Chapter IJoseph L. Schwartz, Captain (MC) USN (Retired)
Facilities of the Medical Department of the Navy
Long before the attack on Pearl Harbor, the 75 officers, 32 enlisted men, and 225 civilians who manned the Ill divisions of the Bureau of Medicine and Surgery under the direction of the Surgeon General, Rear Admiral Ross T. McIntire (MC) USN, were busily engaged with plans and problems involved in processing personnel, expanding physical and material facilities, and stockpiling supplies for the Medical Department of the Navy to meet the needs of war, should it involve the United States. The war already sweeping over Europe had brought forth in 1940 the declaration by President Roosevelt of a Limited National Emergency, and reserve medical department personnel who volunteered for service were therefore ordered to active duty. The expansion of personnel that took place is portrayed in table 1.
Continental and Extracontinental Hospitals
TABLE I.--Increase in Medical Department personnel on active duty, 1939-1945.
30 June 1939 30 June 1941 1945 Medical Corps officers 841 1.957 14,191 Dental Corps officers 255 511 7,012 Nurse Corps officers 439 524 10,968 Hospital Corps officers 195 3,429 Hospital Corps 4,267 10,547 132,500 WAVES 1,125
The naval hospitals and hospital ships in commission in 1941 are listed in table 2. For the continental hospitals, the comparative census of patients is given for 1941 and 1945, indicating the great increase in demand for hospital beds after 7 December 1941.
TABLE 2.--Hospitals and hospital ships in commission in 1941
Patient census 1941 VJ-day U.S. Naval Hospital, Annapolis, Md. (fig 1) 83 284 U.S. Naval Hospital, Bremerton, Wash. (fig. 2) 299 871 U.S. Naval Hospital, Brooklyn, N.Y. (fig. 3) 589 1,125 U.S. Naval Hospital, Charleston, S.C. (fig. 4) 124 697 U.S. Naval Hospital, Chelsea, Mass. (fig. 5) 495 2,701 U.S. Naval Hospital, Corona. Calif. (fig. 6) --- 3,611 U.S. Naval Hospital, Corpus Christi,Tex. (fig. 7) 206 1,115 U.S. Naval Hospital, Great Lakes, Ill. (fig. 8) 350 7,532 U.S. Naval Hospital, Jacksonville, Fla. (fig. 9) 209 1,825 U.S. Naval Hospital, Mare Island, Calif. (fig. 10) 676 2,281 U.S. Naval Hospital, Newport, R.I. (fig. 11) 245 1,305 U.S. Naval Hospital, Parris Island, S.C. (fig. 12) 214 651 U.S. Naval Hospital, Pensacola, Fla. (fig. 13) 227 1,073 U.S. Naval Hospital, Philadelphia, Pa. (fig. 14) 643 3,316 U.S. Naval Hospital, Portsmouth, Va. (fig. 15) 1,199 3,103 U.S. Naval Hospital, Portsmouth, N.H. (fig. 16) 124 390 U.S. Naval Hospital, Quantico, Va. (fig. 17) 118 451 U.S. Naval Hospital, San Diego, Calif. (fig. 18) 1,360 28,069 U.S. Naval Hospital, Washington, D.C. (fig. 19) 210 (3) U.S. Naval Hospital, Pearl Harbor, T.H. U.S. Naval Hospital, Canacao, P.I. U.S. Naval Hospital, Guam, M.I. U.S. Naval Mobile Hospital No. 1, Guantanamo Bay, Cuba U.S.S. Relief (fig. 20) U.S.S. Solace (fig. 21)
After the flames of war spread over Pearl Harbor, the construction of new hospitals was expedited and the bed capacity of existing hospitals was expanded by adding H-type frame ward buildings and by decreasing the normal peacetime 8-foot interval between beds to 6 feet. That the need for additional hospital facilities was great is indicated by the following as shown in figure 22: In June 1939 the total patient census in naval hospitals was 4,124; in June 1941 it was 7,723; the average census of patients for the year 1942 was 13,274; in 1943 it was 39,723; in 1944 it was 70,576; and in 1945 it was 90,635.
Figure 1.--U.S. Naval Hospital, Annapolis, Md.
Figure 2.--U. S. Naval Hospital, Bremerton, Wash.
Figure 3.--U.S. Naval Hospital, Brooklyn, N.Y.
Figure 4.--U. S. Naval Hospital, Charleston, S.C.
Figure 5.--U.S. Naval Hospital, Chelsea, Mass.
Figure 6.--U. S. Naval Hospital, Corona, Calif.
Figure 7.--U.S. Naval Hospital, Corpus Christi, Tex.
Figure 8.--U. S. Naval Hospital, Great Lakes, Ill.
Figure 9.--U.S. Naval Hospital, Jacksonville, Fla.
Figure 10.--U. S. Naval Hospital, Mare Island, Calif.
