

controlled into five military districts,

and an American who served with a

“Huk” battalion later recalled that his

unit had its own “intelligence, communication, ordnance, medical, and maintenance support systems.”14

Similar organization characterized

other guerrilla bands, although the real

effectiveness of their medical support

(as of many other activities) is sometimes difficult to assess through the mist

of wartime claims and postwar romanticizing. The western Leyte guerrilla warfare forces of the controversial Blas E.

Miranda apparently had the form of a

prewar division, with a division surgeon

and regimental surgeons. Miranda

claimed to possess “one of the best hospitals ever built in the Visayas by any

guerrilla organization,” where major

and minor surgery was performed on

“officers, enlisted men and civilians.” As

was the case elsewhere, civilian doctors

and nurses contributed their services

part-time. A chemist tried to find ways to

substitute local herbal medicines for

drugs that could not be imported, and

an ordnance shop fabricated surgical

instruments. The guerrillas encouraged

civilian public health, and a veterinarian

inspected the local barrios to check for

animal diseases. Other organizations on

Leyte called in local physicians to treat

their forces and provided rudimentary

instruction to “first aiders” selected

from the ranks to form medical platoons. The first submarine shipment of

medical supplies reached Leyte in mid1944, though the question of how they

were distributed among the competing

resistance groups remains unclear.15

Unique in many ways was the organization established on Luzon by

Volckmann and Blackburn. Despite

their early troubles, the two escaped

from the Japanese and, aided by the

supposedly anti-American Hukbalahaps, crossed the Central Plains and

found a refuge in the northern mountains among the head-hunting Igorots.

15Elmer N. Lear, “The Japanese Occupation of the

Philippines: Leyte, 1941–1945,” Data Paper no. 42

(Ithaca, N.Y.: Department of Far Eastern Studies,

Cornell University, 1961), pp. 188–92 (quotations, p.

189).

14Quotation from Donald Knox, Death March: The

Survivors of Bataan (New York: Harcourt Brace

Jovanovich, 1981), p. 371. See also documents in files

110–61, 275–2, and 309–84, box 367, Philippine

Archives, RG 407, NARA. Marking’s guerrillas also put

in excellent service for the Sixth Army at the Ibo Dam.

Hukbalahap is an acronym derived from Tagalog words

meaning People’s Anti-Japanese Army.

BEHIND THE LINES 359
Along the way Blackburn recorded in

his diary their various health problems,

ranging from enduring malarial attacks

to plucking leeches out of their eyes. In

the mountains the two Americans

patiently put together a guerrilla organization dedicated, like Fertig’s, to surviving, lying low, and gathering information. As time went by, Japanese brutality nourished the resistance; so did

Filipino courage. The head of a civilian

dispensary falsified his records and sent

medicine, along with highly accurate

intelligence; and Blackburn, with much

experience of his own misfortunes to

draw upon, became the “doctor” at

Volkmann’s headquarters. 

Primitive measures remained the

rule. Blackburn cured himself of an

infected heel by walking barefoot until

the trouble cleared. Some illnesses

were treated by animist priests or magicians. Volckmann appeared to recover

from an illness after two local witches

prayed over him—perhaps, Blackburn

speculated, because the ritual distracted the sick man from his troubles and

showed him “that even strangers sincerely wanted him to get well. Mind

over matter?”16

Despite all obstacles—some created

by bandits calling themselves guerrillas—the cool, literal-minded Volckmann

worked out the structure for a small but

professionally organized army in being,

unable to engage the Japanese forces

but well able to control the countryside.

Dominating the prewar 1st Military

District in northern Luzon from the

spring of 1944 on, his United States

Army Forces in the Philippines,

Northern Luzon (USAFIP-NL), was in

effect a division headquarters that

boasted an executive officer; G–1, G–2,

and G–4 staff sections; seven sector

commands (two of which were under

Blackburn); and a total complement of

about 8,500 officers and enlisted men.

Volckmann had a Filipino staff surgeon, and on 7 October felt strong

enough to establish a medical SOP for

his forces. But obtaining doctors for

the troops was a difficult task until his

forces were able to expand out of their

mountain redoubts to the valley towns,

where most physicians lived. By March

1945, however, the USAFIP-NL had a

medical battalion of 98 officers and 808

enlisted men, organized into eight hospital companies.17

Such relative opulence came but

slowly. Blackburn, commanding a regiment, recorded that his medical section

originally consisted of a doctor and a

nurse. By 1945 guerrilla organization

and prestige had improved; in the town

of Tuao “he found two first-class physicians, Jacob Pena and Juan Asuncion,

and one topflight surgeon, Gonzalo

Cabalquinto.” With these doctors he

“was finally able to organize a badly

needed medical department,” which he

divided into two sections, fixed and

mobile. Pena supervised the building of

four base hospitals, two in each of

Blackburn’s districts. The largest stood

at Manauan, a few miles from Tuao—a

structure with a thatched roof and

floors, containing an emergency room,

operating room, and several wards

whose sixty beds were “closely woven of

17SO 93, 7 Oct 44, Medical Organization, file

USAFIP-NL, box 258, Philippine Archives, RG 407,

NARA; Historical Records Section, G–3, United States

Army Forces in the Philippines, Northern Luzon

(USAFIP-NL), “After-Battle Report: North Luzon

Operations,” p. 5, file Geog S—Luzon 370.2, CMH.

360 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

16Harkins, Blackburn’s Headhunters, pp. 159, 168 (quotation).
bamboo strips.” The mobile section

under Asuncion was a medical company, comprised of a collecting platoon

and three aid stations. Each station followed a battalion in combat.18

Seemingly, equivalent arrangements

were made in the other sectors. In each

an organization loosely based on the

prewar Philippine Army regiment was

set up. Field hospitals were organized,

each, according to Volckmann, with 6

doctors, 1 dental officer, 6–14 nurses,

and 70 enlisted men, augmented when

necessary by civilians. The question of

supplies for this establishment is difficult to clarify. Northern Luzon was the

most remote point in the Southwest

Pacific Area islands; on the other hand,

Luzon contained cities, ports, and

enemy headquarters. Medical materiel

seems to have been sparse and obtained

in great part from local sources, including the Japanese Army. As Volckmann

wrote, “Once when in desperate need of

medical supplies and instruments we

found it necessary to raid two Jap installations, which were successfully moved

lock, stock and barrel, minus the Japs,

out into the mountains.” Prior to the

Lingayen landing, supplies were seized,

purchased (apparently by giving IOUs,

which the American government later

honored), or obtained through donations. Medicines came by submarine

only twice, on 18 December 1944 and

on 10 January 1945.19

To Volckmann and Blackburn, the

value of medical support for the guerrillas was many sided. During the buildup

phases it was essential to personal survival. Both men suffered severely from

diseases and infections, and depended

on any treatment available so that they

could continue to do their jobs, lead

their forces, and fight on. The medical

establishment they created out of such

slight materials aided them in sustaining

morale and also in winning popular support. In camp the discipline of preventive medicine (as they had learned

early) was an important aspect of not

only maintaining health but also

reestablishing a sense of self-worth

among defeated troops. Such medicine

was a long way from the science of great

Army hospitals, but it met the elemental

needs of the guerrillas in a hard and

hostile world.

Once American units had landed at

Lingayen, Volckmann’s guerrillas

became semi-regular forces, enjoying

many of the advantages and facing

many of the problems of the Sixth and

Eighth Armies. They operated in mountainous terrain against General

Yamashita’s tenacious defense; in May

and June 1945 they fought well as regulars while attacking Japanese positions

at Bessang Pass. Large numbers of

severely wounded casualties tested the

guerrilla medics to the full. Surgical

instruments were still few and laboratory facilities poor. For this reason, difficult cases and those needing to be Xrayed were sent back to U.S. Army station hospitals. But litter-bearers

attached to the battalion aid stations

carried out the wounded on Army

stretchers, instead of the “bamboo beds

or hammocks” that had served in earlier fights. Access to regular sources of

supply meant other advantages.

Requisitions by the chief surgeon

brought airdrops at first and then regular resupply via landing craft operating

BEHIND THE LINES 361

18Harkins, Blackburn’s Headhunters, pp. 271–72. 19Volckmann, We Remained, pp. 128 (quotation), 136;

GHQ, FEC, “Guerrilla Resistance Movement,” pp.

44–45, CMH–L; USAFIP-NL, “After-Battle Report,” p.

204, file Geog S—Luzon 370.2, CMH.
along the coast. Apparently, Volckmann

established a division clearing station,

elaborating the original simple chain of

evacuation, and his hospitals expanded

to treat the influx of wounded.20

Expansion was essential, and personnel and supplies were now available. In

February Volckmann had established a

large base hospital, which gradually

expanded from 150 to 800 beds to

accommodate both medical and surgical cases. When rains flooded the camp

site, the hospital moved into large

buildings at Tagudin and obtained its

food from a supply depot nearby.

Surrounded by tented wards, it

attained a 2,000-bed capacity by the

beginning of June. By now the facility

was in all but name a general hospital

and a large one, though by no means

up to U.S. Army standards in equipment or specialists.

Without large increments of civilian

volunteers—doctors, nurses, pharmacists, and attendants—such units could

not have functioned at all. Even so, the

personnel “were practically on 24

hours duty.” Volckmann rewarded

their service with commissions, including the volunteer nurses who entered

the Army Nurse Corps, Philippine

Army. As the Japanese retreated and

the front contracted, smaller hospitals

were merged one by one into the base

hospital. In July 1945 surgical cases

had begun to decline in number,

though apparently the procedures performed increased in complexity, suggesting a more varied professional

staff. By now patients were wearing

pajamas and sleeping on sheets under

mosquito nets—a condition approaching luxury for these hard-bitten onetime irregulars.21

Medical cases continued to climb

until September, with an overall record

that echoed the experience of the Sixth

Army in fighting hard campaigns in the

Philippine disease environment. As had

been the case with American forces

early in the war, commanders proved lax

about enforcing malaria discipline,

which had to be made a command function; a court-martial was ordered for any

officer or enlisted man, sick of malaria,

who was found to have been lax about

taking Atabrine. The effect, according

to one of Volckmann’s surgeons, was to

reduce “malaria morbidity among our

troops to 60%.” Even for a guerrilla

army, well acclimated and overwhelmingly Filipino in makeup and leadership, and equipped with American Army

supplies and medical backup, this old

enemy remained unconquered as fighting ended in August 1945.22

Overall, the guerrilla experience

suggested the critical importance of

very simple things in maintaining the

health of irregular forces. Evans

emphasized that the guerrilla doctor

ought to be young, tough, and adaptable; a general practitioner rather than

a specialist, with experience in surgery;

and, above all, flexible in mind, gifted

with patience, and able to absorb and

survive defeat. The guerrilla band

needed a few men with diverse and

basic skills, a short list of crucial supplies and equipment that could be

brought in over tenuous supply lines, a

good working relationship between surgeon and commander, and—in medi21Ibid., pp. 197 (quotation), 207, file Geog S—Luzon

370.2, CMH. 22Ibid., p. 204, file Geog S—Luzon 370.2, CMH.

362 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

20USAFIP-NL, “After-Battle Report,” p. 207, file Geog

S—Luzon 370.2, CMH.
cine as in all things—the support of the

civil population.

Medical aid given by the guerrillas to

the people among whom they lived

meant much to this relationship. Yet

there can be no question that medical

aid flowed primarily from the populace

to the guerrillas, rather than the other

way around. For medical care as for

food, information, and recruits, the

guerrillas depended on the people.

And the people sustained them—out of

fear, out of loyalty to the prewar government, or out of hatred of the

Japanese.23

Prisoners of War

Armed and free to move about (but

within sharp limits so as not to be detected by the Japanese), the guerrillas maintained their fighting spirit in part by

their intimate knowledge of what happened to those who surrendered. The

Japanese probably did not write the

worst record of World War II in dealing

with prisoners of war; comparative

death rates suggest that that distinction

was earned, either by the Germans for

their treatment of prisoners taken on

the Eastern Front or by the Russians for

their treatment of the Germans. Yet the

Japanese Army was guilty of mistreatment that ranged from neglect to torture, that brought death to many prisoners, and that later caused some officers to be tried and executed as war

criminals.

For medical personnel who fell captive at Bataan and elsewhere, imprisonment meant not only sharing the miseries of their comrades but also attempting, usually against great odds, to save

the lives of officers, enlisted personnel,

captive civilians, and sometimes their

Japanese guards in camps that dotted

the Philippines, Formosa, Manchuria,

Korea, and Japan.24

The practices and cultural assumptions of the Japanese military differed

sharply from those of the Western powers. Japanese soldiers were routinely

brutalized during training, and the

least resistance to orders was savagely

punished. Combatants were, and

expected to be, treated as expendable.

Surrender was a court-martial offense,

a shameful act that cut the prisoner off

from his people and kindred.

Treatment facilities for casualties were

often grossly inadequate, for reasons

that may have been primarily logistical.

Precautionary measures—for example,

safety devices installed in American

warplanes—were regarded, with contempt, as unworthy and cowardly. Such

23Interv, Evans, 29 Jun 56, file 000.71, HUMEDS, RG

112, NARA.

24Howard S. Levie, Prisoners of War in International

Armed Conflict, International Law Studies, vol. 59

(Newport, R.I.: U.S. Naval War College Press, 1978), p.

5; Bernard M. Cohen and Maurice Z. Cooper, A FollowUp Study of World War II Prisoners of War, VA Medical

Monograph (Washington, D.C.: Department of

Medicine and Surgery, Veterans Administration,

1954), pp. 15–24; U.S. Department of Health,

Education, and Welfare, Message From the President of the

United States Transmitting the Report of the Secretary of

Health, Education, and Welfare, Entitled Effects of

Malnutrition and Other Hardships on the Mortality and

Morbidity of Former United States Prisoners of War and

Civilian Internees of World War II: An Appraisal of Current

Information, 84th Cong., 2d Sess., 12 January 1956, H.

Doc. 296, p. 33; Wibb E. Cooper, “Medical

Department Activities in the Philippines From 1941 to

6 May 1942, and Including Medical Activities in

Japanese Prisoner of War Camps,” pp. 144–49, file

314.7, HUMEDS, RG 112, NARA. The legal situation

with respect to Japan, which had signed and ratified

the Hague Convention of 1907 and signed but not ratified the Geneva Convention of 1929, is discussed in

“International Military Tribunal for the Far East: The

United States of America and Others versus Araki

Sadao and Others,” 4:1121, CMH–L.

BEHIND THE LINES 363
attitudes regarding caste, honor,

expendability, shame, and death were

premodern in origin, but formed a

mindset much cultivated by Japanese

officers during the 1920s and 1930s.25

The consequences of Japanese military ideology appeared early in the fighting. The fall of the Philippines in April

1942 delivered tens of thousands of

Americans and Filipinos into the hands

of the Japanese. On Bataan most captives were already in poor condition

from starvation and malaria when they

began a march of about 100 miles, some

in trucks but many on foot, toward

prison camps north of Manila. No medicines were available, except those the

prisoners carried themselves and the little distributed by American medical personnel at makeshift aid stations along

the way. Dysentery and exhaustion were

second to hunger, for no provision had

been made for water or food. Some

Filipino civilians courageously gave

364 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

25Edward J. Drea, “In the Army Barracks of Imperial

Japan,” Armed Forces and Society 15 (Spring 89): 329–48;

“International Military Tribunal for the Far East,”

4:1142–44, CMH–L, in which the defense attorney cites

the views of anthropologist Ruth Benedict. In his article

“Japanese Treatment of Prisoners in 1904–1905—

Foreign Officers’ Reports,” Military Affairs 39 (Oct 75):

115–17, Philip A. Towle presents evidence that Japanese

behavior toward prisoners of war in World War II

reversed an earlier record of humane treatment during

the Russo-Japanese War.

AMERICAN PRISONERS UNDER JAPANESE GUARD SORTING EQUIPMENT
small handouts to the weary marchers,

but supplies were hopelessly inadequate

to the need. No sanitary facilities existed

in rest camps, and the living were often

denied opportunity to bury the dead. 

Brutality by the guards was erratic.

Some prisoners who fell out, unable to

continue, were bayoneted and left by

the roadside; some were buried alive.

Human feeling perished; prisoners

buried dead and living comrades at bayonet point or abandoned fallen friends

in the road. At San Fernando the survivors received a bowl of rice each and

some water, before being jammed into

boxcars for a 25-mile journey into the

Tarlac Province. At the end of the journey they walked another 3.5 miles to

Camp O’Donnell. About 650 Americans

and 5,000 to 10,000 Filipinos had perished on the march.26

Meanwhile, at the end of May the

Japanese partially evacuated the hospitals on Bataan, sending General

Hospital No. 2 to Cabanatuan. Patients

and hospital staff were provided trucks

to ride in, along roads still lined with

decomposing bodies from the march.

(Hospital patients were among the

dead, for some Filipinos, hearing a

rumor that they were to be allowed to

return home, had left while still sick to

join the Death March.) Though

Hospital No. 2 was obliged to go emptyhanded, General Hospital No. 1,

favored on account of its well-run ward

for Japanese prisoners, retained its own

equipment and supplies plus medicines

that had been moved to its stores from

No. 2. The combination of enemy generosity and American cleverness ultimately benefited prisoners at Camp

O’Donnell, where Hospital No. 1 was

sent by stages in late June and early July.

By the time it arrived there it was very

badly needed.27

O’Donnell was a half-completed training camp for Philippine Army recruits.

Its bamboo and nipa structures had

unfinished roofs and unconnected water

pipes. No utilities had been installed,

and the septic system was only partially

complete. Situated in the barren piedmont of the Zambales Mountains, the

camp was surrounded by a heavy growth

of mosquito-infested cogon grass. Here

the 9,000 American and 45,000 Filipino

survivors of the Death March endured

days of burning sun without adequate

food, water, or medicine. 

Dysentery was almost unavoidable, for

the prisoners lacked tools to dig latrines,

oil to kill the maggots that swarmed

there, soap and water to clean themselves or their huts, fuel to boil contaminated water, and drugs to treat illness

when it appeared. In consequence,

the camp became one vast sewer, foul and

stinking. Clouds of flies buzzed everywhere:

in the latrines, where they dropped their

eggs in teeming filth; on the faces of those

BEHIND THE LINES 365

26W. H. Waterous, “Reminiscences of Dr. W. H.

Waterous Pertinent to World War II in the Philippines,”

pp. 56–57, file 314.7–2; Cooper, “Medical Department

Activities,” pp. 100–06, file 314.7. Both in HUMEDS,

RG 112, NARA. See also Stanley L. Falk, Bataan: The

March of Death (New York: W. W. Norton and Co., 1962),

pp. 197–98.

27Waterous, “Reminiscences,” pp. 59–62, file 314.7–2;

James W. Duckworth, “The Official History of General

Hospital Number One, United States Army Forces in the

Far East, at Camp Limay, Bataan, Little Baguio, Bataan,

and Camp O’Donnell, Tarlac, Philippine Islands, From

December 23, 1941 to June 30, 1943,” pp. 4–5, file

319.1–2 (General Hospital 1) Philippine Islands; James

O. Gillespie, “History of General Hospital Number 2,”

pp. 23–32, file 314.7–2; idem, “Recollections of the

Pacific War and Japanese Prisoner of War Camps,

1941–1945,” pp. 25–32, file 314.7–2; Interv, Col James W.

Duckworth, 4 Jun 45, file 000.71. All in HUMEDS, RG

112, NARA. See also Alfred A. Weinstein, Barbed-Wire

Surgeon (New York: Macmillan Co., 1948), pp. 48–67.
in coma, rimming their lips and drinking

from their half-open eyes; over open, dripping ulcers of arm and leg; in filth-soaked

clothing. They settled in an almost solid,

quivering mass on the rice buckets as they

were loaded by shovel from the steaming

kawalis [open kettles], refusing to rise as

they were waved away by K.P.’s.

Eating became a tricky maneuver; one hand

rapidly shoveled rice from mess kit into

mouth while the other moved back and

forth over a rag with which the rice in the

mess kit was kept covered.

Requests to the Japanese guards for

food, medicine, and tools were turned

away. Deaths from amebic and bacillary

dysentery, malaria, and beriberi mounted accordingly. From 15 April to 10 July

about 22,000 Filipinos and 1,500

Americans died—548 on a single day, 27

May.28

In early July most of the surviving

Americans were transferred to the camp

at Cabanatuan, where their arrival made

an unforgettable impression on the relatively strong and well-off captives from

366 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

PRISONERS ON THE DEATH MARCH

28Quotation from Weinstein, Barbed-Wire Surgeon, p.

72. Statistics from Duckworth, “History of General

Hospital Number One,” p. 5, file 319.1–2 (General

Hospital 1) Philippine Islands, and from Gillespie,

“Recollections,” pp. 44–45, file 314.7–2, HUMEDS, RG

112, NARA. Beriberi is caused by vitamin B–1 (thiamin)

deficiency and has two forms, wet and dry.
Corregidor. With tears in his eyes, the

camp’s medical director watched all that

remained of the battling bastards of

Bataan:

Inching their way along the road came a

ragged formation of dirty, unkempt,

unshaven, half-naked forms, pale, bloated,

lifeless. They staggered and stumbled, some

plodded, others uncertain of their balance

and strength lay down. . . . Limbs grotesquely swollen to double their normal size. Faces

devoid of expression, form or life. Aged

incredibly beyond their years. Barefeet [sic]

on the stony road. Remnants of gunny sacks

as loin cloths. Some stark naked. Bloodshot

eyes and cracked lips. Smeared with excreta

from their bowels. Thus they came . . . to the

end of the road, the strong, young and alert

men of the 31st U.S. Infantry, the Air Corps,

Artillery and supporting services.29

Back at O’Donnell, General Hospital

No. 1 confronted the shambles that

remained. Captives, mostly Filipinos,

were dying at the rate of 300–500 a day,

many in St. Peter’s Ward, a makeshift

hospital for terminal dysentery cases,

where 500 patients lay on the dirt floor.

The 156 Americans at the camp also

were gravely ill. Every prisoner was suffering from some form of deficiency disease. Since the Japanese had sent Col.

James W. Duckworth, MC, the commander of No. 1, to Manila to be treated for

appendicitis, the initial work fell to Col.

John J. Schock, DC, a dental officer, who

commanded in his absence. Still in possession of medicines, surgical instruments, mattresses, and even refrigerators brought from Bataan, he and his

subordinates were able to set up a recognizable medical center. Returning on

19 July with a welcome reinforcement of

officers and enlisted medics from

Corregidor, Duckworth found the camp

transformed. The old latrines had been

covered, and the new ones were burned

out daily and sprinkled with lime. The

stagnant pools of water had been

drained and the cogon grass cut and

burned, and all water for drinking was

boiled or chlorinated. The camp was

being policed daily. 

Duckworth continued and amplified

Schock’s work in his own way. He divided his unit into five subsections that provided specialized treatment. In this way

the medics could handle the greatest

possible number of patients and isolate

as many sick as possible from contact

with those who were still well. He

cajoled small quantities of quinine and

diphtheria antitoxin from the Japanese,

extracted more from the “grapevine,” as

he called the camp black market, and

received still more from a married couple, Romeo and Fe Atienza, the

Philippine Red Cross representatives

who risked and suffered beatings for

bringing medicines into the camp.30

Duckworth also persuaded the

Japanese to provide more protein and

vitamins for the prisoners’ diet. The

daily ration of rice, watery weed soup,

and an occasional strip of carabao meat

was supplemented by small weekly additions of fresh fruit, oleomargarine,

coconut oil, sugar, lard, and flour. A tiny

meat ration became standard—about 5

ounces per man per day—and the sick

received some eggs and canned milk.

The medics pitched in to build the facilities the camp desperately needed. They

constructed crude showers, strung elec29Gillespie, “Recollections,” p. 50. file 314.7–2,

HUMEDS, RG 112, NARA.

30Quoted word from Interv, Duckworth, 4 Jun 45, p.

15, file 000.71, HUMEDS, RG 112, NARA. See also

Julien M. Goodman, M.D.P.O.W. (New York: Exposition

Press, 1972), p. 49.

BEHIND THE LINES 367
tric wires, laid water and sewer pipe, dug

drainage ditches, and hammered

together boardwalks over the contaminated soil. 

Duckworth was remarkably successful

in his relations with the Japanese. He

obeyed their orders and maintained firm

discipline among his medical personnel.

Finding that the Japanese lacked a dental corps, he had his own dentists work

on them. American doctors provided

medical treatments as well, for

Duckworth judged Japanese Army doctors to be “very low grade” in the main (a

view commonly held by American medical officers), though he made an exception for the Japanese medical officer at

O’Donnell, a Dr. Yasamira. No doubt

medical attention was part of

Duckworth’s secret for obtaining supplies from the Japanese. But he succeeded also by his presence—his massive

physical build; his soldierly manner; and

his cool dignity that impressed “even . . .

the Japanese who confronted him.”31

Meanwhile, Camp O’Donnell

approached the end of its unhappy history. The Japanese adopted a policy of

indoctrinating the Filipinos in the glories

of the Great East Asia Co-Prosperity

31First quotation from Interv, Duckworth, 4 Jun 45, p.

9, file 000.71, HUMEDS, RG 112, NARA; second quotation from Goodman, M.D.P.O.W., p. 47. See also

Duckworth, “History of General Hospital Number

One,” p. 5, file 319.1–2 (General Hospital 1) Philippine

Islands, HUMEDS, RG 112, NARA.

368 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

AMERICAN PRISONERS AT CAMP O’DONNELL
Sphere, and began to send them to their

homes. With diminishing numbers,

improving food, basic sanitation, and

simple medical treatment, the death rate

among those who remained plummeted

from about 550 a day to 500 a month and

then to 5 a month. During the last two

months at O’Donnell no one at all died.

In January 1943 the Japanese closed the

camp down and sent the majority of the

Americans to Cabanatuan, minus most of

their medical equipment and supplies.

Duckworth went to Old Bilibid, where

most high-ranking officers were

interned, depriving the main American

prison camp of a skilled hand and a

source of leadership and inspiration.32

Cabanatuan

Sixty-five miles north of Manila in the

Central Plains of Luzon, the town of

Cabanatuan was the site of an abandoned

Philippine Army camp. By mid-1942

about 9,000 prisoners lived there, laboring in the camp itself, on an adjacent

farm, and on a nearby airfield. Across the

road from the main camp, General

Hospital No. 2 was just establishing itself

in barracks of bamboo and nipa when

the main transfer of Americans from

O’Donnell occurred. The hospital census

rose from 420 on 8 June to 2,512 on 20

July. With so many patients, many already

moribund, and with almost no supplies,

conditions at Cabanatuan became worse

during the same period that those at

O’Donnell became better. Every day

naked bodies were dragged or carried to

shallow graves. Not until 15 December

was a medical officer at Hospital No. 2

able to record: “1st day since organization of this hospital—no deaths.”33

Col. James O. Gillespie, MC, the commander of Hospital No. 2 on Bataan,

had continued in that position until

July, when an American camp command

was established. He then became the

medical director of the entire camp,

and Lt. Col. William R. Craig, MC, succeeded him at the hospital. In

September Gillespie was sent to

Formosa, the fate of many ranking officers. Craig took his place as medical

director, and Lt. Col. Jack W. Schwartz,

MC, a urologist who had turned himself

into an able general surgeon on Bataan,

took over the hospital.

In turn, each attempted to reach as

many prisoners as possible with the inadequate means available to him. A camp of

the sick surrounded the hospital, divided

into wards for the acutely ill and a convalescent area, while dispensaries served the

working prisoners. The hospital offered

primarily nursing care; the Japanese provided no medicines until late July, and 

not much thereafter. Some contacts had

developed with Filipinos outside the

camp, and a trickle of medical supplies

began to be smuggled in. Nevertheless,

in a twenty-day period of June 498 died

and 789 more in July. The causes were

malaria, diphtheria, dysentery, and the

diseases of malnutrition. The camp cemetery now held 1,287 Americans, and

would contain more than 2,400 before

33Statistics and quotation from Maj Edward R.

Wernitznig, MC, Diary, 8 Jun, 20 Jul, and 15 Dec 42,

Historians files, HUMEDS, RG 112, NARA. See also

Emerson, Guest of the Emperor, pp. 28–29, copy in

CMH–L. 

32Interv, Duckworth, 4 Jun 45, file 000.71; Cooper,

“Medical Department Activities,” pp. 106–09, file 314.7;

Duckworth, “History of General Hospital Number

One,” pp. 5–6, file 319.1–2 (General Hospital 1)

Philippine Islands. All in HUMEDS, RG 112, NARA.

See also Weinstein, Barbed-Wire Surgeon, pp. 71–103;

Kary C. Emerson, Guest of the Emperor (Privately published, 1977), pp. 23–24, copy in CMH–L.

BEHIND THE LINES 369
evacuation and improved food supplies

ended the wave of deaths.34

Conditions at Cabanatuan in the early

days were not much better than the worst

at O’Donnell, and for the same causes.

The diet was grossly inadequate; malaria

and diphtheria went unchecked for several months because of a lack of quinine

and antitoxin. No insect screens were

available, pit latrines overflowed, water

was scarce (three taps for 9,000 men),

and soap not to be found. Flies multiplied and dysentery spread, creating

scenes that were becoming all too familiar wherever Japanese prisons stood. As

Colonel Gillespie wrote, “One might see

the malnourished remnant of a formerly

strong young man eating his rice while

sitting beside a companion either dead

or dying and apparently indifferent to

the filth, flies, foul odors and the utter

horror of the situation.” In the hospital,

attendants could not keep their patients

clean, for almost nothing was available

except cogon-grass brooms to sweep the

wards. A hut numbered 0 was set aside

for moribund dysentery cases, and, like

the St. Peter’s Ward at O’Donnell, assignment to the Zero Ward was tantamount

to a sentence of death for all but a few,

the ward physician recalling that “no tile

floor in a slaughterhouse ever looked

redder than that ward with bloody liquid

stools all over the place.”35

Had such conditions continued, few

prisoners would have survived the war.

But improvements began to be noted

toward the end of July. On the twentysixth the Japanese for the first time

issued quinine, diphtheria antitoxin (an

epidemic had broken out that claimed

125 lives), and a few other medicines.

Two Filipina Red Cross nurses smuggled

large quantities of antitoxin into the

camp with the aid of a Japanese camp

doctor, who was enamored of one of

them. The prisoners responded with an

active cleanup campaign, Army engineers leading the work of constructing

septic tanks, digging wells and drainage

ditches, and building new latrines.

But crowding—80 to 100 men occupied barracks intended for 40—and lack

of medicines to treat dysentery were

continuing sources of illness and death,

as was a diet that averaged 600–800 calories a day, with almost no protein. The

food supply reached its nadir in

October, when a doctor noted that

“patients have been eating cats, dogs,

rats, frogs, and earthworms.”

Improvement came in November, when

the Japanese brought carabao for

slaughter into the camp. Quantities of

meat were added to the whistleweed

soup, and some vegetables were provided from the camp farm. Work details

received bread, and the sick were given

canned milk. But anything that was

remotely edible continued to be consumed. Stray dogs, entering to scavenge

at the slaughterhouse, were trapped in

pits; frogs that invaded the camp in pursuit of maggots wound up, with their

prey, in prisoners’ bellies, after being

cooked on a doctor’s alcohol stove.36

36Maupin Diary, 31 Oct 42, Historians files,

HUMEDS, RG 112, NARA. Whistleweed is an aquatic

vine found in irrigation ditches and ponds. It resembles

the sweet potato vine, but its stems are tough and

woody.

370 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

34Gillespie, “Recollections,” pp. 40–41 (statistics), file

314.7–2; Maj Clinton S. Maupin, MC, Diary, 30 Sep 42,

Historians files. Both in HUMEDS, RG 112, NARA. 35Gillespie, “Recollections,” pp. 40–41 (first quotation, p. 40), file 314.7–2; Waterous, “Reminiscences,”

pp. 68–70 (second quotation, p. 69), file 314.7–2;

Cooper, “Medical Department Activities,” p. 116, file

314.7. All in HUMEDS, RG 112, NARA. Microscopic

examination showed that some of the patients had

cholera.
But better days were at hand. The

Japanese at last formally recognized

their captives as prisoners of war.

Though Japan was not a signatory to the

Geneva accords that set international

standards for the treatment of prisoners

of war, the officers and some enlisted

men were paid small sums that enabled

them to purchase canned goods and

fruit from Filipino vendors, who now

were permitted in the camp. The

Japanese allowed sports equipment and

musical instruments into the camps for

recreation, and at Christmas 1942 issued

Red Cross supplies of medicines and

food—corned beef, meat and vegetable

stew, and sugar. Startling improvements

were noted in beriberi and pellagra

patients. The prisoners began to regain

lost weight, and the death rate fell from

about 300 to 3 or 4 a month.37

The period of stabilization that now

set in was to be repeated many times in

the prisoner-of-war experience. In a new

camp, guards were brutal and food

sparse; prisoners died in great numbers,

and life for a time was almost insupportable. Then more food would become

available, lax or friendly guards would

be identified, and a variety of petty

arrangements—rackets might be a better word—would be worked out among

the prisoners, their guards, and the people outside the camp. In spite of shakedowns, prisoners saved personal articles,

sold them to guards, and used the

money to buy food. Sympathizers outside the wire even smuggled Japanese

occupation notes—Mickey Mouse

money, as the prisoners inevitably called

it—into the camps.

The emergence of a barter economy

brought some unpleasant characters to

the fore. Gillespie remarked that “men

generally degenerated [in the camps,

and the] finer qualities of honor, fortitude, honesty and fair play disappeared.

Some stole, others secured additional

food through fraud and cheating.”

Inebriates got hold of the alcohol used

as fuel in Japanese trucks and “created

disturbances.” Entrepreneurs became

“‘big time’ operators and, in connivance

with Japanese guards, established ‘black

markets’ in food, tobacco, medicines,

and other commodities. They profited

immensely at the expense of their fellow

victims.” He added that “some of the

officers were little or no better than the

worst of the men.” (One memoirist

added that a few medical personnel

were among the offenders, selling sulfa

or quinine tablets originally taken from

Army stores for food or other benefits.)

However, the perception of the traffickers as racketeers should not obscure

their importance in bringing essential

goods into the camps, by whatever

means.38

Prisoners usually worked, earning

small sums, and stole as much as they

could. Sometimes a particular item

(sugar, for example, among prisoners

whose job was loading the commodity)

became a sort of money for a camp, serving as a medium of exchange in many

transactions. Guards were bribed, and

food was purchased from civilians. No

prisoners were prosperous by the stan38Quotations from Gillespie, “Recollections,” p. 48,

file 314.7–2, HUMEDS, RG 112, NARA. See also

Hawkins, Never Say Die, p. 75.

37Waterous, “Reminiscences,” pp. 69, 79, file 314.7–2;

Cooper, “Medical Department Activities,” p. 120, file

314.7; Gillespie, “Recollections,” p. 39, file 314.7–2. All

in HUMEDS, RG 112, NARA. See also Merle M.

Musselman, “Nutritional Diseases in Cabanatuan,” War

Medicine 8 (Dec 45): 325–32; Goodman, M.D.P.O.W.,

pp. 73–74.

BEHIND THE LINES 371
dards of free men. But a few became

kings of the hobo jungle they lived in,

and most became stronger and regained

hope of ultimate liberation. 

Prisoners’ sexual habits reflected the

changes in their condition. When they

were hungriest, the drive entirely disappeared. As their condition improved, it

revived, manifested in nocturnal emissions and masturbation and, for those

who were fortunate, in brief liaisons with

local women or prostitutes during work

details outside the wire. Homosexuality

also appeared, both in the form of prostitution by a few, who bartered their services for food, and in more stable relationships as well. “Homosexuality was

present in all nationality groups,” reported one medical officer. “This reached a

point that . . . [one doctor] conducted a

weekly marital relations clinic, in an

effort to keep the couples happy in our

tight society.”39

A second pattern, supporting the

first, depended on the prisoners’ physical adaptation to short rations and the

stress of prison life. Many successfully

reverted to a primitive level of existence,

and “once that state was achieved, a condition of relative balance resulted, morbidity stabilized, and mortality rates fell,

at least until some severe new stress”

occurred. Lt. Col. Willard H. Waterous,

MC, an eye, ear, nose, and throat specialist captured on Bataan, regretted

that systematic clinical studies of the

phenomenon were impossible under

camp conditions. He observed, however,

that the body could acquire the ability to

use whatever vitamins were available in

the poor rice diet. “In the early days [at

Cabanatuan],” he wrote, “hundreds of

cases of corneal ulcers were seen; in the

later months [of 1942] practically none

were to be seen,” emphasizing that the

change occurred before additional food

and Red Cross packages became available. “In my opinion this all goes to

show the enormous flexibility and

adaptability of the human mechanism

under conditions of duress.”40

Other signs of toughness and flexibility also were noted. Strangely enough,

given the situation in which they lived,

few prisoners became psychotic.

Though irritability and backbiting were

common, psychoneurosis also was rare.

Perhaps those who were susceptible to

depression died early; perhaps others

did not behave irrationally because such

symptoms evoked no sympathy and

offered no escape from hunger and

beatings. The chief exceptions to the

rule were mental disturbances resulting

from the diseases of malnutrition or

cerebral malaria. The psychotics who

did appear were removed to locked

wards at Old Bilibid.41

The matured medical service at the

camp provided a variety of services,

though necessarily in rudimentary form,

given the circumstances. The medical

director established overall medical and

40First quotation from Charles G. Roland, “Stripping

Away the Veneer: P.O.W. Survival in the Far East as an

Index of Cultural Atavism,” Journal of Military History 53

(Jan 89): 79; remaining quotations from Waterous,

“Reminiscences,” p. 102, file 314.7–2, HUMEDS, RG

112, NARA. 41The observations of Army doctors in this respect

were confirmed at the end of the war by Army and Navy

physicians examining newly freed Allied prisoners. See

Department of the Navy, “The United States Navy

Medical Department at War, 1941–1945,” 1:656, files of

Bureau of Medicine and Surgery Archives (BMSA),

Washington, D.C. See also Chapter XIII of this volume.

372 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

39Quotations from Knox, Death March, p. 419. Most

prisoner narratives are reticent about sexual matters;

see, however, Weinstein, Barbed-Wire Surgeon, pp.

160–61, 236; J. E. Nardini, “Survival Factors in

American Prisoners of War of the Japanese,” American

Journal of Psychiatry 109 (Oct 52): 241–48.
sanitary policy, while the hospital commander saw to the acutely ill and convalescent. Usually 50–60 officers—doctors,

dentists, veterinarians, and MACs—were

assigned to the hospital, and about half

that number to the dispensary service,

organized to meet the outpatient needs

of the workers. Despite continuing shortages of all essentials, the medics operated dental clinics, provided sanitary

inspection services, established a rudimentary medical supply system, and

supervised the slaughtering of animals

for food. At the hospital, surgery was performed and an eye, ear, nose, and throat

clinic treated corneal ulcers and loss of

vision resulting from avitaminosis.

The medics could not perform miracles, however, and miracles were needed

at Cabanatuan. In part, the insoluble

problems were the work of the Japanese

prison doctor, a particularly heartless or

obtuse individual later convicted as a

war criminal. But major difficulties

resulted from the course of the war and

the consequent failure of the enemy’s

logistical system. Without warning, the

Japanese began to reduce the diet in the

second half of 1943, until the prisoners

were subsisting on about 1,000 calories a

day. The diseases of malnutrition

promptly reappeared; soon three-quarters of the prisoners showed some symptoms of beriberi, especially the so-called

wet form, with edema of the eyelids,

limbs, and abdomen. In December 1943

another shipment of Red Cross supplies

was issued minus the medical supplies,

which were sent to Old Bilibid and

issued to Cabanatuan on monthly requisition. Improvement in the prisoners’

health, however, was slight, because the

regular ration continued to shrink.

During 1944 each man received less

than 300 grams of rice a day, and salted

fish took the place of meat in the soup.

Hospital reports certified by a Japanese

Army surgeon indicated that more than

90 percent of eye problems were due to

nutritional amblyopia—dimness of

vision caused by avitaminosis.

Perhaps fortunately, the camp shrank

as the ration did, for details were dispatched frequently, either to labor elsewhere in the Philippines or to be taken

(each with its attendant medical officer

and a small cache of Red Cross supplies)

to Japan. By the time the majority of

those remaining at Cabanatuan were

evacuated to Japan in October 1944,

weight loss since capture averaged 30 to

35 pounds per man. By then the best

hope of the prisoners who remained

alive were the mounting successes of the

Allies, which promised an ultimate liberation. Most of those who could be

killed by a radically deficient diet had

already died.42

Bilibid and Santo Tomas

Manila’s military prison Old Bilibid

had once been condemned as unfit for

use, but the stuccoed buildings within its

12-foot rock-and-plaster walls were

home for longer or shorter periods to

many Americans during the Japanese

occupation. The prison housed a naval

hospital; served as a staging area for prisoners in transit to other camps; and proBEHIND THE LINES 373

42Gillespie, “Recollections,” pp. 32–84, file 314.7–2;

Cooper, “Medical Department Activities,” pp. 109–22,

file 314.7; Waterous, “Reminiscences,” pp. 64–76, file

314.7–2; Intervs, Duckworth, 4 Jun 45, and Lt Col

Stephen C. Sitter, 12 Sep 45, file 000.71. All in

HUMEDS, RG 112, NARA. See also Musselman,

“Nutritional Diseases,” p. 330; Emerson, Guest of the

Emperor, pp. 28–35, copy in CMH–L; Lt. Col. Albert

Fields Diary, 27 May 42–29 Jul 43, file 999.2–6, and

Cabanatuan Hosp Med Rpts, 1943–44, file 583–1, box

165, Philippine Archives, RG 407, NARA.
vided transient quarters for the work

details sent to labor in the capital, which

were accompanied by medical detachments organized from the prison staff.

Among its other functions, Old Bilibid

was the center for medical service to

prisoners of war throughout the

Philippines. Red Cross medical supplies

also were stored here. Despite various

shortcomings—requisitions sometimes

took months to fill, and permission to

send patients to the naval hospital was

hard to obtain—the centralized system

benefited prisoners of war in many ways.

The Navy medics organized the hospital, as far as possible, like any other

facility with departments, wards, and

offices. Colonel Cooper, arriving with

the contingent from Cabanatuan,

judged its physical plant the best he had

seen in any prison camp, and Colonel

Gillespie spoke of the “incredible luxury” of living in a real building with electric lights, beds, and a bathroom. The

wards occupied buildings of reinforced

concrete; patients lay on Regular Army

bunks; there was an abundant supply of

running water; and latrines and showers

were connected to the city water and

sewer systems. Sanitary conditions were

satisfactory, and outbuildings housed

dental and outpatient clinics and stored

medical supplies. Hospital records suggest a surprisingly well-supplied facility

whose staff was able to perform surgery

and to provide adequate treatment for

prisoners, nearly all of whom were

malarial and grossly malnourished.43

Here as at Cabanatuan, however, the

ration shrank as Allied victories mounted after mid-1943. Gradually, meat, fat,

and even rice all but disappeared.

Comdr. Thomas H. Hayes, MC, USN,

who took command of the hospital in

October 1943, noted in his diary that his

own meals consisted of old and woody

radishes, a few spoonfuls of rice, and bitter soup. Many inmates survived only

because they could still buy food from

Filipino vendors. But even this resource

disappeared when Manila itself developed an acute food shortage in the

spring of 1944, at least in part because

the interruption of gasoline supplies by

Allied attacks on Japanese shipping

immobilized motor transport. 

Thus, hungry prisoners transferred

from Cabanatuan arrived to find their

ration with less protein than before.

During their six-week stay at Old Bilibid,

weight loss averaged another 15 to 17

pounds. Those who stayed at the prison

lived for the remaining months of captivity on 300 grams of rice and 200

grams of corn per man per day, plus

some greens, and only liberation by the

Sixth Army prevented mass starvation.

By this time the prison must have resembled a cross between a primitive village

and a city slum. The ambulant went

about in rags or loincloths, thin as reeds,

burned mahogany by the sun.44

Allied civilians and American nurses

were more fortunate than the military

43Quoted words from Gillespie, “Recollections,” p.

51, file 314.7–2, HUMEDS, RG 112, NARA. See also

Personal Health Records, Bilibid Hosp, boxes 152–54,

Philippine Archives, RG 407, NARA.

374 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

44Cooper, “Medical Department Activities,” pp.

122–25, file 314.7; Interv, Duckworth, 4 Jun 45, file

000.71. Both in HUMEDS, RG 112, NARA. See also

PhM1c Robert W. Kentner, USN, Journal, 8 Dec 41–5

Feb 45, BMSA; Col Paul D. Bunker Diary, 3 Jan 42–1

Mar 43, file Geog S—Philippines 314.81, CMH; Comdr

Thomas H. Hayes, MC, USN, Diary, file 999.2.224,

Philippine Archives, RG 407, NARA. Hayes’ diary has

been published as A. B. Feuer, ed., Bilibid Diary: The

Secret Notebooks of Commander Thomas Hayes, POW, the

Philippines, 1942–1945 (Hamden, Conn.: Archon

Books, 1987).
captives. Although the Japanese viewed

surrender by men of the armed services

as a disgraceful act, civilians and women

were exempted from the demands of

bushido (“the way of the warrior”). They

were not, however, exempted from the

arbitrariness and neglect that pervaded

the Japanese treatment of captives, nor

the casual brutality of guards, nor the

collapse of the Japanese logistical system

in 1944, with its harsh consequences for

prisoners of all types.