Figure 11.--U.S. Naval Hospital, Newport, R.I.
Figure 12.--U. S. Naval Hospital, Parris Island, S.C.
Figure 13.--U.S. Naval Hospital, Pensacola, Fla.
Figure 14.--U.S. Naval Hospital, Philadelphia, Pa.
Figure 15.--U. S. Naval Hospital, Portsmouth, Va.
Figure 16.--U.S. Naval Hospital, Portsmouth, N.H.
Figure 17.--U.S. Naval Hospital, Quantico, Va.
Figure 18.--U.S. Naval Hospital, San Diego, Calif.
Figure 19.--U. S. Naval Hospital, Washington, D.C.
Figure 20.--U.S.S. Relief
Figure 21.--U.S.S. Solace
Figure 22.--Average patient census, all naval hospitals.
In 1942 alone, nine continental and two extracontinental hospitals were commissioned (table 3):
TABLE 3.---Hospitals commissioned in 1942
U.S. Naval Hospital, Bethesda, Md.4 (fig. 23) 2,426 U.S. Naval Hospital, San Francisco (Treasure Island), Calif. (fig. 24) 1,276 U.S. Naval Hospital, Oakland, Calif. (fig. 25) 5,400 U.S. Naval Hospital, Seattle, Wash. (fig. 26) 3,031 U.S. Naval Hospital, Key West, Fla. (fig. 27) 2,609 U.S. Naval Hospital, Charleston, S.C. 697 U.S. Naval Hospital, Long Beach, Calif. (fig. 28) 2,281 U.S. Naval Hospital, Norfolk, Va. (fig. 29) 1,652 U.S. Naval Hospital, Norman, Okla. (fig. 30) 1,811 U.S. Naval Hospital, Balboa,, C.Z. 192 U.S. Naval Hospital, Coco Solo, C. Z. 236
Figure 23.--U.S. Naval Hospital, Bethesda, Md.
Figure 24.--U.S. Naval Hospital, San Francisco (Treasure Island), Calif.
Figure 25.--U.S. Naval Hospital, Oakland, Calif.
Figure 26.--U.S. Naval Hospital, Seattle, Wash.
Figure 27.--U.S. Naval Hospital, Key West, Fla.
Figure 28.--U.S. Naval Hospital, Long Beach, Calif.
Figure 29.--U.S. Naval Hospital, Norfolk, Va.
In 1939, when world war appeared imminent, the Bureau of Medicine and Surgery realized the need for some type of prefabricated hospital that would be completely self-sustaining and yet transportable and of such construction that it could be set up without the employment of skilled mechanics. As a result U.S. Naval Mobile Hospital No. 1, which is more fully described in chapter III, was designed and constructed. This was a 500-bed, completely equipped, transportable type, general hospital with self-contained power, water, commissary, laundry, and repair facilities. It was first set up at Guantanamo Bay, Cuba, in November 1940, where it served local and fleet units (fig. 31). After its experimental phase in Cuba, its portability was tested by being torn down, shipped to Bermuda, and set up there (fig. 32). The experience in erecting this type of hospital paved the way for better mobile and base hospital construction. Although it was observed that these hospitals did not possess a high degree of mobility, nevertheless they could be moved and set up in any area with a minimum of time, expense, and labor. They contained the following facilities: (a) water purification and softening plant; (b) storage spaces for supplies; (c) laundry: (d) galley; (e) automotive and ambulance equipment; (f) fire-fighting equipment; (g) light and power supplies; (h) refrigeration facilities; and (i) x-ray, dental, laboratory, and other equipment and facilities of a general hospital.
Development of Mobile and Base Hospitals5
Figure 30.--U.S. Naval Hospital, Norman, Okla.
The supplies, equipment, and buildings for all mobile and base hospitals were procured by the Medical Supply Depot, Brooklyn, N. Y., and each hospital was commissioned there. During the period of assembling and packing the hospital supplies and equipment, the hospital staff assembled at the Depot, where they were indoctrinated in the methods of hospital construction and outfitting and were advised regarding the methods of identification of the packed and crated equipment.
Upon reaching their destination the staff of the hospital immediately set up temporary quarters, and when the material for the hospital arrived the hospital corpsmen under the direction and with the physical assistance of the Medical Corps, Dental Corps, and Hospital Corps officers began the job of unloading and sorting the equipment and supplies and erecting the prefabricated components of the hospital--the quonset, Iceland, and similar huts. This was no small task; some of the hospitals had as many as 300 buildings, including huts6 and sheds.
At first some of the hospitals experienced difficulty in obtaining sufficient medical supplies; in particular there was a great shortage of quinine and atabrine. Many administrative difficulties presented themselves. There was some confusion regarding the procedures for requisitioning supplies, often the allotment status was unknown and instructions regarding accounting procedures were not received,
Figure 31.--Mobile Hospital No. 1 at Guantanamo Bay, Cuba.
Figure 32.--Mobile Hospital No. 1 at Bermuda.
and some hospitals were uncertain how to obtain items not listed in the supply catalogue.
The size of the mobile and base hospitals varied from 200 to 2,500 beds. In the majority of the hospitals, the number of medical officers attached ranged from 40 to 54, of dental officers from 1 to 4, of Hospital Corps officers from 1 to 5, and of hospital corpsmen from 235 to 500. Usually about 80 enlisted men with non-medical ratings were attached to the hospital. There were no civilian employees, and until the early part of 1944 none of the hospitals had Navy nurses.
Plans for the construction of mobile and base hospitals having been perfected following the experiences with the U.S. Naval Mobile Hospital No. 1 in Guantanamo and Bermuda, similar but improved versions (fig. 33) were erected in the battle zones all over the world. The first of these, U.S. Naval Mobile Hospital No. 2, was disembarked at Pearl Harbor on 26 November 1941, just 12 days before the attack by the Japanese. By the end of 1942 8 mobile and base hospitals of 500 beds each had been assembled, shipped, and erected in battle zones.
Figure 33.--U.S. Naval Hospitals in the Pacific in 1942.
Figure 34.--Mobile Hospital No. 8 at Guadalcanal.
Two base hospitals and five mobile hospitals were commissioned in 1942 (table 4).
TABLE 4.--Mobile and base hospitals commissioned in 1942
U.S. Naval Base Hospital No. 1, Londonderry, North Ireland
U.S. Naval Base Hospital No. 2, Efate Island, New Hebrides7
U.S. Naval Mobile Hospital No. 2, Pearl Harbor (commissioned Aug 1941)
U.S. Naval Mobile Hospital No. 3, Tutuila, Samoa; Guam8
U.S. Naval Mobile Hospital No. 5, Noumea, New Caledonia9
U.S. Naval Mobile Hospital No. 7, Noumea, New Caledonia
U.S. Naval Mobile Hospital No. 8, Guadalcanal, Solomon Islands (fig. 34)10
The U.S. Naval Fleet Hospital No. 103, Guam, and the U.S. Naval Convalescent Hospital, Harriman, N.Y. (fig. 35), were also commissioned in 1942.
Figure 35.--U. S. Naval Convalescent Hospital, Harriman, N.Y.
In February 1943 the bed capacity of previously constructed mobile hospitals was expanded to 1,000 beds, and in June all base hospitals were equipped for 1,000-bed capacity. In addition numerous new hospitals were commissioned in 1943 (table 5):
TABLE 5.--Hospitals commissioned in 1943
Continental hospitals: U.S. Naval Hospital, Farragut, Idaho (fig. 36) 2,489 U.S. Naval Hospital, Bainbridge, Md. (fig. 37) 1,979 U.S. Naval Hospital, St. Albans, N.Y. (fig. 38) 4,642 U.S. Naval Hospital, Sampson, N.Y. (fig. 39) 2,119 U.S. Naval Hospital, Memphis, Tenn. (fig. 40) 1,321 U.S. Naval Hospital, New Orleans, La. (fig. 41) 1,212 U.S. Naval Hospital, Camp Lejeune, New River, N.C. (fig. 42) 1,730 U.S. Naval Hospital, Oceanside, Calif. (fig. 43) 1,534 U.S. Naval Hospital, Shoemaker, Calif. (fig. 44) 3,031 Extracontinental hospitals: U.S. Naval Hospital, Aiea Heights, T.H. --- U.S. Naval Hospital, San Juan, P.R. --- U.S. Naval Hospital, Trinidad, B.W.I. --- Base hospitals: U.S. Naval Base Hospital No. 3, Espiritu Santo, New Hebrides --- U.S. Naval Base Hospital No. 4, Wellington, New Zealand; Okinawa --- U.S. Naval Base Hospital No. 5, Casablanca, French Morocco --- U.S. Naval Base Hospital No. 6, Espiritu Santo, New Hebrides --- U.S. Naval Base Hospital No. 7, Tulagi, Solomon Islands --- U.S. Naval Base Hospital No. 8, Pearl Harbor, T.H. --- U.S. Naval Base Hospital No. 9, Oran, Algeria --- U.S. Naval Base Hospital No. 10, Sydney, Australia --- U.S. Naval Base Hospital No. 11, Munda, New Georgia --- U.S. Naval Base Hospital No. 13, Milne Bay, New Guinea --- Mobile hospitals: U.S. Naval Mobile Hospital No. 4, Auckland, New Zealand --- U.S. Naval Mobile Hospital No. 6, Wellington, New Zealand --- U.S. Naval Mobile Hospital No. 9, Brisbane, Australia --- U.S. Naval Mobile Hospital No. 10, Russell Islands, Solomon Islands --- U.S. Naval Mobile Hospital No. 11, Guam, Mariana Islands --- U.S. Naval Mobile Hospital No. 12, New Caledonia (Noumea)11 --- Convalescent hospitals: U.S. Naval Special Hospital, Santa Cruz, Calif. 891 U.S. Naval Special Hospital, Asheville, N.C. 367 U.S. Naval Special Hospital, Yosemite, Calif. (fig. 46) 709 U.S. Naval Special Hospital, Sun Valley, Idaho 978 U.S. Naval Special Hospital, Glenwood Springs, Colo. (fig. 47) 526
Figure 36.--U.S. Naval Hospital, Farragut, Idaho.