Santo Tomas University was a

Dominican institution that occupied a

60-acre campus in a densely populated

area of the city. Large classroom buildings, meant to accommodate 6,000 students and a faculty of 300, were surrounded on three sides by a masonry

wall and on the fourth by an ornate iron

fence with gates. Here the Japanese

established a prison for civilian

internees. In January 1942 Santo Tomas

held about 3,500, and a year later about

4,200, including by that time 82 female

military personnel. About 70 percent of

the prisoners were Americans; about a

quarter, British; the rest, a mixture of

many other Allied countries. All had

been caught in the Philippines by the

outbreak of war. Together they formed a

small self-governing international city.

An executive committee of four

Americans and two Britons managed

the internal workings of the place

through a network of subordinate committees on everything from sanitation

and health to entertainment. All but the

BEHIND THE LINES 375

OLD BILIBID HOSPITAL WARD AFTER LIBERATION
smallest children—about 700 lived at

Santo Tomas—were expected to work at

least two hours a day.45

Since they were not prisoners of war,

the inmates had to pay for everything

with money provided by the Red Cross or

borrowed from well-to-do fellow inmates.

Former executives of the Red Cross,

Standard Oil, and General Electric

underwrote many bills and obtained

money from friends still free in Manila.

Since vendors were allowed in to sell

their goods, relative prosperity was the

rule in the early days; a central kitchen

served two meals a day, with lunch as well

for the children, the old, and the sick,

who received some milk, some meat, and

an egg a day. Lt. Ruby F. Motley, a dietician who ran the children’s kitchen, later

declared that all were “very healthy” and

had gained weight in the prison.

Treatment for the sick was provided by

Dr. Charles Leach of the Rockefeller

Foundation, by several medical missionaries, a Manila physician, and eleven

Navy nurses captured at Cavite. With a

small hospital and several clinics, medical

supplies purchased from Manila or given

by the Red Cross, and the assistance of

Filipino doctors and nurses who visited

the prison, a basically healthy population

had at least adequate care.46

Such was the situation at Santo Tomas

when prisoners from Corregidor—fiftyseven Army nurses, three dieticians, and

one physical therapist—arrived early in

July 1942. When they were permitted to

join the main body of prisoners and

internees in August, they began to work

with the Navy nurses on ward duty. Capt.

Maude Davison, ANC, became chief

nurse. In September ten more Army

nurses arrived from Mindanao, where

they had been captured when their

plane went down on its way from

Corregidor to Australia. With an ample

staff of professionals at hand, the little

hospital expanded. Preventive medicine

was the responsibility of the sanitation

and health committee; additional showers and toilets were installed, and vaccinations against cholera and typhoid

were given by the Red Cross. Relenting

on their earlier refusal to pay the captives, the Japanese provided each a

stipend of 70 centavos (about 35 cents)

a day. Since Manila warehouses were still

stocked with food, the period from July

1942 to the end of 1943 passed in relative comfort and good health, given the

fact that a prison was still a prison, that

crowding was the rule, and that food

intake was never entirely adequate for

the adults, probably averaging about

1,700 calories a day. Though no epidemics hit the adults, enteritis and skin

infections were common. During a

memorable period in late 1943 almost

every child in the prison came down

with—and recovered from—measles

and whooping cough.47

Then the situation darkened. Food

became harder to obtain, and in

47Josephine M. Nesbit, “History of the Army Nurse

Corps in the Philippine Islands, September

1940–February 1945,” pp. 38–41, file 314.7; Catherine

L. Nau, “History of the War, Philippines, 1941–1945,” p.

10, file 314.7; Intervs, Adams, 7 Jun 45, and Motley, 26

Apr 45, file 000.71. All in HUMEDS, RG 112, NARA.

376 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

45A. V. H. Hartendorp, The Santo Tomas Story (New

York: McGraw-Hill Co., 1964), pp. 7–29; Michele

Manning, “Angels of Mercy and Life Amid Scenes of

Conflict and Death: The Combat Experience and

Imprisonment of American Military Nurses in the

Philippines, 1941–1945,” p. 45, file ANC 383.6 POW

Nurses, Philippines, CMH. 46Hartendorp, Santo Tomas, pp. 14–18, 21–22; Intervs,

Marie Adams, 7 Jun 45, and Ruby F. Motley, 26 Apr 45

(quoted words), file 000.71, HUMEDS, RG 112, NARA.

Adams was field director of hospital service for the

American Red Cross at the time of her capture.
February 1944 the Japanese military

took direct control of the prison, imposing many restrictions. Gift parcels

ceased to arrive, vendors were excluded,

and outside medical assistance came to

an end. Instead of providing funds to

internees, the Japanese began to provide the food, which immediately

declined both in quantity and quality.

To make up for deficiencies in protein

and vegetables, adults contributed a

part of their ration to the children.

Supplies soon ran so low that in

November the special children’s ration

had to be stopped.

Inevitably, deficiency diseases had

begun to appear. Prisoners lost as much

weight between August 1944 and the liberation as during the previous two and a

half years of confinement. By January

1945 the individual adult ration averaged

only 680 calories a day, and total weight

loss during confinement averaged 32

pounds for women and 51 pounds for

men. On 5 January Canadian internee

Anne Goldthorpe wrote in her diary: “I

worried last night about a lump in my

stomach. Then I found it was my backbone.” Among the crowded inmates,

hunger brought intense irritability; they

wrangled about unimportant things. As

recalled by a nurse, “We were ready to

claw each other’s eyes out over nothing at

all.” Depleted, their bodies either

shrunken or bloated with beriberi, they

lived in the increasing squalor of a prison

where everything was breaking down and

nothing was replaced or repaired.48

The last year of captivity was consumed by a struggle to survive until the

Americans came. The work of the doctors and nurses, civilian and military,

became ever more difficult as, hungry

themselves, they dealt with an increasing

patient load. As the internees’ health

declined, the hospital became overcrowded and additional wards had to be

opened. Twenty-three at Santo Tomas

starved to death in December 1944 and

32 in January 1945. In that month 475

were hospitalized. Liberation came in

February, amid the flame and ruin of the

battle for Manila. An inmate doctor, put

into solitary because he had refused to

falsify the death certificate of an internee

who had starved, was set free. He performed eight major operations on

American casualties of the battle for

Manila, though “passing out cold twice

because of his experiences with starvation and beriberi.”49

Prisoners Outside the Philippines

Despite hunger, occasional labor

drafts, and the torture and execution of

a few prisoners who were accused of

contacts with the guerrillas, civilians

had a comparatively easy time of it.

Military prisoners, on the other hand,

were viewed by the Japanese in a variety

of ways, none conducive to long life.

They were seen as enemies, as warriors

who had failed in their duty, as a disposable labor force to be exploited

wherever needed, and as a potential

danger if recaptured and returned to

duty. Exhibiting them in their helplessness was also seen as a way to break

down the prestige acquired by

Westerners in the Orient during the

generations of imperialism. 48First quotation as cited in Neil Henry, “A Journal of

Human Endurance,” Washington Post, 20 Mar 83.

Second quotation from Interv, Adams, 7 Jun 45, p. 26,

file 000.71, HUMEDS, RG 112, NARA. In loc. cit., see

also Interv, Motley, 26 Apr 45.

49Interv, Adams, 7 Jun 45, p. 28, file 000.71,

HUMEDS, RG 112, NARA.

BEHIND THE LINES 377
Transferring prisoners to the center

of the Empire to exploit them as labor

began early in the war. Comparatively

lucky were a number of high-ranking

officers, including Colonel Gillespie,

who were shipped out during 1942

when the seaways were safe. As the danger of an American invasion of the

islands increased during 1944, many

more were shipped from the Philippines

to labor camps in Formosa, Korea,

Manchuria, and Japan (Map 14). By that

time American submarines and aircraft

roamed the South China Sea, striking at

Japanese shipping wherever found. The

vessels carrying American prisoners

were not marked, and many were sunk

or damaged. Yet those who perished by

friendly fire or by drowning were fortunate by comparison with those who died

of thirst, heat prostration, or dysentery

in the stinking holds.50

No voyage was more harrowing than

that of the last group of American prisoners to leave the Philippines, 1,619 in

all, who sailed from Manila on 14

December 1944 on the Oryoku Maru.

They comprised most of the remaining

senior officers in the islands, including

medical and dental officers of the Army

and Navy and a number of chaplains.

Conditions were atrocious. Packed too

densely into closed ovenlike holds and

denied water, some died of suffocation

while others raved and fought in the

claustrophobic darkness. 

Soon American planes began to

bomb and strafe the Oryoku Maru.

Almost as an answer to the prisoners’

prayers, the ship was hit by a bomb off

Subic Bay. After a miserable few days

ashore, the surviving prisoners were

transferred to the Enoura Maru, bound

for Formosa. This ship in turn was sunk

in the harbor of Takao, Formosa, by

American planes. As a medic wrote,

“Terrible sight to see, pile of dead bodies as result of bombing. No sleep. ‘God

watch over us.’” Three hundred and

eleven dead prisoners were interred in a

mass grave on a sandspit, while the

remainder continued on a third ship,

the Brazil Maru. Five hundred and

eighty survivors arrived in bitter cold at

the harbor of Moji, Japan, on 31 January

1945. Among the dead were about half

the personnel of the Sternberg General

Hospital and General Hospital No. 2.

Some lines composed at Cabanatuan by

Lt. Henry G. Lee, who died at Takao,

may serve as the epitaph of the voyagers:

“If I endure—I must go on enduring /

And my reward for bearing pain—is

pain.”51

In their new prisons the survivors of

such voyages encountered a mixed bag of

Allied prisoners from all the battlegrounds of the Pacific. They met highranking officers who had been transported earlier from the Philippines, including

General Wainwright; sailors and marines

captured on Guam and Wake Islands;

51First quotation from Wernitznig Diary, 9 Jan 45,

Historians files, HUMEDS, RG 112, NARA; second quotation from Henry G. Lee, “Nothing But Praise” (Culver

City, Calif:: Murray and Gee, 1948), p. 33. See also

Cooper, “Medical Department Activities,” pp. 125–33,

file 314.7, and Gillespie, “Recollections,” pp. 73–85, file

314.7–2, HUMEDS, RG 112, NARA; Rpt, Lt Col Paul D.

Phillips to Maj Gen William F. Sharp, CG, VisayanMindanao Force, 13 Oct 45, sub: Trip From Manila, P.I.,

to Moji, Japan, as Japanese P.O.W., December 13, 1944

to January 30, 1945, pp. 1–9, file Geog S—Philippines

314.82, CMH. Casualty figures for the voyage vary;

many sources state that only 250–300 survived. Above

statistics from Oryoku Maru-Enoura Maru-Brazil Maru

file, box 148, Philippine Archives, RG 407, NARA.

50See the diary of a trip on the Haro Maru reproduced in Goodman, M.D.P.O.W., pp. 114–26. However,

there were some decent ships, as Goodman notes on p.

143.

378 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
BEHIND THE LINES 379

American pilots fished from the sea; and

British, Canadian, Dutch, and Australian

fighting men taken in many battles of the

Far East. Officers were usually compelled

to work in the camps, though exceptions

were sometimes made in extremely cold

weather. In Formosa most prisoners were

employed in farming; in Manchuria

many worked in factories. In Japan the

prisoners worked on farms, in mines, on

Nagasaki

Sapporo

Sendai

Nagano

Fukui

Tokyo

Yokohama

Kyoto

Kobe

Nagoya

Hiroshima Osaka

Fukuoka Matsuyama

East

China

Sea

Sea

of

Japan

Soya Strait

P

A

C

I

F

I

C

O

C

E

A

N

Korea Strait

Tsugaru Strait

UNION OF

SOVIET

SOCIALIST

REPUBLICS

MANCHURIA

KOREA

Oki Archipelago

Osumi Is

Sado

KYUSHU

HONSHU

Tsu Shima

HOKKAIDO

SHIKOKU

Prison Camp Areas in Japan

August–September 1945

Miles

0 200

Base camp

Sub-camp

Sendai

Hakodate

Tokyo

Nagoya

Osaka

Hiroshima

Fukuoka

MAP 14
docks, and in munitions plants. In Korea

they often performed coolie labor,

pulling bullcarts to and from factories.

Officers might grow vegetable gardens;

one medical officer, ill with beriberi, was

put to sewing uniforms and making buttonholes. Work in the mines was especially brutal, and everywhere the enlisted

men bore the worst of it.52

Survivors of the Oryoko Maru were

issued warm clothes on their arrival in

Japan, but all prisoners were not so fortunate. Those taken from the tropics

were often inadequately clad for the cold

north Asian winters, and most were fed

wretchedly. Living in drafty wooden

buildings, heatless or warmed only by

hibachis or (in Manchuria) by Russian

coal stoves, they wrapped themselves

cocoonlike in verminous blankets and

slept on straw mats. Diet varied from

place to place, but staples included rice

and a watery soup made with bones or

fish scraps and sometimes thickened

with weevil-infested flour. Apparently,

the food commonly supplied only

1,500–1,700 calories a day—entirely

insufficient for those performing heavy

labor. In some areas the food that was

available from nearby farms was excluded from the camps. At Jinsen, Korea,

where inmates had been starving, tons of

potatoes were found rotting in a storehouse after the camp was liberated. But

at Cheng Chia Tun, Manchuria, a very

meager basic allowance was supplemented by the erratic arrival of Red Cross

packages, and the prisoners, most of

them senior officers excused from work

on account of the intense cold, “got thru

the winter in a relatively good fashion.”53

By 1945 rations were at their lowest,

though a few Red Cross packages still

arrived. In some camps the guards themselves were either hungry or hoarding

what food was available. Hunger dominated the prisoners’ lives, and food

haunted their dreams. They ate anything

remotely edible. A sailor who had been

captured on Guam recalled seeing prisoners consume “beetles, snakes, silkworms, rancid copra, [and] fodder stolen

from horses’ feed buckets.” They killed

and ate rats and cats; they stole chickens

and, in the relative privacy of the latrine,

tore the birds apart and gnawed the flesh

from their bones. But there was never

enough, and deficiency diseases spread

as before, with their complex symptoms

ranging from night blindness to burning

feet to swollen limbs. Dysentery worsened

the situation, spreading for the usual reasons—shallow open latrines; absence of

oil, soap, and uncontaminated water;

absence of adequate fuel to boil water for

drinking; absence of medicines to treat

illness when it appeared.54

52Cooper, “Medical Department Activities,” pp.

134–42, file 314.7, and Gillespie, “Recollections,” pp.

58, 81, file 314.7–2, HUMEDS, RG 112, NARA; Rpt,

Phillips to Sharp, 13 Oct 45, p. 10, file Geog S—

Philippines 314.82, CMH; Jan K. Herman, “Prison

Diary,” U.S. Navy Medicine 70 (Sep 79): 13–14 and 70

(Oct 79): 3, 5, 9; Weinstein, Barbed-Wire Surgeon, pp.

219, 234–35; Goodman, M.D.P.O.W., pp. 138, 153, 184.

Wainwright was confined for a time on Formosa

(Taiwan), where Gillespie encountered him; then he

was transferred to Manchuria.

53Gillespie, “Recollections,” pp. 80–81 (quotation), file

314.7–2, HUMEDS, RG 112, NARA; Herman, “Prison

Diary,” Sep 79, p. 15; Goodman, M.D.P.O.W., p. 131; E.

Bartlett Kerr, Surrender and Survival: The Experience of

American POWs in the Pacific, 1941–1945 (New York:

William Morrow and Co., 1985), pp. 166–67. 54Herman, “Prison Diary,” Oct 79, p. 6 (quotation);

Weinstein, Barbed-Wire Surgeon, pp. 190, 198–99, 234,

272–84; Kerr, Surrender and Survival p. 176; J. N.

Crawford and J. A. G. Reid, “Nutritional Diseases

Affecting Canadian Troops Held Prisoner of War by the

Japanese,” Canadian Journal of Research 25 (1947):

53–85. See also Peter Williams and David Wallace, Unit

731: Japan’s Secret Biological Warfare in World War II (New

Continued

380 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
By the summer of 1945 even tenacious survivors were showing signs of

weakening. Gillespie noted that a simple walk around the compound at

Mukden, Manchuria, to which he had

been relocated, brought on shortness of

breath and muscular weakness.

Insufficient protein caused a slackening

of the abdominal wall muscles so that

the inmates, despite their hunger,

developed the bulge called “rice belly.”

Painful blisters appeared in their

mouths with no clear cause. Psychological symptoms also reflected the stresses

of long imprisonment, crowding, and

inadequate diet. Some prisoners flew

into ungovernable rages over small

problems; senior officers were seen

struggling furiously over small cheap

cupboards, issued by the Japanese to

hold personal belongings. A burning

sensation in the scrotum reported by

many prisoners led Gillespie to suspect

the renewed onset of pellagra, caused

by lack of niacin. Although the severe

dementia that can result from the disease did not appear, episodes of bizarre

behavior became common. A prisoner

would report that one or more inmates

were “off their rockers,” and the next

day they would report the same of

him.55

The effort to function as medical professionals under such conditions continued to tax the devotion and ingenuity of

captive doctors and corpsmen. Doctors

were usually subordinate to the

Japanese medical personnel and dependent upon them and the camp commander for facilities, supplies, and

instruments. As a rule, the Americans

were allowed a section of a building to

hold sick call. At the Tanagawa camp

near Osaka they worked in the hallway

of the camp administration building,

which also contained the Death House,

a closetlike room with space for about

eight patients, where the moribund

were confined to die. In a room next to

the Death House the Japanese medical

staff made out death reports and issued

medicines in meager amounts.56

Because many prison camps lacked

facilities for surgery, the Japanese sometimes allowed serious cases to be taken

to civilian hospitals for treatment. Thus,

prisoner patients at Senryu went to the

Mitsubishi mine hospital and the seriously ill at Umeda and Tanagawa into

Osaka. The enlisted medical technicians

who transported patients to the civilian

hospitals noted violations of sterile technique even there, yet the risks had to be

run for patients who would otherwise

die. Partial exceptions to a generally

bleak picture can be cited. At a camp

whose inmates worked for the Mitsui

Corporation Capt. Thomas H. Hewlett,

MC, recalled that a large camp hospital

was constructed and that “through the

humaneness of Baron Mitsui, a 1919

Dartmouth graduate, we did have bed

space for the sick and wounded,” including two surgical wards. Here he worked

on the bodies of those injured in the

corporation’s coal mines, using “dental

novocaine as an anesthetic and sharpened table knives as scalpels.”57

York: Free Press, 1989), pp. 51–62. The allegation has

been made, though in our opinion not proved, that

Western POWs were used as human guinea pigs by the

Japanese germ warfare establishment in Manchuria. A

brief account of Japanese germ warfare and other medical war crimes is given in Chapter XIII of this volume. 55Gillespie, “Recollections,” pp. 87–88 (quoted

words, p. 87), file 314.7–2, HUMEDS, RG 112, NARA. 

56Kerr, Surrender and Survival, p. 177. 57Ibid., p. 183 (second quotation); Knox, Death

March, p. 377 (first quotation).

BEHIND THE LINES 381
In Hewlett’s camp American doctors

provided care, but in most camps

Japanese military or civilian doctors

were in charge. Some prisoners later

recalled competent treatment from

Japanese physicians. Many, however, had

darker recollections. One American

physician complained that the prison

doctors he observed gave snap diagnoses, had no use for vitamins, and

seemed to be ignorant of the germ theory of disease. Some, adherents of the

traditional Chinese medicine that influenced much of East Asia, favored moxibustion and other folk remedies. Others

apparently were worse than merely illinformed. The prison hospital at the

Shinagawa camp in Tokyo was the main

facility for treatment of the thousands of

prisoners in the capital area. The chief

doctor, nicknamed the butcher or the

spider, was accused of using prisoners as

experimental animals to further his

knowledge of surgery. In consequence,

American medical officers gave false

diagnoses to keep patients on the medical wards and performed operations

themselves at night, kneeling on strawcovered floors. In the closed tuberculosis ward, however, other prisoners

became subjects of bizarre experiments,

which involved the injection of bile or

soybean milk.58

American doctors had to scrounge or

manufacture their own equipment,

aided by their fellow prisoners. Those

on work details bought medicine from

civilians and smuggled it into camp, or

raided Japanese storerooms at night.

Scraps of metal became bone saws; steel

guitar strings, a rib cutter; wood scraps,

a fracture bed to hold a patient with a

broken back, for whom there was not

enough plaster to make a body cast. A

doctor interested in laboratory work

made himself a crude microscope of

“bamboo tubing and field-glass

lens[es].” One surgeon recalled a minor

operation in which he used cocaine as

an anesthetic and, lacking sutures,

sealed off the wound with branding

irons.59

Such expedients were necessary in

large part because medical units had

been stripped of their equipment upon

capture, and because Red Cross medical

supplies, intended for the prisoners,

were often diverted to Japanese use or

stored against future need. Japanese

Army regulations apparently required

commanders to maintain a one-year

reserve of medical materiel, and officers

at the camps obeyed the rule without

regard to their captives’ present needs.

Worsening conditions was Japan’s own

desperate situation; by 1945 prisoners

and internees stood the last in line for

supplies, needed by all, that could neither be imported nor moved safely within Japan itself.60

In spite of everything, the record of

the Japanese camps was not entirely dark.

Conditions varied greatly from one to

another; in the showplace officers’ camp

at Zentsuji, physical abuse was rare, a

well-stocked camp library offered reading matter, and sports equipment and

amateur theatricals provided recreation

59Quotation from Knox, Death March, p. 377. See also

Goodman, M.D.P.O.W., pp. 185–86. 60“International Military Tribunal for the Far East,”

4:1058, 1132, CMH–L. See also Goodman, M.D.P.O.W.

pp. 185–86. 

58Weinstein, Barbed-Wire Surgeon, pp. 189–211; Knox,

Death March, pp. 367–77. Moxibustion is the process of

creating a counterirritant by burning dry herbs against

the skin. The Japanese surgeon in charge at Shinagawa

was later convicted of war crimes and sentenced to

death, but was reprieved after being found insane. See

Chapter XIII.

382 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
to healthy prisoners. (Even here the

Japanese medical officer, a Lieutenant

Saito, and his orderlies seemed indifferent to the needs of the sick, who survived

largely through the efforts of a Navy surgeon, Capt. H. J. Van Peenan, MC.) At

some camps American medics received

substantial quantities of Red Cross shipments from the end of 1943 to the spring

of 1945; a few prisoners, held in onetime

health spas in Japanese mountain resorts,

enjoyed mineral baths. As heartening as

the supplies were the instances of kindness recorded from Japanese officials,

guards, and civilians, who sometimes suffered at the hands of their own countrymen for their generosity of spirit toward

many prisoners.61

Yet when all allowances have been

made, the record of Imperial Japan in

respect to its prisoners of war remained

a dismal one. Neither occasional amenities nor individual kindness modified

the sufferings of those who suffered

daily beatings and hard labor, nor the

fact that virtually all prisoners, even the

lucky ones, were hungry most of the

time. Even leaving aside such extremes

as the torture and vivisection of downed

airmen, the average prisoner lived a life

that ranged from spare downward to

unendurable.62

Understandably, many did not survive. Of the 25,580 Army and Navy personnel captured and interned in the

Philippines, 10,650 died—a death rate

of 42 percent, as against less than 1 percent for American prisoners of war in

the Mediterranean and European theaters. Between 34 and 37 percent of all

American servicemen imprisoned by the

Japanese died in captivity. Surely, the

toll would have been even greater if not

for the efforts of the medical personnel

who shared captivity and all its privations with them.63

62On the treatment of airmen, see Chapter XIII. See

also John M. Gibbs, “Prisoner of War Camps in Japan

and Japanese Controlled Areas as Taken From Reports

of Interned American Prisoners,” pp. 53–65, Ms 4–4.5A

AA, CMH; Kerr, Surrender and Survival, pp. 179–80. 63Office of the Adjutant General, “Army Battle

Casualties and Nonbattle Deaths in World War II, Final

Report, 7 December 1941–31 December 1946,” pp.

92–95, copy in CMH–L; Gillespie, “Recollections,” pp.

58–59, 86, file 314.7–2, HUMEDS, RG 112, NARA. See

also Cohen and Cooper, Follow-Up Study, p. 38;

Goodman, M.D.P.O.W., pp. 153, 169; Herman, “Prison

Diary,” Sep 79, pp. 15–18, and Oct 79, pp. 3, 5. The

long-term effects of imprisonment are briefly discussed

in Chapter XIII, as are the atrocities by Japanese medical personnel later prosecuted in war crimes trials.

61See, for example, Goodman, M.D.P.O.W., pp.

86–97, 182–84. Van Peenan survived the war and was

later promoted to rear admiral. A good account of the

camp is given in Emerson, Guest of the Emperor, pp.

58–75, copy in CMH–L.

BEHIND THE LINES 383
While General MacArthur’s forces

from the Southwest Pacific Area struggled to reconquer the Philippines, those

of Admiral Nimitz from the Pacific

Ocean Areas gathered for an assault on

Okinawa, the largest island of the

Ryukyus and a prefecture of Japan itself.

Fierce resistance was anticipated, and

not only on the ground. Lying 900 miles

from Manila and 1,200 from the closest

bases in the Pacific Ocean Areas, the

island was well within the range of landbased enemy aircraft flying from more

than a hundred fields on Formosa and

the southernmost home island of

Kyushu. Partly for this reason, Nimitz

sent his marines first against the tiny

island of Iwo Jima in the Volcano

Islands, 740 miles from Okinawa.1

Foretastes: Angaur, Peleliu, Iwo

The type of fighting that impended

on Okinawa, against an elaborate system of inland defenses, had already

been encountered during the Allied

advance. The cave systems of Biak had

claimed many casualties from

MacArthur’s forces. During the

approach to the Philippines Admiral

Nimitz’ forces had met similar defensive systems in the Palaus, where casualties had also been heavy. On Angaur the

321st and 322d Regimental Combat

Teams of the 81st Infantry Division

waged a difficult struggle, costing more

than 2,000 casualties.2

Overshadowed by Peleliu, Angaur

received little of the attention it

deserved at the time, in part because

the operation officially lasted only three

days (17–20 September 1944). In reality, the Japanese defenders who were

“dug in on the cliffs and in caves” not

only inflicted large numbers of casualties but continued to resist until midOctober, forcing the 322d Regimental

Combat Team to undergo a bloody,

wearing process to clean them out.

Overall, the medical support, like the

conduct of the fighting troops, was

“beyond reproach,” with efficient organization in the landing of medical units, 1

Roy E. Appleman et al., Okinawa: The Last Battle,

United States Army in World War II (Washington, D.C.:

Historical Division, Department of the Army, 1948), pp.

1–7; Jeter H. Isely and Philip A. Crowl, The U.S. Marines

and Amphibious War: Its Theory and Practice in the Pacific

(Princeton: Princeton University Press, 1951), p. 533; I.

T. M. Gow, with H. P. Willmott, Okinawa 1945: Gateway

to Japan (London: Grub Street, 1986), pp. 20–42.

2

Robert Ross Smith, The Approach to the Philippines,

United States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department of

the Army, 1953), pp. 494–575.

CHAPTER XII

Large-Unit War: Okinawa
quick evacuation from the beaches, and

timely support provided by the 17th

Field Hospital and the 41st Portable

Surgical Hospital. But the harsh rocky

terrain made evacuation difficult from

inland, the Japanese regularly fired on

litter-bearers, and the slow process of

destroying enemy bunkers one by one

resulted in many wounded. Losses of

aidmen were high, and heroism among

them was common. In one fighting unit

five of the seven Silver Stars awarded for

bravery went to medics.3

Peleliu proved even more difficult to

capture. The Japanese garrison was

larger, and the Japanese commander,

Col. Kunio Nakagawa, had constructed

a complex of defensive positions. Here

the marines, after establishing a beachhead and capturing the island’s airfield,

were halted in “savage and costly fighting.” Losses were severe; one regiment

lost over half of its strength. Recalled

from Angaur and attached to the 1st

Marine Division, the 321st Regimental

Combat Team joined in the struggle.

The terrain, which the Americans

called Bloody Nose Ridge, was sowed

with mines and heavily defended by

mutually supporting strongpoints.

Casualties had to be extracted by the

use of ropes and pulleys. Even after the

enemy’s resistance had supposedly been

broken, mopping up proved harder

than on Angaur. For an island that planners had optimistically expected to

seize in four days, fighting against some

pockets went on until late November.

More than 11,000 Japanese died on

Peleliu, and the 81st Division during its

battle in the Palaus suffered almost

3,300 battle casualties.4

The attack on Iwo Jima became legendary for the sacrifices it entailed.

The volcanic and sandy island was

needed, in the opinion of American

planners, as an air base to halt Japanese

raids, to provide returning B–29s an

emergency landing site, and to facilitate fighter support of the long-range

bombers. The bombers, in turn, not

only had a strategic mission against

Japanese cities but also would soon be

employed tactically, at Nimitz’ request,

against Kyushu airfields in support of

the Okinawa invasion. 

On 19 February 1945 three marine

divisions of the V Amphibious Corps

assaulted the barren 5-mile-long island,

supported by four medical battalions,

one for the corps and each division; an

evacuation hospital; and a field hospital.

Offshore support featured the usual

attack transports, hospital LSTs, and a

hospital ship. Maturity gained in earlier

campaigns keynoted the mounting of

the operation. But in many brutal

lessons the Japanese had also learned

how to defend an island. Iwo was heavily fortified, and from caves and bunkers

above the beaches the defenders saturated the landing areas with accurate

and deadly fire. 

Casualties were extraordinarily heavy.

A party of battalion medics, led by two

young medical officers, faced a typical

situation:

3

Buell Whitehill, “Administrative History of Medical

Activities in the Middle Pacific,” block 18c, pp. 22–27

(quotations, pp. 26, 22), file 314.7, Historical Unit

Medical Detachment (HUMEDS), Record Group (RG)

112, National Archives and Records Administration

(NARA), Washington, D.C.

4

Ibid., p. 51, file 314.7, HUMEDS, RG 112, NARA,

gives 1,285 division casualties for Angaur and 2,709 for

Peleliu, versus the above statistics from Smith, Approach

to Philippines, p. 573. Quotation from Frank O. Hough,

The Assault on Peleliu (Washington, D.C.: Historical

Division, Headquarters, U.S. Marine Corps, 1950), p.

83.

LARGE-UNIT WAR: OKINAWA 385
Wounded men were lying all around. It was

impossible to stand erect on the beach, and

the corpsmen crawled from casualty to casualty to bandage wounds and administer morphine and plasma. Within an hour after the

aid station had been set up, a shell exploded

at one side and fragments from it slashed into

several of the men. Dr. [William] McHugh, a

big, young, bluff Irishman, swore at the bad

luck. . . . At best the corpsmen could only

work the wounded back in jumps and starts,

stopping in shellholes to get their breath.

Some of the corpsmen, who would normally

have gone inland in search of casualties, did

not get off the beach, for the wounded never

stopped coming back.5

Fire was so intense that the island’s

thin vegetation was virtually erased.

Casualties ran in excess of 1,000 a day

for twenty-one consecutive days.

Holding them ashore remained excessively dangerous, and almost 18,000 had

to be evacuated from the island during

the month that followed the first landing despite the slow, steady progress of

the attack. Complicating care were high

losses among medical personnel. Some

marine units lost two-thirds of their

corpsmen. Medics were killed attending

casualties; beach parties were blown up

with the injured; landing craft carrying

the wounded and their attendants were

sunk offshore. Some medical units took

higher losses than assault units, because

5

Department of the Navy, Bureau of Medicine and

Surgery, “The United States Navy Medical Department

at War, 1941–1945,” 1:400–66 (quotation, pp. 415–16),

files of Bureau of Medicine and Surgery Archives

(BMSA), Washington, D.C.

386 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

81ST DIVISION CASUALTIES IN A JEEP AMBULANCE
they could not disperse and hide themselves and the casualties. 

The availability of whole blood and

penicillin greatly assisted the wounded,

and the island, as sterile as it looked, was

remarkably free from disease through the

battle and afterward. The Army’s 38th

Field Hospital landed in the second week

and began to receive wounded marines,

and by the end of March the conquered

island had been turned over to an Army

garrison force. While it lasted, the struggle had been the most intense waged by

American forces in World War II, costing

the attackers over 6 casualties per 1,000

troops per day—more than twice that of

the battle of Normandy and almost six

times that of the Sicilian campaign.

Americans fighting in the Pacific and

the public at home were both shocked

by the extraordinary losses—more than

24,000 marines and sailors, of whom

almost 21,000 were battle casualties. As a

vast Allied armada of 1,600 ships carrying 550,000 troops closed in on

Okinawa, news from Iwo Jima grimly

confirmed the belief of American planners that the cost of attacking Japan’s

inner defenses was certain to be high.6

Planning the Attack

American planners had decided to

seize first the Kerama Islands, a small

group off the southwest coast of

Okinawa, as a base for shipping. The 60-

mile-long Okinawa was to be invaded at

a point midway up the west coast, north

of the capital of Naha, on beaches near

the town of Hagushi. Three marine divisions of the III Amphibious Force would

push north, and the four divisions of the

Tenth Army’s XXIV Corps would move

south. Command of the whole force

ashore would fall to Lt. Gen. Simon B.

Buckner, Jr., now the Tenth Army commander. The medical plan was primarily

the work of General Willis, the USAFPOA chief surgeon since November

1944. Promising the troops “all they

need, when and where required,” he

deliberately sought to incorporate all

the lessons learned thus far in the

Pacific war.7

Certainly, experience was at hand.

Though the Tenth Army was a new creation, the principal medical officers of

the invasion force were veterans of earlier campaigns. Col. Laurence A. Potter,

MC, the XXIV Corps surgeon, had

served as 7th Infantry Division surgeon

at Attu and as corps surgeon at Leyte.

Tenth Army surgeon Col. Frederick B.

Westervelt, MC, was an experienced staff

officer whose background meshed well

with Potter’s. Together they planned for

the medical support they believed the

Tenth Army units would need, fitting

their requirements into the general

framework established by the Navy. 

But much of the work of the campaign fell to a third figure, already familiar to the medical personnel of the

Pacific theaters. General Maxwell

6

Ibid., 1:423, 464, BMSA. See also OofSurg, USAFPAC, ETMD, 9 Nov 45, app. C, pp. 16–23, and Army

Service Forces (ASF) Monthly Progress Rpt, 30 Sep 45,

sec. 7, pp. 2, 4, The Historical Unit (THU) Note Cards,

Historians files; Whitehill, “Medical Activities in Middle

Pacific,” block 18f, 1:6, file 314.7. All in HUMEDS, RG

112, NARA. Of the total personnel cited for the

Okinawa invasion, about 350,000 manned the fleet and

about 200,000 comprised the Tenth Army and the

Island Command. Task Force 57, a carrier group used

to screen against attacks from Formosa, belonged to

the British Pacific Fleet. All other units were American.

7

Rpt (Extract), Plans and Opns Sec, OofSurg,

USAFMIDPAC, n.d., sub: Historical Account of

Experiences Since Pearl Harbor, p. 2, Historians files,

HUMEDS, RG 112, NARA.

LARGE-UNIT WAR: OKINAWA 387
moved from the South Pacific to

become surgeon of the Tenth Army’s

subordinate Army Garrison Force, commonly called the Island Command,

under Maj. Gen. Fred C. Wallace.

Outranking Westervelt, Maxwell was

assigned all responsibilities for evacuation, hospitalization, preventive medicine, and medical supply—most of the

duties normally handled by the army

surgeon. Since Maxwell could bring

only a few of his staff with him,

Westervelt placed most of his own personnel on special duty with the Island

Command medical section. This surprising arrangement, for which no clear

rationale emerges from surviving

records, might have caused much difficulty but apparently did not—a tribute

to the pragmatism of both the Island

Command and Tenth Army surgeons.8

In addition to the usual organic units,

each Army division was to be backed up

by a field hospital, two portable surgical

hospitals, and several anti-malaria units.

Ashore, the portables would assist the

clearing station platoons and would

advance by leapfrogging to provide

frontline support as soon as the field

hospital landed. The XXIV Corps

brought with it a Tenth Army field hospital and a station hospital, strengthened by specialist personnel from a general hospital. An Army evacuation hospital was lacking. The corps’ 71st

Medical Battalion was to organize evacuation from the clearing station to either

the shore party or captured airfields.

The corps also brought medical supply

teams and additional anti-malaria units.

Tenth Army units would return to the

control of army headquarters once the

latter came ashore.

The multiplication of preventive

medicine units reflected inaccurate

medical intelligence that pictured

Okinawa as a pesthole. In fact, the

rugged subtropical island was to prove

exceptionally healthy, in this respect

perhaps the least threatening of any that

the relatively lucky Central Pacific forces

had yet fought upon. As Westervelt

noted on 1 May, “So far our troops have

had less sickness than in garrison.” Like

the Army units, each marine division

received a field hospital and a Navy

malaria and epidemic control unit; additionally, the III Amphibious Corps had

two evacuation hospitals attached, providing a more complete chain of evacuation than the Army possessed.9

As usual, an Army shore party and a

Navy beach party would guide evacuation to vessels offshore, consisting of

Army and Navy hospital ships, hospital

LSTs, and converted APAs (transport,

attack). The Navy hospital ships were

truly floating hospitals, with complete

medical, surgical, and neuropsychiatric

facilities aboard; additionally, by stocking medical supplies, the Navy ships

could act as resupply points for other

vessels. The Army hospital ships were

8

Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:72–73, file 314.7, HUMEDS, RG 112,

NARA.

9

In the end the Army provided eleven field hospitals

and eight portables. See ibid., 1:23–24, file 314.7;

Comments (quotation) of [Col Frederick B. Westervelt,

Surg], Tenth Army, 1 May 45, Encl to Ltr, Brig Gen John

M. Willis, CSurg, USAFPOA, to Maj Gen Norman T.

Kirk, SG, Wash., D.C., 8 May 45, file 312.1 Kirk-Willis

Correspondence (SWPA); Rpt (Extract), OofSurg,

USAFMIDPAC, 24 Sep 45, sub: Okinawa Participation,

sec. 13, pp. 1–2, file 370.2; CSurg, USAFMIDPAC,

Annual Rpt, 1945, p. 36, file 319.1–2; Surg, 77th Inf Div,

Quarterly Rpt, Apr–Jun 45, p. 1, THU Note Cards,

Historians files; and 77th Inf Div AAR, Okinawa, 25

Apr–30 Jun 45, pp. 74–75, THU Note Cards, Historians

files. All in HUMEDS, RG 112, NARA. See also “Navy

Medical Department at War,” 1:554, BMSA. 

388 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
less elaborate, for they were conceived

as evacuation vessels—hospital transports—and served effectively in that

role, returning about a sixth of the

388,000 evacuees to the United States

during 1944 and the first half of 1945, or

about the same number as returned by

air. By far the largest number, however,

was carried by troop transports. 

At Okinawa the hospital ships would

first display their Geneva markings, but,

after two attacks, would hide blackedout among the transports at night. The

LSTs would provide patient care and

would also serve as control points,

directing the flow of wounded to the

APAs and the hospital ships. To shuttle

the wounded from shore to ship and

from ship to ship, the invasion force

would rely on seagoing ambulances.

Landing craft in the first four waves

were designated to return wounded to

the hospital ships for treatment, and

craft under the control of the shore

party commander would continue the

work after the troops moved inland.10

By ship or plane the wounded would

be evacuated to bases in the Marianas,

Hawaii, and the United States.

Evacuation policy followed the familiar

pattern: in the assault phase, immediate;

when the island was secured, thirty days.

Air evacuation to the Marianas was slated to begin five days after the initial

assault, with the Air Transport

Command’s Pacific Division taking the

majority of casualties to Saipan initially

and to Oahu later. Army personnel

worked on two hospital ships with Navy

crews, and two of the hospital LSTs were

staffed by Army surgeons as well as by

Navy beach party medical sections.11

Hospitals to the rear prepared for an

influx of casualties. Using the Saipan

campaign as a guide, the joint headquarters estimated 30,000 in the first

sixty days, with about three-quarters

wounded. Some 16,000 beds were to be

made available in the Marianas and

Oahu, about equally divided between

the Army and the Navy. Army hospitals

in the advance casualty reception centers expanded, including a new 5,000-

bed hospital center on Tinian. Care on

Okinawa itself was slated to increase

greatly in the months after the initial

landing, with an array of hospitals, laboratories, and specialized units of various

types scheduled to land in a prearranged order. As in the Philippines,

military government detachments were

assigned the task of dealing with a large

and, in this case, presumably hostile

population.12

Seemingly everything possible in the

way of medical supplies was provided.

The Tenth Army received for the assault

25,000 litters, 50,000 blankets, 7 billion

units of penicillin, 30 million vitamin

tablets, 100,000 cans of footpowder, and

100,000 iodine swabs. In other respects,

some acknowledged gaps existed in the

preparations for the attack. Many of the

troops had little opportunity for training; those on Leyte had hardly rested

from the last campaign before they

embarked for the new one. Shortages in

bed strength existed; Colonel Westervelt

had received only 4,500 of the 8,000

mobile beds he asked for, and he lacked

10ASF Monthly Progress Rpt, 31 Jul 45, sec. 7, pp.

34–35; OofSurg, 96th Inf Div, ETMD, 19 Jul 45, p. 2.

Both THU Note Cards, Historians files, HUMEDS, RG

112, NARA.

11Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:41–42, file 314.7, HUMEDS, RG 112,

NARA. 12Ibid., 1:22–23, file 314.7, HUMEDS, RG 112,

NARA; Appleman et al., Okinawa, p. 35.

LARGE-UNIT WAR: OKINAWA 389
an Army evacuation hospital, none being

available in the Pacific Ocean Areas. On

the other hand, Army medical personnel

for the operation totaled 10,773—fewer

than for Luzon but far more than for any

of the previous operations in the Pacific

Ocean Areas. As on Iwo Jima, blood

banks would be established ashore and

whole blood would be made available as

far forward as the collecting stations.

The medics carried improved first aid

kits, and sturdy Quonset huts were to

replace tents for field medical units during the garrison phase. American

wartime productive capacity, like the

nation’s military maturity, had reached

its zenith and in most respects an ample

allotment of resources had been made

for the casualties to come.13

The Battle Opens

The 77th Infantry Division landed in

the Keramas late in March, seizing the

islands in a swift conquest marked by

low casualties. Then on L-day, 1 April

1945, a pleasant Easter morning, the

invasion of Okinawa began. Lying in the

Japan current, the island is structurally

as complex as Guam, surrounded by

reefs, its mountains encrusted with

coral. The climate is temperate, with

wooded areas clad in conifers. On the

day of the invasion the morning air was

cool, and little resistance was encountered on the Hagushi beaches. The

enemy appeared to have withdrawn, giving notice of his presence somewhere

inland only by light artillery fire.14

The campaign ashore seemed easy as

the American forces moved inland. Two

airfields scheduled for capture on L+3

instead fell on the first day, in usable

condition—one to the soldiers, the

other to the marines. To the north lay

rugged pine-clad mountains, seemingly

the logical place to mount a defense. But

most of the population, the towns of

Naha and Shuri, and other airfields lay

to the south. Here the land featured an

old limestone plateau, pitted by the rains

and marked by low ridges and escarpments. This too provided many natural

fortresses for the defenders to exploit. 

The Tenth Army now divided. The III

Amphibious Corps swung north in the

days that followed. The advance met little

resistance, and the marine medical units

found their major problem in keeping

up with the line units. Army forces

moved more slowly southward, and the

medics, blessed with a measured advance

and few casualties to treat, found no difficulty in adhering to established plans.

On L-day the clearing stations of both the

7th and the 96th Infantry Divisions had

come ashore, and that of the 7th Division

opened for surgery. Similarly, the division’s two portables had arrived, set up,

and begun to receive casualties, mainly

civilians injured in the prelanding bombardment. On L+2 the 71st Medical

Battalion landed, allowing divisional

units to move forward. 

By 7 April, when 7th Division forces

reached the east coast of Okinawa, two

field hospitals had landed, the 69th

opening in a wrecked school building

13Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:50, file 314.7, HUMEDS, RG 112, NARA. 14Ibid., 1:22–23, 45–47, file 314.7; Surg, 77th Inf Div,

Quarterly Rpt, Apr–Jun 45, p. 1, THU Note Cards,

Historians files; OofSurg, Tenth Army, ETMD, 20 Jul

45, p. 1, file 350.05. All in HUMEDS, RG 112, NARA.

See also Appleman et al., Okinawa, p. 74; “Navy Medical

Department at War,” 1:557–58, BMSA. A detailed

account of the 7th Infantry Division’s landing is given

in Samuel Eliot Morison, History of United States Naval

Operations in World War II, 15 vols. (Boston: Little,

Brown and Co., 1964), 14:140–55.