Figure 37.--U.S. Naval Hospital, Bainbridge, Md.
Figure 38.--U.S. Naval Hospital, St. Albans, N.Y.
Figure 39.--U.S. Naval Hospital, Memphis, Tenn.
Figure 40.--U.S. Naval Hospital, Sampson, N.Y.
Figure 41.--U.S. Naval Hospital, New Orleans, La.
Figure 42.--U.S. Naval Hospital, Camp Lejeune, Ne River, N.C.
Figure 43.--U.S. Naval Hospital, Santa Margarita Ranch, Oceanside, Calif.
Figure 44.--U.S. Naval Hospital, Shoemaker, Calif.
Figure 45.--U.S. Naval Base Hospital No. 4, Wellington, New Zealand
Figure 46.--U.S. Naval Convalescent Hospital, Yosemite, Calif.
Figure 47.--U.S. Naval Convalescent Hospital, Glenwood Springs, Colo.
Figure 48.--Mobile and base hospitals in the Pacific in 1944
Figure 48 shows the location of mobile and base hospitals in the Pacific during 1944. In that year the hospital facilities listed in table 6 were commissioned.
TABLE 6.--Hospitals and hospital ships commissioned in 1944
Continental hospitals: U.S. Naval Hospital, San Leandro, Calif. (fig. 49) 1,373 U.S. Naval Hospital, Fort Eustice, Va. (fig. 50) 1,339 U.S. Naval Hospital, Astoria, Oreg. 414 Base hospitals: U.S. Naval Base Hospital No. 12, Netley, Hants, England --- U.S. Naval Base Hospital No. 14, Finschhafen, New Guinea; Cavite, P.I. --- U.S. Naval Base Hospital No. 15, Manus Island, Admiralty Islands --- U.S. Naval Base Hospital No. 16, Woendi, Schouten Islands --- U.S. Naval Base Hospital No. 17, Hollandia, New Guinea --- U.S. Naval Base Hospital No. 18, Guam, Mariana Islands --- U.S. Naval Base Hospital No. 19, Tinian Island, Mariana Islands --- U.S. Naval Base Hospital No. 20, Peleliu, Palau Islands --- Fleet hospitals: U.S. Naval Fleet Hospital No. 113, San Francisco, Calif. --- U.S. Naval Fleet Hospital No. 114, Samar, P.I.12 --- Hospital ships: U.S.S. Bountiful --- U.S.S. Refuge --- U.S.S. Samaritan (fig. 51) --- Convalescent hospitals: U.S. Naval Special Hospital, Arrowhead Springs, Calif. 692 U.S. Naval Special Hospital, Banning, CalIf. 831 U.S. Naval Special Hospital, Beaumont, Calif. 240 U.S. Naval Special Hospital, Sea Gate, N.Y. 685 U.S. Naval Special Hospital, Springfield, Mass. 424
In 1945 the hospital facilities shown in table 7 were commissioned:
TABLE 7.--Hospitals and hospital ships commissioned in 1945
Continental hospitals: U.S. Naval Hospital, Dublin, Ga. (fig. 52) 889 U.S. Naval Hospital, Corvallis, Oreg. (fig. 53) 1,573 Base Hospitals: U.S. Naval Base Hospital No. 21, Kwajalein Island, Marshall Islands --- Fleet hospitals: U.S. Naval Fleet Hospital No. 115, Guam, Mariana Islands --- U.S. Naval Fleet Hospital No. 116, Brooklyn, N Y.; San Pedro, Calif. --- Hospital ships: U.S.S. Benevolence --- U.S.S. Consolations (fig. 54) --- U.S.S. Haven (fig. 55) --- U.S.S. Repose --- U.S.S. Rescue (fig. 56) --- U.S.S. Sanctuary --- U.S.S. Tranquillity (fig. 57) --- Military government hospitals: U.S. Naval Military Government Hospital, Saipan, Mariana Islands --- U.S. Naval Military Government Hospital, Guam, Mariana Islands --- U.S. Naval Military Government Hospital, Tinian, Mariana Islands --- Special augmented hospitals: Special Augmented Hospital No, 3, Okinawa, Ryukyu Islands --- Special Augmented Hospital No, 4, Okinawa, Ryukyu Islands --- Special Augmented Hospital No, 5, Okinawa, Ryukyu Islands --- Special Augmented Hospital No, 6, Okinawa, Ryukyu Islands --- Special Augmented Hospital No, 7, Okinawa, Ryukyu Islands --- Special Augmented Hospital No, 8, Okinawa, Ryukyu Islands --- Convalescent hospitals: U.S. Naval Special Hospital, Asbury Park, N.J. 551 U.S. Naval Special Hospital, Palm Beach, Fla. 1,540 U.S. Naval Special Hospital, Camp White, Oreg. --- U.S. Naval Special Hospital, Camp Wallace, Tex. ---
Figure 49.--U.S. Naval Hospital, San Leandro, Calif.
Figure 50.--U.S. Naval Hospital, Fort Eustice, Va.
Figure 51.--U.S.S. Samaritan
Figure 52.--U.S. Naval Hospital, Dublin, Ga.
Figure 53.--U.S. Naval Hospital, Corvallis, Oreg.
Figure 54.--U.S.S. Consolation
Figure 55.--U.S.S. Haven
Figure 56.--U.S.S. Rescue
Figure 57.--U.S.S. Tranquility
The first of six 15,000-ton hospital ships of the Haven class to be converted from a Maritime Commission C-4 hull. These vessels were completely air conditioned and the medical facilities were equal to those of a large modern hospital.
At the end of the war there were in commission 42 naval hospitals and 12 naval convalescent hospitals in the continental United States. Overseas there were 6 permanent hospitals, 36 mobile, base, or fleet hospitals (figs. 58, 59, 60), 12 hospital ships, 3 hospital transports, and 3 military government hospitals. Logistic support was furnished by 32 medical supply facilities, depots, warehouses, and supply barges (table 8).
TABLE 8.--Medical supply facilities, all types
Medical supply depots: Brooklyn, N.Y. Oakland, Calif. Pearl Harbor, T.H. Guam, Mariana Islands (Annex at Saipan) Medical supply storehouses and storage facilities: Newport, R.I. Charleston, S.C. Seattle, Wash. San Pedro, Calif. San Diego, Calif. Naval Supply Depot, Mechanicsburg, Pa. Naval Supply Depot, Spokane, Wash. Naval Supply Depot, Clearfield, Utah Medical supply storehouses overseas: Balboa, C.Z. Londonderry, North Ireland Exeter, England Sydney, Australia Auckland, New Zealand No. 1, Subic Bay, Philippine Islands No. 3, Kodiak, Alaska h-o, No. 4, Samar, Philippine Islands No. 7, San Juan, P.R. No. 9, Casablanca, French Morocco No. 10, Recife, Brazil No. 11, Espiritu Santo, New Hebrides No. 13, Saipan, Mariana Islands No. Supply Facility Fleet Hospital 105, New Caledonia Supply barges: U.S.S. Silica U.S.S. Lignite U.S.S. Mare YF 787 YF 738 YF 739 YF 740 YF 754
Deficiencies in Mobile and Base HospitalsMobile and base hospitals successfully treated thousands of patients during the war, but they never attained the degree of mobility desired for combat areas. The deficiencies of the mobile (fleet) and base hospitals in combat areas were noted in the Seventh Fleet report for 1944:
Although fleet and base hospitals as presently planned are excellent as to comfort for patients and working conditions for Medical Department personnel, they possess distinct disadvantages. They are bulky and require considerable shipping space to transport, time and effort to establish, and even more effort to dismantle, refit, and move forward. In a fast moving type of warfare over the vast distances typified in the operations in the Southwest Pacific, hospitals have not been capable of receiving casualties until the assault beaches moved far ahead. With the consistent shortage of AH's, APH's, and APA's in the Seventh Fleet, it was necessary in many areas to resort to hospitalizing
Figure 58.--Main ward buildings, Base Hospital No. 4, Wellington, New Zealand.
Figure 59.--One of the wards, Base Hospital No. 4.
Figure 60.--Laundry. Base Hospital No. 6, Espiritu Santo, New Hebrides.
naval patients in Army hospitals. The latter were easily transported and quickly erected, and while they did not afford many of the refinements of the less mobile naval hospitals, they offered excellent early care to casualties at a time when the need was urgent. Canvas-housed, truly mobile hospitals are a paramount need in amphibious warfare, both for Army and Navy support.
In 1945, in the closing months of the war, a new type hospital, the Special Augmented Hospital, was used for the first time on Okinawa. In composition and function it was intermediate between a Marine Corps field hospital and the fleet base hospitals that had been used throughout the war in the Pacific. These special augmented hospitals were designed to bring hospital services and specialized care to personnel in the combat area.
Special Augmented Hospitals
Plans were made by the Bureau of Medicine and Surgery for 8 of these new hospitals. Four were to have a bed capacity of 200 each and 4 to have a bed capacity of 400 each. Of the number planned, 5 left the United States for Okinawa.