390 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
strewn with rubble. The XXIV Corps

had set up an evacuation station, and

three hospital LSTs and a fourth with a

blood bank lay offshore. The lack of

enemy resistance allowed the medical

system ashore to develop without hindrance, as well as offshore evacuation to

be carried on without the frenzy that

had attended other assaults on contested beaches. Despite increasing air

attacks on the fleet, a textbook operation seemed to be in progress.15

The enemy, however, lay in wait. The

Japanese, under Lt. Gen. Mitsuru

Ushijima who had decided not to

oppose the invasion on the beaches but

to fight inland, dug in for shelter from

American firepower. The defending

force consisted of two divisions and an

independent brigade (about 67,000 soldiers in all, of whom an unknown number were Okinawan draftees or

reservists), as well as naval units, 24,000

Okinawan home guardsmen, and a mass

of conscripted laborers. Even older

schoolchildren had been impressed into

the force. Ushijima’s units included a

tank regiment and a strong concentration of artillery, much of it intended for

the Philippines but impossible to ship

because of the disruption of Japanese

maritime traffic by American submarines

and planes. In all, the defenders numbered over 100,000, holed up in 60 miles

of natural caves and artificial tunnels.16

Action began as the ships lying offshore were bloodied by a wave of

kamikazes. After 6 April scattered air

attacks grew rapidly into a full-scale

assault, with ten major and countless

minor onsets, some of which employed a

600-mph piloted flying bomb, the Ohka.

The first medical surprise of Okinawa was

that the ships, supposedly the refuge of

the wounded, proved more dangerous

than the Hagushi beaches, incurring “the

greatest casualty load among their own

personnel . . . in the entire war.”17

Kamikazes baffled Navy medical officers, who could find no way of making

rational plans to meet such “abnormal

and barbarous” tactics. Typical was the

case of the USS Morrison, one of the radar

picket ships that formed the first target of

the suicide planes. Aboard, no safe area

could be found for a main dressing station, and no rational distribution of medical personnel or equipment could be

made. Instead of acting as a team, medics

could only render first aid to the wounded nearby and, like their comrades, pray.

During the final attack on 4 May only one

injured soldier reached the dressing station, where he was trapped when the ship

sank after being hit four times in ten minutes. In the water one doctor and an

uninjured corpsman swam to the various

groups of survivors, trying to give first

aid. A thick layer of fuel oil acted as a palliative for the many severe burns. Taken

aboard a little support craft, 115 wounded were jammed together in “complete

disorder,” and little treatment could be

given but morphine to relieve pain.18

15Surg, XXIV Corps, Daily Journal (copy), 1–8 Apr

45, file 319.1; 69th Field Hosp Quarterly Rpt (copy),

Apr–Jun 45, p. 3, file 319.1; ASF Monthly Progress Rpt,

30 Sep 45, pp. 6–8, THU Note Cards, Historians files.

All in HUMEDS, RG 112, NARA. See also “Navy

Medical Department at War,” 1:560, BMSA. 16On Japanese plans and tactics, see Thomas M.

Huber, Japan’s Battle of Okinawa, April–June 1945,

Leavenworth Paper no. 18 (Fort Leavenworth, Kans.:

Combat Studies Institute, U.S. Army Command and

General Staff College, 1990), pp. 13, 19–20.

17Quotation from “Navy Medical Department at

War,” 1:558, BMSA. See also Morison, Naval Operations

in World War II, 14:170. 18Quotations from “Navy Medical Department at

War,” 1:562–63, BMSA. See also Morison, Naval

Operations in World War II, 14:254–55.

LARGE-UNIT WAR: OKINAWA 391
Such attacks, ultimately involving

thousands of enemy planes (kamikazes,

dive bombers, and other aircraft), battered the fleet for more than two

months. Two hospital ships fell victim,

despite the precaution of having them

stand out to sea at nightfall when the

carrier planes returned to their vessels

and suicide craft struck hardest. The

USS Pinkney and the USS Comfort were

both hit on 28 April, with combined

losses of 65 dead and 60 wounded; on

the Comfort the attacking plane crashed

through three decks to explode in the

surgery, which was crowded with medical personnel and casualties. Anxiety,

especially on the picket ships, caused

psychiatric problems to appear, brought

on by the frequency of the attacks, their

suddenness, and the intense fires that

were their commonest result.19

Even seamen who survived were often

critically hurt. “I doubt,” wrote Samuel

Eliot Morison, “whether anyone could

fully appreciate the results of this desperate fury of the Kamikaze Corps

unless he were present, or in a hospital

where wounded survivors were treated.”

Most were “horribly burned,” often

19Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:103, file 314.7, HUMEDS, RG 112, NARA;

“History of USS Comfort (AH 6),” file USS Comfort,

BMSA.

392 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

FEEDING A SEVERELY BURNED SEAMAN
spending agonized hours in the sea

before rescue. In rear area hospitals

they could be seen, swathed like mummies, breathing and taking food

through tubes. But death by blast, fire or

water was all too common. The Navy,

alone of the services, would record

more dead than wounded in the battle

for Okinawa—a remarkable situation,

possibly unique in its history.20

The Tempo Quickens

Meanwhile, the struggle ashore

became far more difficult. Enemy resistance at first was light for the marines,

who were moving north. Land evacuation was slowed by heavy rain, blown

bridges, and washed-out roads that

caused amphibians to be pressed into service again. Tougher was the conquest of

the rocky Motobu Peninsula.

Accustomed to facing fixed defenses on

small islands, the marines reverted to

textbook maneuvers to envelop the main

enemy stronghold, which fell on 17 April. 

But the hardest fighting in the north

occurred on a small offshore island, Ie

Shima. On 16 April the 77th Division

invaded to secure a major military prize,

large airfields that made the island

resemble “a huge, immovable aircraft carrier.” A strong garrison of 2,000, backed

by a fanatically loyal and determined civil

population numbering perhaps 5,000

more, fought a most tenacious battle in

the town of Ie and on the slopes of a dead

volcano, Iegusugu, which American

troops called the Pinnacle.21

Here the famed journalist Ernie Pyle

was among 172 dead, while 902 wounded filled the medical units. Fighting was

marked by suicidal fury, including

attacks by island women wielding wooden spears and by soldiers and civilians

who charged through their own mortar

fire. One American soldier “had his arm

broken by the flying leg” of a Japanese

soldier, armed only with a satchel

charge, who had attacked as a human

bomb.22

Despite these bizarre elements, the

ridges of Iegusugu formed a classic

Japanese defensive position. The rough

terrain was pocked with fortified caves

and hidden bunkers, both connected by

tunnels, and was sown with crude but

effective mines. Lacking either clearing

elements or portables, which had been

reserved for later operations on

Okinawa, the collecting companies handled all casualties. The wounded were

brought by litter to collecting points and

by jeep ambulances to the beaches.

Mining made the roads perilous, and

two ambulances carrying casualties, drivers, and a collecting company commander were destroyed. Poor sanitation, piles of enemy dead, and a high

dengue rate briefly added a serious disease outbreak to the tale of woe. The

fight lasted only five days. Hospital LSTs

cared for the wounded offshore, and the

sanitary problem was quickly solved. But

Ie Shima was an image in miniature of

the fighting that in the meantime had

begun in southern Okinawa.23

Here the American divisions had

spent the first week of April reducing

heavily defended outposts. Then on the

ninth they encountered the enemy’s

20Over 4,900 died as against 4,824 wounded. See

Morison, Naval Operations in World War II, 14:195, 282. 21Appleman et al., Okinawa, p. 150.

22Ibid., p. 160.

23Surg, 77th Inf Div, Quarterly Rpt, Apr–Jun 45, pp.

1–3, THU Note Cards, Historians files, HUMEDS, RG

112, NARA.

LARGE-UNIT WAR: OKINAWA 393
main line—a complex of fortified ridges

concealing a tightly woven net of mutually supporting strongpoints that protected the ancient Okinawan capital of

Shuri. Japanese medical preparations

for the defense apparently had been

sound, with aid stations dug into the

underground complexes and with regulations for sanitation and exercise to

maintain the health of troops who

would spend much of their time

entombed and waiting.24

Sheltered from naval and air bombardment, with artillery and mortars

registered on the lines of approach, the

Japanese again proved themselves to be

brave and unrelenting foes. The

progress of the fighting was marked by

an endless number of “desperate adventure[s] in close combat.” Suffering

heavy losses, the Americans fought back

with tank-infantry teams that drove the

defenders back into their caves before

blasting the openings with high explosives. Fighting was intense and constant.

The 383d Infantry, 96th Division, lost

326 in one day; one battalion lost half of

its complement. Writing to the USAFPOA chief surgeon, General Maxwell

reported that “the opposition has been

terrific, with the heaviest mortar and

artillery fire [that] any of our men have

ever experienced.” Accurate enemy fire

aimed at command posts in at least one

instance fell on a nearby aid station as

well.25

Yet attrition tolled more heavily on

the Japanese, who, with fewer forces,

were cut off from resupply. Familiar

enemy doctrine emphasized attack, and

the instincts and personality of the 32d

Army’s fiery chief of staff, Lt. Gen. Isamu

Cho, pointed in the same direction. A

counterattack, however, allowed

American firepower free rein to savage

Japanese soldiers, who withdrew bloodied to their defenses. In turn, General

Buckner brought in his reserve division,

the 27th, and ordered a full-scale

assault, preceded by air strikes and the

heaviest bombardment of the Pacific

war. The attack on 19 April failed, resulting in heavy casualties and the loss of

twenty-two tanks. 

Then, in four days of sustained fighting as bitter as any in the campaign, the

Americans worked their way into positions on the outer Shuri defense ring.

Enemy defenses proved to have been

masterfully placed. Japanese soldiers

exploited reverse slopes brilliantly; they

yielded no ground but rather died by

flame and demolition. American losses

continued to be heavy. Half-tracks and

tanks evacuated many wounded, but

heavy casualties and fatigue sapped the

combat efficiency of the three divisions—

7th, 27th, and 96th—so far committed.26

Hence, in late April and early May,

Buckner reorganized. He sent the 27th

Division north to mop up; brought the

marines of the III Amphibious Corps

south to aid the attack; and replaced the

battered 96th Division with the 77th,

fresh from its victory on Ie Shima. The

new troops arrived just in time to

receive, on 4 May, the brunt of a valiant

but hopeless Japanese counterattack,

again undertaken at the urging of

excitable officers who had lost patience

with a strategy that amounted to slowing

24Appleman et al., Okinawa, pp. 189–90, 210. 25Ibid., pp. 118, 129, 256 (first quotation); Ltr, Brig

Gen Earl Maxwell, OofSurg, Island Cmd, to Brig Gen

John M. Willis, CSurg, USAFPOA, 4 May 45, p. 1 (second quotation), Encl to Ltr, Willis to Kirk, 8 May 45, file

312.1 Kirk-Willis Correspondence (SWPA), HUMEDS,

RG 112, NARA. 26Huber, Japan’s Battle of Okinawa, pp. 67–68.

394 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
the Americans by dying in place. Four

days of desperate fighting produced

5,000 enemy casualties, to no purpose.

American losses in the hardest hit divisions were high—379 in the 7th and

77th together—but not comparable to

those of the Japanese.

Nevertheless, the enemy still was able

to wage an effective battle of attrition.

On 11 May the 1st and 6th Marine

Divisions and the 77th and 96th

Divisions (which had returned to relieve

the 7th) opened an assault on the inner

Shuri line. The fighting again featured

heavy Japanese mortar and artillery barrages from reverse slopes, which the

Americans endured without the defenders’ benefit of prepared defenses. The

Japanese infiltrated at night; the

Americans pressed forward during the

daylight hours. Incessant sniping took

its toll on both armies.

Seizure of a single hill—the Sugar

Loaf—cost the 6th Marine Division

2,662 killed or wounded and 1,289 cases

of combat fatigue. On Ishimmi Ridge,

where the 77th Division’s 307th Infantry

seized high land only to be encircled,

“the dead lay in pools of blood where

they fell, or were pushed from holes to

make room for the living. An aid man

[sic], although wounded himself, continued his work until his supplies were

exhausted.” Relieved at last, the company that had made the first attack

returned the division area, carrying its

wounded, having lost 75 percent of its

204 officers and enlisted men.27

In the last week of May furious rains

bogged down the heavy equipment,

making evacuation by wheeled vehicle

almost impossible. At one airfield almost

14 inches of rain fell during May, hindering everything from combat support

to resupply to spraying DDT. Eight litterbearers were needed to move a single litter. As vehicles were immobilized, evacuation times grew, and the combat forces

endured new misery in the water-filled

mudholes that sheltered them from the

enemy. Yet the Japanese at last showed

signs of cracking. On the twenty-seventh

the Okinawan capital of Naha fell almost

without bloodshed to the marines, a ruin

more complete, if possible, than Manila

had been. Two days later Shuri Castle

was captured by an enveloping maneuver of the 7th Division, exploiting night

and rain. A Japanese counterthrust led

to intense fighting in which T. Sgt.

William Goodman, the only medic left in

Company I, 32d Infantry, 7th Division,

stopped bandaging the wounded long

enough to kill five infiltrators. But the

enemy’s fortified area was in danger as

the American left and right wings both

advanced.28

By the end of the month the toll on

both armies was heavy. The Japanese

had lost at least 50,000 dead, including

many of their best troops. The American

ground forces had lost over 26,000

killed, wounded, and missing. The rate

of psychiatric casualties apparently was

higher than in any previous Pacific battle. But the threat of encirclement for

the Japanese holding the Shuri defenses

continued to grow. Hence, General

Ushijima prepared for his last stand,

skillfully withdrawing into redoubts dug

into hill masses, called Yaeju-Dake and

Yuza-Dake, in extreme southern

Okinawa. For another three weeks

28Ibid., p. 382; Island Cmd AAR, Okinawa, 30 Jun 45,

p. 8-XIV-7, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA. 

27Appleman et al., Okinawa, pp. 302, 323, 336 (quotation), 338.

LARGE-UNIT WAR: OKINAWA 395
American soldiers and marines fought

on, until the enemy’s last positions fell.

By 22 June, as the mop-up began, both

commanders were dead, General

Buckner killed by a chunk of coral

hurled out by the explosion of a shell

and General Ushijima, to whom

Buckner had offered terms of surrender, by his own hand in ritual seppuku.

Despite this theatrical conclusion to

the last great battle of World War II,

some 7,400 Japanese soldiers—an altogether unprecedented number—surrendered, most at the end of the campaign. Civilians emerged from hiding;

no mass suicides occurred on Okinawa

itself, though the story was different on

the offshore islands. The next phase of

the work could now proceed in greater

security—not only to rebuild Okinawa

as a base for the coming invasion of

Japan but also to minister to the human

wreckage of the 93-day campaign for the

Ryukyus, the longest since Guadalcanal

and the bloodiest of the entire Pacific

war.29

The Medical Problem

The struggle had featured large

American units in continuous, grinding

combat with an entrenched, desperate,

well-armed foe. But if it resembled

European war in the numbers of men

and cannon, the Okinawa campaign was

essentially of the Pacific in the proportion of killed to captured among the

defenders, in the tactics employed by

both sides for the conduct of island warfare, in the assault of the kamikazes, and

in the prodigious rains that reduced the

lowlands to seas of mire. 

As usual in the Pacific, medics were

not spared, and their casualty rate was

the highest of any branch except the

infantry. Nor were the ranks easy to fill.

The killing and wounding of enlisted

medics left a continuing deficit of

trained personnel in line units, because

of the inevitable time lag experienced

by the USAFPOA chief surgeon in

obtaining replacements. Those who

remained bore an added burden in the

interim, making it necessary to pull soldiers from combat units—on one occasion, forty field artillerymen were sent

forward as litter-bearers—to move the

overflow of wounded who otherwise

could not have been evacuated at all.

Officer replacements were adequate in

numbers, but Colonel Potter, the XXIV

Corps surgeon, complained of the red

tape that obstructed their use:

An officer is killed—the Division prepares a

requisition, sends it to XXIV Corps, we send

it on to Tenth Army, who [sic] in turn, sends

it to the Replacement Depot. During the

week, the Medical Officer sits around at the

Depot, while the Division operates short a

medical officer, who is physically present on

the Island and doing nothing.30

Evacuation at the front was typical of

many Pacific struggles. Armed company

and battalion medics, litter-bearers from

the collecting companies, and infantry

replacements worked in difficult terrain, hidden sometimes by chemical

smoke. At all times they were targets of

29Appleman et al., Okinawa, pp. 184–474 (statistics);

Isely and Crowl, Marines and Amphibious War, pp.

543–79; Hough, Assault on Peleliu, pp. 364–78. The

Okinawa campaign officially ended on 2 July 1945.

Losses at Iwo Jima were higher in proportion to the

numbers engaged.

30Surg, XXIV Corps, Daily Journal (copy), 5 May 45

(quotation), file 319.1; 77th Inf Div AAR, Okinawa, 25

Apr–30 Jun 45, pp. 73–76, THU Note Cards, Historians

files; OofSurg, 96th Inf Div, ETMD, 19 Jul 45, encl. 1,

THU Note Cards, Historians files. All in HUMEDS, RG

112, NARA.

396 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
aimed enemy fire. It was in such conditions that Pfc. Desmond T. Doss of the

medical detachment, 307th Infantry,

77th Division, won the Medal of Honor.

A conscientious objector who refused to

carry a weapon and kept the Seventh

Day Adventist sabbath every Saturday,

Doss at the end of April was a company

aidman during his unit’s assault on a

400-foot escarpment. The troops seized

the crest, only to be hit by furious fire

from the reverse slope. As they scattered, Doss remained alone at the top to

help casualties. He carried the wounded

to the edge and, after tying them to litters, lowered them to friendly hands.

On another occasion Doss treated those

lying in the very mouth of an enemyheld cave; on a third, wounded himself,

he gave up his place on a litter to a more

severely injured soldier. Doss then

splinted his own fractured arm with a

rifle stock and crawled to safety.31

Savagery, bravery, and improvisation

marked the front line as in all the Pacific

fighting. Once out of the combat area,

however, evacuation for the first time in

31WD GO 97, 1 Nov 45, p. 2; [77th Division

Association], Ours To Hold It High: The History of the 77th

Infantry Division in World War II (Washington, D.C.:

Infantry Journal Press, 1947), pp. 303–04.

LARGE-UNIT WAR: OKINAWA 397

LITTER-BEARERS TRAVERSING OKINAWA’S DIFFICULT TERRAIN
the experience of many veterans

assumed the form dictated by field service regulations. The 77th Division surgeon reported that his main supply road

was usable, that evacuation times were

short, that an efficient shuttle of ambulances was easy to maintain, and that the

wounded from the clearing station—

aided by whole blood, for the first time

available at collecting stations—were in

good condition. Similarly, the 96th

Division surgeon said that “the terrain

and road nets [sic] lent themselves well

to the needs of rapid evacuation.”

Before and after (though not during)

the rains, such conditions briefly created the image of conventional warfare on

Okinawa.32

Until the field hospitals came ashore,

division ambulances moved casualties

from aid stations to the Hagushi beaches, where clearing stations and portables

awaited them. Once transferred to Navy

beach party medics, they were carried by

landing craft offshore to the hospital

LSTs. Here, after treatment and sorting,

the seriously injured were sent on to

hospital ships and transports for evacuation to the Marianas. In the general hospitals on Saipan, the impact of Iwo Jima

and Okinawa was abrupt. As casualties

flooded in, surgical services burgeoned

and ward medical officers stood roundthe-clock duty.33

The treatment received by the wounded on Okinawa in many ways was a model

of matured forward medicine. Beginning

to arrive on L+5, field hospitals established themselves at road junctions south

of the beaches (Map 15), some 4,000 to

6,000 yards from the fighting line—close

enough that enemy shells sometimes

landed in the hospital areas. Most

worked under canvas, or in abandoned

dwellings, and many used the lull that followed the landings to organize and prepare themselves for the heavy work

ahead. At first under division control,

they passed in sequence to the XXIV

Corps and then to the Tenth Army, the

higher headquarters, when it arrived. As

the chain of evacuation grew more complex, corps clearing stations moved

ahead of the hospitals, to treat less serious cases, and the corps’ 71st Medical

Battalion took over the movement of

wounded from clearing stations to hospitals. Between 25 April and 20 June five

field hospitals not attached to divisions

also arrived. They worked in a variety of

ways, some serving in effect as station and

others as small evacuation hospitals. Four

station hospitals arrived in late May and

June, to receive the overflow of casualties

from the fighting in the south.34

For most of the campaign the field

hospitals were the key elements in

treating the wounded ashore. They

served diverse functions, just as the

portables had during earlier small-unit

fighting, receiving the sick and wounded. Yet, because the expected casualties

from sickness did not materialize in the

numbers the Army had anticipated, few

hospitals, despite the heavy casualties,

operated much in excess of their rated

capacity. (In the 31st Field Hospital, for

32Surg, 77th Inf Div, Quarterly Rpt, Apr–Jun 45, p. 3;

96th Inf Div AAR, Okinawa, 1 Apr–30 Jun 45, p. 20

(quotation). Both THU Note Cards, Historians files,

HUMEDS, RG 112, NARA. 33148th Gen Hosp ETMD, 20 Oct 45, pp.1–5, file

350.05, HUMEDS, RG 112, NARA.

3431st Field Hosp AAR (copy), Okinawa, 1945, pp.

1–4, file 319.1; 69th Field Hosp Quarterly Rpt (copy),

Apr–Jun 45, pp. 2–4, file 319.1. Both in HUMEDS, RG

112, NARA. See also Tenth Army, “Action Report:

Ryukyus, 26 March to 30 June 1945,” pp. 11-XV-8 to 11-

XV-14, U.S. Army Center of Military History Library

(CMH–L), Washington, D.C.

398 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
example, the campaign brought in 7,660

surgical cases but only 876 medical

cases.) Moreover, the field hospitals were

well served by other units. Forward medical units, defending themselves in

perimeters surrounded by “trip-flares,

booby-traps, concertina wire and wellarmed guard posts” were at the peak of

medical and military efficiency. A constantly improving system of sorting and

evacuation prevented the wounded from

piling up, especially after the Tenth

LARGE-UNIT WAR: OKINAWA 399

69th Field Hospital

74th Field Hospital

76th Field Hospital

82d Field Hospital

31st Field Hospital

96th and 98th Portable Surgical Hospitals

51st and 67th Portable Surgical Hospitals

52d and 66th Portable Surgical Hospitals

68th Field Hospital

EAST

CHINA

SEA

CHIMU BAY

NAKAGUSUKU 

BAY

Bishi R

Ie Shima

Imadomari

Toguchi MOTOBU 

PENINSULA

Nago

Ishikawa

Taba Hagushi

Yonabaru

Shuri Naha

Minatoga

Keise Is

OKINAWA

Ozato

Adaniya

Futema

Isa

Kuba

OROKU 

PENINSULA

ELEVATION IN METERS

0 100 200 300 and Above

HOSPITALS ON OKINAWA

April 1945

Airfield

0 10

Miles

MAP 15
Army’s 96th Medical Battalion started

work on 26 April. Soon the battalion

established an Okinawa Evacuation

Center, a centralized facility that moved

casualties to ships, airfields, hospitals,

and prisoner-of-war stockades. It also set

up a special 500-bed hospital for prisoners. The portable surgical hospitals provided essential support close to the fighting line, although they soon faced heavy

patient loads with small staffs intended

for a different kind of war.35

The quality of care given by the field

hospitals is less easy to assess. Planners

had wisely strengthened these relatively

low-echelon facilities so that each field

hospital averaged twenty-two doctors

instead of the authorized thirteen. Extra

general, orthopedic, eye, and neurosurgeons were assigned, each with enlisted

technicians to support his work. Surgical

teams were organized, each consisting of

two surgeons, an anesthetist, a surgical

nurse, and three technicians. When the

heavy influx of wounded began, many

teams worked steadily for thirty-six to

forty hours at a stretch; some split up to

handle more cases. Under intermittent

fire from the enemy, team members slept

in foxholes close to their place of work.

Yet the surgical teams were few in

number—the Tenth Army had requested twelve but received only five—and

they worked, like the field hospitals as a

whole, understaffed and underequipped. Shortages were noted in many

critical specialties, including anesthesiology, neurosurgery, thoracic surgery, eye

surgery, and maxillofacial surgery. For

the first month the hospitals also lacked

female nurses, who were excluded from

Okinawa during that period. With such

deficiencies, the field hospitals had to fill

two demanding roles, their own traditional function of forward support and

the duties of evacuation hospitals as well.

Possibly as a result, consultants rated at

least four field hospitals as weak in

surgery. “We are finding,” wrote Colonel

Westervelt, “that one cannot make an

evacuation hospital out of a ‘souped up’

field hospital. . . . Many of the casualties

being received are terrible. Two and

three limbs, complicated by belly and

chest wounds, are not infrequent in one

soldier.” One basket case was found still

alive twenty-four hours after losing all

four limbs.36

While the hospitals struggled to care

for the severely wounded, especially

those with multiple injuries, more than

5,000 others with less severe problems—

including the neuropsychiatric (NP), or

white, cases that required less than fifteen days of hospitalization—never

received complex treatment ashore.

They were sent to the ships, and the

evacuation system shouldered a burden

that, for the sake of the fighting forces

and the casualties themselves, ought to

have been borne ashore.37

35Tenth Army, “Action Report: Ryukyus,” pp. 11-XV-6

to 11-XV-25, CMH–L. See also 31st Field Hosp AAR

(copy), Okinawa, 1945, p. 13, file 319.1; Ltr, 1st Lt Ted

Bloodhart, CO, 5th Med Museum and Arts Det, thru CO,

18th Med Gen Lab, to CSurg, USAFPOA, 5 May 45, sub:

Observations During the Initial Phase of the Okinawa

Operation, p. 2 (quotation), Encl 3 to Ltr, Willis to Kirk,

7 May 45, file 312.1 Kirk-Willis Correspondence (SWPA).

Both in HUMEDS, RG 112, NARA. On 23 June, when

the battle was almost over, the 80th Medical Group was

established and the system organized further. See 71st

Med Bn Quarterly Rpt (copy), Jul–Sep 45, p. 2, file 319.1,

HUMEDS, RG 112, NARA. 

36Comments of [Westervelt], 1 May 45, Encl to Ltr,

Willis to Kirk, 8 May 45, file 312.1 Kirk-Willis

Correspondence (SWPA), HUMEDS, RG 112, NARA. 37OofSurg, USAFPAC, ETMD, 28 Sep 45, THU Note

Cards, Historians files; OofSurg, Tenth Army, ETMD,

20 Jul 45, p. 3, file 350.05; 31st Field Hosp AAR (copy),

Okinawa, 1945, p. 3, file 319.1; Ltr (copy), Lt Col

Harold A. Sofield to Col Leonard T. Peterson, 20 Jul 45,

Continued

400 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Although overworked, the surgeons

had some compensating advantages.

Supporting the severely injured both in

transit and in surgery was an abundant

supply of whole blood. Naval Air

Transport Service planes, equipped with

special refrigeration units, flew blood

from Los Angeles and San Francisco to

Guam. Initially, ships carried it to

Okinawa, but air service began on 18

April. As employed in the Philippines, a

specially equipped LST received, stored,

and disbursed the blood. Twice as much

whole blood as plasma was used; whole

blood replaced plasma in the management of shock and burns. Blood was

given as far forward as collecting stations,

and the officer in charge of the Army’s

blood program, Lt. Col. Douglas B.

Kendrick, visited Okinawa during the battle to inspect field hospitals, to give lectures on the advantages of whole blood,

and to assist on the shock wards. The hospitals alone utilized 14,000 pints of whole

blood, and more than 40,000 were transfused in the course of the campaign.38

The casualty arriving at a field hospital

entered a medical assembly line. He went

first to the triage ward, where an experienced surgeon examined him, X-rays

were made, and his priority for surgery

was established. If he was in shock or in

danger of shock—a potentially fatal condition caused by blood loss, with typical

symptoms of cold, anxiety, and elevated

pulse rate—he was sent to a special shock

ward, where teams of internists went into

action. Routine tests determined among

other things the percentage of red cells

in a given volume of blood, and hence

the amount of blood lost. He then

received plasma, intravenous glucose,

and probably the amount of whole blood

needed. When ready for surgery, he was

taken to one of the tented operating

rooms, with tarpaulin floors to minimize

the intrusion of dust or mud.

Here steam from an autoclave provided warmth. Enlisted surgical technicians

acted as scrub nurses and surgical assistants, and an enlisted technician administered a spinal anesthetic, open drop

ether, or Pentothal under the supervision of a commissioned nurse anesthetist

or anesthesiologist. Operations were carried out by general surgeons or by specialists, depending on the type of injury.

The six hard-working orthopedists on

Okinawa accomplished an exhausting

task in dealing ably with some 15,000

injuries, many resulting from artillery.

The presence of neurosurgeons on

detached service from general hospitals

made early treatment of brain and spinal

cord injuries possible, almost from the

first day of severe fighting.39

sub: Orthopedic Surgery on Okinawa, Historians files;

Surg, XXIV Corps, Daily Journal (copy), 21 Apr 45, file

319.1. All in HUMEDS, RG 112, NARA. It should be

noted that Colonel Potter remained a strong supporter

of the role of the portables, writing that “the value of

the Portable Surgical Hospitals cannot be over-emphasized especially in the administering of definitive treatment to severe non-transportable battle casualties.” See

Rpt, Surg, XXIV Corps, n.d., sub: Iceberg Operation, p.

17, file 319.1–2, HUMEDS, RG 112, NARA. 38OofSurg, USAFPAC, ETMD, 28 Sep 45, THU Note

Cards, Historians files; Whitehill, “Medical Activities in

Middle Pacific,” block 18f, 1:148–50, file 314.7. Both in

HUMEDS, RG 112, NARA. See also Interv, Mary Ellen

Condon-Rall with Douglas B. Kendrick, 7 Oct 80, CMH;

Douglas B. Kendrick, “The Blood Program,” in B.

Noland Carter, ed., Activities of Surgical Consultants,

Medical Department, United States Army in World War

II, 2 vols. (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1962–64), 1:160–61.

3931st Field Hosp AAR (copy), Okinawa, 1945, pp.

9–10, 23–31, file 319.1; Ltr (copy), Sofield to Peterson,

20 Jul 45, Historians files. Both in HUMEDS, RG 112,

NARA. Full use of air evacuation and the establishment

of a separate neurosurgical chain of evacuation to

speed movement and minimize injury in transit, however, were not attained until the Korean war. 

LARGE-UNIT WAR: OKINAWA 401
ADMINISTERING WHOLE BLOOD AND ETHER in tented operating rooms
In sum, Army hospitalization on

Okinawa provided a qualitatively excellent surgical service, equipped, however,

with too few beds and too few specialists

for a campaign that was longer and

bloodier than planners had foreseen. A

surgical conference held in the

Marianas in July 1945 brought general

agreement that Okinawa casualties arriving at the general hospitals there were

in the best condition of any so far

received from the Pacific battlegrounds.

But consultants’ reports indicated that

ample room for improvement existed in

a theater where Army medical support,

by comparison with Europe and even

with the Southwest Pacific Area, still

lacked a fully developed chain of evacuation. As reported by the surgeon general in September: “The heavy load of

[battle] casualties and of psychiatric

patients demonstrated again the inadequacy of field hospitals used as the

exclusive hospital support for combat

divisions.” Although he concluded that

excellent evacuation took up much of

the slack, he did not add the obvious

corollary—that too many casualties were

removed from the battle zone and lost

to their hard-pressed units.40

Stress and Disease

Less successful, though fortunately

less needed, was the medical service provided to sick soldiers. “Of ten field hospitals observed in this operation,” wrote

the Tenth Army medical consultant,

“the medical service was good to very

good in three, fair in one, and poor in

six.” Laboratory work, he added, was

poorly done, and tonnage limitations

prevented the 14th Medical Laboratory

from functioning at its full potential.

Transport difficulties on Okinawa itself

complicated the task of sending specimens to the laboratory. In view of the

medical consultant’s findings, it was fortunate that sickness was not a serious

problem on Okinawa and that the psychiatric service was of high quality.41

Combat stress and related disorders

showed the interacting effects of two

developments. On one hand, psychiatric

support had reached maturity; on the

other, unremitting combat in a battle of

attrition caused ever-increasing stress.

Fighting an aggressive campaign against

an entrenched but unpredictable foe

was wearing in itself. The nature of the

campaign was intensely frustrating, with

little progress and bitter struggles over

featureless ridges. Not surprisingly,

many soldiers came to believe that they

faced only an endless series of fights,

with their chances of survival constantly

diminishing.42

Heavy enemy shellfire contributed

significantly to psychiatric breakdowns.

A Sanitary Corps officer described the

situation on Okinawa:

40ASF Monthly Progress Rpt, 30 Sep 45, pp. 8–9 (quotation), THU Note Cards, HUMEDS, RG 112, NARA.

On average 5 percent of the battle injured who reached

medical care died of their wounds—slightly above the

wartime average of about 4 percent. It is unclear what

contributed most to the result, deficient bed strength

or improved evacuation.

41Surg, Tenth Army, ETMD, 29 Aug 45, p. 3, file

350.05, HUMEDS, RG 112, NARA. Col. Walter B.

Martin attributed the poor situation in the field hospitals only to unsatisfactory personnel. 42Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:182–86, file 314.7; XXIV Corps AAR,

Okinawa, 1 Apr–30 Jun 45, pp. 78–79, THU Note

Cards, Historians files. Both in HUMEDS, RG 112,

NARA. See also Oscar B. Markey, “Tenth U.S. Army,” in

Albert J. Glass, ed., Overseas Theaters, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1973), p. 643.

LARGE-UNIT WAR: OKINAWA 403
It is said that the Japanese artillery on

Okinawa has been the heaviest and most

accurate that we have encountered. This

surprising and violent change in the

Japanese tactics caused a remarkable reaction among the front line [sic] troops. Many

psychoneurotic patients were brought in

during the days of the heaviest Japanese

shelling. Our troops, though veterans, had

no way of personally combating this artillery.

Having no choice but to get into a hole and

“sweat it out,” many developed severe anxiety and fear neuroses. These “battle

fatigues” were brought to the aid stations

trembling violently, glassy-eyed, crouched

and flinching, and many were crying hysterically. Old, hardened soldiers broke up the

same as new troops.43

About 1 in every 7 hospital admissions

was for causes loosely termed psychiatric.

Attached to the Tenth Army for the

Okinawa operation was Col. M. Ralph

Kaufman, MC, the USAFPAO neuropsychiatric consultant, who brought to bear

the accumulated experience of past

years in the South Pacific Area and the

Pacific Ocean Areas. Active therapy at

the earliest possible time and at the most

forward possible echelon was Kaufman’s

aim. Those suffering only from exhaustion and mild anxiety received sedation

and rest at aid stations and were

returned to duty after twenty-four hours,

while more serious cases went to a division clearing station to be seen by the

division psychiatrist. Here treatment for

most consisted of reassurance, rest, hot

meals, sleep, and a change of clothes.

However, as the clearing stations became

overcrowded, the overflow went to the

field hospitals, each of which had a psychiatrist on its staff and trained enlisted

men in the neuropsychiatric wards. The

number of casualties continued to grow

so that on 25 April the 82d Field

Hospital opened specifically to care for

NPs, both soldiers and marines. Here

the most difficult cases received more

complex treatment, including group

therapy and hypnosis. 

Eventually, because psychiatrists from

other hospitals were assigned to the 82d,

it became the best staffed facility of its

kind in the Pacific war. Deliberately

operating closer to the front line than

other field hospitals, the 82d embodied

Kaufman’s conviction that NPs must be

held in the danger zone and continue to

make their cots, to stand in chow lines,

and to hear the “shells whiz over their

heads” if they were to recover and

return to duty. For the same reason, four

rest camps—where soldiers recovering

from combat fatigue finished their recuperation on duty status—were set up forward of the field hospitals, rather than

to the rear. In some units the results

were as good as any in World War II. The

77th Division, for example, reported

that 76 percent of all neuropsychiatric

cases returned to full duty and that less

than 10 percent of those returned to

combat failed to hold up under renewed

stress.44

As a whole, however, the Tenth Army

had less satisfactory results, for reasons

that had nothing to do with the scheme

of forward treatment in itself. More than

half of the 3,118 Army and Marine neuropsychiatric cases had to be evacuated,

many going untreated to the rear

because the wounded had priority for

44Quotation from Markey, “Tenth U.S. Army,” in

Glass, ed., Overseas Theaters, p. 672. See also 77th Inf Div

AAR, Okinawa, 25 Apr–30 Jun 45, p. 76, THU Note

Cards, Historians files, HUMEDS, RG 112, NARA. 

43Ltr, Bloodhart, thru CO, 18th Med Gen Lab, to

CSurg, USAFPOA, 5 May 45, p. 3 (quotation), Encl 3 to

Ltr, Willis to Kirk, 7 May 45, file 312.1 Kirk-Willis

Correspondence (SWPA), HUMEDS, RG 112, NARA.

404 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
bed space on Okinawa. Progress since

the early days of the war was plain to see.

But so were continuing problems—the

lack of forward beds, the long supply

lines, and the relative poverty of the

Pacific theaters.45

No serious disease outbreaks afflicted

the troops during the campaign. The

inevitable cases of diarrhea, skin disease,

and respiratory complaints, if mild, were

handled adequately in individual units,

with the sick soldiers remaining on duty

status. Elaborate pre-invasion preparations to meet malaria, schistosomiasis,

scrub typhus, and even poisonous

snakes revealed the inadequacy of the

medical intelligence on islands long

held by the Japanese. (Local doctors

who had lived on Okinawa all their lives

told American medical officers that they

had never seen scrub typhus.) Yet one

serious disease—filariasis, infection with

a parasitic nematode—was common.

The organism was spread by mosquitoes, and the discovery led to greater

control efforts, using DDT sprayed from

airplanes. Fortunately, an overestimate

of the malaria menace had resulted in

plenty of equipment and supplies. 

The change from a tropical to a mild

subtropical climate in itself appeared to

make a major difference in the extent

and severity of common illnesses. Skin

diseases were far less troubling. An outbreak of dengue occurred on the southeast coast, but never grew into an epidemic. Most cases of malaria probably

originated on Leyte, from where the 7th

Division had come, as did the few cases

of infectious hepatitis and even the

worm infestations that turned up in 416

troops. Fly control was the business of

sanitary units operating immediately

behind the front, which sprayed enemy

dead with arsenite and DDT and buried

them with bulldozers. Only toward the

end of the campaign did diarrheal disease begin an upward spiral, especially

in forward areas—a function of the

destruction of war and the accumulation of unburied dead. (According to

some grim accounts, corpses of

Japanese infiltrators, blanketed with

flies, were lying a few feet from the foxholes of GIs who could not leave their

shelter to bury them.) Airplane spraying

provided only limited control, and diarrheal disease rates rose to 200–300 per

1,000 troops per year in June—higher

than those of the Sixth Army on Luzon.

The command was fortunate that the

diarrheal diseases, though common,

were not very severe; the causes of most

cases, for lack of proper laboratory facilities, were never definitely identified.46

Despite exceptions, the story of preventive medicine on Okinawa was

remarkable for the Pacific war. In

almost any operation the sick will outnumber the wounded. On Okinawa,

however, daily casualties from sickness

did not outnumber battle casualties

until 28 May, fifty-eight days after the

45Markey, “Tenth U.S. Army,” in Glass, ed., Overseas

Theaters, pp. 639–78.

46ASF Monthly Progress Rpt, 30 Sep 45, sec. 7, pp.

5–6, THU Note Cards, HUMEDS, RG 112, NARA. After

Okinawa was secured, an outbreak of Japanese B

encephalitis among civilians alarmed the armed forces

staging for the invasion of Japan. Ultimately, 38 possible

cases and 2 deaths were recorded for U.S. personnel.

See Albert B. Sabin, “Epidemic Encephalitis in Military

Personnel: Isolation of Japanese B Virus on Okinawa in

1945; Serologic Diagnosis, Clinical Manifestations,

Epidemiologic Aspects and Use of Mouse Brain

Vaccine,” Journal of the American Medical Association 133

(Feb 47): 281–93, and W. D. Tigertt and W. M.

Hammon, “Japanese B Encephalitis: A Complete

Review of Experience on Okinawa, 1945–1949,”

American Journal of Tropical Medicine 30 (Sep 50):

689–722.

LARGE-UNIT WAR: OKINAWA 405
invasion began. Throughout the campaign, noneffective rates from disease

remained low and total nonbattle casualties, both sick and injured, numbered

only two-thirds of those killed, wounded, and missing in action. In no other

respect did the last battle of the Pacific

war so completely depart from past

norms.

Evacuation

Evacuation of all casualties was difficult along the fighting line but fundamentally well-organized and efficient

further to the rear. As the battles against

the Shuri lines and the southern

redoubt progressed, the contrast grew.

The onset of torrential rains soon compounded the work of division medics.

The valleys became bogs, and tanks had

to be employed as evacuation vehicles,

dragging out ambulances and jeep

ambulances that were hopelessly stuck.

Sometimes tank crews came to the aid of

casualties pinned down by enemy fire,

straddling the victim and pulling him to

safety through the escape hatch. At

other times tanks, moving at low speed,

ran interference for litter teams that

were unable to reach the wounded.

Weapons carriers (3

⁄4-ton trucks), tractors, and Weasels likewise served as

ambulances. 

406 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

MALARIA CONTROL EFFORTS ON OKINAWA
Yet, despite such mechanical assistance, human muscle remained the best

reliance for moving casualties over the

harsh terrain, with its steep slopes,

ravines, escarpments, and coral boulders. To move under fire in such country, carrying an inert body, was brutal

labor. Extra litter-bearers had to be

requested, and loading posts were established beside battalion aid stations wherever vehicles could run. Even at the field

hospital, the problem continued. At the

31st, for example, mud was so deep for a

time that litter-bearers could not carry

casualties between wards, and ambulances made such transfers, churning

through the “lake of mud” in which the

hospital worked.47

When roads were impassible, both

Army and Marine units attempted to

evacuate by water or by cub plane. Thus,

a 7th Division clearing station evacuated

casualties to a coastal collecting point,

from where they were taken by landing

craft up the east coast to a collecting platoon at Kuba and then on to the 74th

Field Hospital—a very similar arrangement to the one the same division had

used on Leyte’s west coast in the autumn

of 1944. Light planes again, as in the

Philippines, became an essential part of

the evacuation team. From mid-June on,

when the small craft arrived on

Okinawa, cubs landed and took off from

hard-surfaced roads near collecting stations, returning the evacuees to division

and corps hospitals. 

Despite the few casualties that could

be taken per flight, short distances and

the persistence of pilots flying shuttle

permitted multiple trips. The 1st

Marine Division evacuated about 800

wounded in this way, and the 7th and

96th Divisions together moved out

1,232. Light planes enabled some to

receive hospital care within an hour or

two of being wounded, and the terrain,

especially as the weather began to

clear, almost demanded forward air

evacuation.48

Of the 21,000 casualties evacuated

from Okinawa, about 16,000 went by

ship, which maintained blackout conditions after the first incidents of enemy

48Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:157–58, file 314.7, HUMEDS, RG 112,

NARA; Bennett F. Avery, ed., The History of the Medical

Department of the United States Navy in World War II, 3 vols.

(Washington, D.C.: Bureau of Medicine and Surgery,

Department of the Navy, 1950–53), 1:112.

4731st Field Hosp AAR (copy), Okinawa, 1945, p. 5

(quoted words), file 319.1; Whitehill, “Medical

Activities in Middle Pacific,” block 18f, 1:151–54, file

314.7. Both in HUMEDS, RG 112, NARA. 

LARGE-UNIT WAR: OKINAWA 407

TANK USED FOR FRONTLINE EVACUATION
attack. With several large airfields

under Allied control, however, the

growth of air evacuation was inevitable.

The Navy had evacuation hospitals,

unlike the Army, and casualties were

transferred from the XXIV Corps holding stations or the Navy hospitals to the

airfields, where the 645th Collecting

Company unloaded the ambulances

and loaded the C–54s and DC–4s of the

Naval Air Transport Service and the Air

Transport Command’s Pacific Division.

Flight nurses and enlisted technicians

accompanied the wounded, and by 25

April the outflow had reached 200 a

day. In all, 13,387 soldiers were evacuated from Okinawa, and of these more

than 7,500 went by air, apparently the

greatest proportion for any of Admiral

Nimitz’ campaigns.49

Victims of War

The campaign in the Ryukyus was the

first in which Americans took large

numbers of enemy prisoners and,

except for Saipan, the first in which they

encountered a heavy population of

Japanese civilians. On Okinawa the latter proved to be no great problem

behind the lines, if only because the

Japanese Army had conscripted most of

the males between the ages of fifteen

and forty-five; those most likely to cause

trouble were serving with General

Ushijima and could be dealt with as

combatants. However, the treatment of

the civilians was important not only in

the context of the war but in view of the

greater problem that lay just ahead—the

management by military commanders

of the civil population of Japan.

Hence, preparations were exceptionally thorough. Though ultimate responsibility for military government rested

upon Admiral Nimitz, the fact that the

Army would garrison the islands caused

him to delegate his power to General

Buckner, who in turn passed it to

General Wallace. Each Tenth Army division had brought with it 70,000 civilian

rations of rice, soybeans, and canned

fish, and medical supplies as well.

Special rations had even been prepared

for small children, nursing mothers,

and laborers. Military government specialists, supplied by both armed services,

followed the assault waves. The Navy

408 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

FLIGHT NURSE ACCOMPANYING

OKINAWAN CASUALTIES

49Whitehill, “Medical Activities in Middle Pacific,”

block 18f, 1:162–63, file 314.7, HUMEDS, RG 112,

NARA; Avery, ed., Medical Department of United States

Navy, 1:110–13; Appleman et al., Okinawa, pp. 412–15.
provided two types of medical detachments to serve civilian needs—a 24-bed

dispensary with 1 medical officer and 6

corpsmen, and a 500-bed hospital with

15 medical officers and 150 enlisted

men. In all, roughly 1,000 naval medical

personnel were committed to the

effort.50

The number of those who required

aid was great and rose rapidly as the

conquest proceeded. By the end of

April about 127,000 civilians had passed

to American control. The increase was

more gradual during May, because of

the stalemate before Shuri; but, after

the breakthrough, numbers again rose

rapidly. By the beginning of June

144,311 men, women, and children

were under military government control. Of the civil population at the start

of the battle—probably over 400,000

people—between a tenth and a fourth

perished in the fighting, and wounds

among the survivors were serious and

common. In July a single dispensary

recorded 5,000 outpatient and 731

inpatient treatments. One of the hospitals, after the breaking of the Shuri line,

had a peak census of 1,180 cases, more

than double its table-of-organization

strength.51

Initially collected in barbed-wire

stockades to keep them out of the way,

Okinawans were quickly moved to

camps established around villages that

had escaped destruction, where they

received food, water, clothing, shelter,

and medical care. An energetic public

health campaign began. Many civilians

first encountered their conquerors in

the form of enlisted medics, who dusted

them with DDT to kill any lice and fleas. 

With such assistance, the Okinawans

quickly proved to be a hardy lot. Largely

an agricultural people, they were industrious at growing and harvesting crops,

and the Army cooperated by helping to

round up domestic animals that were

running wild behind the lines and turning them over to the camps to provide a

more adequate diet. Poverty and hard

work, frugality and discipline had

keynoted the Okinawans’ lives during

peacetime; to survive the battle, they

adapted docilely to events and sought to

make “the best of the disaster which had

overtaken them.”52

On the whole, the Okinawans were

comparatively healthy as well as hardy.

Inhabitants of a civilized and temperate

if poor and backward land, they suffered

little from communicable disease,

although cases of malaria, encephalitis,

leprosy, intestinal disorders, and filariasis were noted. Tuberculosis was a major

scourge in Asia, and about a quarter of

the civilians tested showed some evidence of the disease. Army hospitals

provided some assistance, on occasion

detailing medical personnel to civilian

hospitals. The overwhelming burden of

civilian care and treatment, however,

was borne primarily by the Navy medical

detachments of the military government. After the battle, any cases that

could not be treated by civilian doctors

or by military government medics were

sent to Navy hospitals and dispensaries. 

50“Disaster Relief Administration: Public Health,” pp.

1–6, Historians files, HUMEDS, RG 112, NARA. 51Ibid., p. 5, Historians files, HUMEDS, RG 112,

NARA; Arnold G. Fisch, Jr., Military Government in the

Ryukyu Islands, 1945–1950 (Washington, D.C.: U.S.

Army Center of Military History, 1988), pp. 42, 45.

52Quotation from Appleman et al., Okinawa, p. 415.

See also ASF Monthly Progress Rpt, 30 Sep 45, sec. 7, p.

10, THU Note Cards, Historians files, HUMEDS, RG

112, NARA. The subsequent course of events on

Okinawa is detailed in Fisch, Military Government in

Ryukyu Islands.

LARGE-UNIT WAR: OKINAWA 409
The effort to treat civilians and provide the basics of public health appears

to have been one of the success stories

of the Okinawa campaign. The mere

fact that humanity should have been

shown at all astonished those who came

trembling into American lines, in expectation of torture and death. The provision of food and its transportation over

long distances, when space was at a premium, marked the depth of the commitment by Nimitz’ headquarters to a

wise and successful policy.53

The full weight of responsibility for

caring for Japanese prisoners of war fell

upon the Army. During most of the campaign, in line with past experience, few

enemy soldiers surrendered; many of

those who did were unconscious or otherwise helpless. Suicide remained common. Some Japanese soldiers would fire

a last shot and then wait in plain view to

be killed, while others would hold

grenades against their bellies and pull

the pins. But at the end of the fighting

7,401 preferred surrender to death—

though 3,339 of those who gave themselves up were laborers, rather than

fighters. 

Hard used during the terrible campaign, most Japanese prisoners were in

poor condition from the effects of starvation and stress. Many were wounded

as well. They entered Army hospitals in

a state of acute anxiety that reflected the

atrocity stories spread by anti-American

propaganda. The 96th Medical

Battalion’s holding station was the first

unit to receive them, and the 88th Field

Hospital was later dedicated to their

care. They received nourishment, beds,

and care similar to that given American

soldiers, except in three particulars:

they were not given American blood,

plasma, or penicillin. At the end of the

fighting Army hospitals on Okinawa

held 1,065 Japanese prisoners—“an

unprecedented number for the Pacific,”

as the surgeon general reported. They

responded well to food and medical

treatment and answered questions

freely. Those who were ambulatory carried litters and water if able, as well as

assisted in the care of bed patients.54

Reviewing the Campaign

The joint headquarters that planned

medical support and the officers who

directed it in the field had cause for satisfaction in the record of Okinawa. As

ever, courage and endurance at the line

were the foundations of success. But

sound planning had incorporated the

hard-learned lessons of past operations, giving the troops some advantage. Better intelligence, more surgical

teams, more abundant and earlier use

of light planes, and the presence of a

few helicopters could have improved

the situation further, as could an Army

evacuation hospital, had one been

available. But in surgery, bed strength,

and evacuation, the three essentials for

such a campaign, the theater achieved

an impressive record under difficult

conditions.

As a whole, the Tenth Army sustained

65,631 casualties, about 2,000 more

than on Luzon, and roughly 1 in 9 died.

Its four divisions suffered 34,736 casual53Appleman et al., Okinawa, pp. 415–19; ASF Monthly

Progress Rpt, 30 Sep 45, sec. 7, p. 10, THU Note Cards,

Historians files, HUMEDS, RG 112, NARA.

54ASF Monthly Progress Rpt, 30 Sep 45, p. 9 (quotation), THU Note Cards, Historians files; Whitehill,

“Medical Activities in Middle Pacific,” block 18f, 1:135,

file 314.7. Both in HUMEDS, RG 112, NARA. See also

Appleman et al., Okinawa, pp. 465–67.

410 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
ties, of whom 4,582 were killed or died

of wounds. The marines lost 2,792 dead,

while the Navy, reflecting the bitterness

of the struggle at sea, lost 4,907 dead,

although many fewer wounded than the

land forces. The intensity of the Ryukyus

fighting is less easy to measure. In killed

and wounded per 1,000 troops per day,

only Iwo Jima was higher than Okinawa;

in Europe, the battle of Normandy was

approximately equal. 

Beginning as a series of savage

episodes, the campaigns in the Pacific

ended in a large-unit struggle for the

Ryukyus, in which 12,281 Americans

and 110,000 Japanese died. Total

American casualties, including wounded and nonbattle injuries, were in excess

of 75,000. Roughly speaking, 2

Americans either died or went to the

hospital for every 3 Japanese who were

killed, surrendered, or committed suicide. These figures were grim reading

for the American planners, who already

had begun to look ahead to the invasion

of Japan.55

55For statistics and analysis, see Appleman et al.,

Okinawa, pp. 489–90; ASF Monthly Progress Rpt, 30 Sep

45, sec. 7, pp. 2–5, THU Note Cards, Historians files,

HUMEDS, RG 112, NARA.

LARGE-UNIT WAR: OKINAWA 411
Even as Admiral Nimitz’ forces on

Okinawa moved inland in early April

1945, the Joint Chiefs of Staff prepared

for the final phase of the Pacific war.

Shortly after the establishment of a new

headquarters, called the United States

Army Forces, Pacific (USAFPAC), under

the command of General MacArthur,

they ordered him to develop plans for

the invasion and occupation of Japan.

When the Okinawa campaign ended in

July, USAFPOA soldiers were likewise

assigned to MacArthur’s USAFPAC

headquarters, while Admiral Nimitz

became commander of all naval forces

in the Pacific. The time of geographic

commands dividing the Pacific was over;

but, as before, no single supreme commander controlled all Allied, or even all

American, forces in the region.

Organizational Problems

General Denit became the USAFPAC

chief surgeon on 9 June, when personnel were assigned to the new headquarters. As a planning and policy-making

unit for a vastly increased consolidated

command, Denit’s office expanded,

though the usual administrative lag

caused the arrival of new personnel to

be delayed beyond the end of the war.

As chief surgeon, Denit’s mission was to

exercise general technical supervision

over the medical service of the Pacific

theater, to advise MacArthur, and to

translate his commander’s decisions

into plans. 

Denit found that his new position had

strengths and weaknesses. Previously, he

functioned as both the USAFFE and the

USASOS chief surgeon. Under the new

setup in which the logistical command

was renamed the United States Army

Forces, Western Pacific (USAFWESPAC), Denit continued as the

USAFWESPAC chief surgeon only until

19 August, when the Fifth Army surgeon, Brig. Gen. Joseph I. Martin, MC,

was appointed to the post. Meanwhile,

the Army logistical system that had supported the USAFPOA became the

United States Army Forces, Middle

Pacific (USAFMIDPAC), the headquarters remaining in the Hawaiian Islands.

With this geographic division

between the service commands, the

USAFWESPAC became responsible for

the logistical support of the western

Pacific region, including Okinawa, and

of the planned invasion of Japan. Denit

faced the complex tasks of managing

the elaborate medical supply, evacuation, and hospitalization systems that

now stretched across the vast distances

of the western Pacific, including the

CHAPTER XIII

The Last Act
older base sections of Australia, New

Guinea, and the South Pacific, as well as

the newer ones of the Philippines. The

rapid decrease of troops in New Guinea

as the forces shifted forward brought a

decision to close some bases there and,

on 31 July, to dissolve the local logistical

commands, placing those bases that

remained under the USAFWESPAC’s

direct control.1

Even as the USAFWESPAC prepared

for its supreme test, it remained in a

sense the captive of its own history.

Geography had early dictated that

decentralization should be the rule in

the Pacific commands, and the

Southwest Pacific had been no exception to the rule. As the explicit policy of

General Headquarters, SWPA, and of

USAFFE, decentralization had come to

mean virtual autonomy among the

many subordinate commands, all of

which seemed to exist more or less on

the same level. USAFFE’s eight major

commands appeared to resent as

unwarranted interference attempts

from higher headquarters to shift

resources or personnel from one to

another or, as Denit had discovered, to

impose technical supervision. His own

position as both the USAFFE and the

USASOS chief surgeon had been

absolutely necessary to overcome the

infighting of earlier years, yet by some

accounts had contributed to a new kind

of particularism: Because he was identified with the USASOS, other commands

accused him of favoritism.

The major problem, however, was

that of getting things done in a bureaucratic system that depended upon consensus far more than is customary in a

military organization. A mere proposal

to move a medical officer, according to

Denit, launched a round of conferences

and requests for concurrence, which in

the end usually brought a refusal from

the local commander who viewed the

officer in question as part of his official

“family”—or even as his personal property. The continuing shortages of key

people, both officer and enlisted, often

served to justify resistance to demands

from above. But the resulting problems

were many. For example, the work of

consultants in evaluating the ability of

medical officers and the needs of particular units was often nullified or suffered

endless delays. “It became,” Denit complained, “almost a policy to avoid any

action which might remotely be construed as interference with lower command activities.”2

The chief surgeon was not all-powerful, and he acknowledged that he could

neither reorganize the command nor

separate the medical system from the

rest in a “theater having such strong traditions of independent action.” Yet

there could be no question that Denit’s

position had been greatly improved by

the creation of the USAFPAC. Only

those who had suffered through the

confusion that had reigned in the past

could fully appreciate the advantages of

1

CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 2, pp.

168, 270; CSurg, USAFPAC, Semiannual Rpt, Jun–Dec

45, pp. 4–5. Both file 319.1–2, Historical Unit Medical

Detachment (HUMEDS), Record Group (RG) 112,

National Archives and Records Administration

(NARA), Washington, D.C. Briefly during 1945 the

three major areas under General Headquarters, SWPA,

and USAFPAC control had unified logistical commands: the Philippines Base Section, the New Guinea

Base Section, and the Australia Base Section.

Subcommands were called bases, with letter designations—for example, Base X (Manila) and Base M (San

Fernando).

2

CSurg, USAFPAC, Semiannual Rpt, Jun–Dec 45, pp.

15–19 (quotations), file 319.1–2, HUMEDS, RG 112,

NARA.

THE LAST ACT 413
having a single capable hand at last on

the tiller.3

USAFPAC Planning

As the initial step in the final Pacific

campaign, code-named DOWNFALL,

MacArthur’s staff prepared Operation

OLYMPIC, an assault by the Sixth Army on

southern Kyushu starting 1 November

1945. A second plan foreshadowed an

invasion of the main Japanese island,

Honshu, by the Eighth and Tenth

Armies from the Pacific and by the First

Army from Europe. But this operation,

code-named CORONET, remained little

more than a general concept. Knowing

nothing of the atomic bomb then being

readied for use, MacArthur’s staff devoted only limited effort to planning for

the peaceful occupation of Japan, in the

event of a surrender. Work on such a

contingency plan started in May, under

the name BLACKLIST, but was still incomplete when the war ended. 

OLYMPIC was a natural successor to the

earlier campaigns of the Pacific war, for

it contemplated using amphibious tactics and large-unit operations ashore to

seize an enemy-held island, which in

turn would serve as an advanced air base

and staging area for the later invasion of

Honshu. The medical contribution

included, as usual, casualty estimates

and plans for support of the fighting

forces and for the evacuation and treatment of the wounded. The task was

familiar, but its scale dwarfed the invasions of the past.4

Denit’s planners developed the medical plans to support the three operations, giving heavy emphasis to OLYMPIC.

They worked within the general assumptions of MacArthur’s staff, namely, 

that the Japanese would employ

260,000–300,000 troops to defend

Kyushu; that their first line of defense

would be special suicide units, air and

sea; and that they would return to their

earlier practice in the war of defending

the landing beaches. Hence, to secure

an anchorage, the Americans, as at

Okinawa, would first attack offshore

islands before landing by corps on the

eastern and western sides of Kyushu.

Involved were the I and XI Corps and

the V Amphibious Corps.5

Medical support for the invasion

would benefit by the experience of

more than three years of war. Although

the proportion of medics to troop

strength continued to decline and the

Eighth Army was short of both doctors

and nurses, the medical endowment for

the Sixth Army would be even more

ample than in the past. Each division

would have not only its organic units,

including its medical battalion, but also

an attached separate clearing company,

a medical company from an engineer

3

Ibid., p. 20, file 319.1–2, HUMEDS, RG 112, NARA.

4

Department of the Army, Reports of General

MacArthur, 4 vols. (1950; reprint ed., Washington, D.C.:

Government Printing Office, 1966), 1:27, 67–89; Walter

Krueger, From Down Under to Nippon: The Story of the Sixth

Army in World War II (Washington, D.C.: Combat Forces

Press, 1953), pp. 333–40; John Ray Skates, The Invasion

of Japan: Alternative to the Bomb (Columbia, S.C.:

University of South Carolina Press, 1994), pp. 1–7. The

actual decision to invade was made by President Harry

S Truman on 18 June. See Louis Morton, “The Decision

To Use the Atomic Bomb,” in Kent Roberts Greenfield,

ed., Command Decisions (Washington, D.C.: Office of the

Chief of Military History, United States Army, 1960),

pp. 500–01. 5

Olympic Opn Log Instrs no. 1, OofCG, USAFWESPAC, 16 Jul 45, in “History of Planning Division, ASF,”

11:1, Ms 3–2.2 AA 11, files of U.S. Army Center of

Military History (CMH), Washington, D.C.; Warren W.

Daboll, “From OLYMPIC to BLACKLIST,” ch. 15 of

“Medical Service in the Asiatic-Pacific Theater,” pp.

5–6, Historians files, HUMEDS, RG 112, NARA.

414 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
special brigade, two portable surgical

hospitals, and an evacuation hospital. In

addition, each corps would have five

field hospitals, plus an ambulance company, a medical supply company, malaria survey and control detachments, and

a veterinary food inspection detachment. The Sixth Army was to have two

medical groups to organize evacuation,

plus an array of special units, including

a medical laboratory. The commander

of the Far East Air Forces, created in

June 1944 as the higher headquarters

for the Thirteenth and Fifth Air Forces,

allocated three squadrons of L–5s to

evacuate casualties from the forward

areas—a clear indication that the

lessons of air evacuation taught by

Luzon and Okinawa had been learned.6

The chief surgeon, with the objective

of controlling the movement of casualties from the time they left the beaches

until they arrived in the rear-area hospitals, assigned Lt. Col. Paul Taylor, MC, in

April 1945 to be the USAFPAC medical

regulating officer. As usual, the first stop

would be the eighteen hospital LSTs offshore, where the wounded would be

received, treated, sorted, and transferred to other vessels. Naval assault

craft would evacuate the wounded to

Okinawa, where marines would be dispatched by air or by hospital ship to the

Marianas and, if necessary, to Oahu and

the United States. The well-equipped

naval assault transports would sail directly to the Marianas or the Philippines.

Army casualties would be sent by air or

hospital ship to the treatment centers in

the Philippines. In either case, those

whose condition required them to leave

the theater would travel to the United

States by returning transports or by the

C–54s and C–87s of the Air Transport

Command’s Pacific Division. In June the

USAFPAC authorized 62,250 hospital

beds for the Philippines and Okinawa,

some 37,000 of which were to be on

Luzon alone, with more than 22,000 in

Manila. 

As soon as possible, airfields to be

built on Kyushu would be exploited to

provide direct air transport to Okinawa

and beyond. An array of new hospitals

would then be built on Kyushu, with

capacity almost as great as the whole

medical establishment supporting

OLYMPIC. The USAFWESPAC was

assigned the responsibility for establishing 33,250 fixed beds on Kyushu, including 13,250 at Kagoshima, 15,500 at

Shibushi, and 4,500 at Miyazaki. This

would permit a gradually increasing

evacuation policy, as Japan’s southernmost island—like Australia, New Guinea,

the Philippines, and Okinawa before it—

became a base for operations beyond. It

would also prepare the way for the climactic blood-letting of CORONET.

7

The precise calculation of casualties

upon which this extraordinary medical

establishment was predicated is not easy

to deduce from the records. Probably

6

An 4 (Medical) to Log Instrs no. 1, 16 Jul 45, in

“History of Planning Division, ASF,” 11:1–6, Ms 3–2.2

AA 11, CMH; Daboll, “From OLYMPIC to BLACKLIST,” pp. 10–11, Historians files, HUMEDS, RG 112,

NARA; John H. McMinn and Max Levin, Personnel in

World War II, Medical Department, United States Army

in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), pp.

108, 368–70.

7

Daboll, “From OLYMPIC to BLACKLIST,” pp.

14–15, 23.1, Historians files; CSurg, USAFWESPAC,

Annual Rpt, 1945, pt. 2, pp. 222–23, 227, file 319.1–2.

Both in HUMEDS, RG 112, NARA. See also App B

(Major Hospitalization Areas) and App C (Hospital

Facilities—Tentative) of An 4 (Medical) to Log Instrs

no. 1, 16 Jul 45, in “History of Planning Division, ASF,”

11:1 and 11:1–2, and An 5 (Engineer) to ibid., in ibid.,

11:15, 24, 30, Ms 3–2.2 AA 11, CMH; Crawford F. Sams,

“Medic,” 1:331, 335, CMH Library (L). 

THE LAST ACT 415
basic to the confusion is the fact that

debate continued in the highest circles

of the Truman administration over the

advantages of an invasion, rather than a

blockade and bombardment, as the

means to induce Japan to surrender.

General MacArthur evidently saw high

casualty projections as likely to influence this debate in a direction he did

not desire. On 18 June his headquarters

reported to the War Department that

battle casualties—with no breakdown as

to dead and wounded—would number

50,800 for D-day to D+30, 27,150 for

D+30 to D+60, and 27,100 for D+60 to

D+90, with an additional 4,200 nonbattle casualties per month. These figures

appear to give a total of 117,650 for the

first 90 days.

However, MacArthur followed with a

message stating that the reported USAFPAC figures were “purely academic,”

that he had never seen them before, and

that he did “not anticipate such a high

rate of loss.” He asserted that the estimates were based upon Normandy and

Okinawa, implying that they represented an upper limit of possibility. In seeking the president’s reconfirmation of his

decision in favor of OLYMPIC, General

Marshall was even vaguer; he mentioned

no numbers at all. “Marshall and his colleagues,” as a later Army study revealed,

“were not willing to estimate the number of casualties to be expected from an

invasion of Kyushu, but they presented

many reasons for their belief that they

would be acceptable.”8

The figures later reported by Medical

Department historians differed sharply

from those of MacArthur. By their

account the basis for calculating probable casualties in Operation OLYMPIC was

neither Normandy nor Okinawa but

rather Luzon, which resembled Kyushu

in topography. Their breakdown of figures was far more precise. Besides nonbattle injuries, the chief surgeon anticipated that the invaders would face a

number of serious disease threats,

including dysentery, scrub typhus, and

Japanese B encephalitis. Denit forecasted in the first 60 days after the landing a

total of 176,663 casualties, including

55,906 battle casualties, and in the first

120 days a total of 394,859, including

125,935 battle casualties. In all, about

119,000 would require evacuation from

Kyushu, some 44,000 ultimately needing

transport to the United States.9

8

Statistics from MFR, A.J.G. [Lt Col Andrew J.

Goodpaster, Opns Div, WDGS], 18 Jun 45, and first two

quotations from Msg, MacArthur to Marshall, 18 Jun

45, file OPD 704, box 178, Entry 419, RG 165, NARA.

Remaining quotations from Henry G. Morgan, Jr.,

“Planning the Defeat of Japan: A Study of Total War

Strategy,” p. 167, Ms 2–3.7 AB.J, CMH.

9

Daboll, “From OLYMPIC to BLACKLIST,” pp. 14,

18, Historians files, HUMEDS, RG 112, NARA. This

document is marked “Gen Denit,” and appears to contain Denit’s marginalia, including a check on the casualty figures. Estimates of 500,000 or more were cited at

the time by Secretary of War Henry L. Stimson, who was

attempting to modify the unconditional surrender doctrine, and after the war by President Truman and others, who were attempting to justify the use of the atomic bombs. Such estimates presumably related to losses

anticipated for both OLYMPIC and CORONET. Some

scholars have cited much lower figures—for example,

Rufus E. Miles, Jr., “Hiroshima: The Strange Myth of

Half a Million American Lives Saved,” International

Security 10 (Fall 85): 121–40. However, many of the

numbers cited by Miles are estimates of battle casualties

only; as USAFPAC figures indicated, disease and nonbattle injury would have expanded the toll over the

anticipated four months of fighting to almost 400,000

American casualties. These, of course, were only the

projected losses for OLYMPIC; more severe fighting

accompanied by even heavier losses would have followed in CORONET, as the final battles were fought in

one of the most heavily settled parts of Japan. If a fifth

of American battle casualties in OLYMPIC died—not an

unreasonable assumption—and if, as in the past, 22

Japanese died on average for 1 American, the sum total

of all deaths, Japanese and American, for the invasion

of Kyushu alone would have been 579,301.

416 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Strengthening the medical system to

handle such numbers was no easy task.

Despite the end of the fighting in

Europe, the process of moving troops to

the Pacific was cumbersome, and support troops as usual lagged behind the

combat forces. Denit’s office calculated

the needs of the theater for the forthcoming operations on the basis of 4.8

beds per 1,000 troops and 32 medical

officers per 1,000 beds. Initial assignment of medical officers remained the

chief surgeon’s prerogative, but his difficulties in reassigning his own people

were not eased by the slow influx of

medical officers from Europe.

In turn, the USAFPAC’s preoccupation

with officers precluded securing qualified

enlisted, probably contributing to a constant loss of trained enlisted personnel,

including a virtual hemorrhage through

the Replacement Command. Depots

redistributed enlisted personnel on the

basis of requisitions received, rather than

expertise or prior training. If no medical

MOS requisitions were pending when

trained medics arrived, the latter were

simply reclassified and sent out to serve as

riflemen—or whatever else was currently

desired. Not only were trained medics

lost in the process, but infantrymen and

soldiers trained in other specialties

showed up at medical units to fill losses

there, learning whatever they could

through on-the-job training or classes

conducted by the units themselves.10

Despite personnel problems, the

chief surgeon looked forward to a new

influx of medics following the end of

the war in Europe. The First Army headquarters was committed to the Pacific, to

build up a new field army for CORONET,

and thousands of medical personnel

had been earmarked for transfer to the

Pacific. Surgeon General Kirk promised

Denit officers from Europe to assist in

educating 1.5 million troops about cold

injury—an important consideration, as

the war front moved out of the tropics in

summertime into temperate Japan in

the autumn. Even more important, in

view of the high casualties anticipated,

was the growing sophistication of the

blood supply program and its orientation toward the Pacific fighting.

Through much of the fighting whole

blood had to be obtained locally, by hospitals bleeding their staffs, by support

troops answering emergency appeals,

and by line units contributing blood in

cantonments for their own later use in

combat. Australian civilians gave generously, but long Pacific distances and

transport delays had made their blood

less and less useful as the Allies pressed

north. Not until late in 1944 had forward

centers been established, at Hollandia

and on Guam. Then, in October the surgeons general of the Army and the Navy

invited the American Red Cross to join

in establishing an airlift of blood from

the United States. The Red Cross quickly agreed to participate and the airlift

began late in 1944, with blood supplied

by centers in San Franciso, Oakland, and

Los Angeles. By mid-1945, with Germany

out of the war, East Coast centers joined

the Pacific airlift, and soon 12,000 pints

a week were reaching the casualties of

Iwo Jima, Luzon, and Okinawa. This

massive capability promised well for the

invasion of Japan.11

10Daboll, “From OLYMPIC to BLACKLIST,” pp. 28,

32, Historians files, HUMEDS, RG 112, NARA.

THE LAST ACT 417

11Douglas B. Kendrick, Blood Program in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1964), pp. 582–600; Tom F.

Continued
USAFWESPAC Prepares

At the USAFWESPAC the Plans and

Training Division managed invasion

planning. But virtually every part of the

headquarters—supply, evacuation, hospitalization, personnel, and the dental

and veterinary divisions—contributed to

the process, as did the surgeons of bases

and other subordinate commands.

Geography, preexisting facilities, and

planned construction helped to determine which hospitals would be chosen

to receive the wounded.

The sheer size of the logistical command was somewhat daunting. By 1945

the growth of the USASOS had transformed the once-small organization into

a giant, whose area of responsibility covered more than 2,000 miles of ocean,

primitive islands, developed lands, and

modern cities. The end of the

Philippines campaign saw the rear areas

of the Southwest Pacific consolidated

under the Australian Base Section, with

two subordinate bases, and the New

Guinea Base Section, with eight. The

Philippine Base Section now included

major bases at San Fernando (M) on

Lingayen Gulf, Batangas (R) on southern

Luzon, Tacloban (K) on Leyte, Cebu City

(S) on the Visayan island of Cebu, and

especially Manila (X) (Map 16). During

the summer of 1945 the ruined capital,

life throbbing among the rubble,

emerged as the prime source of supply,

repair, and maintenance for all military

equipment. Here were the workshops,

the depots, and the open-air storage facilities that sustained the forces and prepared the coming invasion. Port facilities

were needed to accommodate a greater

tonnage than that handled by New York

harbor authorities.

Yet the virtual destruction of Manila

during the fighting made it a perilous

place for troops and civilians alike.

Public health was a pressing problem,

and Denit ordered his preventive medicine specialist, Colonel Pincoffs, “to take

over—or rather recreate—the health

department of a large city.” Pincoffs’ primary aim was simply to survey the situation. In February 1945 his first view of

Manila, from a plane coming in at

10,000 feet, was of a tower of brown

smoke. At ground level the city posed a

daunting challenge: “Dust, ruins,

garbage, smells, swarming humanity—

and flies, flies, flies,” he lamented in a

letter to friends. “There is one obvious

advantage: whatever I accomplish can

only be an improvement.”12

The city lacked water supply, sewage

disposal, food, fuel, electricity, transport,

and communications. Its residents

cooked rice, and little of that, over fires

fed by the wood of wrecked houses.

Heaps of garbage lay under a haze of

flies; the bare ground was a common

latrine. A glance at the crowds showed

people with edema or emaciation, the

signs of starvation, and poverty increased

the incidence of prostitution and venereal disease. The phone system was

wrecked, the streetcars were burned, the

post office was in flames. If Pincoffs wanted to find someone, he sent out runners

to track the person down on foot.

Hospitals lacked everything except the

Whayne and Michael E. DeBakey, Cold Injury, Ground

Type, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon

General, Department of the Army, 1958), p. 229.

12Quotations from Katharine R. Pincoffs, Maurice C.

Pincoffs, M.D.: Letters From Two World Wars and a Sketch of

His Life by His Wife (Baltimore: Garamond/Pridemark,

1967), p. 251. See also CSurg, USAFWESPAC, Annual

Rpt, 1945, pt. 1, pp. 6–12, file 319.1–2, HUMEDS, RG

112, NARA. 

418 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
PHILIPPINE BASES

June 1945

0 150

Miles

PHILIPPINE

SEA

SOUTH

CHINA

SEA 

SULU SEA

Lingayen

Gulf

NORTH

BORNEO

Corregidor

Bataan

PALAWAN

PANAY

NEGROS

MINDANAO

Visayan

Sea

Sibuyan

Sea

MINDANAO SEA

Leyte

Gulf

LUZON

BABUYAN IS

BOHOL

SAMAR MASBATE

MINDORO

Aparri

Iloilo

Davao

Manila

Dagupan

CEBU

CUYO

 IS

Tacloban

LEYTE

DINAGAT

Cavite

San Bernardino Strait

Surigao S trait

Cebu

Batangas

San Fernando

Philippine Base Section Headquarters

and Base X

 Base K

 Base R

 Base S

 Base M

MAP 16
sick and wounded, and the dead, who

were no longer iced, stank and rotted in

the morgues. 

Amid the chaos, the Philippine civil

affairs units struggled to feed the people

and distribute medical supplies, supported by the XIV Corps surgeon with what

he could spare from the Army hospitals

under his control. Pincoffs, long a

staunch opponent of government health

care at home, made the only recommendation he could—to establish a central

authority under American control to

coordinate all medical efforts, and attach

to it the malaria survey and control, laboratory, and supply units without which it

could not function. In this way the new

Department of Health and Welfare was

created, under Pincoffs himself.13

From a headquarters at the San

Lazaro Contagious Disease Hospital, he

drew into the effort a number of able

Americans—Pincoffs, who had served in

the Pacific since 1942, commanding the

42d General Hospital and serving on

MacArthur’s Combined Advisory

Committee, knew whom he wanted—

plus a staff of well-trained Filipino doctors. He divided the city into eight districts, each with a civil affairs unit whose

medical officer became the district

health officer. A system for reporting

communicable diseases was reestablished, with a bicycle messenger to collect daily reports from the hospitals. 

It quickly became clear that despite

the circumstances, no major epidemic

was in progress. Nevertheless, suspect

cases were concentrated at San Lazaro

for diagnosis and treatment. Death certification resumed, and bodies again

were buried in established cemeteries,

rather than vacant lots. Army engineers

restored the main water conduit,

though the flow remained small until

the reservoirs in the hills were retaken

from the Japanese. Pit latrines were dug

and oiled, pending restoration of the

sewage system. DDT disposed of many

flies; bulldozers buried the garbage.

The work was done in ten weeks,

from the end of February to early April.

At its end the city still resembled a huge

gypsy camp, but it was functioning, and

the solid tradition of public health

established before the war had been

reborn in the shambles. To Pincoffs the

change he had wrought was symbolized

in the Children’s Hospital, near the university (and now vacated prison) of

Santo Tomas. When he arrived, the hospital had been a gathering place for the

wounded. Bandaged figures covered

420 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

COL. MAURICE C. PINCOFFS, MC

13Pincoffs, Maurice C. Pincoffs, M.D., pp. 265–68.
the floors and the stench of gangrene

filled in the air. On the last day of his

tenure he revisited the hospital and

found the halls spotless, clean sheets on

the beds, and children on the wards. A

“Well Baby” competition had been

announced, and the courtyard of the

hospital was thronged with “Filipinos in

their best embroidered shirts, all carrying babies.”14

Venereal disease (VD) required special attention, for, as medical investigators remarked in June, the incidence was

“increasing to a level so high as to interfere with the military efficiency of the

command.” About a million men were

stationed in the Philippines, and even

with antibiotic therapy the prospect was

bleak. Overall rates for Leyte and Luzon

through April reached 100 per 1,000

troops per annum, and small areas in the

islands saw rates of 1,000 to 2,000.

Contributing factors were the long continence of troops stationed on the

Southwest Pacific’s remote jungled

islands, the free and friendly relations

between Americans and Filipinas, the

poverty of the civil population after years

of war and occupation, and the heavily

infected state of local prostitutes. During

the summer, at Denit’s suggestion, a full

program of prevention began. The command propagandized, put brothels off

limits (despite the complaints of local

politicians, who had found them a lucrative investment), held commanders

responsible for VD cases in their units,

provided prophylactic stations, and

enforced curfews. Medical installations

began a new standardized penicillin regimen for gonorrhea. How far the program might have succeeded under

Philippine conditions remained unclear,

for the end of the war transformed the

situation again.15

The rebirth of Manila was a crucial

part of the logistical plan, but the whole

was a complicated puzzle. The

USAFWESPAC headquarters had to carry

out the customary duties of a theater

logistical command: to procure supplies

and equipment for all soldiers in its

region of the Pacific; to transport equipment and personnel; and to construct

and maintain bases, ports, and the military railway system. Meanwhile, its preparations for the invasion demanded an

ever-increasing commitment of

resources. Growing numbers of troops,

including new arrivals from the United

States, massed at its bases in the

Philippines and at the Okinawa logistical

command, which was still under the control of the Tenth Army. The headquarters

organization of the old South Pacific Base

Command arrived in the Philippines to

support the Sixth Army under the title of

the Army Service Command—OLYMPIC

(ASCOM-O). Assigned to the USAFWESPAC early in June, ASCOM-O settled on

Luzon and joined the planning for the

invasion. Similarly, ASCOM-C would support CORONET from its headquarters at

Manila. Each service command was to

pass to the control of the army it supported when the planned operation actually

began.16

14Ibid., pp. 269–80 (quotation).

15Thomas H. Sternberg et al., “Venereal Diseases,” in

Ebbe Curtis Hoff, ed., Communicable Diseases Transmitted

Through Contact or by Unknown Means, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1960), pp. 292–99 (quotation,

p. 292). In the Philippines as in Hawaii, breaking up

houses of prostitution apparently reduced the incidence of disease by lowering the total number of sexual contacts—that is, by making sex less convenient and

more expensive. 16CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 2, pp.

24–25, file 319.1–2, HUMEDS, RG 112, NARA.

THE LAST ACT 421
By mid-June 1945 all the Philippine

bases had been established. Denit knew

that troops would stage for OLYMPIC

through Manila, Tacloban, and San

Fernando. The development of a hospital system to accommodate those who

would return as casualties was under way

but far from complete.

During 1944 a new pattern in hospitalization had emerged as victory followed victory in the Pacific. Early in the

war, command surgeons throughout the

Allied-controlled Pacific had broken

hospitals up into smaller units, to serve

on islands and support small garrison

forces scattered over primitive country.

But as the lines of attack converged and

the forces engaged grew larger, hospitals had followed suit, small units recombining into large ones. During 1945 no

more units were disbanded and reorganized, and the development of major

hospital centers made progress as many

general hospitals were put under a single administrative headquarters to prevent duplication of services and to

exploit fully the talents of the few

remaining specialists. One of the largest

was the huge 26th Hospital Center at

Mandaluyong near Manila, with 12,000

beds. Other hospital centers were being

planned with the base surgeons and the

Corps of Engineers.17

Rapid construction was necessary to

meet the anticipated invasion date for

Kyushu. With Okinawa under the Tenth

Army and the southern Philippines

under the Eighth Army, and with both

armies destined for CORONET, the

USAFWESPAC construction program

basically concerned Luzon. The usual

problems promptly appeared, for example, a shortage of materials and low priority for engineer work on hospitals, and

the command thus concentrated on

Mandaluyong rather than dispersing its

limited means over the whole system. But

some other projects also received backing, including a stockaded station hospital near San Fernando for injured prisoners of war. Existing facilities were ordered

to increase their expansion beds, and

medical personnel were pressed into service as construction workers.18

New means of moving casualties out

of the theater made their appearance in

midsummer. Until June, all water evacuation to the United States had been carried out by troopship, with medical care

provided by provisional hospital ship

platoons of two officers and fifteen

enlisted men each. In the next month,

however, an Army hospital transport—

the Emily H. M. Weder, named for an

Army nurse who had been killed in

action—joined the work in the

Philippines, loading 580 evacuees. Air

evacuation from the Philippines to the

United States began in June and eventually became a regular service, with the

Air Transport Command’s Pacific Wing

craft flying via Guam, Kwajalein,

Johnson Island, and Honolulu to San

Francisco. Psychotic and suicidal

patients received the highest priority for

air transport, primarily because the trip

was comparatively short.19

17Ibid., pp. 54–57, file 319.1–2; 26th, 27th, 28th, 29th,

30th, and 31st Hosp Centers Quarterly Rpts (copies),

Jan–Mar 45, file 319.1 (SWPA). All in HUMEDS, RG

112, NARA. 

18CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 2, p.

67, file 319.1–2, HUMEDS, RG 112, NARA. See also An

4 (Medical) to Log Instrs no. 1, 16 Jul 45, in “History of

Planning Division, ASF,” 11:4–6, and App C (Hospital

Facilities—Tentative) of ibid., in ibid., 11:1–2, Ms 3–2.2

AA 11, CMH. 19CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 2, pp.

251–53, file 319.1–2, HUMEDS, RG 112, NARA.

422 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
As might be expected, supply was a

huge and complicated task. Troops being

readied for OLYMPIC were reequipped

according to priority: first, the ground

and service forces that had fought in the

Philippines; second, the troops that had

not participated in the battles of the

Philippines and New Guinea but designated for the invasion of Japan; and

third, the soldiers of USAFWESPAC

itself. Medical maintenance supplies and

equipment were ordered from two kinds

of standardized units, maintenance units

of items needed in combat and hospital

resupply. Though some orders had to be

placed in the United States, the

USAFWESPAC found most of the

required materiel in the theater itself.

Ironically, it lacked medical supply personnel for ASCOM-O, most of whom had

to be requisitioned from the United

States. The situation apparently reflected

not only the continuing shortage of personnel in the vast Pacific theater, and

especially of those with critical skills, but

also the difficulty of transferring personnel, of which Denit had complained.20

20Ibid., pp. 266–67, file 319.1–2, HUMEDS, RG 112,

NARA; An 4 (Medical) to Log Instrs no. 1, 16 Jul 45, in

“History of Planning Division, ASF,” 11:7–9, Ms 3–2.2

AA 11, CMH.

THE LAST ACT 423

NAVY TRANSPORT EVACUATING CASUALTIES TO THE STATES
Pacific distances made the obtaining

and storage of biologicals a particular

problem. Stocks of smallpox vaccine,

which had the shortest lifespan of all—

ninety days—were concentrated at

Manila for the troops in the Philippines

and at Hollandia for those still in New

Guinea. Each had to be adjusted to local

levels of consumption, with resupply

based on priority. For the coming operations, resupply responsibility for biologicals was concentrated in the 19th

Medical General Laboratory, which

became the USAFWESPAC agent for

procurement, storage, and issue.21

The Sixth Army

The strains in personnel and construction that afflicted the chief surgeon

also confronted the Sixth Army as it

made ready for future battles. The invasion forces would consist of eleven Army

and three marine divisions, organized in

three Army and one marine corps.

Medical support was slated to include,

beside the organic divisional units, eighteen evacuation hospitals, fifteen field

hospitals, and twenty-five portable surgical hospitals. The Sixth Army was to

have fixed hospitals under its command—twenty-five general and thirteen

station hospitals.22

A fundamental if familiar problem

was the lag between the troop list being

developed for the invasion and the

much slower influx of medical personnel. Thus, the Sixth Army surgeon

reported that his deficit of medical officers grew over the summer from 165 to

226. Apparently, more than 500 medical

officers would be needed to fill the gaps

left by the initial understrength, the

growing troop list, and the ongoing

demobilization process of readjustment—the discharge or transfer of

those with long overseas service—following the end of the war in Europe. Yet

actual replacements as yet were negligible—too few to make up for normal

attrition. And shortages of trained

enlisted men—1,500 as the summer

began—had to be filled by riflemen,

many fresh from basic training. The

question of whether they could be

trained in time for their new duties was

pressing but unanswerable.23

Amid many uncertainties, preparations for the invasion began. The health

of the command improved rapidly after

the Eighth Army took over the ongoing

combat against Yamashita’s surviving

forces. In permanent bivouacs, area control was reestablished, malaria suppressed, and the troops’ diet enriched

and diversified. Adequate rest improved

all aspects of health. The complicated

process of reequipping began. Supplies

necessary for the troops’ health included not only medical materiel but also

new personal equipment and clothing

needed to fight in a colder climate. All

units were ordered to carry with them

supplies for thirty days, with additional

stocks for fifteen days in division dumps

and medical supply units. Reserve stocks

were built up in Okinawa and Manila

and packaged for rapid delivery by airdrop or by fast ships. Ample supplies of

penicillin were provided, and the old

system for exchanging litters and blankets—a source of annoyance in many 21CSurg, USAFWESPAC, Annual Rpt, 1945, pt. 2, p.

269, file 319.1–2, HUMEDS, RG 112, NARA. 22Harrison J. Shull, “Experiences of the Consultant in

Medicine, Sixth United States Army,” p. 7A, Historians

files, HUMEDS, RG 112, NARA.

23Surg, Sixth Army, Quarterly Rpt (copy), Jul–Sep 45,

p. 4, file 319.1, HUMEDS, RG 112, NARA.

424 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
past campaigns, when these items had

tended to pile up in rear areas—was

replaced by a system of automatic resupply to the forward depots that were to be

established on Kyushu.

Storing and distributing the newly

available supplies of whole blood was

especially important. Each corps took a

mobile refrigerator with 200 pints ready

for the landing of the assault echelon.

Each field and evacuation hospital took

an additional 100 pints. Blood collected

by the American Red Cross, air-shipped

to the Navy’s Whole Blood Distribution

Center on Guam, would be delivered by

plane to the fighting front in refrigerated containers on a daily basis. Off

Kyushu six hospital LSTs were to be designated as blood banks, storing the precious substance to resupply the other

LSTs and the attack transports.24

The Rear Areas

Preparations for the invasion were

not confined to the western Pacific. The

demands of the immense undertaking

were felt thousands of miles to the east

as well. 

Under the USAFMIDPAC the long

evolution of the prewar Hawaiian

Department reached its final stage. No

longer involved in planning assaults on

enemy-held islands, the headquarters

commanded a complex of logistical

organizations. The chief surgeon’s office

was responsible for supervising the medical activities of the USAFMIDPAC’s

three subordinate commands: the

Western, Central, and South Pacific Base

Commands. The South Pacific Base

Command was the rump remaining

from the South Pacific Area; the Central

Pacific Base Command included chiefly

the Hawaiian Islands; and the Western

Pacific Base Command, created on 25

April 1945 under the USAFPOA, organized the Army forces on Saipan, Guam,

Tinian, Iwo Jima, Peleliu, Ulithi, and

Angaur. The growing medical establishment in the Marianas had already played

a key role in the Leyte, Iwo Jima, and

Okinawa campaigns.25

The Western Pacific Base Command

surgeon, Col. Elliott G. Colby, supervised all Army medical activities in the

region and continued carrying out the

same mission when the USAFMIDPAC

succeeded the USAFPOA on 1 July. The

prospective invasion of Japan brought

intensified activity to what had become a

major system of forward bases.

Especially important were the hospitals

and the support provided to the airfields, from which much of the bombing

(including, in August, the atomic bombing) of Japan was launched and directed. Eighteen general hospitals worked

in the command during 1945, to

include five from the 821st Hospital

Center on Tinian, where the major air

bases were located. Army strength,

including air force personnel, reached a

total of 183,837 in August, and the hospital construction program expanded,

in anticipation of a new influx of wounded. Capacity was already great—the hospitals treated more than 25,000 casualties in June—and during the summer

bed capacity rose rapidly from just

under 12,000 to a maximum of 19,000.