Personnel for the special augmented hospitals were assembled at San Bruno, Calif., in the late summer of 1944. There they were given comprehensive physical conditioning which included hiking and camping expeditions under conditions that approximated those in the field of combat. The men lived in tents, ate from mess kits, practiced field sanitation, and were instructed in infiltration tactics, the use of the rifle, tent construction and maintenance, and chemical warfare. Special groups received instruction in tropical diseases at Treasure Island, Calif. General duty corpsmen were given refresher courses and some men were detailed to Navy hospitals for training in the specialties, such as laboratory and x-ray.
Special Augmented Hospital No. 6 was commissioned on 7 March 1945, and 3 days later Special Augmented Hospital Nos. 3, 4, 7, and 8 were commissioned. Special Augmented Hospital No. 6, the first to sail, arrived at Okinawa on 4 May 1945, and received its first patients on 17 June 1945. Special Augmented Hospitals Nos. 4, 7, and 8 arrived on 14 July 1945. Of the five special augmented hospitals to arrive in Okinawa, only Nos. 3 and 6 actually received patients before the surrender of Japan. The others received their first patients in September, and continued to care for them for several months after the war.
Regarding the function of the "Augmented" Hospital, the following comments were made:
Although the exact place of the augmented hospital was never made clear, nevertheless, certain comments can be made. If it was intended that this type of hospital should be in operation during the active campaign for the island, then its equipment and construction contained too much of a semipermanent or permanent character, so that it could not be erected quickly. On the other hand, if it was intended that this hospital should come into operation after the termination of hostilities, as was the case, then its construction was too temporary in character to afford desired comfort and efficiency.
Not knowing what were the planned expectations for such a hospital, it was difficult to judge its effectiveness. Probably the most effective function of this hospital was the ability to keep beds available for the demand for admissions which was placed upon it; however, because evacuation had to be made so frequently, prolonged treatment, elective surgery, and complete diagnostic procedures had to be curtailed.
Two base hospitals were established in the United Kingdom. The 300-bed Naval Base Hospital No. 1 at Londonderry, Ireland, was commissioned in February 1942 and provided hospitalization and outpatient service for personnel of the Allied Services as well as of the U.S. Navy. Naval Base Hospital No. 12 was set up in the Royal Victoria Military Hospital at Netley, Hants, Southampton, which was turned over to the Navy on 28 February 1944.
Medical Facilities; European, Atlantic, & African Theaters
A fuller account of its development as a 1,000-bed hospital and of its outstanding achievements is given in chapter III.
Naval Base Hospital No. 12 was established primarily for the treatment of casualties during the invasion of Europe. The first D-day casualties were received on 9 June 1944 and in the following 4 months a total of 7,877 patients (including 4,226 war casualties) were admitted. There were only 18 deaths during this period, 11 of these the result of wounds incurred in action against the enemy. The mortality rate of combat casualties was only 0.26 percent.
Prior to the establishment of this hospital, all U.S. Navy patients requiring return from the European area to the United States for further treatment or disposition were evacuated through the U.S. Naval Dispensary at Roseneath, Scotland. Evacuations through the Base Hospital proved more satisfactory because of its proximity to the southern ports where there were fewer travel difficulties. After it was decommissioned on 30 September 1944, U.S. Naval Advanced Amphibious Base, Plymouth, Devon, and U.S. Naval Base No. 2, Roseneath, Scotland, were designated as evacuation centers for the southern and northern areas respectively.
At Camp Knox, Reykjavik area, the headquarters of the Naval Operating Base, Iceland, a dispensary was already functioning in July 1942. It had 21 huts and contained 109 beds. During 1942, approximately 75 percent of the patients were from ships operating in Iceland waters. This dispensary was centrally located, well staffed, and equipped to meet hospital needs of Navy personnel stationed in Iceland or in ships operating in Icelandic waters. Auxiliary dispensaries were established at the Tank Farm and at Falcon Comperea at Hoalford, as well as at the Fleet Air Base, Reykjavik.
Dispensary facilities in the United Kingdom were located at the activities listed in table 9, and other dispensaries were established at Saltash, Appledore, Falmouth, Fowey, Salcombe, Dartmouth, Teignmouth, Penarth and Milford Haven, St. Mawes, Poole, Portland-Weymouth, Southampton, Deptford, Exeter, and Calstock. On 15 June 1944 a dispensary of 50 beds was set up in Blackheath, London, to care for convalescent and overflow patients from the main dispensary and to serve as a dressing station for bomb casualties. During the 5-month period prior to D-day, the number of available beds in England for reception of casualties had reached 3,500.