Major medical supply depots were also 24Ibid., pp. 10–11, file 319.1; Daboll, “From

OLYMPIC to BLACKLIST,” p. 23, Historians files; Col.

Ashley W. Oughterson, MC, Diary, 6 Aug 45, file 319.1.

All in HUMEDS, RG 112, NARA.

25CSurg, USAFMIDPAC, Annual Rpt, 1945, p. 1, file

319.1–2, HUMEDS, RG 112, NARA.

THE LAST ACT 425
readied to support the invasion of

Japan.26

The mobilization of the Pacific’s own

resources constituted the main part of

the story for OLYMPIC. But during the

summer a small number of personnel

and quantity of equipment, originally

destined for the European battlefields,

also began to arrive. In late July surgeon

General Kirk assembled in Washington

the key medical officers from the Pacific

theaters, including Generals Denit,

Hagins, Martin, Maxwell, and Willis, and

Colonel Westervelt. Many were accompanied by consultants and staff officers. In

three days of discussions Denit outlined

to Kirk and his staff the developing plans

for the final campaigns and his requirements for units, personnel, and equipment. Kirk promised that all help possible would be sent to the Pacific, at last

elevated to the rank of the nation’s most

important theater of war. The timing of

these discussions was not without irony.27

Within weeks the end of the war came

with stunning abruptness. On 6 August

the B–29 Enola Gay, flying from Tinian,

dropped an atomic bomb on the

Japanese city of Hiroshima with catastrophic effects. Three days later

Nagasaki underwent a similar attack.

The Soviet Union declared war and

invaded Manchuria, and on 14 August

Japan surrendered.

The Occupation Begins

With equal abruptness, a phase of

planning that heretofore had received little emphasis became the basis for theaterwide action. In mid-May—when peace in

Europe was less than a week old, when

the battle for the dams was ending on

Luzon, and when the troops on Okinawa

seemed immobilized along the front—

the USAFPAC had begun to plan for the

military occupation of a beaten Japan,

under the code-name BLACKLIST.

28

The move was timely, for Japan’s ability to wage war had been reduced, as

General Ushijima had shown on

Okinawa, to little more than dying in

the most expensive manner possible.

Planning for the occupation had to take

into account the fact that no one knew

as yet whether the enemy might collapse

before OLYMPIC, or at the time of the

invasion of Kyushu, or after Kyushu but

before CORONET. Assuming that defense

did not go to the last ditch, these

seemed to be the principal possibilities.

General MacArthur would prepare the

plans for the occupation and command

the occupation forces once ashore;

Admiral Nimitz would provide the ships

needed to move the troops to Japan.

USAFPAC planners looked initially to

the occupation of the four largest home

islands, plus some peripheral areas,

including Korea. Japanese armed forces

were to surrender their arms; the civil

government was to continue in operation under the direction of the occupying power; and Japanese nationals living

outside the home islands were to be

returned to Japan. Much of the conquered nation already lay in ruins. Yet,

even after surrender, armed resistance

might continue in one form or another,

and starvation and epidemics might face

the civil population. With a wide range

of possibilities, many unpleasant, 26Surg, WPBC, Annual Rpt, 1945, pp. 1, 27, 39, 81;

CSurg, USAFMIDPAC, Annual Rpt, 1945, pp. 22, 33.

Both file 319.1–2, HUMEDS, RG 112, NARA. 27Daboll, “From OLYMPIC to BLACKLIST,” pp.

23.1–23.2, Historians files, HUMEDS, RG 112, NARA.

28Ibid., p. 24, Historians files, HUMEDS, RG 112,

NARA.

426 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
MacArthur’s staff decided that the

Eighth Army should occupy Honshu,

from the Tokyo-Yokohama region north,

and the northernmost island of

Hokkaido; that the Sixth Army should

occupy Kyushu and southern Honshu;

and that the Tenth Army should move

directly from Okinawa to Korea, which

would be occupied in conjunction with

the Russians. Tentative troop lists for

BLACKLIST were completed only a week

before the actual surrender of Japan,

and the last two weeks of August

“undoubtedly . . . found a considerable

increase in the midnight oil burning . . .

in more than one headquarters staff.”29

Going ashore in Japan, Americans

confronted for the first time the full

consequences of their own handiwork.

One of the first medical officers to enter

Yokohama saw “only ashes, literally miles

of ashes interspersed with tall isolated

brick chimneys and steel safes.” In

Tokyo he picked his way through subway

tunnels, where thousands of homeless

lay in the dark, many already ill with diseases—smallpox, typhoid, and typhus—

that could easily become epidemic.

Hospitals were filthy and mostly vacant;

Colonel Oughterson, now assigned as

the USAFPAC’s surgical consultant,

found only 1,700 beds in all of Tokyo.

Contagious diseases were running at

about three times normal rates. Hunger

was common, and the merchant marine

that would have brought supplies to the

island nation now lay at the bottom of

the sea.30

General MacArthur emerged as the

central figure in the occupation of

Japan. As the Supreme Commander,

Allied Powers (SCAP), he gave direction to the Japanese civil government;

as the USAFPAC commander, he gave

orders to the troops. Disestablishment

of the Tenth Army left the XXIV Corps

to occupy Korea, with the medical

problems of that former Japanese

colony consigned to Colonel Potter as

corps surgeon. Meanwhile, the occupation of the home islands proceeded

rapidly and without the resistance that

had been feared. General Hagins, the

Sixth Army surgeon, moved with his

army’s headquarters into Kyoto, while

Eighth Army surgeon Brig. Gen.

George W. Rice took up residence in

Yokohama. Troops poured ashore, and

with them arrived the ample medical

establishments that had been built up

for combat.31

Suddenly, the troops had too many

medics rather than too few. Accidents

did occur and outbreaks of dysentery

and respiratory diseases took place;

some Americans celebrated too freely

and fifteen died after sampling wood

alcohol as an enhancement to sake.

Rates of venereal disease predictably

began to rise, reaching 171 per 1,000

troops per year in November 1945. An

Army field hospital even played host to

former Premier Hideki Tojo, who had

29Ibid., p. 37, Historians files, HUMEDS, RG 112,

NARA. 30Quotation from Sams, “Medic,” 2:349, CMH–L. See

also Oughterson Diary, 4 Sep 45, file 319.1, HUMEDS,

RG 112, NARA. On conditions in Japan and Korea after

V–J Day (2 September 1945), see Albert E. Cowdrey,

The Medics’ War, United States Army in the Korean War

(Washington, D.C.: U.S. Army Center of Military

History, 1987), pp. 36–68; D. Clayton James, The Years of

MacArthur, 3 vols. (Boston: Houghton Mifflin Co.,

1970–85), 2:778–92. 31Surg, Sixth Army, Quarterly Rpt (copy), Oct–Dec

45, p. 1, file 319.1, HUMEDS, RG 112, NARA; Blanche

B. Armfield, Organization and Administration in World

War II, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1963), pp.

489, 495.

THE LAST ACT 427
bungled an attempt at suicide, saving

him for later trial and the gallows.32

But the primary fact about troop

medical care was its superfluity. Typical

was the experience of Maj. Gen. Innis P.

Swift’s I Corps, Sixth Army, which occupied the Osaka-Kobe-Kyoto area. Unit

dispensaries and corps collecting and

clearing companies were well able to

care for ordinary medical problems, and

the few men who became seriously ill

were sent offshore to Navy hospital ships

or flown to the vast (and now largely

useless) hospital centers of the western

Pacific. Preventive medicine was important. Troops infected earlier continued

to take Atabrine, while teams dusted

with DDT the Japanese Army barracks to

be used as housing. Engineers worked

to upgrade water purification.

Meanwhile, hospitals were arriving as

scheduled, setting up shop, and waiting

for patients who never came. At the

beginning of 1946 at least eighteen

medical units—portable surgical hospitals, evacuation hospitals, collecting and

clearing companies, and the medical

battalions of five divisions—were “trying

to operate hospitals of some sort in I

Corps zone of responsibility, and in

many cases located within two blocks of

each other.”33

This situation did not last long. The

process of readjustment had been

delayed in the Pacific theaters, because

of the anticipated invasion of Japan.

The end of the fighting in Europe had

already launched the complex process

of reshuffling personnel, and soldiers

with low adjusted service rating scores

were identified and moved into units

destined for the USAFPAC. The end of

the war in Asia now brought readjustment to the Pacific. Political pressure

for quick discharges mounted, as soldiers and their families demanded—

and the president and Congress hastily

conceded—that all who had served

overseas should return home as soon as

possible. The critical point score was

adjusted downward, not once but again

and again, and on 21 September 1945

the Eighth Army bade farewell to its first

group of departing veterans. By

November the 4th Replacement Depot

near Yokohama was processing 25,000

soldiers a month.

Meanwhile, half-trained replacements arrived—in the jaundiced view of

medical officers a poor lot, by and large,

immature and susceptible to psychoneurotic disabilities and a long list of childhood and venereal diseases. The rapid

depletion of the invasion force and the

departure of medical troops ended the

brief period of superfluity in Japan. In a

few years there would again be too few

Army medics in the Far East, as General

MacArthur would discover in 1950,

when the Korean war began.34

Despite such rapid changes, the

health of the troops proved to be the

least pressing of medical problems during the early months of the occupation.

Far more serious were the conditions

that medical officers discovered among

the liberated prisoners of war and the

Japanese people.

32OofSurg, USAFPAC, ETMD, Oct 45, pp. 19–21, file

350.05, box 72, Entry 54B, RG 112, NARA; William

Craig, The Fall of Japan (New York: Penguin Books,

1979), pp. 316–27; Cowdrey, Medics’ War, p. 44. 33Surg, I Corps, Annual Rpt, 1946, p. 3, file 319.1–2,

box 565, Entry 54A, RG 112, NARA.

34On the readjustment process, see Cowdrey, Medics’

War, pp. 65–68; Graham A. Cosmas and Albert E.

Cowdrey, Medical Department: Medical Service in the

European Theater of Operations, United States Army in

World War II (Washington, D.C.: U.S. Army Center of

Military History, 1992), pp. 596–602.

428 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
For Allied prisoners, the end of the

war brought a sudden transformation

from being remnants of defeated armies

to members of victorious ones, and from

a lifestyle resembling slavery to freedom.

Elaborate schemes for handling the former prisoners of war had formed part of

the BLACKLIST planning. Responsibility

for the more than 11,000 Americans set

free in Japan fell to the Eighth Army,

and the treatment of hospital patients

was assigned to the 42d General

Hospital at Tokyo.

Typically, liberated prisoners were

moved to seaside repatriation centers,

where an Allied port commander separated them by nationality. Americans

discarded their prison clothing, bathed,

received thorough physicals, and

dressed in completely fresh uniforms.

Stretcher cases were received by medical

facilities, on- or offshore, and underwent a similar ritual. Intelligence officers questioned recovered prisoners

about their prison experiences, including any war crimes that they had witnessed. The interrogations revealed

ample new evidence in a grim story, the

rudiments of which were already known,

though imperfectly, in Allied countries.

The physical examinations tended to

confirm the accounts, for they revealed

the consequences of prolonged malnutrition and abuse. 

Most Allied prisoners had been taken

in the earliest battles, and those who had

THE LAST ACT 429

LIBERATED ALLIED PRISONERS gathering air-dropped supplies at a camp near Tokyo
endured so long an ordeal presented “a

picture of severe starvation, sunken eyes,

high, prominent cheek bones [sic], distended abdomens, [and] marked atrophy of all muscles.” Symptoms of beriberi

were common, reflecting the poor rice

diet on which many had lived, and virtually all had intestinal parasites. Amebic

dysentery, chronic coughs, and tuberculosis were also noted. Doctors were surprised to see that—as those confined in

the camps had long believed—psychoneurotics were rare. Medics who

examined the prisoners emphasized

their essential normality and the powerful group bonding that had enabled

them to survive. As one report stated,

“They regard themselves as perfectly normal and do not ask for nor expect pity.”35

430 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

LIBERATED PRISONER ENJOYING A FULL MEAL AND ATTENTIVE CARE

35Quotations from OofSurg, USAFPAC, ETMD, Oct

45, pp. 106–07, 108, file 350.05, box 72, Entry 54B, RG

112, NARA. See also Armfield, Organization and

Administration, p. 496; Cowdrey, Medics’ War, p. 45.
The primary treatment for all except

the dying was food. Dieticians readied a

special ration, which was served three

times a day with no limit on refills.

Canteens and post exchanges provided

snacks twenty-four hours a day. In the

three weeks that most remained under

medical care in Japan, the average

weight gain was twenty pounds, and thirty to forty pounds was not uncommon.

By the time they left for home, few

looked like men who had undergone a

long ordeal. But as later studies were to

emphasize, the effects of imprisonment

were not to be easily shaken off, and lifelong susceptibility to many ills would

mark a large proportion of the survivors.

Former prisoners of war from the Pacific

theaters, in comparison to those from

the European theater, suffered much

more severely—in particular from

chronic tuberculosis, emotional disturbances, eye problems, gastrointestinal

disorders, and heart conditions. Many

lived out long and essentially normal

lives at home, but others had suffered

permanent impairments and met

untimely deaths.36

Medical War Crimes

As the former prisoners filled out

written questionnaires about their experiences and responded to interrogators,

evidence accumulated about war crimes.

Trials of major defendants, accused of

launching the wars against China and

the West, began in Tokyo in May 1946.

Other trials in Yokohama, Manila, and

Rabaul examined evidence and pronounced verdicts upon lesser defendants. In some cases, military courts of

Allied armed forces brought charges

locally against prison camp guards and

commandants. The trials disclosed no

systematic program of extermination

resembling the Nazi holocaust, but they

did bring to light overwhelming evidence of widespread cruelty and neglect

in the treatment of prisoners and captive populations. The trials also demonstrated that a few Japanese doctors had

played roles in the wartime atrocities.37

No doubt much of the inadequate

medical treatment received by prisoners

in Japanese camps reflected the fact that

Japanese medical officers of good quality were unlikely to be assigned to their

care. Indifference or casual brutality seconded incompetence. An American

Army doctor at Fukuoka No. 1 camp on

Kyushu, to which many survivors of the

Oryoku Maru had been brought, voiced a

common complaint when he told interrogators after the war that “the Japanese

doctors in this camp are not worthy of any

consideration whatever, that they were very

neglectful in their duties and at times refused

to supply medicine to the American officers

who were dying of pneumonia and whose

lives could have been otherwise saved.” Cases

turned up in which Japanese camp

physicians had falsified death certificates—in one case certifying, without

troubling to examine the body, that a

prisoner who had been beaten to death

was a victim of enteritis.38

There were, of course, exceptions.

Even reports prepared in the immediate

36Bernard M. Cohen and Maurice Z. Cooper, A

Follow-Up Study of World War II Prisoners of War, VA

Medical Monograph (Washington, D.C.: Department

of Medicine and Surgery, Veterans Administration,

1954), pp. 19–23, 65.

37Arnold C. Brackman, The Other Nuremberg: The

Untold Story of the Tokyo War Crimes Trials (New York:

William Morrow, Quill, 1987), pp. 33–44. 38John M. Gibbs, “Prisoner of War Camps in Japan and

Japanese Controlled Areas, as Taken From Reports of

Interned American Prisoners,” p. 7, Ms 4–4.5A AA, CMH.

THE LAST ACT 431
postwar period acknowledged that some

Japanese physicians attached to the prisons were conscientious, like the one at

Fukuoka No. 22 who visited the hospital

twice weekly, remaining all day, and

spent a third day at the convalescent

ward. He belonged to the staff of one of

the better camps, where treatment of

the prisoners was generally good and

morale, despite hard labor and cold

weather, was reported to be excellent. In

several camps, however, Japanese enlisted orderlies made a practice of overruling POW doctors, making their own

diagnoses and ordering the sick back to

work as they pleased. A medical sergeant

at Niigata, one of the worst camps in

Japan, was sentenced to death for his

contribution to the sufferings of some

captured Australians.39

Such cases reflected the unsatisfactory conditions in the customary run of

Japanese camps. By contrast, medical

experiments on living captives were rare

but horrifying. Vivisection was carried

out by Japanese military and civilian

doctors, apparently reflecting the official view that B–29 crews who bombed

civilian targets were not prisoners of war

but war criminals. Turned over to the

Kempei Tai (military police), the captured airmen were often tortured and

executed with or without trial. 

Others, viewed as dead men in any

case and therefore expendable, became

human guinea pigs. Between eight and

twelve experimental operations were

performed in the autopsy room of the

Kyushu Imperial University medical

school, with Japanese Army doctors,

civilian physicians, and medical students

observing. Surgeon Ishiyama Fukujiro

removed the healthy lung of an anesthetized prisoner, who was then killed; a

second victim, after losing one lung and

part of the other, died on the autopsy

table; three fliers were drugged and dissected, also dying on the table. Sick prisoners who were not airmen also suffered. At Shinagawa Hospital and

Prisoner of War Camp, the commandant, Hisakichi Tokuda, was also the

chief medical officer. Though he experimented on prisoners, killing four by

injecting them with a soybean solution,

he escaped the death penalty when a

General Headquarters, SCAP, review

determined that he was not sane.40

Those responsible for some of the

most flagrant medical mistreatment of

prisoners were not prosecuted in the

war crimes trials. At Pingfan, near

Harbin, Manchuria, a special unit under

Lt. Gen. Shiro Ishii developed bacteriological weapons, breeding vectors and

making bombs to disseminate a variety

of diseases. The unit kept prisoners—

apparently Chinese, Manchurians, and

White Russians—to use as experimental

subjects, infecting, treating, and reinfecting them until they died. The procedures were comparable to those in some

Nazi concentration camps, where Jews,

Poles, Russians, and members of other

unfavored groups were used in

grotesque experiments.

Yet Ishii and his accomplices escaped

prosecution. When the data they supplied to American interrogators proved

39Ibid., pp. 49–50, 118, Ms 4–4.5A AA, CMH; General

Headquarters (GHQ), Supreme Commander for the

Allied Powers (SCAP), “History of the Nonmilitary

Activities of the Occupation of Japan: Trials of Class “B”

and “C” War Criminals,” pp. 112, 115, Ms 8–5 AA 2,

CMH.

40GHQ, SCAP, “Occupation of Japan: Trials of War

Criminals,” pp. 183–201, Ms 8–5 AA 2, CMH; Saburo

Ienaga, The Pacific War: World War II and the Japanese,

1931–1945 (New York: Random House, Pantheon

Books, 1978), pp. 189–90.

432 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
tantalizing to experts in the American

biological warfare program, General

MacArthur recommended that Ishii and

some of his colleagues be given assurances that, if they provided more complete information, it would not be used

as evidence of war crimes. The cabinetlevel State-War-Navy Coordinating

Committee was divided over the issue;

the military departments were favorable

to MacArthur’s proposal, but the State

Department was reluctant to give explicit approval. Delay allowed the period

during which evidence was being taken

for the Tokyo trials to elapse. As a result,

the American government gained Ishii’s

information—and denied it to the

Russians—without making a formal

promise. The policy recommended by

General MacArthur and tacitly allowed

by Washington entailed a double standard of justice in the treatment of

German and Japanese war criminals in a

case involving one of the worst medical

atrocities of World War II.41

The Japanese

At the war’s end, prisoners were not

the only people in Japan who were in

need of help. Many of the Japanese were

also in poor condition. Working through

the Japanese government, the occupation authorities imposed upon the entire

Japanese people the kind of health discipline that, in the United States, characterized the armed services alone.42

Such ample powers were needed by

MacArthur’s chief of public health and

welfare, Col. Crawford F. Sams, MC,43

selected by the surgeon general to head

the newly created office under the

USAFPAC’s G–5 (civil affairs) section.

During the period of invasion planning

Sams had prepared to use field and station hospitals, staffed by Japanese medical personnel, to care for civilians

injured in the fighting, and he had earmarked grain supplies, blankets, and

clothing for civilian use. The Japanese

surrender had eliminated the danger of 41Materials on the Trial of Former Servicemen of the

Japanese Army Charges With Manufacturing and Employing

Bacteriological Weapons (Moscow: Foreign Languages

Publishing House, 1950); Cowdrey, Medics’ War, pp.

218–19. See also Msg, CINCFE C-52423 to WDGID, 6

May 47, file 107–0, box 1519, Entry 143, RG 153, NARA. 42Armfield, Organization and Administration, p. 498;

Cowdrey, Medics’ War, p. 37.

43Sams had served as the U.S. Army Forces in the

Middle East surgeon from 1941 to 1944 and thereafter

was assigned to the War Department General Staff in

Washington.

THE LAST ACT 433

BRIG. GEN. CRAWFORD F. SAMS, MC

(Rank as of 12 May 1948)
vast numbers of additional civilian war

casualties, but in other respects had left

him still facing a most difficult situation. 

Now in charge of public health and

welfare, Sams confronted the problems

of a wrecked and defeated nation.

Public health in prewar Japan had been

combined with labor affairs in a single

ministry, and on the local level had primarily been the responsibility of the

police. Lacking medical direction, public health had languished; despite the

striking modernity of some prewar

Japanese cities, most of the people had

lived in comparatively primitive conditions. As a result, malaria, typhus, and

encephalitis were endemic, tuberculosis

was widespread, and enteric diseases

were common. Many years of war had

devastated the cities and left a population of homeless, ill-nourished, and

exhausted people ripe for outbreaks of

disease. As millions of Japanese were driven out of their overseas conquests,

exotic as well as homegrown ailments

threatened the home islands.44

The policy of the American occupation was to improve national health in

order to prevent disease and unrest and

to safeguard the health of Allied troops

by protecting that of the civil population.

In September General Headquarters,

SCAP, began a comprehensive survey of

hospital facilities, medical supplies, and

food. The Navy quarantined the ports,

and Army medical supplies were diverted from the Philippines to Japan. In the

fall and winter the spread of life-threatening diseases confirmed Sams’ early

forebodings; smallpox increased and

louse-borne typhus fever appeared

among Korean coal miners on Hokkaido

and spread to Honshu as the liberated

workers headed for home. Smallpox was

rooted out by mid-1946 through the systematic vaccination of the entire

nation—some 75 million people. The

fight against typhus was more complex.

Repatriates returning from mainland

Asia introduced typhus into port cities,

notably Osaka. An often fatal disease

spread by lice, typhus was traditionally

associated with cold weather, when people bathed and changed clothes less frequently, and had long historical associations with times of hunger and the disruptions of war. With many Japanese living on 1,000–1,400 calories a day, the

nation appeared in danger of a major

epidemic. Foci of the disease developed

wherever louse-infested people huddled

for warmth. At railroad stations, crowds

of shivering vagrants spread the disease

to the passengers, who traveled by the

thousands every day from homes in the

countryside to jobs in the shattered

cities. The trains themselves were memorably crowded, with people jamming the

interiors and hanging on the exteriors.

Not only did lice spread under such conditions, but the microbes that cause

typhus were inhaled by passengers from

dry louse feces on their neighbors’

clothes and hair.45

44GHQ, SCAP, “History of the Nonmilitary Activities

of the Occupation of Japan: Public Health, September

1945 Through December 1945,” pp. 1–7, Ms 8–5 AA

7/5, CMH. See also Crawford F. Sams, “American

Public Health Administration Meets the Problems of

the Orient in Japan,” American Journal of Public Health

and the Nation’s Health 42 (May 52): 557–65; Thomas B.

Turner, “Japan and Korea,” in Ebbe Curtis Hoff, ed.,

Civil Affairs/Military Government Public Health Activities,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1976), pp. 664–65.

45GHQ, SCAP, “Occupation of Japan: Public Health,”

pp. 8, 28–30, Ms 8–5 AA 7/5, CMH. Typhus is caused by

rickettsiae, organisms that are larger than viruses but

smaller than bacteria. See Arthur Hurst et al., Medical

Continued

434 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
By December 1945 typhus had

reached “epidemic proportions.”

General Headquarters, SCAP, had reorganized the Japanese Ministry of

Welfare to concentrate solely on public

health, while labor questions were transferred to a new government department. Under Sams’ direction and with

the assistance of American medical officers the reformed ministry organized a

national campaign, using the expertise

of the United States of America Typhus

Commission and supplies of antityphus

vaccine and louse-killing DDT powder

imported from the United States. Cities

were divided into areas of twenty-five

blocks each. Teams of Japanese workers

traced cases of possible fever and used

dust guns to disinfect anyone who might

have had contact with the disease.

DDT’s residual killing powder enabled

health workers to dust ships and railroad cars. A campaign of education

spread the facts on typhus through the

THE LAST ACT 435

INOCULATING AGAINST TYPHOID

Diseases of War, 4th ed. (Baltimore: Williams and Wilkins

Co., 1944), pp. 235–60, and Hans Zinsser, Rats, Lice and

History: Being a Study . . . Which . . . Deals With the Life of

Typhus Fever (New York: Blue Ribbon Books, 1935).

Descriptions of the trains abound in the literature of the

time; see, for example, Michihiko Hachiya, Hiroshima

Diary: The Journal of a Japanese Physician, August

6–September 30, 1945, trans. and ed. Warner Wells (Chapel

Hill: University of North Carolina Press, 1955), p. 93.
radio, press, pamphlets, and posters. By

March 1946 the epidemic of about

30,000 cases had been contained. In the

second half of 1946 only 1,202 cases

were reported; in all of 1947, 1,141; in

1948, 474; and in 1949, 121. The textbook suppression of the disease can be

attributed to the unique interaction of

military medicine, Japanese social discipline, and the public health methods

developed by American researchers during World War II.46

Other contagious diseases were controlled or stamped out in turn by

reestablishing sanitation and launching

a program of immunization that benefited some 20 million people. A dangerous increase in typhoid rates was

reversed, and in the spring of 1946 a

cholera outbreak was contained. The

reconstruction of functional water and

sewer systems in the cities enabled Sams

to roll back a threatening wartime rise

in Japan’s dysentery rate. In this case,

however, cultural habits prevented longterm improvement. Farmers continued

to fertilize with nightsoil, many foods

continued to be eaten either raw or

lightly cooked, and a multitude of street

stalls and tiny restaurants baffled public

health control.

Ultimately, General Headquarters,

SCAP, accomplished a revolution in

public health, building upon foundations that were laid in the immediate

postwar period. National expenditures

on health and sanitation rose from

about 30 million yen in 1945 to 1,167

million in 1950. The medical and nursing professions were reorganized, and

Japanese manufacturers were encouraged to produce their own biologicals

and other medical needs under strict

quality controls. Systematic collection of

statistics on disease, which had almost

ceased in 1945 under the pressure of the

war, resumed the following year.

Humanitarianism and sound policy

coincided, and the benefits were reaped

by the Japanese people. Life expectancy

rose during 1947–50 from fifty to fiftynine years for men and from fifty-four to

sixty-two years for women. Sams

received well-merited praise for “one of

the great recent public health achievements,” which he explained as “just a

matter of organization.”47

Nuclear Warfare

Humane policy, however, could not

erase all the consequences of a struggle

that had been merciless even by the standards of World War II. As of this writing,

the Japanese-American war remains the

only one in which atomic weapons have

been used. Tracing the medical consequences at Hiroshima and Nagasaki

became the preoccupation of a number

of Japanese and American scientists in

the postwar period, including some

Army medical officers.

One of the first to visit Hiroshima was

Colonel Oughterson, Denit’s chief surgical consultant. In civilian life

Oughterson had been a distinguished

academic physician, who entered the

Army from a position on the faculty of

Yale University’s medical school. In four

and a half years of service with the

USAFISPA, USAFPOA, and USAFPAC

he had seen much of war, but nothing

46GHQ, SCAP, “Occupation of Japan: Public Health,”

pp. 27–30 (quoted words, p. 28), Ms 8–5 AA 7/5, CMH.

47Ibid., pp. 102, 134, 146, 166, Ms 8–5 AA 7/5, CMH;

“A Good Man Gone,” Newsweek, 8 Aug 55, p. 46 (quotations). As in Germany, DDT and penicillin had been

known in wartime Japan only on an experimental basis.

436 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
that prepared him for the blasted plain

that had been Hiroshima. On 8

September 1945, unarmed and relying

entirely on the protection of the

Japanese, Oughterson departed from

Tokyo with a mixed group of American

and Japanese medical professionals.

Flying over Hiroshima, he viewed

“destruction . . . beyond words—

thought of a child building a city with

blocks and when he was thru, knocking

it all down. . . .”48

After landing, Oughterson and his

party traveled on an ancient bus that

broke down twenty times on the way.

Each time a small circle of curious

Japanese gathered, their faces breaking

into smiles when the Americans passed

out candy and cigarettes. A ferry ride

across the Inland Sea took the group to

the island of Miyajima, where the

Americans, after being wined and

dined, retired to their hotel rooms a little bemused by the reception their

recent enemies had given them. “The

adaptability, flexibility of the human

mind,” noted Oughterson in his diary,

“and the faith of mankind at times in

each other amazes me.”49

The next day the group returned to

the city and entered a zone of cyclonic

destruction, amid a plague of flies.

Buildings had been twisted and crushed;

the rubble, finely divided; and everything, but for a few telephone poles,

chimneys, and concrete structures, leveled and burned. A major from the

Imperial General Headquarters who had

seen the bombing described the “great

violet bright light” and the blast and heat.

Estimations of the dead were uncertain,

and the memories of the survivors were

unreliable. A Japanese doctor who had

lived through the blast summed up the

scene: “Hiroshima was no longer a city,

but a burnt-over prairie.”50

The explosion had come upon a city

waking up, breakfasting, and moving to

work. Almost without warning, survivors

found themselves transported into a

nightmare world, surrounded by shattered buildings and by the dead and

wounded. Venturing into streets filled

with dust, smoke, and the heat of winddriven fires, they joined processions of

battered people, many of whom were

naked. Those who had been burned

walked with their arms stretched out, to

avoid the friction of one raw surface

against another. 

In the few surviving hospitals patients

were packed “like the rice in sushi.”

Showing early signs of radiation sickness, they vomited and defecated, lay in

their own filth, and turned the hospital

halls and doorways into latrines. Two

hundred and seventy of the city’s 298

doctors and 1,654 of its 1,780 nurses had

been injured or killed. Visitors who

entered the city found bizarre sights—

the nude corpse of a railroad worker

with white lettering from the back of his

work uniform clearly visible on his

burned torso; human shadows burned

into cement; a dead man who still sat on

his bicycle, propped against a bridge

railing. Meanwhile, refugees fled into

the hills, some sloughing their burned

skin so that they looked like ragged

scarecrows. Many died along the roads.51

48Oughterson Diary, 8 Sep 45, file 319.1, HUMEDS,

RG 112, NARA. Before its destruction Hiroshima had

contained both the 2d Army and Western Command headquarters, a military school, and a military hospital. 49Ibid.

50First quotation from ibid.; second quotation from

Hachiya, Hiroshima Diary, p. 8. 51Hachiya, Hiroshima Diary, pp. 11 (quotation),

14–15; Oughterson Diary, 9 Sep 45, file 319.1,

HUMEDS, RG 112, NARA.

THE LAST ACT 437
For a time, Japanese doctors had

been confused by the emerging symptoms of radiation sickness, a problem

compounded by the destruction of

microscopes and blood count devices

that might have enabled them to note

the victims’ characteristic leukopenia,

or low white blood cell count. Symptoms

of malaise, nausea, vomiting and diarrhea, and the development of ulcers in

the mouth were noted. Japanese soldiers who had been ordered into the

city to aid the survivors became abnormally fatigued and soon developed

symptoms like the bomb victims. The

bone ash of victims “showed 100 times

natural radiation,” Oughterson noted,

and relatives piously carrying bone fragments away from funeral pyres sometimes received radiation burns. Japanese

physicians believed at first that poison

gas or bacteriological weapons had been

used in conjunction with the bomb, misled by not only the symptoms of the

injured but also the city’s strong smell

that had been produced by the ionizing

radiation of the bomb. Oughterson’s

first action when he arrived back at

Tokyo was to send 100 million units of

penicillin to Hiroshima.52

Oughterson then departed for

Nagasaki with a team of medical officers, including Col. Stafford L. Warren,

MC, chief of the Manhattan District’s

medical section. Because of his expertise on the effects of radiation, the former University of Rochester professor

was selected to join the Manhattan

Project team organized to study the

atomic bombings. Before the bombing

Nagasaki had been an important military target, with the Mitsubishi steel

works and a torpedo factory. But the city

also had been the port through which

Western medicine had entered Japan

and the site of a medical school, which

had been completely destroyed with all

of its faculty and students. Oughterson

saw, in addition to the Japanese casualties, several Allied prisoners of war who

were showing symptoms of radiation

sickness. The city government counted

35,000 confirmed deaths, and more

were expected, since the area devastated

by the second atomic bomb had a population of about 120,000 residents. The

Navy hospital ship USS Haven, at anchor

in the harbor, already had sent supplies,

including penicillin.53

By the time he viewed the ruined

cities, Oughterson had already formulated and presented to Denit a plan for

a scientific investigation of the atomic

bombings. When the chief surgeon

approved, Oughterson and Warren

agreed to coordinate Army and

Manhattan Project efforts and to prepare a joint report. On returning to

Tokyo from Nagasaki, Oughterson put

forward the suggestion for a cooperative

investigation by a Japanese-American

commission. In so doing, he recognized

the efforts that the Japanese had

launched in the immediate aftermath of

the bombings at a number of medical

schools and institutes. Chief among

their investigators were Masao Tsuzuki,

professor of surgery at Tokyo Imperial

University and an admiral in the

Japanese Navy, and Takeo Tamiya, the

Harvard-educated dean of the Imperial

52Oughterson Diary, 9 Sep 45, file 319.1, HUMEDS,

RG 112, NARA.

53Ibid., 20–23 Sep 45, file 319.1, HUMEDS, RG 112,

NARA; Vincent C. Jones, Manhattan: The Army and the

Atomic Bomb, United States Army in World War II

(Washington, D.C.: U.S. Army Center of Military

History, 1985), pp. 543–44. A small number of Allied

prisoners of war also died at Hiroshima. 

438 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
University Medical School, who placed

all the facilities of the school at the commission’s disposal. 

Finally, the U.S. Navy became

involved. Its Bureau of Medicine and

Surgery dispatched Comdr. Shields

Warren and a medical research unit,

drawn from the Naval Medical Research

Institute in Bethesda, Maryland, as part

of the Naval Technical Mission to Japan.

Working from the Haven, the naval medical unit began its studies in Nagasaki on

25 September. The unit soon joined the

Army and Manhattan Project teams at

the Omura Naval Hospital, where the

Japanese commanding officer, Admiral

Kodo Yasuyama, aided the ongoing

work. The involvement of the principals,

the pointlessness of duplicate investigations, and the contributions already

made by the Japanese all favored, as did

common sense, the pursuit of a single

combined effort to understand the

effects of atomic weapons both on the

people who had died and on those who

survived. General Headquarters, SCAP,

thus formed the Joint Commission for

the Investigation of the Effects of the

Atomic Bomb in Japan, placing

Oughterson in charge.54

The investigators, consisting of

American military personnel and

Japanese scientists, were divided into

two groups, one of which entered

Nagasaki on 28 September and the

other Hiroshima on 12 October. They

reexamined the records, studied the

survivors, collected autopsy material,

and assembled photographs and films.

In the professional interaction between

the Japanese and Americans, a common

concern with understanding the effects

of the bomb and assisting its victims

helped to lessen the familiar hatreds of

the war. The Joint Commission’s report,

classified for six years after the war, was

ultimately made public by the Atomic

Energy Commission in 1951. 

On the whole, it appeared that about

106,000 people had died in the two

atomic attacks, most from blast, burns,

and gamma radiation. Also documented

were the terror that had followed the

bombings, the flight of the populations

from the shattered cities, and the overwhelming number of medical facilities

that had survived the attacks. In 1955

Oughterson and Shields Warren repeated and amplified the conclusions that

they and their associates had reached,

admitting that even then much

remained unknown. Whether survivors

would develop cancers to an abnormal

degree, suffer shortened lifespans, or

show decreased fertility and other genetic abnormalities were questions that

remained a decade after the bombs and

still would require “many years or even

generations for their final solution.”55

54Jones, Manhattan, p. 545; Ashley W. Oughterson

and Shields Warren, Medical Effects of the Atomic Bomb in

Japan (New York: McGraw-Hill Book Co., 1956), pp.

6–9; Committee for the Compilation of Materials on

Damage Caused by the Atomic Bombs in Hiroshima

and Nagasaki, Hiroshima and Nagasaki: The Physical,

Medical, and Social Effects of the Atomic Bombings, trans.

Eisei Ishikawa and David L. Swain (New York: Basic

Books, 1981), pp. 508–09. Masao Tsuzuki, as a student

at the University of Pennsylvania before the war, had

published a study of X-ray radiation effects; see

“Experimental Studies on the Biological Action of Hard

Roentgen Rays,” American Journal of Roentgenology and

Radium Therapy 16 (1926): 134–50. See also Ashley W.

Oughterson et al., Medical Effects of the Atomic Bombs: The

Report of the Joint Commission for the Investigation of the

Effects of the Atomic Bomb in Japan (Oak Ridge, Tenn.:

United States Atomic Energy Commission, 1951).

55Quotation from Oughterson and Warren, Medical

Effects, p. 426. See also United States Strategic Bombing

Survey, The Effects of Atomic Bombs in Hiroshima and

Nagasaki, Report of 30 June 1946 (Washington, D.C.:

United States Government Printing Office, 1946), p.

Continued

THE LAST ACT 439
Despite such gaps, the findings of the

various survey groups that studied the

bombs embodied the last and most

telling wisdom to be learned from the

medical history of the Pacific war, even

as they suggested lessons for wars to

come. In the struggle against Japan,

modern medicine had overcome many

problems that had seemed insuperable.

But the comprehensive destructiveness

of nuclear weapons appeared to pose a

challenge to which there was no medical

solution.56

15, copy in CMH–L, which cites higher figures. A subsequent study suggests that genetic effects of the bombs

are less serious than had been feared, but that certain

types of cancer—especially bone marrow, thyroid, and

breast (female)—can be traced to the brief exposure of

the survivors to intense radiation. See John D. Boice, Jr.,

“Studies of Atomic Bomb Survivors: Understanding

Radiation Effects,” Journal of the American Medical

Association 264 (Aug 90): 622–23. 56Jones, Manhattan, pp. 543–50.

440 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Until the last months of the fighting,

the medical service that supported the

American Army in the war against Japan

faced immense obstacles to success.

Unlike the medics in other theaters of

operations, those in the South and

Southwest Pacific Areas were given little

time to organize or prepare. The

Southwest Pacific Area was the scene of

bitter fighting from the first day of the

war, and action continued in the mountains of Luzon until its end. The South

Pacific Area was the scene of the first

American counterstroke.

Both area commands fought bitter

actions, on the Solomons and New

Guinea, when supply lines were tenuous

and environmental conditions almost

intolerable. They also fought another

kind of enemy—severe malaria epidemics, to which the immaturity of their

medical systems and the indifference of

some commanders to medical advice

contributed. For a time, the rates of sickness resembled pre-twentieth century

war. While the environmental conditions were reminiscent of earlier

American campaigns in the Caribbean

and the Philippines, the scale of the

Pacific conflict was incomparably

greater, and as a result almost insoluble

logistical difficulties beset medical planners in the headquarters and units in

the field. Meanwhile, on the continent

of Asia, China-Burma-India medics

encountered conditions that were no

less threatening and logistical tangles

that were even more disheartening than

those on the Pacific islands. 

In consequence, disease continued to

take a toll even after the medics and the

line alike had become sophisticated in

the ways of jungle warfare. Although the

early epidemics of malaria in the South

and Southwest Pacific Areas were not

repeated after the spring of 1943, and

although astonishing success was

recorded in controlling outbreaks that

might have threatened operations, the

Southwest Pacific continued to have the

highest death rate from disease of any

theater, immediately followed by ChinaBurma-India. Indeed, these two theaters

accounted for three-fourths of the

Army’s disease deaths during the war. 

In historical context, however, that

record appeared in a more favorable

light. Death rates from disease were only

slightly over 1 per 1,000 troops per year,

at a time when the rate for the Army as

a whole was .59 and for the European

theater of operations only .55. As recently as World War I, the Army’s annual

death rate from disease had been 16.47,

or twenty-eight times as high as the

World War II rate. A comparatively small

EPILOGUE

The Medical Service in Retrospect
medical service, working in often dreadful environments in the Southwest

Pacific and China-Burma-India, was able

to exploit the well-established methods

of preventive medicine plus a few recent

discoveries—notably Atabrine and

DDT—to reduce losses to historically

low levels. The two theaters provided

the darkest shading in what was, overall,

an extraordinarily bright picture.1

Advances that were equally notable

marked medical organization. The Army

as a whole had been organized to fight

mass battles on land; amphibious war

demanded changes that were nowhere

more difficult to accomplish than

among medical support units, whose

effectiveness depended ultimately on a

few skilled individuals. Dividing up medical units among battalion landing

teams, enhancing regimental medical

support to enable combat teams to fight

alone, drawing upon an inadequate pool

of doctors to support the garrisons of

many small islands, and devising units to

operate in deep jungle all strained medical resources and demanded the utmost

in improvisation. Amphibious medical

support evolved within a framework of

doctrine first devised by the Marine

Corps and subsequently modified by

World War II experience in the Pacific

and Mediterranean theaters. By the war’s

end it had become a well-established

technique, marked by Army-Navy cooperation, by the rapid and well-coordinated advance of direct support units, and

by the early landing of medical units

whose sole purpose was disease prevention and care of the civil population.

To some extent even the great Pacific

distances yielded to the airplane. The

rise of air evacuation was noted in

almost all theaters where American

medical personnel worked, but was

nowhere more dramatic than in the

Pacific. Wherever evacuation routes

were long, terrains almost impossible to

traverse on foot, and ships too slow, the

air ambulance (and, far more frequently, the converted cargo plane) came into

its own. In some respects, China-BurmaIndia exaggerated the features of the

island war. Fighters in continental Asia

lacked the ocean as the universal medium of transport and supply. Hence,

deep penetration units lived longer in

the jungle, depended more upon the

native peoples, and felt an even greater

need for air resupply and evacuation.

During the war, however, the potential

of existing aircraft was not fully realized

and exploited. The few Army helicopters employed in China-Burma-India

and later in the Philippines were only a

brief prevision of future frontline

aeromedical evacuation. 

Despite many common features—the

great distances, the tropical climate, the

critical role of the Navy in protecting

American and interrupting Japanese supply lines—the medical experience in the

Central Pacific was so different from that

of the theaters to the south that it almost

seemed to belong to another war. In contrast to the South and Southwest Pacific

Areas, the Central Pacific Area was given

plenty of time to prepare. Most of the

islands where marines and soldiers

fought were free of malaria, and with few

exceptions they were not so harassed by

other tropical diseases. On the other

442 MEDICAL SERVICE IN THE WAR AGAINST JAPAN

1

Frank A. Reister, ed., Medical Statistics in World War II,

Medical Department, United States Army in World War

II (Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1975), pp. 11, 32. It should be

noted that World War I in its time had marked epochal

progress in controlling disease in American armies.

According to Reister, death rates were reduced by about

90 percent during the century preceding World War I.
THE MEDICAL SERVICE IN RETROSPECT 443

hand, the tactical situation in some

respects was more severe because the

atolls were too small to permit surprise

landings. Entrenched Japanese resistance

caused very high casualty rates, especially

among the marines at Tarawa and later at

Iwo Jima. Army statistics lumped together

the sickly South Pacific and the comparatively healthy Central Pacific. Even so,

admission rates for disease were lower in

the Pacific Ocean Areas than for any theater of the war except the European and

the zone of interior.2

With the approach of American

forces to the large islands of the western

Pacific, circumstances changed again.

Struggles on land engaging one or more

field armies became the rule in the

Philippines and Okinawa. The increasing skill of Japanese commanders in

defense and their desperation as the

Allies approached the home islands

made for appalling losses on both sides.

In the final campaigns the medical service provided more conventional support, resembling that in the European

theater. In the Philippines, however, the

tropical climate continued to take its

toll. Casualty figures suggested that the

problem of adequately supporting prolonged high-intensity combat in such a

disease environment remained unsolved

at the war’s end.

The presence of large civilian populations—friendly to the Allies in the

Philippines but hostile on Okinawa—

served to complicate medical difficulties

still further. As Army medical officers in

the ruins of Manila and their Navy

brethren in the devastated towns of

Okinawa confronted the aftermath of

conquest, the tasks of reconstruction

began to overlap those of the war.

Medics going ashore in Japan took on

duties of exceptional scope and difficulty, against the background of a shattered

nation and the results of atomic war. In

the rubble of Hiroshima and Nagasaki,

medical officers viewed the effects of a

kind of warfare that comprehensively

destroyed doctors, nurses, and hospitals

together with most of those to whom

they might have given aid.

Medical military records of the time

placed great emphasis on the problems

brought by the war. Those problems were

immense, and some were fundamentally

insoluble. Yet the contemporary preoccupation with obstacles reflected in part the

mindset of an era during which great

strides in preventive and curative medicine—symbolized by the introduction of

DDT and penicillin, but by no means limited to those discoveries—bred an optimism that threw into sharp relief the difficulties that remained. From the viewpoint of the present, the terrain no

longer seems divided so clearly into monumental accomplishments and frustrating obstacles.