TABLE 9.--Dispensaries in the United Kingdom
Bed capacity Date commissioned USN Base, Roseneath, Scotland 325 Aug. 24, 1942 USNAATB, Appledore, Devon 61 July 29, 1943 USNAATSB, St. Mawes, Cornwall 34 Sept. 7, 1943 USNAATB Falmouth, Cornwall 220 Oct. 11, 1943 USNAATSB, Fowey, Cornwall 93 Oct. 25, 1943 USNAATB, Plymouth, Devon 500 Nov. 6, 1943 USNAATSB, Salcombe, Devon 117 Nov. 25, 1943 USNAATSB, Teignmouth, Devon 87 Dec. 1, 1943 USNAAB, Dartmouth, Devon 356 Dec. 24, 1943 USNAAB, Milford Haven, Wales 800 Jan. 12, 1944 USNAAMSB, Penarth, Wales 50 Jan. 12, 1944 USNASB, Exeter, Devon 46 Feb. 3, 1944 USNAAMB, Deptford, London 10 Apr. 10, 1944 USNAAB, Portland-Weymouth, Dorset 123 May 1, 1944 USNAAB, Poole, Dorset 24 May 11, 1944 USNAAB, Southampton, Netley, Hants 10 May 11, 1944
The hospital and dispensary facilities established in the European, Atlantic, and North African theaters are shown in figures 61, 62, and 63.
TABLE 10.--Hospitals and dispensaries in the Atlantic
Canal Zone: Balboa: Naval hospital 350 Dispensary (naval station) 8 Marine sick bay (annex to naval station) 14 Sick bay, naval ammunition depot 4 Coco Solo: Naval hospital 464 Dispensary (naval station) 30 Dispensary (Cristobal Annex to naval station) 4 Dispensary, Naval air station 90 Farfan: Sick bay (radio station) 5 Tobago Island: Dispensary (naval station) 20 Galapagos Island: Dispensary (naval base) 15 Puerto Castilla, Honduras: Dispensary (naval base) 14 Corinto, Nicaragua: Dispensary (naval base) 16 Barranquilla: Dispensary (naval base) 4 Netherlands West Indies: Curacao (naval camp) 24 Virgin Islands: St. Thomas naval station 10 Brazil: Caravellas, dispensary 10 Maceió, dispensary 11 Rio de Janeiro, Dispensary (naval operating facility) 8 Santa Cruz, Dispensary 15 British West Indies: Antigua (N.A.A.F.) 2 Great Exuma (N.A.A.F.) 4 Trinidad: Hospital 290 NAS dispensary 66 Cuba: Guantanamo Bay: Naval station 220 Naval air station 16 Marine Corps Base 8 Puerto Rico: Roosevelt Roads (naval station) 7 San Juan: Naval hospital 200 Naval air station 39
Figure 61.--Naval hospitals and dispensaries in the European Theater
Figure 62.--Naval hospitals and dispensaries in the North and South Atlantic Theaters
Figure 63.--Naval hospitals and dispensaries in North Africa
As the forces moved into North Africa, dispensaries were established there. Two days after the landing operation had started, on 10 November 1942, naval medical personnel set up a small sickbay in a camel barn on the dock of Fedala. Later, dispensaries were set up at Oran, Port Lyautey, Arzew, Bizerte, and Casablanca. Because of the importance of Casablanca as a port of entry and as an evacuation center, the dispensary there later became U.S. Naval Base Hospital No. 5. Dispensaries were established at Fedala, Safi, and Agadir in French Morocco, and sickbays of varying sizes were set up at Mers-el-Kebir, Algiers, Nemours, Beni Saf, Mostaganem, T&egrav;né, Cherchel, and Dellys in Algeria. By summer of 1943 it was obvious that a naval hospital was required for personnel in the Northwest African waters, and to meet this need U.S. Naval Base Hospital No. 9 was disembarked at Oran on 3 September 1943. With the assistance of construction battalions, this 500-bed, completely equipped hospital was ready to receive patients 2 months after construction began.
In Sicily a 50-bed dispensary was established at Palermo and smaller units were set up on the south coast of the island. In September 1943, all U.S. Navy activities in Sicily were consolidated at the Naval Operating Base, Palermo, where a dispensary of 160 beds was established. Later in 1944, 25-bed dispensaries were established at Calvi, Bastia, Ajaccio, Corsica, and at La Maddalena Island, Sardinia (table 11). The largest and most important dispensary in Italy was at Naples, but Salerno and Rome each had a small dispensary.