All in all, the American-Japanese war

presents a picture of near-miraculous

ingenuity in adapting to rapidly changing circumstances. It remains rich in

interest for students of military medicine

for a variety of reasons—the tropical diseases, the logistical problems, the wide

spectrum of settings from the most primitive jungles to the shattered but complex urban areas of the Philippines and

Japan. Yet its ultimate lesson may lie in

the flexibility of spirit and organization

shown by medical personnel. Trained, by

and large, for work in a developed

nation and a temperate climate, they

mastered a new kind of medicine and

practiced it over a vast and varied part of 2

Ibid., p. 27. the Earth’s surface. Because they learned
and adapted so well, they were able to

save lives and improve health conditions

among a kaleidoscope of peoples—

American soldiers, New Guinea natives,

Polynesians, Japanese, Filipinos, and

Okinawans—during the years of a most

bitter and unrelenting struggle.

In those harsh times the medics successfully maintained the fighting

strength of the Army in remote and disease-ridden lands. No less important was

their role in preserving the humane tradition, which alone gave promise of a

better future.

444 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
The Medical Department: Medical Service

in the War Against Japan represents the

end product of a long period of

research and writing, which began in

The Historical Unit (THU) of the Office

of the Surgeon General. A large collection of THU note cards, assembled by

anonymous researchers, Donald

Mitchell’s lengthy manuscript “The U.S.

Army Medical Service in the War

Against Japan,” and Warren W. Daboll’s

manuscript “Medical Service in the

Asiatic-Pacific Theater” are products of

the unit’s work. Although we found

them to be an invaluable source of material, we developed the current volume

largely from primary and printed

sources. Specific attributions to records

and repositories will be found in the

footnotes, where each source is cited in

full at first mention in each chapter and

subsequent references in the same chapter are shortened. Abbreviations are

identified in the list of abbreviations.

Many original documents, including

most of those used by THU researchers,

were first borrowed from and later

returned to the collection of Army

records at the National Archives and

Records Administration (NARA),

Suitland, Maryland, when The Historical

Unit became part of the U.S. Army

Center of Military History. We retrieved

most of these documents from the

National Archives on a loan basis for the

duration of the project. Upon publication of this volume, they will be returned

to the National Archives’ new facility in

College Park, Maryland, and incorporated into the Historical Unit Medical

Detachment (HUMEDS) collection of

Record Group (RG) 112, Records of the

Office of the Surgeon General (Army).

As part of our Historians files, the THU

note cards cited by us will also be added

to the HUMEDS collection.

Particularly useful documents were a

number of interviews, manuscript histories, unpublished memoirs, and diaries

of medical service in the Pacific theaters

of war, prepared as a rule by officers who

were on the scene, with personal knowledge of the organizations and actions

they describe. Among these documents

were the following: Wibb E. Cooper,

“Medical Department Activities in the

Philippines From 1941 to 6 May 1942,

and Including Medical Activities in

Japanese Prisoner of War Camps”; W. H.

Waterous, “Reminiscences of Dr. W. H.

Waterous Pertinent to World War II in

the Philippines”; James W. Duckworth,

“The Official History of General Hospital

Number One, United States Army Forces

in the Far East, at Camp Limay, Bataan,

Little Baguio, Bataan, and Camp

O’Donnell, Tarlac, Philippine Islands,

From December 23, 1941 to June 30,

1943”; James O. Gillespie, “Recollections

of the Pacific War and Japanese Prisoner

of War Camps, 1941–1945,” and “History

of General Hospital Number 2”; Ruth B.

Kelly, “History of Nursing Service in the

South Pacific, World War II, 1945”;

Josephine M. Nesbit, “History of the

Army Nurse Corps in the Philippine

Bibliographical Note
Islands, September 1940–February

1945”; Buell Whitehill, “Administrative

History of Medical Activities in the

Middle Pacific”; and Gordon H. McNeil,

“History of the Medical Department in

Alaska in World War II.” Officers in the

China-Burma-India theater were prolific,

especially James H. Stone, author of a

number of manuscript histories, including: “Organization and Development of

Medical Supply in India and Burma,

1942–1946,” and “The Hospitalization

and Evacuation of Sick and Wounded in

the Communications Zone, ChinaBurma-India and India-Burma Theaters,

1942–1946.” Additionally, Robert G.

Smith’s two-volume “History of the

Attempt of the United States Army

Medical Department To Improve the

Efficiency of the Chinese Army Medical

Service, 1941–1945,” proved invaluable.

In addition to RG 112, we consulted

other NARA records of interest in RG

153, Records of the Office of the Judge

Advocate General (Army); in RG 165,

Records of the War Department General

and Special Staffs; in RG 225, Records of

the Joint Army and Navy Boards and

Committees; and in RG 407, Records of

the Adjutant General’s Office, 1917–,

especially the Philippine Archives.

We found another rich source of personal material on medical officers and

their contributions to policy and practice

in the archives of the U.S. Army Military

History Institute (MHI) at Carlisle

Barracks, Pennsylvania. The Maurice C.

Pincoffs Papers were particularly informative on preventive medicine.

For the Navy medical story, volume 1

of Department of the Navy, Bureau of

Medicine and Surgery, “The United

States Navy Medical Department at War,

1941–1945,” prepared in 1946 and

presently in the files of the Bureau of

Medicine and Surgery Archives (BMSA)

in Washington, D.C., offered many valuable insights.

Among printed sources, we relied primarily upon the series United States

Army in World War II, published in

Washington, D.C., by the Army’s

Historical Division and its successor

agencies, the Office of the Chief of

Military History and the Center of

Military History. Particularly important

volumes covering the strategic, operational, and tactical aspects of the Pacific

campaigns were Louis Morton, Strategy

and Command: The First Two Years (1962),

and The Fall of the Philippines (1953);

Maurice M. Matloff and Edwin M. Snell,

Strategic Planning for Coalition Warfare,

1941–1942 (1953); Clarence McKittrick

Smith, The Medical Department:

Hospitalization and Evacuation, Zone of

Interior (1956); and Stetson Conn, Rose

C. Engelman, and Byron Fairchild,

Guarding the United States and Its Outposts

(1964); John Miller, jr., Guadalcanal: The

First Offensive (1949), and CARTWHEEL:

The Reduction of Rabaul (1959); Samuel

Milner, Victory in Papua (1957); Philip A.

Crowl and Edmund G. Love, Seizure of

the Gilberts and Marshalls (1955); Philip

A. Crowl, Campaign in the Marianas

(1960); Charles Romanus and Riley

Sunderland, Stilwell’s Mission to China

(1953), Stilwell’s Command Problems

(1956), and Time Runs Out in CBI

(Washington, 1959); M. Hamlin

Cannon, Leyte: The Return to the

Philippines (1954); Robert Ross Smith,

The Approach to the Philippines (1953),

and Triumph in the Philippines (1963);

Roy E. Appleman, James M. Burns,

Russell A. Gugeler, and John Stevens,

Okinawa: The Last Battle (1948); and

Vincent C. Jones, Manhattan: The Army

and the Atomic Bomb (1985). 

446 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
BIBLIOGRAPHICAL NOTE 447

No less important was the series

Medical Department, United States

Army in World War II, published in

Washington, D.C., by the Army’s Office

of the Surgeon General, a source that

provides both organizational studies and

numerous physician-written accounts of

the clinical problems encountered in the

war against Japan. Using, to some

degree, almost all of the volumes in the

series, we found the following to be especially valuable: Blanche B. Armfield,

Organization and Administration in World

War II (1963); Charles M. Wiltse, Medical

Supply in World War II (1968); John H.

McMinn and Max Levin, Personnel in

World War II (1963); Robert J. Parks,

Medical Training in World War II (1974);

Ebbe Curtis Hoff, ed., Communicable

Disease: Malaria (1963), Communicable

Diseases Transmitted Through Contact or by

Unknown Means (1960), Communicable

Diseases: Arthropodborne Diseases Other

Than Malaria (1960), Communicable

Diseases Transmitted Chiefly Through

Respiratory and Alimentary Tracts (1958),

and Civil Affairs/Military Government

Public Health Activities (1976); B. Noland

Carter, ed., Activities of Surgical

Consultants (1962–64); W. Paul Havens,

Jr., ed., Activities of Medical Consultants

(1961), and Infectious Diseases and General

Medicine (1968); Albert J. Glass, ed.,

Overseas Theaters (1973); Douglas B.

Kendrick, Blood Program in World War II

(1964); Tom F. Whayne and Michael E.

DeBakey, Cold Injury, Ground Type

(1958); and Frank A. Reister, Medical

Statistics in World War II (1975). Also covering topics of importance is James H.

Stone, ed., Crisis Fleeting: Original Reports

on Military Medicine in India and Burma in

the Second World War (1969).

Among medical sources that are not

official publications, we found especially

enlightening Earl Baldwin McKinley, ed.,

A Geography of Disease (Washington, D.C.:

George Washington University Press,

1935); George MacDonald, The

Epidemiology and Control of Malaria

(London: Oxford University Press,

1957); James Stevens Simmons, Global

Epidemiology: A Geography of Disease and

Sanitation (New York: J. B. Lippincott Co.,

1944); and Kurt J. Isselbacher, Raymond

D. Adams, Eugene Braunwald, Robert G.

Petersdorf, and Jean D. Wilson, eds.,

Harrison’s Principles of Internal Medicine,

12th ed. (New York: McGraw-Hill Book

Company, 1991).

We also found significant aspects of

the medical story in a number of special

studies and in corps and unit histories.

Among the most useful were William F.

Heavey, Down Ramp!: The Story of the Army

Amphibian Engineers (Washington, D.C.:

Infantry Journal Press, 1947); Edward J.

Drea, Defending the Driniumor: Covering

Force Operations in New Guinea, 1944 (Fort

Leavenworth, Kans.: Combat Studies

Institute, 1984); Thomas M. Huber,

Japan’s Battle of Okinawa, April–June 1945

(Fort Leavenworth, Kans.: Combat

Studies Institute, 1990); Edmund G.

Love, The 27th Infantry Division in World

War II (Washington, D.C.: Infantry

Journal Press, 1949), and The Hourglass:

A History of the 7th Infantry Division in

World War II (Washington, D.C.: Infantry

Journal Press, 1950); William F.

McCartney, The Jungleers: A History of the

41st Infantry Division (Washington, D.C.:

Infantry Journal Press, 1948); Philip A.

Schaefer, ed., 54th in Review: A Resume of

the Activities of the 54th General Hospital,

1943–1945 (Tokyo: Dai Nippon Printing

Co., 1946); Orlando R. Davidson, J. Carl

Willems, and Joseph A. Kahl, The

Deadeyes: The Story of the 96th Infantry

Division (Washington, D.C.: Infantry
Journal Press, 1947); Richard J. H. Krebs

[Jan Valtin], Children of Yesterday (New

York: Reader’s Press, 1946); Edward M.

Flanagan, The Angels: A History of the 

11th Airborne Division, 1943–1946

(Washington, D.C.: Infantry Journal

Press, 1948); [77th Division Association],

Ours To Hold It High: The History of the

77th Infantry Division in World War II

(Washington, D.C.: Infantry Journal

Press, 1947); B[ertram] C. Wright,

comp., The 1st Cavalry Division in World

War II (Tokyo: Toppan Printing Co.,

1947); Stanley A. Frankel, The 37th

Infantry Division in World War II, ed.

Frederick Kirker with John MacDonald

(Washington, D.C.: Infantry Journal

Press, 1948); [6th] Division Public

Relations Section, The 6th Infantry

Division in World War II, 1939–1945

(Washington, D.C.: Infantry Journal

Press, 1947); 33d Infantry Division

Historical Committee, The Golden Cross:

A History of the 33d Infantry Division in

World War II (Washington, D.C.: Infantry

Journal Press, 1948); and Francis D.

Cronin, Under the Southern Cross: The Saga

of the Americal Division (Washington,

D.C.: Combat Forces Press, 1951). 

In a war where joint and combined

operations were the rule, the official histories of other American armed services

also gave essential data. Preeminent

among these works were Samuel Eliot

Morison’s History of United States Naval

Operations in World War II, 15 vols.

(Boston: Little, Brown and Co.,

1947–62), and The Two-Ocean War: A

Short History of the United States Navy in the

Second World War (Boston: Little, Brown

and Co., 1963). Also consulted were

Robert D. Heinl, Jr., and John A. Crown,

The Marshalls: Increasing the Tempo

(Washington, D.C.: Historical Branch,

G–3 Division, Headquarters, U.S. Marine

Corps, 1954); Frank O. Hough, Verle E.

Ludwig, and Henry I. Shaw, Jr., Pearl

Harbor to Guadalcanal, History of U.S.

Marine Corps Operations in World War

II (Washington, D.C.: Historical Branch,

G–3 Division, Headquarters, U.S. Marine

Corps, 1958); Bennett F. Avery, ed., The

History of the Medical Department of the

United States Navy in World War II, 3 vols.

(Washington, D.C.: Bureau of Medicine

and Surgery, Department of the Navy,

1950–53); and Jeter A. Isely and Philip A.

Crowl, The U.S. Marines and Amphibious

War: Its Theory and Practice in the Pacific

(Princeton: Princeton University Press,

1951). Mae Mills Link and Hubert A.

Coleman, Medical Support of the Army Air

Forces in World War II (Washington, D.C.:

Office of the Surgeon General, USAF,

1955), was invaluable, as were the relevant volumes of The Army Air Forces in

World War II, edited by Wesley Frank

Craven and James Lea Cate.

For full coverage of the medical story,

we also consulted Allied and Japanese

histories. Essential to our understanding

of the role played by America’s Allies

were Allan S. Walker’s The Island

Campaigns, Australia in the War of

1939–1945, Series 5, Medical (Canberra:

Australian War Memorial, 1957); Field

Marshal Viscount William J. Slim’s Defeat

Into Victory (New York: David McKay Co.,

1961); and Louis Allen’s Burma: The

Longest War, 1941–1945 (New York: St.

Martin’s Press, 1984). Providing welcome

insights into the other side of the war

were Saburo Ienage’s The Pacific War:

World War II and the Japanese, 1931–1945

(New York: Pantheon Books, 1978), and

Michihiko Hachiya’s Hiroshima Diary: The

Journal of a Japanese Physician, August

6–September 30, 1945, trans. and ed.

Warner Wells (Chapel Hill: University of

North Carolina Press, 1955).

448 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Finally, the many nonofficial studies of

the war proved indispensable. These

included general studies of the war, especially Ronald H. Spector, Eagle Against the

Sun: The American War With Japan (New

York: Free Press, 1985), and John

Costello, The Pacific War (New York:

Wade Rawson, 1981). Among biographies, the multivolume work by D.

Clayton James, The Years of MacArthur, 3

vols. (Boston: Houghton Mifflin Co.,

1970–85), was notable. Studies of specific topics included Eric Larrabee,

Commander in Chief: Franklin Delano

Roosevelt, His Lieutenants, and Their War

(New York: Harper and Row, 1987);

Arnold C. Brackman, The Other

Nuremberg: The Untold Story of the Tokyo

War Crimes Trials (New York: William

Morrow, 1987); Gordon W. Prange, in

collaboration with Donald M. Goldstein

and Katherine V. Dillon, At Dawn We

Slept: The Untold Story of Pearl Harbor (New

York: McGraw-Hill Book Co., 1981);

William M. Leary, ed., We Shall Return!:

MacArthur’s Commanders and the Defeat of

Japan, 1942–1945 (Lexington: University

Press of Kentucky, 1988); Walter Lord,

Day of Infamy (New York: Henry Holt and

Co., 1957); James H. and William H.

Belote, Corregidor: The Saga of a Fortress

(New York: Harper and Row, 1967);

Richard B. Frank, Guadalcanal: The

Definitive Account of a Landmark Battle

(New York: Random House, 1990);

Stanley L. Falk, Decision at Leyte (New

York: W. W. Norton, 1966); Lyda Mayo,

Bloody Buna (New York: Doubleday and

Co., 1974); S. L. A. Marshall, Island

Victory: The Battle of Kwajalein Atoll

(Washington, D.C.: Infantry Journal

Press, Penguin Books, 1944); Barbara W.

Tuchman, Stilwell and the American

Experience in China, 1911–1945 (New

York: Macmillan Co., 1970); Charlton

Ogburn, Jr., The Marauders (New York:

Harper and Brothers, 1959); Brian

Garfield, The Thousand-Mile War: World

War II in Alaska and the Aleutians (New

York: Doubleday and Co., 1969); and

Gwenfread E. Allen, Hawaii’s War Years,

1941–1945 (Honolulu: University of

Hawaii Press, 1950). 

Memoirs supplied an essential dimension to the story, notably Robert L.

Eichelberger, in collaboration with

Milton Mackaye, Our Jungle Road to Tokyo

(New York: Viking Press, 1950); Walter

Krueger, From Down Under to Nippon: The

Story of the Sixth Army in World War II

(Washington, D.C.: Combat Forces

Press, 1953); Jay Luvaas, ed., Dear Miss

Em: General Eichelberger’s War in the

Pacific, 1942–1945 (Westport, Conn.:

Greenwood Press, 1972); and Joseph W.

Stilwell, The Stilwell Papers, arr. and ed.

Theodore H. White (New York: William

Sloane Associates, 1948). Valuable

insights were found in the medical

memoirs of the war, which include

Gordon S. Seagrave, Burma Surgeon

(New York: W. W. Norton and Co.,

1943), and Burma Surgeon Returns (New

York: W. W. Norton and Co., 1946);

Alfred A. Weinstein, Barbed-Wire Surgeon

(New York: Macmillan Co., 1948);

George Sharpe, Brothers Beyond Blood: A

Battalion Surgeon in the South Pacific

(Austin, Tex.: Diamond Books, 1989);

Katharine R. Pincoffs, comp., Maurice C.

Pincoffs, M.D.: Letters From Two World

Wars and a Sketch of His Life by His 

Wife (Baltimore: Garamond/Pridemark,

1967); Tressa R. Cates, The Drainpipe

Diary (New York: Vantage Books, 1957);

and Juanita Redmond, I Served on Bataan

(Philadelphia: J. B. Lippincott Co., 1943).

On the effects of the atomic bombs, useful works included Ashley W. Oughterson

and Shields Warren, eds., Medical Effects of

BIBLIOGRAPHICAL NOTE 449
the Atomic Bomb in Japan (New York:

McGraw-Hill Book Co., 1956); and Committee for the Compilation of Materials

on Damage Caused by the Atomic Bombs

in Hiroshima and Nagasaki, Hiroshima

and Nagasaki: The Physical, Medical, and

Social Effects of the Atomic Bombings, trans.

Eisei Ishikawa and David L. Swain (New

York: Basic Books, 1981).

Finally, we made use, as appropriate,

of the huge literature of articles in military, historical, and medical journals.

Specific references will be found in the

footnotes.

450 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
AAA Antiaircraft artillery

AAF Army Air Forces

AAR After-action report

ACofS Assistant chief of staff

Adv Advance

AG Adjutant general

An Annex

APA Transport, attack

App Appendix

Arty Artillery

ASCOM Army Service Command

ASurg Assistant surgeon

AUS Army of the United States

Bde Brigade

BMSA Bureau of Medicine and Surgery Archives, Department of the

Navy, Washington, D.C.

Bn Battalion

Br Branch

Cav Cavalry

CBI China-Burma-India

Cdr Commander

CG Commanding general

CinC Commander-in-chief

Cmd Command

CMH U.S. Army Center of Military History, Washington, D.C.

CNurse Chief nurse

CO Commanding officer

CofS Chief of staff

COMSOPAC South Pacific Command

Cong Congress

CP Command post

CPA Central Pacific Area

CPBC Central Pacific Base Command

CSurg Chief surgeon

List of Abbreviations
Def Defense

Dept Department

Det Detachment

Dir Director

Dist District

Div Division

Engr Engineer

ETMD Essential technical medical data

Exh Exhibit

F Fahrenheit

FA Field artillery

FSurg Flight surgeon

G–1 Personnel officer or section, division or higher staff

G–2 Intelligence officer or section, division or higher staff

G–3 Operations officer or section, division or higher staff

G–4 Supply officer or section, division or higher staff

G–5 Civil affairs officer or section, division or higher staff

Gen General

GHQ General Headquarters

GO General Order

Gp Group

Haw Hawaii, Hawaiian

Hosp Hospital

HQ Headquarters

HUMEDS Historical Unit Medical Detachment

Inf Infantry

Insp Inspection, Inspector

Instrs Instructions

Intel Intelligence

JB Joint Board

L Library

LCI Landing craft, infantry

LCT Landing craft, tank

LST Landing ship, tank

Log Logistics

Ltr Letter

452 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
MAC Medical Administrative Corps

MC Medical Corps

Med Medical

MFR Memorandum for the record

MHI U.S. Army Military History Institute, Carlisle Barracks,

Pennsylvania

NARA National Archives and Records Administration,

Washington, D.C.

NP Neuropsychiatric

Off Officer

OofCSurg Office of the Chief Surgeon

OofSurg Office of the Surgeon

Opns Operations

OQMG Office of the Quartermaster General

PACU Philippine civil affairs unit

Phil Philippine

Plt Platoon

Port Portable

Prov Provisional

QM Quartermaster

RCT Regimental combat team

Regt Regiment

Rpt Report

SC Sanitary Corps

Sec Section

Sess Session

SG Surgeon general

Sit Situation

SO Special Order

SofW Secretary of War

SPA South Pacific Area

SPBC South Pacific Base Command

Spec Special

Sta Station

Surg Surgeon, Surgical

Svc Service

SWPA Southwest Pacific Area

LIST OF ABBREVIATIONS 453
THU The Historical Unit

USAFCBI United States Army Forces, China, Burma and India

USAFFE United States Army Forces in the Far East

USAFIA United States Army Forces in Australia

USAFIBT United States Army Forces, India-Burma Theater

USAFICPA United States Army Forces in the Central Pacific Area

USAFIP-NL United States Army Forces in the Philippines, Northern Luzon

USAFISPA United States Army Forces in the South Pacific Area

USAFMIDPAC United States Army Forces, Middle Pacific

USAFPAC United States Army Forces, Pacific

USAFPOA United States Army Forces, Pacific Ocean Areas

USAFWESPAC United States Army Forces, Western Pacific

USASOS United States Army Services of Supply

USFCT United States Forces, China Theater

USFIA United States Forces in Australia

USFIP United States Forces in the Philippines

VD Venereal disease

WD War Department

WDGS War Department General Staff

WPBC Western Pacific Base Command

454 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Abdominal wounds: 15, 134, 164, 206, 207, 243,

288, 301, 315

Adak: 154, 155, 157, 159, 163, 166, 172, 174

Admiralty Islands: 200–202

Advance Base (New Guinea): 128, 144–45

Advance Base Surgeon, Office of the: 128–29

Aid stations: 93, 208

Alaska: 161–62

Attu: 164, 166–67

on beaches: 203

Navy beach party: 212, 214–15

New Guinea: 203, 206

Philippine Islands: 24

Aidmen, Navy: 238

Air ambulances: 64, 75, 154

Air clearing stations: 302, 307, 312

Air Commando, 1st: 307

Air Commando Group, 3d: 345n45

Air evacuation. See Medical evacuation, air.

Air evacuation nurses: 91

Air evacuation officers: 205–06

Air evacuation squadrons: 97

Air Force, USAFFE: 21

Air forces

Fifth: 51, 129, 131, 132, 148, 253, 415

Seventh: 94–95, 271, 277–78

Tenth: 291, 295–96

Eleventh: 150, 151, 158–60, 172

Thirteenth: 415

Fourteenth: 295–96

Air Forces Training Command: 295–96

Air holding stations: 345, 348

Air Service Command: 51, 295–96

Air surgeons

competition among in the CBI theater: 296

Hawaii: 11

Seventh Air Force: 94

South Pacific Area: 102

Southwest Pacific Area: 50–51

Air Transport Command

Alaska Wing: 154–55

India-China Wing: 296

and medical evacuation: 96–97, 188–89,

259–61, 276, 277–78, 408, 415

Pacific Division: 389, 408, 415

Air Transport Command—Continued

Pacific Wing: 96–97, 188–89, 243, 276, 422

Southwest Pacific Wing: 259–61

Airborne Division, 11th: 327–28, 331n22, 336, 338

Aircraft

ambulance planes: 307, 309, 328

amphibious planes: 188, 193, 276

artillery liaison planes: 328, 333

B–17 bombers: 6, 201

B–25s: 201

bombers: 145, 154

C–47 transports: 143, 147, 193, 201, 245,

277, 289, 307, 312, 327, 334, 339, 346,

348, 349

C–54s: 243, 260–61, 276, 277, 327, 346, 408

C–64s: 345, 348

cargo planes: 309

cub planes: 328, 407

DC–4s: 408

equipped for air evacuation: 276, 307

helicopters. See Helicopters.

L–1s: 307

L–5s: 307, 333, 339, 343, 345, 348, 350

light liaison planes: 312

Navy: 122, 188–89, 276, 277

transports used for air evacuation: 122,

154–55, 243, 277

used for medical supply: 122, 147

Airmen

medical problems of: 94–95

medical services for: 246, 271–72

treated as war criminals: 432

Aitape: 202, 205–08, 320

Aitutaki: 45, 101n39, 108

ALAMO Force: 178n3, 209, 210

Alaska: 149–76

Alaska Defense Command: 150–51, 152, 154,

158–59, 170–71, 172, 174

Alaskan Department: 150–51, 152

Aleutian Islands: 149, 158–76

Alimentary disorders: 292

Alligators (LVT): 223, 225, 227–28, 237, 242

Altfather, Lt. Col. Ellis M., MC: 151

Ambulance battalions: 88

Ambulance companies: 63, 112–13, 332–33, 348

Index
Ambulance corps: 13

Ambulance service: 30–31

Ambulance trains: 75, 76

Ambulances: 113

amphibians used as. See Amphibians. 

Australian: 181

Biak: 212

Gilbert Islands: 223, 225–26

Guadalcanal: 122

Hawaii: 13, 14

jeep: 119–20, 135, 181, 223, 225–26, 230,

232, 238, 241–42, 326, 328, 347, 393,

406

landing craft used as. See Landing craft

(LCI/LCT), used as ambulances.

Mariana Islands: 238, 241–42

Marshall Islands: 229–30, 232

New Guinea: 135

Okinawa: 398, 406

Philippine Islands: 326–27, 328, 334,

345–46, 347

rubber boats used as: 119

seagoing: 258, 389

trucks used as: 13, 14, 207

used for medical supply transport: 122

Wakde Island: 209

Amchitka: 159, 163, 172

Americal Division: 101, 103, 104, 112, 113, 117,

119–20, 121–22, 123, 124, 126, 187,

195–96

American Medical Association: 10, 13

American Military Mission to China: 286, 288

American Red Cross: 11, 13, 26, 296, 417, 425

American Red Cross volunteers: 24n33,

376n46

American Volunteer Group (Flying Tigers):

291

Amphibian Tank Battalion, 708th: 227

Amphibians: 212–13, 214–15, 225, 226, 227–28,

229, 230–31, 232, 242, 323, 325, 326,

389

Amphibious corps

III: 233, 246, 249, 388, 390, 394–95

V: 233, 239, 245, 270–71, 385, 414

Amphibious forces

III: 191, 323, 387

V: 221, 270–71

VII: 178, 179, 181, 202, 320

Amphibious medical battalions: 339

Amphibious medical companies: 202, 212, 214,

332

Amphibious operations: 160, 177–218

Alaska: 149, 172–73, 174

medical planning for: 102, 388–90

Amphibious operations—Continued

medical support for: 177–78, 180, 181,

197–98, 199–200, 202–03, 206, 209,

212–13, 220–33, 320, 332–33, 442

training for: 160–61, 172

Amphibious trucks: 206

Amputations: 33, 134, 145, 198

Anderson, Capt. Thomas C., MC, USN: 219

Anesthesiologists: 400, 401

Anesthetists: 91, 92, 153, 191, 400, 401

Angaur: 384–85

Animals

used for food: 372–73

used for medical evacuation: 345

used to pull litters: 325, 340, 350

used for transportation: 315

Anti-biological warfare officers: 85–86, 92

Antidiarrheal drugs: 122

Anti-malaria school: 138

Antimalarials: 59–60, 268

Atabrine. See Atabrine.

Quinine. See Quinine.

shipping priorities for: 60, 138

shortages of: 111, 137

Apamama: 221, 225

Arawe: 196–98

Armies

Sixth. See Army, Sixth.

Eighth: 253, 330, 331, 334, 336, 340–41,

342–43, 348–49, 352, 361, 414, 422,

424, 426–27, 428, 429

Tenth: 387–88, 389–90, 398, 399–400,

404–05, 408–09, 410–11, 414, 421, 422,

426–27

Armored Group, 13th: 331n22

Armstrong, Col. George E., MC: 313, 316, 317–18

Army, Sixth: 51, 54, 141, 178, 253, 254, 320, 322,

323–24, 327, 329, 331, 336n28, 342–43,

351–52, 361, 362, 374, 414, 421,

424–25, 426–27, 428

Civil Affairs Section: 329–30

medical support for: 326, 334, 338–39, 345,

414–15

surgeon: 319, 334, 351

Army Air Forces

in Australia: 50–51, 61

in the CBI theater: 295

on Hawaii: 9

medical depots for: 90

medical supplies for: 50–51

medical support for: 246, 295

and New Guinea: 51, 61

nurses for: 91

Army Air Forces, India-Burma Sector: 295–96

456 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Army Corps of Engineers: 33, 56–57, 87, 253,

282

Army Garrison Force (Okinawa): 387–88

Army Nurse Corps: 7, 89, 284

Army Nurse Corps, Philippine Army: 362

Army of the United States (AUS): 4

Army Service Command-OLYMPIC: 421, 423

Army Service Command, SWPA: 254, 322,

325–26, 332, 334, 345

Arnold, Harry L., Sr.: 13

Asiatic Fleet, U.S.: 4–5, 23

Assam Province: 291, 292, 294

Asuncion, Juan: 360–61

Atabrine: 118, 124n16, 442

and CBI theater: 293, 303, 306

used in Guadalcanal: 123–25

used in New Guinea: 138, 207, 255

used in the Philippine Islands: 36n64, 322,

351, 357, 362

Athlete’s foot: 125

Atienza, Fe: 367

Atienza, Romeo: 367

Atka: 159

Atomic bomb: 426, 436–40, 443

Atrocities: 132, 431, 432–33

Attu: 149, 159–60, 162, 163–72, 173

Augustin, Col. Marcus V.: 358–59

Australia: 54–60

Army Air Forces in: 50–51

malaria in: 58–60

medical evacuation to: 26, 58, 145

and operations in New Guinea: 128

planning for medical facilities in: 48

role as Allied base: 47, 49–50, 254

U.S. medical facilities in: 143n59

withdrawal of MacArthur to: 31

Australian Army

Advanced Depot of Medical, Dental, and

Veterinary Supplies: 77

in New Guinea: 129, 131, 132, 133, 178–79,

180

and scrub typhus: 266

training provided by: 70, 138

Australian Army Medical Corps: 58–59, 179

Australian Base Section: 255

Aviation medicine: 11, 87, 94–95

Aviation Medicine, Army School of: 21, 87

Avitaminosis: 125

Baker, Lt. Col. Benjamin M., MC: 109, 111

Baker Island: 86, 89

Barbey, Rear Admiral Daniel E.: 178, 202

Barking Sands Army Air Base: 94

Barnes, Brig. Gen. Julian F.: 47

Base sections (Australia): 61–68, 75–77

Bassett, Capt. John W., MC: 168

Bataan: 5, 22, 27–39, 40, 340

American POWs taken from: 364–67

Death March: 364–67

general hospitals: 24n34, 40

and malaria: 5, 27, 30, 31, 32, 36–37

medical supplies for: 49

withdrawal to: 25–26, 27

Battalion aid stations

Biak: 212

CBI theater: 294–95

Central Pacific Area: 220

enemy attacks on: 239

Gilbert Islands: 223

Guadalcanal: 118

Hawaiian Islands: 95

Mariana Islands: 238–39, 247

Marshall Islands: 232

New Georgia: 186

New Guinea: 133, 134, 179, 206–07

Okinawa: 407

Philippine Islands: 30, 31, 37, 345

staffing of: 186, 294–95

Battalion combat teams: 178–79

Battalion landing groups: 173–74

Battalion landing teams: 227, 228, 238

Battalion medical detachments: 222, 223,

306–07

Battalion medical sections: 220, 230

Battle casualties

Admiralty Islands: 200–201

Biak: 212

forward treatment of: 134, 212–13, 220

friendly fire: 225

Gilbert Islands: 223, 224

Guadalcanal: 117

lack of proper treatment for: 186, 188, 242

Mariana Islands: 242

New Georgia: 185–86

New Guinea: 133–34

Philippine Islands: 27, 28, 33, 340–41,

346–47, 350

Beach party medical sections: 388–89, 398

Bed capacity

Alaska: 153–54, 175

Australia: 65, 71, 251–52

Biak: 214, 260

Bougainville: 192–93

CBI theater: 292, 302

Central Pacific Area: 220, 279

expandable: 88, 251, 256, 328–29, 349, 422

general hospitals: 87–88, 91

Hawaii: 11, 17–18, 87–88, 90, 91, 278

INDEX 457
Bed capacity—Continued

hospital ships: 322

Mariana Islands: 241, 250

mobile: 210–11, 251

New Georgia: 187–88

New Guinea: 71, 129, 144–45, 251–52, 256,

258

Okinawa: 403, 415

Philippine Islands: 21, 22, 24, 322, 326,

328–29, 349, 362, 415, 422

for planned invasion of Japan: 415, 417,

425–26

portable surgical hospitals: 210–11

shortfalls in: 108, 241, 256

South Pacific Area: 108

Southwest Pacific Area: 251–52, 256, 260

transport ship hospitals: 259

USAFPOA: 279

Wakde Island: 210–11

Bed requirements

estimates: 389

Hawaii: 86–87

invasion of Japan: 415, 417

Okinawa: 389

Southwest Pacific Area: 54, 68, 251

underestimation of: 54, 251

Beds, shortages of

CBI theater: 310

Guadalcanal: 120–22

New Georgia: 186–88

New Guinea: 129, 135, 137, 141–42, 144–45,

181

Okinawa: 389–90, 404–05

Philippine Islands: 30, 326, 338–39

South Pacific Area: 108–09

Bellows Field: 14, 94

Berezin, Maj. Martin A., MC: 126–27

Beriberi: 34, 41, 127, 196, 366, 371, 373, 377,

380, 430

Biak: 209, 210, 212, 255, 259, 260, 266, 320, 348

Bill, Lt. Col. H. E., MC: 173–74

Biological warfare: 85–86, 432–33

Bismuth: 111

Blackburn, Lt. Donald D.: 353, 359–60, 361

Blake, Francis G.: 265–66

Blank, Col. Julius M., MC: 128–29

Blast injuries: 342

Blood

banks: 16, 241, 347, 425

donors: 16, 120, 417

not given to Japanese POWs: 410

plentiful supplies of: 328–29, 347, 349, 387,

390–91, 398, 401, 417

shortages: 241

Bombardment Wing, 18th: 9

Bomber Command, XX: 296

Bomber Squadron, 71st: 63

Bora Bora: 101n39, 108

Bougainville: 102, 191–96

Breene, Brig. Gen. Robert G.: 97–98, 102, 116

Brereton, Maj. Gen. Lewis H.: 21

Brett, Lt. Gen. George H.: 47–48, 50

Brigade (Provisional), 5332d: 311–14

British Medical Society: 100

Brothers, Col. Clyde L., MC: 295–96

Brown, Maj. Gen. Albert E.: 161, 163, 166

Brown, T. Sgt. 4 Ronald M.: 301

Buckner, Lt. Gen. Simon B., Jr.: 150–51, 158,

159, 387, 394–96, 408

Buna: 30, 131–33, 135, 137, 138, 139–40,

142–43, 147

Bureau of National Aid to China: 296

Burma: 46, 286–90, 294, 297–98, 300–303, 309,

311–14, 316, 318

Burma Road: 286, 288, 291, 294, 312–13, 315

Burns, treatment of: 16, 23–24

Cabalquinto, Gonzalo: 360

Cabanatuan: 365, 366–67, 369–73, 374, 378

Cabanatuan prison: 337–38

Cabcaben: 26, 28, 30, 40

Camp O’Donnell: 365, 367, 368–69, 370

Cannibalism: 132, 216–17

Canton Island: 86, 89, 94

Cape Gloucester: 198–99

Carroll, Brig. Gen. Percy J., MC: 26, 48, 50–51,

200

and base section medical services in

Australia: 67–68

as Chief Surgeon, USAFFE: 51, 54, 252, 253

as Chief Surgeon, USASOS: 50, 54, 57–58,

68, 128–29, 178

and hospital size and equipment: 70–73, 81,

134–35

and malaria prevention: 138, 139

and medical supplies: 80

and neuropsychological disorders: 146–47

and Papua campaign: 129, 130

and portable surgical hospitals: 134–37

and preventive medicine: 60

problems with medical policies of: 54

and SPA bed capacity: 251–52

and SWPA evacuation system: 75–77, 81

and training for medical personnel: 129

Casablanca Conference: 177, 196

Casual companies: 191, 195

Casualties. See also Deaths.

Admiralty Islands: 200–202

458 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Casualties—Continued

Angaur: 384, 385n4

Attu: 167–68

Australian: 179

Biak: 213–14

Bougainville: 192, 196

British: 312

Chinese: 309, 312, 314–16, 318

Corregidor: 41, 42–43

estimates for invasion of Japan: 415–16

estimates for Kiska: 174

friendly fire: 174–75, 184, 225, 237, 323

Gilbert Islands: 223, 224, 225, 226–27, 278

Guadalcanal: 108–09, 117, 118

guerrillas in the Philippine Islands: 361–62

Hawaii: 14, 16–18, 84

Ie Shima: 393

Iwo Jima: 385–87, 396n29

Mariana Islands: 236, 237–38, 246–47, 249

Marshall Islands: 229, 232

Merrill’s Marauders: 309–10

New Britain: 197–98

New Georgia: 108–09, 184, 185–86, 188

New Guinea: 133–34, 147–48, 179, 204, 208

New Zealand Army: 108

Okinawa: 391, 392, 393, 394–95, 396, 409,

410–11

Palau Islands: 385

parachutists: 179–80

paratroopers: 340–41

Peleliu: 385

Philippine Islands: 25n39, 27, 323, 330–31,

333–34, 336, 340–42, 343, 348

triage of: 242, 343, 401, 415

Wakde Island: 209, 210, 211–12

Casualties, civilian

Hawaii: 14, 17–18, 84

Mariana Islands: 238

Okinawa: 390, 409

Philippine Islands: 21, 30, 222–23, 329–30,

333, 336–39

planning for the care of: 21

Casualties, Japanese

Admiralty Islands: 202

airmen: 132

Attu: 168

Bougainville: 196

Guadalcanal: 118, 132

Mariana Islands: 238

New Georgia: 185–86

New Guinea: 132, 204, 206, 208

Okinawa: 394–95

Peleliu: 385

Philippine Islands: 336

Casualties, Marine Corps

Admiralty Islands: 202

Bougainville: 196

Corregidor: 41

Gilbert Islands: 225

Guadalcanal: 117, 118

Hawaii: 14

Mariana Islands: 236, 238

Marshall Islands: 229, 232

New Georgia: 108–09

Okinawa: 395, 410–11

Casualties, medical personnel

Angaur: 385

Attu: 167–68

Biak: 214

CBI theater: 309

Corregidor: 42–43

Hawaii: 16

Iwo Jima: 386–87

New Guinea: 133–34

Okinawa: 391, 392, 396

on ships: 391, 392

Wakde Island: 210

Casualties, Navy

Corregidor: 41

Guadalcanal: 108–09

Hawaii: 14, 16, 17

Ie Shima: 393

New Georgia: 108–09

Okinawa: 393, 411

Casualty evacuation stations: 238

Cates, Tressa: 25

Cavalry Brigade, 2d: 343

Cavalry Division, 1st: 200, 202, 323, 327–28, 334,

336, 343

Cavalry regiments

26th (PS): 19, 36

112th: 197, 206, 208

124th: 311

Cavite Naval Base, Philippine Islands: 23, 24, 25

Central Pacific Area (CPA): 442–43

Army-Navy cooperation in medical services:

231–32, 233–34, 270–71, 272

medical command challenges: 271–72

medical evacuation from: 96–97

medical planning for: 219, 249–50, 272,

273–74

Office of the Chief Surgeon: 233–34,

271–72, 276

and preventive medicine: 279

Central Pacific Base Command (CPBC): 273,

274, 276, 278–80, 281–82, 283, 284, 425

Central Pacific Combat Air Transport Service: 276

Chamorros: 249

INDEX 459
Chemical warfare: 70

Chennault, Maj. Gen. Claire L.: 291, 295

Chest wounds: 134, 206, 243, 315

Chiang Kai-shek, Generalissimo: 286–87, 288,

300, 313, 315

Chiggers: 46

Chilkoot Barracks: 150, 154

China: 286–87, 290, 291, 294, 297, 314–18

China-Burma-India (CBI): 286–318, 441–42

China Defense Supply Program: 296

Chindits: 301, 303, 306n36, 307

Chinese Army

American medical support for: 289, 291–92,

297–98, 300–302, 307, 310, 311–12,

314–18

Medical Administration: 296, 317

medical service: 287, 288, 291, 298–99, 309,

314, 316–17

medical supplies for: 296–97, 298

units: 288, 290, 300–301, 307, 312

X-Force: 297, 299–300, 316

Y-Force: 297, 299, 300, 313, 314, 315, 316,

317

Z-Force: 299, 314, 316–17

Chinese Training and Combat Command: 314,

317–18

Cho, Lt. Gen. Isamu: 394

Cholera: 289, 294, 370n35, 376

Christmas Island: 86, 89, 92, 94

Churchill, Col. Lawrence: 21

Civilian aid stations, Hawaii: 13, 84

Civilian casualties, Army responsibility for

Hawaii: 12–13, 84

Philippine Islands: 322–23, 329–30, 333,

336–39

Civilian liaison activities

Australia: 56–60

Hawaii: 10, 11, 13, 84–86, 271–72

Philippine Islands: 329–30

Civilians

American medical services for: 239–40,

241–42, 245–46, 249, 250, 278, 357–58,

442, 443

Army medical services for: 152, 154, 216,

226, 232–33, 322

Navy medical care for: 408–10

Clagett, Brig. Gen. Henry B.: 47

Clark Field: 21, 23, 24, 334

Clearing companies

added to medical battalions: 173–74

Alaska: 162, 173–74

Australia: 63

Bougainville: 191

CBI theater: 311

Clearing companies—Continued

Central Pacific Area: 220, 222

divided: 112

Guadalcanal: 120–21

Mariana Islands: 239

Marshall Islands: 227, 229

New Caledonia: 112–13

New Georgia: 184, 187–88

New Guinea: 129, 199–200, 202, 206

Philippine Islands: 20–21, 30, 37, 38, 320,

322, 336, 338, 345–46, 347

reinforced: 191, 220, 222, 227

stranded: 210

Clearing Company, 896th: 311, 312, 313–14. See

also Medical clearing companies.

Clearing company platoons: 112–13, 129

Clearing station platoons: 388

Clearing stations

Admiralty Islands: 201

Attu: 164, 166–68

Gilbert Islands: 223

Hawaii: 14, 88

Marshall Islands: 229

New Georgia: 185, 186–88

New Guinea: 134, 143, 179, 181, 205

Okinawa: 390, 398, 404, 407

Philippine Islands: 30, 345, 362

provisional: 345

staffing of: 186

Clement, Capt. M. Jane: 66–67

Clerical workers, women: 269

Clothing 

miticides used on: 141, 200 215, 266,

280–81, 322

problems in Alaska: 152, 161, 170–71, 173

Colby, Col. Elliott G.: 425

Cold Bay: 154, 163, 174

Cold injuries: 166, 170–71, 173, 175, 417

Collecting companies

added to medical battalions: 173–74

Alaska: 173–74, 175

augmented: 222

Biak: 212–13

Bougainville: 191, 192

Central Pacific Area: 222

divided: 112

enemy attacks on: 210

Ie Shima: 393

Marshall Islands: 229

New Caledonia: 112–13

New Georgia: 184

New Guinea: 129, 209

Philippine Islands: 20–21, 30, 31, 37, 320,

322, 336, 345, 347, 348, 350

460 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Collecting companies—Continued

surgical teams attached to: 191, 192

Collecting Company, 645th: 408. See also Medical

collecting companies.

Collecting platoons: 130, 143

amphibious operations: 163, 179, 199–200,

227, 229

Attu: 161–62, 163, 167

Mariana Islands: 239, 247

Marshall Islands: 227, 229–31, 232

New Georgia: 184

New Guinea: 199–200, 203

training for: 228

Collecting stations: 118–20, 134, 135, 143, 230,

398, 401

Collins, Maj. Gen. J. Lawton: 107

Combat fatigue

Attu: 166

Bougainville: 195–96

Corregidor: 41–42

Guadalcanal: 117

Mariana Islands: 240–41

Okinawa: 403–04

treatment of: 195–96, 240–41

Combined Advisory Committee on Tropical

Medicine, Hygiene, and Sanitation:

51n13, 59–60, 138, 141, 420

Combined Chiefs of Staff: 286–87

Combined Operational Service Command: 128

Communicable diseases: 87, 88, 420, 427,

433–36. See also particular diseases.

Company aidmen: 186, 193, 206, 222, 232

Composite Unit (Provisional), 5307th: 301, 307.

See also GALAHAD.

Convalescent camps: 191, 195

Cook Islands: 98, 101

Coomalie Creek Hospital: 63

Cooper, Col. Wibb E., MC: 19, 21, 22, 24, 25–26,

28, 31, 34, 38, 41, 374

Corlett, Maj. Gen. Charles H.: 172, 173

Corps

I: 56–57, 131–32, 133, 136–37, 202, 331,

332, 333–34, 343, 344–45, 414, 428

X: 320, 322, 323, 325, 326, 327, 328

XI: 334, 336, 340, 343, 414

XIV: 184, 185, 186, 192, 331, 332, 334, 336,

343, 420

XXIV: 320, 322, 323, 325, 326, 327, 387,

388, 391, 396, 398, 408, 427

Corpses, treatment of: 232, 234, 248–49, 280–81,

405

Corregidor: 5, 21, 22, 26, 27, 31, 38–43, 340–42,

366–67, 376

Craig, Lt. Col. William R., MC: 369

Cub Three unit (Navy): 187

Cyanosis: 243

Darwin: 61–63, 64

Davao Penal Colony: 356

Davison, Capt. Maude, ANC: 376

Day, Maj. Lemuel C., MC: 143

DDT: 234, 244, 266, 280, 281, 293, 314n49, 405,

409, 420, 428, 435–36, 442, 443

Dearing, Capt. Arthur H., MC, USN: 102, 116

Deaths

American. See Deaths, American.

from atomic bomb: 437–38, 439

Australian: 148

civilian: 336, 409

during evacuation by air: 243

Japanese: 185–86, 202, 204, 208, 209, 211–12,

213, 224, 229, 232, 249, 330–31, 336,

342, 343, 346, 395, 411, 437–38, 439

Marine Corps: 226–27, 229, 232, 249, 411

medical personnel: 134n44, 167–69, 301

Navy: 411

POWs in Japan: 431, 433, 438

POWs in the Philippine Islands: 365, 366,

367, 368–70, 371, 383

POWs outside of the Philippine Islands: 383

POWs in transit: 378

Deaths, American

Admiralty Islands: 201

Attu: 167–68

Biak: 213–14

Gilbert Islands: 224, 225, 226–27

Guadalcanal: 117, 118, 148

Hawaii: 14, 16

Mariana Islands: 249

Marshall Islands: 229, 232

New Britain: 197n40

New Georgia: 184, 185–86

New Guinea: 134n44, 204, 208, 148, 179

Okinawa: 393, 410–11

Philippine Islands: 42–43, 330–31, 342, 343,

365

POWs. See Deaths, POWs.

Wakde Island: 209, 211–12

Decoursey, Col. Elbert, MC: 279–80

Deficiency diseases: 34, 41, 127, 196, 366, 371,

373, 377, 380, 381

Deiber, Col. Harry M., DC: 284

Del Carmen Field: 23

Dengue: 46

Admiralty Islands: 201

in Australia: 56, 63, 65

in CBI theater: 292

control of: 281

INDEX 461
Dengue—Continued

epidemics: 95, 101, 226, 244, 284

Gilbert Islands: 226

in Hawaii: 91, 95

in Mariana Islands: 234, 244, 249, 284

New Caledonia: 101

New Guinea: 128, 131, 133, 138, 140, 205,

255

Okinawa: 405

Philippine Islands: 329, 351

Denit, Brig. Gen. Guy B., MC: 200, 215, 261, 426

appointed Chief Surgeon, USAFFE: 253

as Chief Surgeon, USAFPAC: 412–14

as Chief Surgeon, USASOS: 253, 319

and hospital construction: 256

and Philippine Islands invasion: 319,

323–24, 347

and Japan: 438

and medical planning for the invasion of

Japan: 414, 416, 417, 422, 423

and personnel shortages: 268–69, 270

and public health in Manila: 418, 421

and scrub typhus: 266

and surgical teams: 347

Dental clinics: 21, 28, 92, 374

Dental Corps: 10

Dental laboratories: 66

Dental officers: 91–92, 186, 284, 361, 368

Dental technicians: 153

Dentists: 16, 30, 66, 90, 91–92, 153, 272, 299,

316, 373

Dermatologists: 195

DeRosier, T. Sgt. Edwin C.: 134n44

DeWitt, Lt. Gen. John L.: 150–51, 159–60

DeWitt, Col. William F., MC: 295–96

Diarrhea: 34–35, 125, 128, 130, 140, 152, 172,

184, 189, 201, 205, 215, 294, 351, 405

Dietary deficiencies

Australia: 63

Bataan: 33–36, 37, 38–39

Chinese Army: 298

Corregidor: 41

Guadalcanal: 117

POWs: 338, 367, 370–71, 372, 373, 377, 380

Dieticians: 90–91, 109, 269, 376

Diphtheria: 194, 367, 369–70

Diphtheria antitoxin: 367, 370

Dispensaries

Air Force: 295–96

Alaska: 150, 154

CBI theater: 295–96

Far East Air Force: 21

Hawaii: 11, 95

Japan: 428

Dispensaries—Continued

Philippine Islands: 21, 22, 332–33

POW camps: 373

Distinguished Service Cross: 134n44

Doe, Brig. Gen. Jens A.: 213

Doss, Pfc. Desmond T.: 397

Douglas, Lt. Col. Wallace I., MC: 98

Downs, Col. Charles McC.: 320

Duckworth, Col. James W., MC: 26, 31–32, 367,

368–69

Dutch Harbor: 150, 154, 159, 174

Dypsnea: 243

Dysentery: 45

amebic: 329, 330, 427

Australia: 63

bacillary: 101

Biak: 215

on board ships: 112, 378

Bougainville: 194, 196

in CBI theater: 289, 306, 309

Chinese Army: 298

control of: 281

Gilbert Islands: 226

Guadalcanal: 117

Hawaii: 91

in Japan: 427, 430, 436

Japanese Army: 310–11

Japanese deaths from: 196

Mariana Islands: 249

New Caledonia: 112

New Georgia: 184, 189

New Guinea: 128, 131, 181

Philippine Islands: 31, 34–35, 37, 38, 329,

330

among POWs: 364–66, 367, 369–70, 380, 430

Efate: 101, 107, 109, 122

Egeberg, Roger O.: 178n3

Eichelberger, Lt. Gen. Robert L.: 131–32, 133,

138, 202, 213, 330, 331, 348–49, 352

Ellice Islands: 223

Elmendorf Field: 150

Emergency medical plans

Hawaii: 9–14

Philippine Islands: 19–23

Emergency Plan WHITE: 12

Emmons, Lt. Gen. Delos C.: 18n20, 82, 85, 95, 97

Encephalitis: 405n46, 434

Engebi: 232–33

Engineer Boat and Shore Regiment, 532d: 179

Engineer special brigades: 314–15

2d: 177–78, 180, 320

3d: 178n2, 332

4th: 178n2, 332

462 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Eniwetok: 227, 232–33

Enteritis: 376, 434

Epidemics

Biak: 215

CBI theater: 309

dengue: 95, 101, 226, 244, 249, 284

diphtheria: 370

dysentery: 226, 249, 281, 309

Gilbert Islands: 226

hepatitis: 92–93, 152, 216

Japan: 434–36

malaria: 101, 124–25, 137–40, 145, 441

Mariana Islands: 244, 249

New Guinea: 137–40, 145

POW camps: 370

scrub typhus: 215, 217

typhus: 434–36

Epidemiologists: 279–80, 281

Epidermophytosis: 125

Epstein, Pvt. Hymie Y.: 134n44

Espiritu Santo: 98, 101, 103–04, 105, 107, 109,

122, 193

Essential technical medical data reports: 272

Evacuation. See Medical evacuation.

Evacuation, chain of

from CBI theater: 306

for neurosurgical cases: 401n39

from New Guinea: 77, 137

from Okinawa: 388, 398, 401, 403

Evacuation hospitals

Admiralty Islands: 200

Australia: 64, 65

CBI theater: 297–98, 300–301, 313

Central Pacific Area: 220, 241, 250

for invasion of Japan: 414–15, 424, 425

Iwo Jima: 385

Mariana Islands: 234, 241

Navy: 388, 408

needed near front lines: 137, 241, 248, 250

Okinawa: 388, 398, 400, 408

Philippine Islands: 320, 322, 327, 332, 334,

336, 337–38, 343, 345, 347, 349

splitting of: 70–71

Southwest Pacific Area: 70–71

Evacuation hospitals (units)

1st: 56–57, 137

7th: 111, 332

10th: 145

14th: 302

21st: 191, 192, 332, 338

25th: 105

29th: 197–98, 217, 332, 337

30th: 199, 206

36th: 202, 203–04, 258, 320, 345–46

Evacuation hospitals (units)—Continued

48th: 302

52d: 104

54th: 206, 209–11, 332, 337–38

58th: 201, 320

71st: 337

73d: 300–301, 302, 307

92d: 203–04, 212, 214, 215, 332

Evacuation planning. See Medical planning.

Evacuation policy

and amphibious operations: 160, 166

Attu: 166

Biak: 214

Bougainville: 192–93

CBI theater: 302, 309

Central Pacific Area: 220

effects on Army strength: 121–22, 129, 145,

160, 242, 276–77, 310

Guadalcanal: 121–22

Mariana Islands: 241, 242

and neuropsychiatric cases: 189

New Georgia: 188, 189

New Guinea: 129, 145

Okinawa: 389

Philippine Islands invasion: 322, 326, 343

Southwest Pacific Area: 75–77, 259

USAFPOA: 276–77

Evacuation stations: 142–43

Evans, Capt. James L., MC: 357–58, 362

Exhaustion

Bougainville: 195–96

CBI theater: 306, 307, 309, 310, 311

Guadalcanal: 117, 125

New Georgia: 189

New Guinea: 131, 133

Okinawa: 404

Philippine Islands: 38, 351, 364–65

treatment of: 195–96, 404

Eye problems: 373

Fairley, Col. N. Hamilton, AMC: 58, 59, 141

Fanning Island: 86, 89

Far East Air Force: 21, 51

Far East Air Forces: 415

Far East Air Service Command: 21

Faus, Maj. Robert: 13

Fellmeth, Lt. Floramund A.: 26, 66

Fertig, Col. Wendell W.: 349, 354–58, 360

Fevers, unspecified

Biak: 213

Mariana Islands: 249

New Guinea: 130–32, 133, 134, 138, 205

Field hospital companies for Chinese Army:

299–300

INDEX 463
Field hospital platoons: 107, 133, 142–43, 161,

162, 166, 172, 220, 229–30, 248,

315–16, 317, 318

Field hospitals

Alaska: 167, 175

Australia: 65, 70–71

Bougainville: 191

CBI theater: 298, 309

Central Pacific Area: 220, 229–30

for Chinese Army: 315

enemy attacks on: 240

Guadalcanal: 119, 120, 124

Iwo Jima: 385, 387

for malaria cases: 124

Mariana Islands: 234, 239, 240

mobile: 250

for neuropsychiatric cases: 404

New Caledonia: 112–13

New Guinea: 199–200, 256

for Okinawa: 388, 390–91, 398–400, 401,

403, 407

Philippine Islands: 30, 31, 332, 336, 345,

347, 349

for planned invasion of Japan: 424, 425

protection for: 240

splitting of: 70–71, 161

staff for: 124, 400

surgery performed at: 120

Field hospitals (units)

1st: 320

1st Provisional: 223

2d: 142–43, 147, 320

3d: 320

5th: 332, 338

6th: 175

14th: 161

17th: 184, 185, 188, 384–85

20th: 161, 166, 171–72

23d: 332

24th: 332

25th: 301, 302, 307, 309, 313–14

27th: 317

31st: 227, 229–30, 234, 239–40, 241, 242,

244, 398–99, 407

36th: 232–33, 234, 246–47

37th: 210–11, 332

38th: 234, 239, 240–41, 387

41st: 332, 338

43d: 332, 345, 346

44th: 313–14

52d: 191, 192

69th: 328, 390–91

74th: 407

82d: 404

Field hospitals (units)—Continued

88th: 410

91st: 346

Fighter Group, 49th: 63

Fiji: 45, 98, 101, 105, 108–09, 111, 122, 189–90

Filariasis: 46, 101, 405

Filipino guerrillas: 327–28, 329, 340, 343, 344,

347, 349, 352, 353–63

Finschhafen: 254, 255, 256, 258, 268

First aid kits: 390

First aid stations, Hawaii: 13, 84

Fischer, Lt. Col. Arthur F.: 37

Fleas: 48

Flies: 128, 189, 201, 215, 226, 249, 250, 306, 322,

330, 351, 365–66, 370, 405, 418, 420

Flight medicine: 243

Flight nurses: 408

Flight surgeons

Australia: 51

Christmas Island: 89

Hawaiian Islands: 94, 102

Mariana Islands: 243

and medical evacuation: 96–97, 243, 276

Navy: 122

Philippine Islands: 24

squadron: 94

training for: 87

Flying Tigers: 291

Food inspection

in Australia: 56, 57

CBI theater: 294

in Hawaii: 85, 92

in New Zealand: 98n37, 100

Food supplies, inadequacy of 

Bataan: 27, 31, 33–36

New Guinea: 131

POW camps: 365–66, 369–71, 372, 373, 374,

376–77, 380, 381, 383

Foot injuries: 170–71, 173, 175, 325, 334

Formosa: 369, 378, 379–80, 384

Forts

Armstrong, Hawaii: 12, 92

Brent, Philippine Islands: 21

De Russey, Hawaii: 12

Glenn, Alaska: 174

Greeley, Alaska: 174

John Hay, Philippine Islands: 21

Kamehameha, Hawaii: 12

William McKinley, Philippine Islands: 21,

22, 24, 25

Mason, Calif.: 80

Mears, Alaska: 159, 174

Mills, Philippine Islands: 21, 22, 40, 43

Ord, Calif.: 92, 160–61, 172, 173

464 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Forts—Continued

Randall, Alaska: 174

Richardson, Alaska: 150, 153, 154, 174

Ruger, Hawaii: 18

Shafter, Hawaii: 89–90

Stotsenburg, Philippine Islands: 21, 22, 24,

48–49

Fractures

from parachute jumps: 340–41

treatment of: 16, 118, 145, 223, 300,

341–42

Friend, Lt. Col. Dale G., MC: 112, 113, 119, 124,

125

Friends Ambulance Unit: 288, 290

Fromant, Sgt. Robert W.: 295

Fukujiro, Ishiyama: 432

Fuller, Maj. Gen. Horace H.: 213

GALAHAD: 301, 302, 309–10, 311. See also Merrill’s

Marauders.

Gangrene: 145

Garlick, Maj. William L., MC: 210

Garrisons, medical support for: 271, 278–79,

280, 284, 292

Gas gangrene: 33, 41, 188, 198, 224, 238, 325,

347

Gay, Maj. Elmer D.: 13

Geiger, Maj. Gen. Roy S., USMC: 192, 246

General Headquarters, SCAP: 432, 434, 435,

436, 439

General Headquarters, SWPA: 128, 132n39, 209,

251, 252, 253, 264

Combined Advisory Committee: 266

and decentralization of subordinate commands: 413

and guerrillas in the Philippine Islands:

354, 356, 357, 358

and women: 269

General hospitals

Australia: 64–65, 68, 71, 76, 254, 255

CBI theater: 298, 307

combined into hospital centers: 422, 425

Hawaii: 11, 12, 14–15, 18, 86–88, 91, 94, 278

Mariana Islands: 279

New Guinea: 255, 256

Philippine Islands: 21, 22, 39–40, 41, 322,

325–26, 339

staffs for: 71

teaching function of: 91

General hospitals, Bataan

No. 1: 24n34, 26, 27, 28, 30, 31–33, 38, 365,

367

No. 2: 26, 28, 30, 31–32, 33, 37, 38, 365,

369, 370, 373, 378

General hospitals (units)

4th: 68, 71, 76, 254, 258

8th: 104

18th: 98

20th: 302, 307

29th: 104

39th: 98, 100

42d: 71, 76, 429

49th: 339

54th: 258

105th: 71, 76

118th: 71, 76

133d: 325–26

147th: 88, 278

148th: 88, 93, 236

204th: 88

218th: 278

Geneva Conventions: 75, 363n24, 371

Genitourinary surgeons: 320

Gentry, Lt. Col. Thomas C., MC: 291

Ghormley, Vice Admiral Robert L.: 97–98, 103,

115

Gilbert Islands: 221–27, 271, 274, 276,

278–79

Gill, Maj. Charles C., MC: 13

Gill, Lt. Col. James P., MC: 19

Gillespie, Col. James O., MC: 31, 369, 370, 371,

374, 378, 380n52, 381

Gillman, William: 169

Glattley, Lt. Col. Harold W., MC: 19–20, 28, 31

Glenn, Col. Frank M., MC: 319n1

Goldthorpe, Anne: 377

Gonorrhea: 57–58, 421

Goodenough Island: 265

Goodman, T. Sgt. William: 395

Graves registration units: 33

Gray, Pfc. Vonnie W.: 229

Great Britain: 47, 288–89, 290–91, 296, 297, 300,

301, 307, 311–14

Green Islands: 196

Grindlay, Capt. John H., MC: 288

Griswold, Maj. Gen. Oscar W.: 185, 192

Guadalcanal: 46, 98, 101n39, 108–09, 111, 113,

115–27, 132, 187, 190

casualties evacuated to: 188, 193, 277

and malaria: 58, 189

and medical supplies for New Georgia:

186

Guam: 4, 23, 233, 234, 236, 245, 246–49, 279

Gunn, Maj. E. Mansfield, MC: 133

Hagins, Brig. Gen. William A., MC: 141, 178,

266, 320, 323, 326, 330, 334, 426, 427

Hague Conventions: 75, 363n24

INDEX 465
Halazone tablets: 322

Hallam, Col. Franklin T., MC: 184, 186, 188,

190

Halsey, Admiral William F.: 97, 115–16, 177, 185,

191, 196

Harman, Lt. Carter: 307

Harmon, Maj. Gen. Millard F.: 97, 102, 115–16,

185

Harper, Maj. Jesse T.: 48n6

Harper, Lt. Col. Paul A., MC: 280

Hart, Admiral Thomas C.: 23

Harvard University: 71

Hawaiian Air Force: 9, 11, 94

Hawaiian Antiaircraft Artillery Command: 95

Hawaiian Department: 82, 86, 270, 271, 425

chief surgeon: 9–10, 83

hospitals: 90

medical personnel: 10

medical supply system: 89–90

Office of the Chief Surgeon: 13, 17–19, 83

Hawaiian Division: 9, 11

Hawaiian Islands: 9, 412

emergency medical plans for: 9–10

hospitals on: 86, 271, 274, 277, 278

martial law in: 17–18, 82, 271–72

medical evacuation to: 389

medical support for: 274

outer islands: 92–94

Territorial Board of Health: 85, 86, 93

Hawaiian Seacoast Artillery Command: 95

Hawkins, Lt. Jack, USMC: 356

Hay, John M.: 4

Hayes, Comdr. Thomas H., MC, USN: 374

Head wounds: 164, 206, 243

Health statistics: 280

Healy, Lt. Col. Romeyn J., Jr., MC: 219

Heat exhaustion, prevention of: 322

Helicopters: 307, 333, 343, 442

Hemorrhages: 118, 164, 223

Henderson Field: 116–17, 122

Hepatitis: 92–93, 140, 152, 216, 329, 351

Hewlett, Capt. Thomas H., MC: 381–82

Hickam Field: 9, 11, 14, 85, 90, 94

Hickam Station Hospital: 14, 88, 91, 271, 276

Hillman, Brig. Gen. Charles C., MC: 251

Hilo Field: 94

Hiroshima, Japan: 426, 436–38, 439, 443

Hollandia: 202–05, 254, 255, 258, 268, 320

Homma, Lt. Gen. Masaharu: 27, 37–38

Homosexuality: 372

Honolulu Medical Society: 13, 15, 84

Hookworm disease: 45, 194, 208

Horses: 57

Hospital centers: 254, 258, 389, 422, 428

Hospital centers (units)

26th: 258, 422

27th: 258

28th: 260

821st: 425

Hospital commanders: 54

Hospital construction

Australia: 64, 71

on Espiritu Santo: 105, 107

by Filipinos: 33

Hawaii: 83, 86–87, 90

medical personnel responsible for: 71–72,

83, 104, 105, 107, 256, 422

on New Caledonia: 104

New Guinea: 71, 256

Philippine Islands: 33, 422

for planned invasion of Japan: 422,

425–26

prefabricated: 71–72, 104, 256

using bamboo: 33

Hospital corpsmen: 89, 238

Hospital facilities

Alaska: 159

Australia: 63–65, 68–69

CBI theater: 298, 312

construction. See Hospital construction.

dug into sand: 179, 223

Fiji: 105

Gilbert Islands: 223

Hawaiian Islands: 13, 271, 274, 279

New Caledonia: 104

New Guinea: 134

Okinawa: 398

Philippine Islands: 325–26, 330, 345

POW camps: 365, 367, 369, 370, 373, 378,

381–82

protection for: 169, 250

sites for: 325–26

tents: 28, 30, 33, 63–64, 89, 119, 134, 166,

179, 298, 398

underground: 159, 223

Hospital platoons

Alaska: 161

used to carry medical supplies ashore: 174

Hospital ship platoons (Navy): 166, 223

Hospital ships

Army medical personnel for: 258–59

Assam: 289

assault divisions’ need for: 250

Australian: 76, 145

at Biak: 214–15

Comfort, USS: 258, 392

converted LSTs: 180, 320, 388–89

Dutch liners used as: 75

466 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Hospital ships—Continued

Emily H. M. Weder: 422

enemy attacks on: 324, 389, 391, 392

and Geneva regulations: 259, 389

Haven, USS: 438, 439

Hope, USS: 258

at Iwo Jima: 385

lack of: 77, 238–39

Mactan: 26, 48, 66, 75

Maetsuycker: 75

at Mariana Islands: 234, 238–39, 241, 242,

248, 249–50

Mercy, USS: 258

Navy: 231, 258–59, 323, 388–89, 428, 438

at Okinawa: 388–89, 391, 398

at Pearl Harbor: 16

at Philippine Islands invasion: 320, 322,

323–24, 326, 330, 348, 422

Pinkney, USS: 392

Relief, USS: 231

Solace, USS: 16, 231, 232

Tasman: 75

used for evacuation to the United States:

75, 77, 388–89

used for medical evacuation to New Guinea:

258

used as mobile medical supply depots: 258,

388–89

used as mobile outpatient departments:

258

at Wakde Island: 211

Hospital trains: 288

Hospital transports: 226, 227–28, 229–30, 234,

238–39, 248, 258–59

Hospital units

consolidation of: 254, 264

shortages of: 256, 298

split: 64, 90, 107–08

transport to combat zones: 129

Hospitals

base section: 64, 66

civilian. See Hospitals, civilian.

convalescent: 32, 98, 100, 145, 166, 278,

310, 339, 345

division: 119–20, 191, 227

equipment for mobile hospitals: 70–71,

72n43, 80, 282, 325–26

fixed: 64, 68–69, 294–96, 297–98, 310, 312,

314

for guerrillas in the Philippine Islands: 354,

356, 358, 360–61, 362

on isolated islands: 108

Japanese attacks on: 61–63, 133–34, 143,

159, 167–68, 214

Hospitals—Continued

LSTs used as. See Landing ship, tank

(LST)

mobility of: 70–72, 334. See also Portable surgical hospitals.

Navy: 107, 108–09, 120, 159, 187, 191, 192,

223, 373–74

portable: 65, 71, 72–73. See also Portable surgical hospitals.

provisional: 88

psychiatric: 264, 265, 278

staff for: 91, 284

surgical: 65, 71. See also Portable surgical

hospitals.

Hospitals, civilian

Alaska: 150

Australia: 68–69

Burma: 286, 290–91, 299–300

Hawaii: 13, 16, 18, 86

Japan: 381

New Zealand: 98, 100

Philippine Islands: 21, 354, 356, 358, 360

Seagrave hospital: 286, 290–91, 299–301,

302, 307, 311–12

Hsu Hsu Lin, General: 317

Hukbalahap: 359–60

Iba Field: 23, 24

Ie Shima: 393

Iemp, Lt. Col. John: 236n33

Immunizations: 85, 91, 280

cholera: 294, 329

for civilians: 329, 436

contaminated serum: 60, 92–93, 152

Philippine Islands: 329, 330

smallpox: 329

typhoid: 92, 294

typhus: 294

yellow fever: 92–93

India: 46, 287, 290–99, 300

Infantry divisions

6th: 210–11, 217, 331n22, 343

7th: 92, 160–61, 227, 228–29, 323, 326,

390–91, 394–95, 405, 407

24th: 11, 202–04, 213, 258, 323, 340, 347,

349–50

25th: 11, 107, 117, 121–22, 185, 187–88,

189–90, 331n22, 344

27th: 83, 92, 93–94, 221, 232, 233–34,

236–37, 239, 240–41, 243, 245, 394

31st: 211, 349–50, 367

32d: 129, 130, 131, 132, 133, 135, 138,

141–42, 145, 148, 199–200, 205–06,

344, 345

INDEX 467
Infantry divisions—Continued

33d: 211, 344–45

37th: 101, 185, 187–88, 190, 191, 192,

195–96, 331n22, 334, 336–37, 344, 345

38th: 340

40th: 93–94, 331n22

41st: 129, 138, 143, 178–79, 202–03, 204,

209, 212, 213–14

43d: 184, 185–86, 189–90, 208, 331n22,

358–59

77th: 92, 234, 246, 248, 249, 328, 390, 393,

394–95, 397–98, 404

81st: 92, 384, 385

96th: 92, 390, 394, 395, 398, 407

98th: 92

Infantry regiments

4th: 153

17th: 172, 175

19th: 203

20th: 210

21st: 203, 349

34th: 213, 341

35th: 188

45th (PS): 19, 30–31

57th (PS): 19

102d: 89

105th: 221, 222, 236–37

106th: 232

126th: 130, 148

127th: 206

128th: 130, 206

132d: 119

138th: 153

158th: 209, 210

162d: 178–79

163d: 143

164th: 117, 120

165th: 221, 222, 236–37, 239

169th: 184, 185

172d: 184, 185–86

182d: 120

307th: 395, 397

383d: 394

475th: 311

Infection, prevention of: 15, 16, 23–24, 33, 134,

205

Infections due to lack of surgical support: 307

Insect control units: 234, 244, 248–49, 250,

280

Insecticides: 60

Internees held by Japanese: 373–77

Intestinal parasites: 208

Intravenous fluids: 122

Ishii, Lt. Gen. Shiro: 432–33

Island commands: 279, 282, 387–88

Ivins, Lt. Col. John C., MC: 248

Iwo Jima: 384, 385–87, 396n29, 398

Japan

and atomic bomb: 426, 436–40, 443

occupation of: 426–31, 433–36

planning for the invasion of: 412, 414–18,

421–26, 433–34

planning for the occupation of: 414

POW camps in: 378, 379–80, 381, 382

public health: 433–36

treatment of prisoners of war: 363–83,

431–33

Japanese Army

failures of supply system: 216–17, 394

medical service: 169–70

Japanese forces

14th Army: 27, 37

14th Area Army: 340

32d Army: 394

Kembu Group: 340

Manila Naval Defense Force: 336

Shimbu Group: 343

Shobu Group: 340, 344

Japanese Hospital: 18

Japanese medical service, failures of: 310–11

Japanese military

medical care for: 363

treatment of soldiers: 363–64

Jaundice: 60, 92–93

Jeeps: 113

used to deliver medical supplies: 166

used for medical evacuation: 119–20, 135,

166–67, 181, 302, 312, 326, 347

Johns, Brig. Gen. Dwight F.: 128, 129

Johns Hopkins University: 71

Joint Chiefs of Staff: 49–50, 97, 115, 117, 177,

196, 219, 233, 242, 319, 412

Joint Commission for the Investigation of the

Effects of the Atomic Bomb in Japan:

439

Joint Purchasing Board: 100

Jungle warfare

CBI theater: 286, 292, 300, 302–03, 306–07,

318, 442

medical support for: 186–90, 198–99,

206–07, 300–303, 306–07, 310, 311,

312, 318

New Britain: 198–99

New Georgia: 184–86, 190

New Guinea: 206–08

Philippine Islands: 340

training for: 93

468 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Kachins: 301, 302, 309

Kahuku Army Air Base: 94

Kamehameha School for Boys: 17–18

Kamikazi attacks: 391–93, 396

Kamish, Lt. Col. Robert J., MC: 161, 169, 227

Kaneohe Bay Naval Air Station: 14, 17

Kaneohe Territorial Hospital: 17, 18

Kapa Kapa Trail: 130

Kauai: 88, 90, 93, 94

Kaufman, Col. M. Ralph, MC: 284, 404

Kempf, Maj. Peter, MC: 26

Kendrick, Lt. Col. Douglas B.: 401

Kennard, Lt. Col. William J., MC: 21, 178

Kenney, Maj. Gen. George C.: 51

Kerama Islands: 387, 390

Kilauea Military Camp: 11

King, Lt. Col. Arthur G., MC: 103–04

King, Brig. Gen. Edgar, MC

as anti-biological warfare officer: 85–86

and Central Pacific Area: 222, 226

as Chief Surgeon, Hawaiian Department:

83–84

as Chief Surgeon, USAFICPA: 222, 271–72

as Chief Surgeon, USASOS: 83–84

and emergency medical planning for

Hawaii: 9–13, 15, 18–19, 83–84

and hospital facilities: 86–90

and medical evacuation: 96–97

and medical personnel shortages: 90–92

and medical planning for offensives: 86,

281–82

and medical supplies: 281–82

and portable surgical hospitals: 222

and preventive medicine: 280

and VD control: 84–85

King, Maj. Gen. Edward P., Jr.: 31, 38

King, Lt. Col. Everett, MC: 258

Kinkaid, Vice Admiral Thomas C.: 166

Kirk, Brig. Gen. Norman T.: 71–72, 140–41, 175,

252, 253, 256, 261, 282–83, 417, 426

Kiska: 159, 172–76

Kodiak: 150, 154

Kokoda Trail: 127, 128, 130, 265

Koontz, Lt. Col. Amos R., MC: 98, 275

Korea: 378, 380, 426–27

Krueger, Lt. Gen. Walter: 201–03, 204, 210,

211–12, 213, 330, 331, 333, 343

Kwajalein: 227, 228–32, 242–43, 277, 278, 279

Kyushu: 384, 385, 414, 415, 416, 422, 424–25,

426–27

Labor camps: 378–83

Laboratories: 21, 28, 213, 403

Laboratory technicians: 153, 191, 272

Lae: 133, 179, 254, 255, 259

Landing craft (LCI/LCT)

used as ambulances: 160, 166, 179, 180,

197–98, 201, 209, 212, 223

used to deliver medical supplies: 179

used for medical evacuation: 326, 389, 398,

407

used for operation of portable surgical hospitals: 197–98, 200

Landing ship, tank (LST)

as blood supply centers: 401, 425

casualty-converted: 242, 320, 323, 325,

332–33, 348, 385, 388–89, 398

hospital: 385, 390–91, 393, 415

Landing vehicle, tracked (LVT). See Alligators

(LVT).

Landrum, Maj. Gen. Eugene M.: 166

LaRoche, Col. Laurant L., MC: 274–75

Larsen, Nils P.: 13

Leach, Charles: 376

Ledo Road: 291–92, 294, 297, 300, 302–03,

311–12, 313

Lee, Lt. Henry G.: 378

Legions of Merit: 190

Lend-lease for China: 296

Leyte: 319–31, 340, 347, 348, 349, 352, 359

Libasci, Col. Alfonso M., MC: 49, 147, 267–68

Limay: 22, 26, 27, 28, 40

Littell, Lt. Col. George S., MC: 47, 48, 49, 68

Litter hauls

Attu: 164, 166–67

Biak: 213, 214

CBI theater: 300, 306–07, 315–16

Guadalcanal: 118–19

in jungles: 185, 315, 325, 328, 333–34, 345

in mountainous areas: 164, 166–67, 210–11,

328, 333–34, 345, 348, 396–97, 407

New Caledonia: 112–13

New Guinea: 141–42, 179, 180–81

Okinawa: 396–97

in the Philippine Islands: 325, 328, 333–34,

340, 343, 345, 348

Litterbearers

Admiralty Islands: 200, 201

Angaur: 384–85

Biak: 213, 214

CBI theater: 300, 301, 307, 315–16

Chinese: 300, 307, 315–16

Filipinos: 333–34, 343

Guadalcanal: 118–20, 122

infantrymen used as: 118–19, 164, 396–97

Japanese attacks on: 164, 207, 214, 385,

396–97

Mariana Islands: 239, 241–42

INDEX 469
Litterbearers—Continued

Marshall Islands: 230

natives: 141–42, 179–81, 200, 206–07, 302,

345

New Georgia: 186–87

New Guinea: 134, 141–42, 203–04, 206–07

Okinawa: 395, 396–97, 407

protection for: 207, 345, 406

shortages of: 186–87, 239, 241–42, 396–97

training for: 172

used to transport supplies: 122

Wakde Island: 210

Litters

pulled on travois by animals: 325

shortages of: 28, 237, 361

sled: 155, 334

Stokes: 118, 334

used to transport portable hospitals: 73

Little Baguio: 28, 32–33, 38

Logistical base commands: 273

Los Negros: 200–201

Luzon: 21, 23, 24, 25, 111, 319, 331–34, 336–48,

351, 352, 358, 359–61, 369, 422

Luzon Force: 31, 38

MacArthur, General Douglas: 6, 19, 47, 59

and air ambulances: 75

appointed as Supreme Commander, SWPA:

49–50

and Bataan: 25–26, 27, 31, 33–34, 35, 38–39

as Commander, USAFFE: 51

and disease prevention: 59–60, 266

and Philippine Islands invasion: 319, 323,

327, 330–31, 340, 342, 352

and medical organization in Southwest

Pacific Area: 252

and medical support for Southwest Pacific

Area: 178, 253–54

and New Britain: 196

and New Guinea: 127, 130, 131–32, 138,

141, 177, 202–03

and the occupation of Japan: 426–27

and planning for the invasion of Japan: 414,

416

and problems with medical policy: 59–60

and USAFPAC: 412, 426

and war criminals: 433

McCarthy, Maj. Edward B.: 237

MacCauley, Lt. Col. Bernard J., MC: 210

MacDonald, Lt. Florence: 26

McGowan, Col. Frank J., MC: 341–42

McHugh, William: 386

McLaren, Jock: 357

Magee, Maj. Gen. James C.: 6, 22, 48, 59, 69, 103

Magsaysay, Ramon: 359

Majuro: 227, 228

Makin: 221, 222, 224–25, 226

Malaria

and Australia: 56, 58–60, 63, 65, 137

among Australian military personnel: 181

and Bougainville: 194

and Burma: 46

as cause for evacuation: 137–39, 145, 306

causes of: 46–47, 194

and CBI theater: 292–93, 306

in the Central Pacific Area: 219

Chinese Army: 298

deaths from: 36

Efate: 101

epidemics: 101, 124–25, 137–40, 145, 441

forward treatment of: 133, 138

and Guadalcanal: 46, 117, 123, 124–25, 189

and India: 46

in Japan: 434

Japanese deaths from: 196

Japanese troops and: 310–11

and medical personnel: 143

and Merrill’s Marauders: 303, 306

and New Georgia: 184, 189

and New Guinea: 46, 58, 59, 128, 1311–32,

133, 137–40, 143, 145, 148, 181,

207–08, 255

and Okinawa: 405

and the Philippine Islands: 5, 27, 30, 31, 32,

36–37, 41, 351, 353, 354, 356–57, 358,

360, 362, 418, 420

planning for control of: 5, 405

among POWs: 364, 366, 369–70, 372, 374

problems in the control of: 46

in the South Pacific Area: 101, 109

in the Southwest Pacific Area: 59

suppressive treatment for: 133

symptoms: 109

Malaria control

Admiralty Islands: 200

Australia: 58–59

Bougainville: 191, 194–95

CBI theater: 292–93, 314

Espiritu Santo: 103–04

Guadalcanal: 117, 124

need for command responsibility for:

137–38, 139, 362

New Guinea: 138. 206, 207–08

Okinawa: 388

Philippine Islands: 320, 322, 329, 330,

332–33, 418, 420

South Pacific Area: 103–04

Southwest Pacific Area: 59–60

470 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Malaria control detachments: 194–95, 220, 320,

322

Malaria Control School: 255

Malaria control teams: 59, 117, 124, 138, 191,

194, 200, 206, 207–08

Malaria control units: 129, 292–93, 320, 322,

332–33, 388, 418, 420

Malaria control units, Navy: 124, 185, 189, 201,

388

Malaria discipline: 194–95, 201, 207, 255–56,

303, 306, 322, 351, 362

Malaria survey detachments: 194–95, 220, 320,

322

Malaria survey teams: 59, 138, 191, 199–200,

201, 206, 207–08

Malaria survey units: 332–33, 420

Malariologists: 137, 138, 280

Malinta Tunnel: 22, 39–43

Malnutrition

Guadalcanal: 117

Japanese forces: 117–18, 120, 310–11

Philippine Islands: 33–36, 37, 38–39, 351

among POWs: 369–70, 372, 373, 374,

429–30

Manchuria: 378, 379–80, 381

Manila: 5, 6, 22, 24, 25, 331, 334, 336–39, 418,

420–21

Manila Hospital Center: 24, 25–26

Mann, Capt. William L., Jr., MC, USN: 151

Manus: 200–201, 320

Mariana Islands: 233–50, 271, 276–77, 278–79,

282, 389, 398, 403

Marine Amphibious Corps, I: 191, 192, 233

Marine divisions

1st: 115–17, 124, 145n65, 198, 385, 395, 407

2d: 117, 196, 221, 233, 245

3d: 192, 233, 246

4th: 227, 233, 236–37, 238, 245

6th: 395

Marine Provisional Brigade, 1st: 233, 246

Marines, 4th: 19, 41

Marines Regimental Combat Team, 22d: 232

Mariveles: 5

Marking (Col. Marcus V. Augustin): 358–59

Marquesas Islands: 98, 101

Marshall, General George C.: 47, 138, 196, 416

Marshall, Brig. Gen. Richard J.: 50

Marshall Islands: 227–33, 271, 274, 278–79

Martin, Maj. Gen. Frederick L.: 11

Martin, Brig. Gen. Joseph I., MC: 412, 426

Martin, Col. Walter B.: 403n41

Maxwell, Maj. Gen. Earl, MC: 102–03, 107–08,

109, 111, 114, 116, 119, 184, 191,

274–75, 387–88, 394, 426

Medals of Honor: 190, 397

Medical Administrative Corps: 112, 373

Medical Administrative Corps officers: 151, 186,

268–69, 272

Medical Air Evacuation Transport Squadron,

803d: 301–02, 307, 312

Medical battalion commanders: 93

Medical battalions

augmented: 347

for guerrillas in the Philippine Islands: 360

split: 129, 173–74

Medical battalions (units)

6th: 210, 217

7th: 161, 163, 169, 227–28, 229, 326–27

12th: 20–21

13th: 301–02, 307, 311–12

24th: 11, 202, 258

25th: 11, 121, 185

59th: 173

70th: 332, 346, 348

71st: 94, 322, 388, 390, 398

96th: 399–400, 410

102d: 94, 221–22, 234, 239–40, 243

107th: 129, 130, 141–42

112th: 185, 191, 192, 336–37

116th: 129, 178, 203, 214

118th: 184, 190, 358–59

121st: 117n5

135th: 320, 323–24, 332, 334, 343, 348

151st: 294, 299–300, 302, 307, 312

262d: 177–78, 179, 180, 203, 320, 322

263d: 332, 348, 349

264th: 332, 339, 348

302d: 234, 246–47, 248

Medical clearing companies

394th: 330

893d: 330, 338

Medical collecting companies

409th: 339

506th: 209

644th: 330

645th: 328

Medical command problems: 103–04

Medical companies (Navy): 191

Medical consultants: 191, 284, 319, 403

Medical control officers, amphibious operations:

227–28

Medical corpsmen, Filipino: 30

Medical corpsmen, Navy: 122

Medical detachments

Alaska: 153

Australia: 63–64

Christmas Island: 89

Hawaii: 11

INDEX 471
Medical detachments—Continued

Marshall Islands: 232

New Guinea: 179–80

Philippine Islands: 20, 21, 39

Medical disposition boards: 259–60, 264,

277–78

Medical evacuation

Admiralty Islands: 201

by air. See Medical evacuation, air.

Alaska: 154–55, 174

for amphibious operations: 179, 181, 193,

197–98, 212, 223, 227–28, 229–32, 237,

238–39, 241–43, 245, 248

by amphibious tractors: 193

by amphibious trucks: 206, 207, 212–13,

214–15, 223, 229–31, 232, 241–42

Angaur: 384–85

Attu: 163, 164, 166, 167

Australia: 62–63, 64

to Australia: 26, 48, 129, 145, 258

Biak: 212–14, 260

Bougainville: 192–93

buses used for: 38

by carabao cart: 340

CBI theater: 288, 299–300, 302, 306–07,

309–10, 312, 314–15, 316–17, 318

from the Central Pacific Area: 276

for Chinese Army casualties: 315

Corregidor: 39, 41

by dog teams: 155

Gilbert Islands: 223–24

Guadalcanal: 117, 118–20, 121–22

Hawaiian Islands: 96, 276

to Hawaiian Islands: 86–87, 96–97, 223–24,

231, 276

Ie Shima: 393

Iwo Jima: 386–87

in jungles: 192–93

for malaria cases: 137–40

from Manila to Bataan: 25–26

Mariana Islands: 234, 237, 238–39, 241–43,

245, 248, 249–50

Marshall Islands: 227–28, 229–32

in mountainous areas: 396–97, 407

Navy responsibility for: 193, 198, 202, 212,

326

of neuropsychiatric patients: 96, 109, 277,

422

New Britain: 197–98

New Caledonia: 112–13

New Georgia: 186–87, 188

New Guinea: 64, 77, 141–47, 179, 180–81,

202–04, 206–07, 254–55, 258, 259

officers in charge of: 186

Medical evacuation—Continued

Okinawa: 388–89, 390–91, 394, 395,

396–400, 401n39, 403, 406–08, 410–11

Philippine Islands: 25–26, 30–31, 38, 39,

41, 322, 323, 324–27, 328, 332–34,

336–37, 340, 343, 345–46, 348, 349–50,

357, 422

planning for invasion of Japan: 414–15

preparation of patients for: 113–14, 119, 145

by rail: 24, 154, 288–89, 312

by ship. See Medical evacuation, water.

South Pacific Area: 103, 109, 113–14

Southwest Pacific Area: 75–77, 276

tanks used for: 394, 406

by truck: 318

to the United States: 75, 76–77, 96, 109,

166, 254–55, 258, 259–60, 276, 388–89,

422

Wakde Island: 209, 210–11

Medical evacuation, air: 96–97, 145, 442

Admiralty Islands: 201

Alaska: 154–55, 174

Australia: 64, 75, 76, 143–44

Bougainville: 193

CBI theater: 289, 306–07, 312, 314

deaths due to: 243

and evacuation policy: 259–60

Gilbert Islands: 223–24

Guadalcanal: 122

by helicopter: 307, 333, 343, 348

holding stations for: 339, 345, 348

by light plane: 347, 348, 407

Mariana Islands: 234, 242–43, 245, 277–78

Marshall Islands: 231

need for dedicated aircraft: 154–55

for neurosurgical cases: 401n39, 422

New Guinea: 75, 142–44, 204

Okinawa: 389, 407–08

Philippine Islands: 327, 333, 334, 339,

345–46, 347, 348, 349–50, 422

plans for invasion of Japan: 415

priorities for: 276–77

problems of: 277–78

on Qantas flights: 64

by seaplane: 76, 145, 223

staff for: 276

to the United States: 276–77, 422

USAFPOA: 276–78

Medical evacuation, water

by barge: 206

by flying boats: 64, 119–20

by hospital ship: 26, 48, 398, 422

by landing craft: 179, 180, 188, 201, 223,

227–28, 230–31, 248, 407

472 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Medical evacuation, water—Continued

by LCT: 197–98, 398

by LST: 188, 201, 202, 214–15, 234, 242,

245, 248, 348, 398, 415

by motor torpedo (PT) boats: 119–20

problems of: 122, 231–32, 242, 248, 323,

328

by seaplane: 76, 145, 223

by ship: 76, 119–20, 122, 142, 145, 166, 188,

193, 201, 223–24, 227–28, 231, 234,

248, 258, 289, 323, 326, 328, 333, 348,

388–89, 407–08, 422

by small boat: 119, 167, 328, 336–37, 350

by submarine: 357

on transport ships: 96

Medical Field Service School: 4

Medical general laboratories

18th: 279–80

19th: 424

Medical groups

80th: 400n35

135th: 322, 334, 348

Medical hospital ship platoons: 96

Medical intelligence

Central Pacific Area: 219–20

failures of: 215, 216

Okinawa: 388, 405

USAFPOA: 279–80

Medical laboratories: 332–33, 418, 420

Medical laboratories (units)

3d: 65

14th: 403

Medical maintenance units: 90, 111, 155, 174,

186, 243, 281, 296, 327, 358, 423

Medical officers

assigned to amphibian ambulances:

227–28

assignments: 283–84

Australia: 70

and diagnosis of neuropsychological disorders: 264

Hawaii: 10

lack of training for: 186

Navy: 180, 181

Philippine Army: 30

Philippine Islands: 23, 24–25, 30

promotions for: 95

reassignments of: 413, 417

relations between career military and volunteers: 70

replacements: 186, 396, 424

shortages of: 90–91, 109, 186, 424

training for: 70, 88, 109, 168–69

used as construction laborers: 256

Medical personnel, Army

arming of: 112, 164, 168–69, 173, 179, 237

assignments to Chinese Army units: 314–15,

317–18

attacks on by enemy patients: 224, 301

battle deaths of: 167–68, 210, 237, 386–87

battle injuries: 309, 349, 385, 386–87

casualties: 16, 42–43, 133–34, 167–68, 210,

214, 237, 238

difficulties uniting with hospitals: 325–26

enlisted men: 10, 23, 24–25, 30, 69–70, 88,

90–91, 97, 109, 264

illnesses among: 249, 265

and medical care on transport ships: 320

for Okinawa: 390, 396–97

for planned invasion of Japan: 417, 424

POWs: 367–69, 374–76, 381

replacement: 186–87, 396–97, 417, 424, 428

shortages. See Medical personnel, shortages

of.

strength. See Medical personnel, strength.

training for amphibious warfare: 160–61,

172, 228, 234

training in arms: 173, 228

training for enlisted men: 69–70, 88, 91

training in jungle and island warfare: 116,

228

as transporters of medical supplies and hospitals: 134, 135–37, 179, 325–26, 333,

348

used as construction laborers: 71–72, 256,

258, 261, 340, 422

warrant officers: 10

Medical personnel, Chinese Army: 314–17

Medical personnel, civilian

Bataan: 30

Filipino: 329, 338–39

Hawaiian Department: 90–91

Medical personnel, Navy: 122, 374, 383

Medical personnel, shortages of: 284

Alaska: 153, 154

Attu: 164

CBI theater: 298

Hawaii: 10

Hawaiian Department: 90–92

New Georgia: 184

Okinawa: 396–97, 400

for planned invasion of Japan: 417, 424

South Pacific Area: 109

Southwest Pacific Area: 61, 69–70, 268–70

USAFPAC: 413, 414–15

Medical personnel, strength

Alaska: 153, 154, 173–74

Army doctrine regarding ratios: 153

INDEX 473
Medical personnel, strength—Continued

Gilbert Islands: 221–22

Hawaii: 10

Hawaiian Department: 90–91

Philippine Islands: 23

ratio to total Army strength: 10, 23, 90–91,

153, 154, 221–22, 251, 252

Southwest Pacific Area: 251, 252, 270n31, 283

USAFPOA: 283–84

Medical planning

for Alaska: 161–62

Army-Navy cooperation: 116, 193, 219,

225–26, 332–33, 387, 410

for Australia: 48, 56

for Bougainville: 191–92, 193

CBI theater: 297–300

Central Pacific Area: 219–20, 225–26,

233–34, 249–50, 281–82

for Guadalcanal: 116

for the invasion of Japan: 412–13, 414–18,

420–26

for Kiska: 172–73, 174

for liberated areas: 219

for Mariana Islands: 233–34, 242–43, 249–50

for New Georgia: 184

for New Guinea: 129

for Okinawa: 387–90, 405, 410

for Operation FORAGER: 277

and ORANGE plans: 5

for Philippine Islands invasion: 327, 332–33

South Pacific Area: 102–03, 107–09, 178,

184, 191

Southwest Pacific Area: 50, 51, 54, 178

for supplies: 281

USAFFE: 51, 54

for the USAFPOA: 281

Medical policy: 51, 54, 56–57, 60, 66, 264

Medical regiments

11th: 11

12th (PS): 19–20, 28, 38

101st: 112–13, 117n5, 119–20, 122, 124

102d: 92, 93–94

135th: 63, 145, 197, 198, 199, 214–15

Medical regulating officers: 415

Medical reservists: 5, 7

Medical resupply: 81, 155, 179, 186, 281–82,

311, 327–28, 388–89, 423–25. See also

Medical maintenance units.

Medical sections

of base sections: 61–63

battalion: 153, 161–62, 163

personnel shortages: 153

shore party: 163

Medical Service, CPBC: 274

Medical specialists: 109, 272, 388, 422

Medical Squadron, 1st: 200

Medical supplies

abandonment of: 26

Alaska: 155–58, 174

for amphibious landings: 174, 202, 225,

227, 248

Attu: 164

Australia: 77, 80–81

availability of complete hospital units: 282

Biak: 213

captured Japanese: 243, 245–46, 249, 354, 361

carried ashore by medical personnel: 174

CBI theater: 287, 296–97, 301, 302, 307,

311, 316–17

Central Pacific Area: 222

for civilians: 330

combat-loading of: 160, 174, 222

Corregidor: 40

destroyed by the enemy: 26, 40, 147, 184

for dispensaries: 22

equipment repairs: 268

equipment shortages: 22, 28, 30, 80, 111

excesses: 282–83

for general hospitals: 22, 40

Gilbert Islands: 222, 225

Guadalcanal: 118, 122

for guerrilla forces in the Philippine Islands:

354, 356–57, 358, 359, 360, 361–62

Hawaii: 11, 13, 18–19, 281

improvisation: 354, 356–57, 359, 381

for Japan: 433, 434, 438

local procurement of: 80

Mariana Islands: 234, 243, 248

Marshall Islands: 227

mislabeling of: 186

New Caledonia: 112, 113

New Georgia: 185, 186

New Guinea: 131, 135–37, 147–48, 202–03

obsolete equipment: 22

Okinawa: 389–90

palletized: 222, 227, 243, 281

parachute packs of: 174

Philippine Islands: 22, 27, 28, 30, 32–33,

327–28, 330, 356, 359, 360–61, 420

for planned invasion of Japan: 423–25

for portable surgical hospitals: 135–37

POW camps: 367, 368–69, 373, 374, 376,

382, 383

requisition system for: 267–68, 281, 282,

296–97

shared with the Navy: 111

shortages of: 27, 32–33, 111, 131, 248,

316–17, 327–28, 356, 359, 361

474 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Medical supplies—Continued

South Pacific Area: 111, 112, 113

Southwest Pacific Area: 267–68

for station hospitals: 22

stockpiling of: 13, 18–19, 281

storage of: 157–58. See also Medical supply

depots.

theft of: 248

transportation for. See Medical supplies,

transportation for.

USAFPOA: 281–83

warehouses for: 28. See also Medical supply

depots.

Medical supplies, transportation for

by air: 122, 129, 312

hand-carried: 174, 203, 213, 227

lack of: 112, 113, 147, 213

need for air transport: 111

parachute drops: 129, 147, 174, 290, 301,

302, 311, 312, 327–28

by ship: 129, 147, 281. See also Shipping priorities.

by submarine: 357, 358, 359, 361

Medical supply aviation platoons: 199–200

Medical supply depot companies: 332–33

Medical supply depots

Australia: 61, 64, 65, 80–81

China: 297

divided: 64

Fort Mason: 80

Guadalcanal: 186

Hawaii: 18–19, 89–90, 281–82

hospital ships used as: 258

mobile: 258

New Caledonia: 111, 116

New Georgia: 186

New Guinea: 128–29, 147

Philippine Islands: 5, 26, 36, 40, 41, 43, 346

for planned invasion of Japan: 425–26

splitting of: 77, 80–81

Medical supply depots (units)

3d: 77

4th: 77

5th: 19, 90

9th: 77, 147, 268

Medical supply detachments: 113

Medical supply dumps: 243, 248

Medical supply officers

ASCOM-O: 423

CBI theater: 296–97

shortages of: 77, 296–97, 423

USAFIA: 48, 49

USAFPOA: 282

Medical supply platoons, 332

Medical supply teams: 388

Medical technicians: 272

Medical units

CBI theater: 298

composition of: 71–72

shortages of: 298, 327

training for: 272

understrength: 61

Medical war crimes: 380n54, 382, 383n63, 431–33

Medicine chests: 22, 80, 281

Medicines, lack of in POW camps: 364–65, 369,

370, 380, 382, 431

Merrill, Brig. Gen. Frank D.: 301, 303, 306

Merrill’s Marauders: 301, 302–03, 306–07,

309–11

Midway Island: 94, 158–59

Miehe, Col. William J., MC: 129, 134–35,

136–38, 140, 141–42, 145, 178

Miles, Rufus E., Jr.: 416n9

Military decorations: 190, 214, 385, 397

Military districts (Philippine Islands)

1st: 360

10th: 356

Military government, Okinawa: 408–09

Military government detachments: 389, 408–10

Military government specialists: 408–09

Military occupation specialty (MOS) system:

283–84

Milk: 57, 100

Miller, Col. Alvin C., MC: 15, 86–87

Milne Bay: 137–38, 142, 143n59, 255

Mindanao: 21, 319, 348–52, 354, 356–57

Miranda, Blas E.: 359

Missing-in-actions: 208, 211, 213, 229, 232

Miticides used on clothing: 141, 200, 215, 266,

280–81, 322

Mitsui Corporation: 381

Mobile hospitals: 298. See also Portable surgical

hospitals.

Mobile surgical teams: 197–98

Moore, Col. Luther R., MC: 151, 153–56, 176

Moorhead, John J.: 15

Moorhouse, Lt. Col. Charles H., MC: 24

Morale

effect of quick evacuation of casualties on:

143

and women nurses in the Southwest Pacific

Area: 269–70

Morgan, Brig. Gen. Hugh J., MC: 252–53

Morgues: 64

Morphine: 14–15, 49, 119, 122, 164, 170, 174, 328

Mosquito control: 56–57, 58–59, 93, 95, 124–25,

244, 249, 250, 255–56, 405

Mosquito nets: 30, 36–37, 58–59, 118, 124, 181

INDEX 475
Mosquito repellants: 118

Mosquitoes

Aedes: 46, 56, 234

Anopheles: 46, 59, 63, 100, 122, 128, 137,

189, 194, 234

Motley, Lt. Ruby F.: 376

Mount Isa: 63–64, 66

Myitkyina: 288, 301, 302–03, 307, 309–11, 312,

313, 314, 315–16

Nagasaki: 426, 436, 438–39, 443

Nakagawa, Col. Kunio: 385

National Guard: 92–93

Nau, Catherine L.: 24n33

Naval Air Transport Service: 97, 401, 408

Naval Technical Mission to Japan: 439

Navy beach party medical units: 223, 238, 320

Netherlands East Indies: 49–50

Neuropsychiatric consultants: 404

Neuropsychiatric disorders

Admiralty Islands: 201

and airmen: 95

Attu: 171–72

as cause of disability separations: 264

as cause for evacuation: 109, 125, 145–47,

189–90, 264–65, 277, 404–05

caused by kamikaze attacks on ships: 392

in the CBI theater: 293–94

delusions: 184

diagnosis of: 87–88, 96, 146–47, 195–96, 264

forward treatment of: 96, 125–26, 147,

189–90, 195–96, 240–41, 264–65, 351,

404–05

Guadalcanal: 125–27

on jungled islands: 109, 184–85, 189–90,

195–96, 264

lack of forward treatment for: 293

malaria and: 146–47

Mariana Islands: 240–41

New Georgia: 184–85, 189–90

New Guinea: 208

Okinawa: 395, 400, 403–05

Philippine Islands: 41, 351

among POWs: 372, 381, 430–31

prevention of: 264, 293–94, 351

psychosis: 41, 372

in South Pacific Area: 109

in Southwest Pacific Area: 146–47, 264–65

treatment of: 125–27, 264, 404

Neuropsychiatric patients

air evacuation of: 401n39, 422

facilities for the evacuation of: 96, 146–47,

241, 265

facilities for on hospital ships: 388–89

Neurosurgeons: 400, 401

New Britain: 51n12, 177, 196–99

New Caledonia: 98, 101, 104–05, 108–09,

112–13, 116, 117, 122, 195, 275

New Georgia: 108–09, 181, 184–90, 193

New Guinea: 49–50, 51, 58, 59, 61, 64, 66,

67–68, 77, 81, 127–48, 202–08, 216–17,

254–55. See also Papua.

New Guinea Base Section: 255

New Hebrides Islands: 98, 101, 103, 122

New Zealand: 97–98, 100, 101n39, 108–09, 122,

196n39

Nichols Field: 21, 23, 24

Nielson Field: 23

Nimitz, Admiral Chester W.: 49–50, 82, 86, 90,

97, 115, 117, 151, 159–60, 202, 219,

221, 227, 232, 234, 236–37, 270–71,

272, 273, 283

and Philippine Islands invasion: 319, 333

and Iwo Jima: 385

and Okinawa: 384, 408, 410

and planning for the invasion of Japan: 412,

426

Noemfoor: 216–17, 320

Norman, Lt. Col. Abraham, MC: 221

North, Lt. Col. William D., MC: 26, 31–32, 33

North Pacific Area: 149

North Sector General Hospital: 87–88, 94, 278

Noumea: 102, 104, 111, 112

Nurses

air evacuation: 91, 97, 276

Alaska: 161

Army: 24–25, 26, 66–67, 91, 272, 284,

323–24, 338, 374–75, 376, 400

assignments of: 66–67, 91

Australia: 66–67

Burmese: 290, 307

civilian: 13, 21, 25, 26, 90–91, 290, 307

enlisted men trained as: 73

on Espiritu Santo: 105, 107

excluded from combat areas: 400

facilities for: 105, 107

Filipino: 21, 25, 26, 358, 359, 360, 361, 362,

370

flight: 243, 408

Hawaii: 10, 13, 90–91, 284

illnesses among: 284

male: 73, 161

morale of: 91

Navy: 376

and neuropsychiatric cases: 264

New Guinea: 67

Okinawa: 400

Philippine Islands: 24–25, 26, 30, 38, 323–24

476 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Nurses—Continued

POWs: 338, 374–75, 376

rotation for: 91, 284

shortages of: 10, 90–91, 109, 284, 414–15

South Pacific Area: 107, 109

Southwest Pacific Area: 269–70

training for: 88, 272

USAFPAC: 414–15

USAFPOA: 284

women: 66–67, 91, 269–70, 284, 400

Oahu: 9, 11–13, 14–19, 84, 86, 87, 88, 89–90, 92,

94, 95

O’Hara, Capt. Donald M., DC: 288

Okinawa: 46, 384, 385, 387–411, 443

Okinawa Evacuation Center: 400

Old Bilibid prison: 336, 337–38, 369, 372, 373–74

Operations

CARTWHEEL: 177, 178–81, 196, 199, 200

CORONET: 414, 415, 416n9, 417, 421, 422,

426

DOWNFALL: 414

FLINTLOCK: 228

FORAGER: 233–34, 240–41, 246, 277

OLYMPIC: 414, 415–16, 422, 423, 426

Ophthalmic surgeons: 320, 400

Opium: 111

Oral surgery: 66

Ormoc: 325, 326–27, 328

Oro Bay: 137, 254, 255–56

Orthopedic consultants: 191

Orthopedic surgeons: 284, 320, 347, 400, 401

Oughterson, Col. Ashley W., MC: 284, 427,

436–37, 438, 439

Owen Stanley Range: 127, 128

Owi Island: 212, 215, 260

Oxygen, shortages of: 111

Oxygen masks: 243

Pacific Fleet, U.S.: 4–5, 9, 49–50, 82

Pacific Ocean Areas (POA): 49–50, 82, 442–43

Palau Islands: 384–85

Panay: 32

Papua: 58, 64, 127–48. See also New Guinea.

Parachute Infantry, 503d: 179–80, 340–41

Parasites: 45, 46

Parasitologists: 138

Parry Island: 232–33

Parsons, Col. William B., MC: 198

Patch, Maj. Gen. Alexander M., Jr.: 101, 113,

117, 123, 124, 126

Pazdral, Lt. Col. Nuel, MC: 50–51

Pearl Harbor: 9, 14–19

Peleliu: 384, 385

Pellegra: 34, 371, 381

Pelzman, Lt. Col. Ivy A., MC: 57–58

Pena, Jacob: 360

Penicillin: 205, 216n81, 234, 254, 266, 278, 294,

319, 323–24, 328, 347, 349, 387, 389,

410, 421, 424–25, 436n47, 438, 443

Personnel management: 103, 109, 111, 153, 154,

272, 283, 284

Petrarca, Pfc. Frank J.: 190

Pharmacies: 28

Pharmacists: 153

Philippine Army: 6, 19, 20, 21, 22, 25, 28, 30,

34–35, 36–37, 354, 361, 362

Philippine civil affairs units (PCAU): 322,

329–30, 333, 338

Philippine corps

I: 38

II: 38

Philippine Department, Office of the Chief

Surgeon: 5–6, 19–20, 21, 22

Philippine Division: 19–20, 22, 27

Philippine Islands: 4–5, 49–50, 319–52, 443

American guerrillas in: 353–63

civil affairs units: 329–30, 333, 420

Japanese attack on: 23–26

Japanese occupation of: 350, 352, 353

medical care for civilians: 357–58, 361, 363,

420

military adviser to: 6

planning for the defense of: 4–6, 19–23

planning for the invasion of: 254, 319–20,

322

planning for medical support for the invasion of: 258, 260, 320

public health: 329–30, 351, 359, 418,

420–21

resistance to Japanese occupation: 353–63

Philippine Scouts: 19–20, 23

Phoenix Islands: 89

Physical therapists: 90–91, 109

Physicians, civilian: 376

Hawaii: 13, 84

Japanese: 382–83, 431–34, 436, 438

New Zealand: 100

Physicians, Filipino: 21, 26, 30, 353, 356, 358,

359, 360, 361, 362, 376, 420

Pincoffs, Col. Maurice C., MC: 141, 266, 418,

420

Pinkerton, Forrest J.: 13

Plague: 46, 93

Plasma

delivery by air: 327–28

not given to Japanese POWs: 410

problems with: 164, 166, 301

INDEX 477
Plasma—Continued

shortages of: 111, 122, 315, 341–42

substituted for blood: 241

use of to prevent shock: 14–15, 16, 118,

119, 179–80, 210–11, 212, 401

Plasma banks: 13, 16, 347

Pneumonia: 431

Polio: 91

Port Moresby: 64, 67, 80, 128–29, 133, 142, 143,

144–45, 254, 255, 265

Portable surgical hospitals: 77n48, 128n29

Admiralty Islands: 200–201

Biak: 212–13, 214

Bougainville: 191

CBI theater: 298, 301–02, 311–12, 313–14,

315, 318

Central Pacific Area: 220, 222

facilities for: 134, 135

Gilbert Islands: 222, 223, 225

for Japan invasion: 414–15

on LCTs: 197–98, 199–200

Mariana Islands: 234, 239

Marshall Islands: 227, 232

New Britain: 197

New Georgia: 184

New Guinea: 133, 134–37, 142–43,

178–79, 199–200, 202, 203, 205,

206–07, 209

Okinawa: 388, 390, 398, 400

Philippine Islands: 322, 332, 334, 336, 343,

345, 347–48, 350

placement in military organization:

135–37

provisional: 222

on ships: 232, 245

South Pacific Area: 184, 191

split: 315

supplies for: 135–37

used as aid stations: 135

used as evacuation facilities: 134–35

Portable surgical hospitals (units)

1st: 206

2d: 142–43, 209–10

3d: 134, 209, 210

4th: 128

5th: 206, 207

6th: 198

8th: 198

9th: 142–43, 258

10th: 323

11th: 210–11

13th: 198

14th: 135

16th: 320

Portable surgical hospitals (units)—Continued

17th: 133–34

18th: 135, 206, 340, 341, 342

19th: 130, 135, 320

22d: 135

23d: 135, 136, 146

24th: 179

27th: 200, 320

30th: 200

32d: 315

34th: 318

41st: 384–85

42d: 301, 307, 309

43d: 301

45th: 311–12

46th: 301

58th: 309

60th: 311–12

64th: 340

95th: 234, 246–47, 328

96th: 234, 239

97th: 234, 239

98th: 234, 239

Porter, Col. Hervey B., MC: 291, 295–96

Potter, Col. Laurence A., MC: 161, 166, 227,

320, 330, 387, 396, 400n37, 427

Presidential unit citations: 169, 203, 342

Preventive medicine: 443

Admiralty Islands: 201

Australia: 56–57

Biak: 215, 216

Bougainville: 196

CBI theater: 294, 441–42

Central Pacific Area: 279

Chinese Army: 298–99

command responsibility for: 47, 59–60,

255–56, 294, 421

failures of: 215, 216, 294

Hawaii: 85, 93

Japan: 428

Japanese forces: 170

lack of section for in Office of the Chief

Surgeon, SWPA: 54

Mariana Islands: 234, 250

New Guinea: 205

Okinawa: 405–06

Philippine Islands: 351–52, 361, 421

in POW camps: 376

school of: 281

Southwest Pacific Area: 54, 59–60, 441–42

USAFPOA: 279–81

Preventive medicine units: 388

Prisoner-of-war camps: 271, 336, 337–38, 365,

366–67, 369–77, 431–32

478 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Prisoners of war

Allied: 374–75, 428–30, 432, 438

American. See Prisoners of war, American.

Filipino: 364, 367, 368–69

Japanese. See Prisoners of war, Japanese.

Japanese civilians: 408, 410

Korean: 229

Prisoners of war, American

Bataan and Corregidor: 43, 338, 352,

363–83

liberation of: 336, 337–38, 428–30

in Manila: 336, 337–38, 373–77

medical care for: 431–32

medical care for after liberated: 336,

337–39, 429, 431

nurses: 338, 374–75

transferred to labor camps outside the

Philippine Islands: 378–83

Prisoners of war, enemy. See also Prisoners of war,

Japanese.

medical care for: 230, 239–40, 241–42, 400,

410, 422

Okinawa: 396, 400, 408, 410

Prisoners of war, Japanese

Admiralty Islands: 202

Alaska: 168

Biak: 213

CBI theater: 309

Gilbert Islands: 224

Guadalcanal: 120, 127

Mariana Islands: 238, 249

Marshall Islands: 229

New Guinea: 132, 208

Okinawa: 408, 410

as patients: 120, 132

Philippine Islands: 32, 342, 422

Wakde Island: 211–12

Prostitution: 58, 64, 84–85, 280, 421

Provisional general hospitals

No. 1: 17–18

No. 2: 18, 88

No. 3: 18

No. 4: 18

Provisional vertical battalions: 113

Psychiatric consultants: 191, 293–94

Psychiatrists: 90–91, 127, 189–90, 404

CBI theater: 293–94

division: 195–96, 240–41, 264–65

shortages of: 109, 146–47, 351

Southwest Pacific Area: 264–65

USAFPOA: 284

Public health

Australia: 56–60, 63

China: 314

Public health—Continued

Hawaii: 91

Japan: 409–10, 428, 433–36

medical intelligence regarding: 219–20

New Guinea: 128, 129

Philippine Islands: 329–30, 351, 359, 418,

420–21

Public health officials

Australia: 56, 57–58

Hawaii: 86

Public Health Service: 6–7, 232

Public Health Service officers: 138, 219

Purple Hearts: 190

Pursuit Wing, 14th: 9

Quarantine

and air medical evacuation: 95

of pets: 95

Philippine Islands: 329

of units for hepatitis: 92–93

Quartermaster Corps: 152, 161

Quinine: 118, 124n16, 127, 204, 354, 357, 367,

370

Quinine shortages: 36–37, 49, 123, 131

Rabaul: 116, 177, 191, 192, 196, 199

Radiation sickness: 437–39

Rangoon: 286, 288

Rat control: 93, 255–56

Rations (food): 33–35, 41, 57, 125, 131, 185,

280, 327–28, 367, 408–09, 410

Red Cross. See also American Red Cross.

in Australia: 65

and chartering of hospital ships: 26

Chinese National Society: 296

packages for POWs: 372, 380

Philippine: 21, 367, 370, 371

supplies for POWs: 374, 376, 382, 383

Redmond, Lt. Juanita: 32–33, 40, 41

Refugees: 289–91

Regimental aid stations: 31, 37, 95, 179, 341

Regimental combat teams

clearing companies for: 20–21

collecting companies for: 20–21

medical support for: 113, 129, 134, 206,

246–47, 384–85

Regimental combat teams (units)

32d: 228–29

34th: 202, 340

126th: 130–31, 133, 143, 199–200

127th: 131

128th: 130–31, 135

149th: 340

158th: 331n22

INDEX 479
Regimental combat teams (units)—Continued

162d: 212, 213

163d: 143, 209–10

182d: 113

184th: 228–29

186th: 212–13, 214

305th: 246–47

306th: 246–47

307th: 247

321st: 384, 385

322d: 384–85

503d: 341

Remund, Maj. Donald E., MAC: 282

Rendova: 186, 188

Replacement Command: 417

Respiratory infections: 41, 60, 140, 152, 172,

278, 357, 405, 427, 430, 431

Rice, Brig. Gen. George W., MC: 48, 50, 51, 54,

60, 251, 253, 427

Richardson, Lt. Gen. Robert C., Jr.: 270, 273

Rockefeller Foundation: 6–7

Rockefeller Institute: 92–93

Rockwell, Rear Admiral Francis W.: 174

Roosevelt, Franklin D.: 6, 19, 82, 313

Russell Islands: 101

Russo-Japanese War: 364n25

Ryukyus Islands: 384, 396, 408, 410–11

St. Louis College: 18

Saipan: 233–34, 235–45, 249, 271, 279, 281, 284,

389, 398, 408

Salamaua: 133, 178–79

Salomon, Capt. Ben L., DC: 237

Salt tablets: 131, 322

Sams, Col. Crawford F., MC: 433–34, 435–36

San Lazaro Contagious Disease Hospital: 420

Sandfly fever: 46

Sanitary companies: 235–36, 250, 332–33

Sanitary Company, 743d: 244

Sanitation Corps: 232

Sanitation officers: 279–80

Sanitation problems

Attu: 172

Biak: 215

CBI theater: 287, 298, 306

Chinese Army: 298–99, 315

Gilbert Islands: 226

Japanese Army: 310–11

Mariana Islands: 234, 248–49

New Georgia: 189

New Guinea: 205

Okinawa: 405

Philippine Islands: 338, 351

at POW camps: 367, 370, 372–73, 374, 375–76

Sanitation problems—Continued

USAFPOA: 280

Santo Tomas University: 336, 337–38, 375–77

Sapero, Comdr. James J., MC, USN: 194

Sarmi: 208, 209, 210, 211–12

Schistosomiasis: 45, 322, 329

Schlanser, Col. Adam E., MC: 19, 22

Schock, Col. John J., DC: 367

Schudmak, Maj. Melvin A., MC: 306

Schwartz, Lt. Col. Jack W., MC: 369

Scrub typhus: 46, 219

Australia: 265

Biak: 213, 215

Bougainville: 194

causes of: 140–41, 215

CBI theater: 306, 309

control measures: 199, 215, 217, 281

mortality of those afflicted: 265

New Britain: 199

New Guinea: 128, 131, 133, 140–41, 181,

200, 205, 207–08, 217, 265–66

Philippine Islands: 322, 329

prevention of: 141, 266, 322, 329

Southwest Pacific Area: 264, 265–66

treatment of: 140, 199, 208, 215, 217,

265

Scurvy: 34, 338

Seagrave, Maj. Gordon S., MC: 286, 288, 290–91,

300–301, 309, 313

Seaplanes: 76

Service Unit Officers Field Training School:

272

Sharpe, Capt. George, MC: 333

Shipping priorities

antimalarials: 60, 138, 268

CBI theater: 297

hospitals: 108, 214, 249, 256

medical personnel: 61

medical supplies: 268, 297

Ships. See also Hospital ships.

difficulties unloading: 325–26, 327

hospital facilities on: 96, 122, 197–98, 202,

223, 226, 229–30, 232, 234, 238, 242,

245, 248, 258–59, 320, 322, 323, 326,

330, 332–33, 348, 385, 388–89, 390–91,

393, 398, 415

Japanese: 378, 380, 431

lack of operating rooms on: 238–39

LSTs: 197–98, 200, 202, 320

Navy: 47, 54, 77, 89, 180, 192, 232, 234, 239.

See also Hospital ships, Navy.

operating rooms on: 166, 192, 197–98, 200,

202, 212, 242, 248, 320, 323, 325,

332–33, 388–89

480 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Ships—Continued

shortages of: 75, 90, 96, 108, 111, 191, 234,

242, 250, 268, 282–83

used to transport American POWs: 378

Shock: 118, 223, 315

Shore party medical sections: 220, 223, 229–30,

232, 320, 388–89

Short, Lt. Gen. Walter C.: 17–18

Silver Stars: 190, 385

Simmons, Brig. Gen. James S., MC: 280

Sitka: 150, 154

Slim, Lt. Gen. William J.: 300, 313–14

Skin diseases

Admiralty Islands: 201

Australia: 65

Bougainville: 194, 195

CBI theater: 306

Guadalcanal: 125

Mariana Islands: 249

New Georgia: 184

New Guinea: 128, 131–32, 133, 140, 205,

208

Okinawa: 405

Philippine Islands: 351, 357, 358

POW camps: 376

treatment for: 133, 357, 405

Skin problems caused by miticides: 266

Smallpox: 93, 289, 424, 434

Smith, Col. Andrew W., MC: 11, 94, 95

Smith, Lt. Gen. Holland M., USMC: 161, 221,

227, 236–37

Smith, Col. Howard F., MC: 138

Smith, Maj. Gen. Julian C., USMC: 221

Smith, Maj. Gen. Ralph C.: 221

Society Islands: 98, 101

Sodium amytal: 241

Solomon Islands: 101, 115, 117, 181, 185–86,

191

South Pacific Area (SPA): 97

Army-Navy cooperation in medical services:

102–03, 184, 187–88, 191–92, 193, 196

horses for: 57

medical planning for: 102–03

medical service operations: 178

Navy responsibility for medical support: 102

South Pacific Base Command (SPBC): 273,

274–75, 276, 425

South Pacific Combat Air Transport Service: 122

Southwest Pacific Area (SWPA)

coordination of Army, Navy, and Marine

medical units: 178, 181, 202

evacuation policy: 76–77

horses for: 57

medical command problems: 140, 251–53

Southwest Pacific Area (SWPA)—Continued

medical service: 177–78

medical supply problems: 267–70

medical units: 61

problems of medical organization in: 264

problems of medical policy in: 50, 51, 54, 264

Supreme Commander: 49–50

Surgeon, General Headquarters: 50

Special Service Force, 1st: 172

Splitter, Col. August W., MC: 260

Spruance, Vice Admiral Raymond A.: 221

Starvation

American guerrillas in the Philippine

Islands: 354–55

American POWs: 364–65, 374, 377, 380,

381, 429–30

Japanese forces: 120, 127, 130, 132, 206,

211–12, 213, 216–17, 343, 410

in Manila: 418, 420

Station hospitals

Alaska: 153–54, 155, 159, 166, 174, 175

Australia: 64–65, 70–71, 254

Christmas Island: 89

designated to treat neuropsychiatric cases:

264

Fort Brent: 21

Fort John Hay: 21

Fort William McKinley: 21, 22, 24, 25, 26

Fort Mills: 21, 39–40

Fort Stotsenburg: 21, 22, 23–24, 25

Hawaii: 11, 12, 16, 87–88, 91

Kwajalein: 278

Mariana Islands: 246, 279

New Guinea: 67, 129, 255, 256

Okinawa: 388, 398

Owi Island: 260

Philippine Islands: 322, 326, 333, 361

Southwest Pacific Area: 73, 254–55, 264

Station hospitals (units)

1st: 89

9th: 104

12th: 64

20th: 121–22

22d: 278

27th: 104

31st: 104

95th: 295

98th: 291

109th: 104, 108–09

153d: 67, 68–69, 144–45

156th: 93

165th: 328

171st: 145

176th: 236

INDEX 481
Station hospitals (units)—Continued

179th: 166, 174

227th: 339

289th: 236, 246, 249

328th: 175

331st: 104

332d: 104

336th: 104

369th: 236, 239

Sternberg General Hospital: 5, 21, 22, 23, 25, 26,

48–49, 378

Stilwell, Lt. Gen. Joseph W.: 286–87, 288,

290–91, 297, 300, 301, 302–03, 306,

309–10, 311, 313, 314

Stilwell Road: 313

Stimson, Henry L.: 47, 175, 416n9

Stone, Lt. James H.: 292

Streit, Maj. Gen. Paul H., MC: 274

Suicides, Japanese: 169, 170, 213, 224, 225, 237,

238, 342, 410, 411

Sulfa drugs: 11, 14–15, 16, 18–19, 33, 134, 170,

174, 354, 357

Sulfadiazine: 125, 171

Sulfaguanidine: 111, 125, 189

Sulfanilamide: 14–15, 23–24

Sulfathiazole: 15, 301

Sulfonamides: 118

Surgeon General, Office of the

and malaria control organizations: 59

and medical intelligence: 279–80

Preventive Medicine Division: 6–7

Preventive Medicine Service: 280

and Southwest Pacific Area: 252, 258–59

Surgeon generals. See Kirk, Brig. Gen. Norman

T.; Magee, Maj. Gen. James C.

Surgeons. See also Medical officers; Physicians.

Army Air Forces staff: 51

assigned first aid and evacuation tasks: 135

assigned to collecting companies: 191

Australian military: 56

base: 103–04

base section: 48, 56, 64, 66, 75–76

command: 103–04

district command: 93

division: 93, 135

Navy: 209, 212, 232, 240

regimental: 95, 135

service commands: 83, 93

shortages of: 90–91, 186, 298

Surgery

on beaches: 200–201, 203–04, 239

under blackout conditions: 200–201, 206,

239–40

and Merrill’s Marauders: 307

Surgery, facilities for

Corregidor: 39–40

in dugouts: 200–201, 214, 239

under parachutes: 307

in POW camps: 381, 382

on ships. See Ships, operating rooms on.

tents: 206, 401. See also Portable surgical

hospitals.

Surgical consultants: 191, 347

Surgical detachments: 220

Surgical dressings: 11

Surgical Hospital, 33d: 65

Surgical hospitals. See also Portable surgical hospitals.

Bataan: 30, 33

Guadalcanal: 120

portables used as: 73

Southwest Pacific Area: 73

Surgical specialty teams: 320

Surgical teams: 300–301, 320, 332–33, 347, 400

Surgical technicians: 347, 401

Swift, Maj. Gen. Innis P.: 428

Tacloban: 322, 323, 327

Tali Medical School: 314

Tamiya, Admiral Takeo: 438–39

Tamraz, Col. John M., MC: 291–92, 294, 296,

297–98, 310

Tarawa: 221, 222, 225–26, 271, 276

Task forces

51: 163

4591: 89

6184: 101, 112

CYCLONE: 216

HURRICANE: 212, 214, 216

MARS: 311, 313

medical support for: 253, 271`, 272, 279

PERSECUTION: 205

RECKLESS: 202–03

TORNADO: 209, 210

Task forces, Navy

54: 221

77: 202

Taylor, Lt. Col. Paul, MC: 415

Tetanus: 238

Thompson, Lt. Col. Arthur H., MC: 121

Thoracic surgeons: 320, 400

Tinea: 125

Tinian: 233–34, 237, 238, 241, 245–46, 248, 249,

279, 282, 389

Toem: 208, 209

Tojo, Hideki: 427–28

Tokuda, Hisakichi: 432

Tonga Islands: 101

482 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Tongareva: 101n39, 108

Tongatabu: 101n39, 108, 111

Training

for ambulance personnel: 113

in amphibious warfare: 160–61, 172, 272

of anit-malaria details: 138

on board ships: 112

cadres for medical detachments: 20

for Chinese Army medical personnel: 288,

291, 299, 314–15, 316, 317

for cold weather operations: 170–71

in island warfare: 116

in jungle warfare: 93, 116, 129, 130, 272

lack of: 28

of medics: 112, 116, 129, 172, 272

of medics in arms: 112, 173, 272

for nurses: 272

Philippine Army medics: 28

sanitation: 228

tropical medicine: 70, 100, 112, 272

Trains used for medical evacuation: 24,

288–89

Transportation Corps: 259

Transportation problems: 22, 112–13, 150,

155–58

Trench foot: 171, 175, 325

Triage: 242, 343, 401, 415

Tripler General Hospital: 11, 12, 14–15, 18,

86–87, 88, 89, 91

Trombiculid mite: 46

Tsutsugamushi fever. See Scrub typhus.

Tsuzuki, Masao: 438–39

Tuberculosis: 57, 87, 100, 357, 382, 409, 430–31,

434

Tulagi: 101, 115

Turner, Rear Admiral Richmond Kelly: 221,

227

Typhoid: 92, 100, 294, 376, 436

Typhus: 46, 294, 434–36

Typhus Commission, U.S.A. See United States of

America Typhus Commission.

Umnak Island, Alaska: 154

Unalaska Island: 159

Underwood, M. Sgt. James B.: 337

Unit Jungle Training Center: 272

United China Relief: 296

United States Army Forces, China, Burma and

India (USAFCBI): 286–87

chief surgeon: 291, 313

cooperation with British medical service:

312

medical missions: 287, 291

Office of the Chief Surgeon: 294n15

United States Army Forces, Far East (USAFFE):

51

chief surgeon: 51, 253

problems of medical policy in: 51, 54, 253,

413

United States Army Forces, Middle Pacific

(USAFMIDPAC): 412, 425

United States Army Forces, Pacific (USAFPAC):

412, 413–17, 426–27, 428, 433

United States Army Forces, Pacific Ocean Areas

(USAFPOA): 273

bed capacity: 279

medical planning: 387

Office of the Chief Surgeon: 273–74, 280,

283, 284

and preventive medicine: 279–81

United States Army Forces, Western Pacific

(USAFWESPAC): 412–13, 415, 418,

421, 422, 423–24

United States Army Forces in Australia

(USAFIA): 48

chief nurse: 66

Committee on the Adaptation of Australian

Materials and Supplies: 68

Office of the Chief Surgeon: 48–49, 50

United States Army Forces in the Central Pacific

Area (USAFICPA): 86, 270, 273, 279,

283

United States Army Forces in the Far East

(USAFFE): 19–20, 23, 26, 31, 39

United States Army Forces in New Zealand: 98

United States Army Forces in the Philippines,

Northern Luzon (USAFIP-NL): 360

United States Army Forces in the South Pacific

Area (USAFISPA): 97–98

chief surgeon: 102, 274

Office of the Chief Surgeon: 193–94

United States Army Services of Supply, CBI: 291,

292, 296, 313

United States Army Services of Supply, SPA: 102,

111

United States Army Services of Supply, SWPA:

50, 51, 254–55, 323, 418

Australian Base Section: 255, 418

base sections: 254–56, 338, 412–13, 418

Intermediate Section: 254–55

Luzon Base Section: 338, 343

and medical support for Philippine Islands

invasion: 322, 332–33, 338

New Guinea Base Section: 255

Office of the Chief Surgeon: 51, 54, 61, 178,

253, 319, 413

U.S.-Australian Hospitals Subcommittee: 68

United States Forces in Australia (USFIA): 47–48

INDEX 483
United States Forces in the Philippines (USFIP):

31

U.S. Marine Corps

and amphibious operations in Alaska:

160–61

Army medical support for: 197, 199

on Espiritu Santo: 104

and Iwo Jima: 384, 385

and Okinawa: 387

and Peleliu: 385

U.S. Naval Base Hospital No. 11: 187n20

U.S. Naval Hospital, Canacao: 25

U.S. Naval Hospital, Pearl Harbor: 16

U.S. Naval Mobile Base Hospital No. 2: 16

U.S. Navy: 442–43

Bureau of Medicine and Surgery: 439

and defense of Alaska: 150

and Espiritu Santo: 104

and medical support for amphibious operations: 160, 198

and medical support for Philippine Islands

invasion: 326

responsibility for medical care on transport

ships: 320

and South Pacific Area medical services:

102–04, 108–09

United States of America Typhus Commission:

215, 265–66, 435–36

University of Maryland: 71

University of Oklahoma: 191

Ushijima, Lt. Gen. Mitsuru: 391, 395–96, 408, 426

Van Peenan, Capt. H. J., MC, USN: 383

Vandegrift, Maj. Gen. Alexander A., USMC: 116,

117, 124, 191, 192

Vanderboget, Col. Carlton L., MC: 31–32

Venereal diseases: 45

in Alaska: 151–52

in Australia: 56, 57–58, 64, 254

in the CBI theater: 286, 292, 294

control measures: 57–58, 84–85, 93, 152,

280, 322

in Hawaii: 84–85, 93

in Japan: 427

in the Mariana Islands: 234

in New Guinea: 138, 140

in New Zealand: 100

in the Philippine Islands: 322, 330, 351,

418, 421

in the South Pacific Area: 101

Veterinarians: 57, 92, 299, 316, 359, 373

Veterinary Corps: 10, 35–36, 57, 85–86, 100, 186,

294

Veterinary Evacuation Hospital, 18th: 311

Veterinary hospitals: 92

Veterinary laboratories: 21

Visayan Islands: 21

Vitamin deficiencies: 31n52, 41, 131

Vitamin pills: 280

Vogelkop Peninsula: 216–18

Volcano Islands: 384

Volckmann, Col. Russell W.: 344, 353, 359–62

Voorhees, Col. Tracy S., JAGD: 268, 281–83,

297

Wainwright, Maj. Gen. Jonathan M.: 19, 31, 35,

36, 38–39, 43, 354, 378–79, 380n52

Wakde Island: 208–12

Wake Island: 23

Walker, Capt. Albert T., MC, USN: 178

Wallace, Maj. Gen. Fred C.: 388, 408

War crimes: 431–33

War criminals, Japanese: 363, 373, 380n54, 382,

383n63, 427–28, 429, 431

War plans

BLACKLIST: 426–27, 429

and diseases: 190

ORANGE: 4–6

RAINBOW 5: 6, 22

Ward, Lt. Col. Thomas G., MC: 280–81

Warmenhoven, Lt. Col. Simon, MC: 133, 135

Warren, Comdr. Shields, USN: 439

Warren, Col. Stafford L., MC: 438

Waste disposal, problems of: 45, 56, 152, 189,

420

Water supply

Australia: 45, 56, 63

Bataan Death March: 364–65

Biak: 213, 215

CBI theater: 306

Central Pacific Area: 220–21

chlorination of: 140, 170, 172, 221, 280, 306

Guadalcanal: 125

Hawaii: 85

Japan: 436

New Caledonia: 112

New Georgia: 189

New Guinea: 129, 131, 140

Philippine Islands: 40, 337–38, 341–42, 343,

351, 420

POWs: 365, 370, 378, 380

purification: 80, 131, 140, 280, 322, 367, 428

quality: 45, 63, 131, 215, 280, 306, 351, 380,

436

on ships: 69, 378

shortages: 40, 125, 189, 213, 215, 220–21,

280, 306, 341–42, 364–65, 370, 378

Waterous, Lt. Col. Willard H., MC: 372

484 MEDICAL SERVICE IN THE WAR AGAINST JAPAN
Weight losses

Bataan: 34–35

CBI theater: 306

Guadalcanal: 125

POWs: 373, 374, 377

Wells, Lt. Col. Paul O., MC: 325

Western Defense Command: 150–51, 153

Western Pacific Base Command (WPBC): 425

Western Reserve University: 71

Westervelt, Col. Frederick B., MC: 387, 388,

389–90, 400, 426

Wheeler Field: 9, 14, 16, 94

Wilkinson, Rear Admiral Theodore S: 191

Williams, Maj. Louis F., MAC: 282

Williams, Maude R.: 40, 41

Williams, Col. Robert P., MC: 287, 288–89,

290–91, 292, 293, 294, 296, 297, 298,

299, 309, 313, 314–15, 316–17

Willis, Brig. Gen. John M., MC: 274, 278–79,

282, 283, 387, 426

Willoughby, Brig. Gen. Charles A.: 357

Wilson, Col. Bascom L., MC: 51

Wilson, Col. William L.: 252–53

Wingate, Maj. Gen. Orde C.: 301, 303, 307

Women: 8, 66–67, 269–70

Woolgar, Lt. Col. William A. D., MC: 83

Wurz, Lt. Col. John F., MC: 205–06, 207

X-ray machines: 113, 166, 253–54

X-ray technicians: 153

Yamashita, General Tomoyuki: 340, 342, 344,

352, 361, 424

Yasuyama, Admiral Kodo: 439

Yaws: 45, 234, 358

Yellow fever vaccine, contaminated: 60, 92–93,

152

Young, Col. Charles T., MC: 279–80

Zambales Military District: 359

INDEX 485