Dispensaries were set up on the French
TABLE 11.--Medical Department facilities in the African Theater, 1 January 1945
Algeria: Arzew, Dispensary U.S. Naval Station 98 Oran, Base Hospital No. 9 500 Oran, Dispensary, U.S. Naval Station 44 French Morocco: Agadir, Sick Bay, FAW 15, Detachment No. 1 68 Casablanca, Base Hospital No. 5 96 Port Lyautey, Dispensary (NAS) 130 Tunisia: Bizerte Dispensary, AATB 68 Corsica: Dispensary, Ajaccio 25 Sicily: Palermo Dispensary, NOB Sick Bay (Port area) 155 Dispensary, Palermo 100 Italy: Naples Dispensary, USN Detachment 140 Rome, DIspensary (SENALUSLO) 4 Sardinia: La Maddalena Is. PT Base No. 12 10 Dispensary, La Maddalena Island 25
invasion beaches, OMAHA and UTAH, on 12 July 1943. Later, after the ports became available, dispensaries were established at Cherbourg, Le Havre, Chateau de La Prunay, Louvecinnes, and Seine-et-Oise. The most important medical installation in southern France was the dispensary at Marseilles, established after the Normandy invasion. On the heels of the Allied crossing of the Rhine, 50-bed dispensaries were established at Frankfort and Berlin, Germany.
Prior to World War II there were about 8 medical officers in the Navy who were qualified in submarine medicine and therefore particularly interested in the sanitary and hygienic aspects and the safety problems of life in a submarine. They had been trained primarily in deep-sea diving and were familiar with the construction and operation of a submarine, the problems of submarine escape and salvage. the use of the rescue "bell" and the submarine escape "lung," and the operation of the training tank. With the advent of war a great many more officers trained in submarine medicine were immediately required and the facilities of both the Deep Sea Diving School, Washington, D. C., and the Submarine Base, New London, Corm., were activated. For the first 2 years of the war these medical officers, like their predecessors, were trained primarily in deep-
sea diving, and so were not prepared to cope with all the medical aspects of submarine duty. When the inadequacy in training became apparent, the course was lengthened by 3 weeks, and beginning June 1943 the training included "tank instruction and escape, inspection and instruction trips on submarines, dark adaptation instruction, and similar matters," as well as "demonstration of diving equipment, lectures, and demonstrations and . . . . participation in the submarine personnel and sound listening personnel selection system."
A deterrent to efficient submarine medicine in the early part of the war was the necessity of at times assigning to a submarine base, submarine tender, or submarine squadron, a senior medical officer who was not trained or qualified in submarine medicine. In March 1944, when qualifications14 in submarine medicine became a prerequisite for such assignments, a broad program of submarine medicine was activated. Distribution of medical supplies was then reorganized and a careful check was made of the physical condition of submarine personnel before going on patrol or immediately upon return. Pharmacist's mates attached to submarines were indoctrinated in special phases of submarine medicine, a pool of graduates of the "School of Pharmacist's Mates entering the Submarine Service" was established, and a system of refresher training for those in the pool was inaugurated.
When the V-boats were commissioned in 1924, medical department personnel were not assigned to the submarines. With improvement in submarine design, long cruises became routine and there arose the need for Hospital Corps personnel aboard. The assignment of hospital corpsmen was a success, for a good pharmacist's mate proved to be one of the most valuable members of the crew, not only because of his specialized knowledge but also because of his influence on the morale of the crew. How well they performed is a matter of record--the superb manner in which they carried out their assignments during World War II is attested to by the commendations and awards they received.
Early in the war, Hospital Corps personnel assigned to submarines were obtained from the forces afloat or ashore and were given a course of indoctrination in submarine operation at the Submarine School, New London, Conn., prior to assignment to duty in submarines. As the war progressed it became apparent that not all Hospital Corps personnel assigned to submarines had been adequately trained. In June 1943 a School for Pharmacist's Mates entering Submarine Service was established; there the 6 weeks' course included didactic and practical instruction in first aid and minor surgery, hygiene and sanitation, materia medics, toxicology, anesthesia, laboratory procedures, pharmacy, chemistry, and indoctrination in the environmental factors of life in a submarine. After March 1945 only men who were graduates of the Hospital Corps School were assigned to the "School for Pharmacist's Mates entering the Submarine Service." Graduates of this school were invaluable, for they not only provided care for the sick and injured in a highly efficient manner but also performed general operational duties such as sonar operator, radar operator, lookout, and librarian.
Submarine Patrol ExaminationsPre-patrol examinations of all personnel were conducted to make certain that no man who was physically or emotionally below par was permitted to go on patrol. Such men were transferred to a rest camp. Elaborate facilities for rest and recreation were established at the Royal Hawaiian Hotel as well as on Midway, Majuro, Guam, Saipan, Manus, and Milne Bay. Immediately after return from patrol another complete physical examination, including roentgenograms of the chest, was done by qualified submarine medical officers. A complete dental examination was also made and the needed dental repairs recorded. Results of both the physical and dental examinations were entered upon cards, which were filed aboard the ship and formed a continuous history of the physical condition of each man. Upon transfer to another submarine force activity, the history card was transferred to the receiving unit. If transferred out of the submarine service,
the card was filed at SubBase, Pearl Harbor. The pharmacist's mate in each submarine was required to make appropriate entries on the history card while on patrol. Thus the medical problems and health conditions occurring on patrol were reported to the Force medical officer by recording and forwarding to him a summary of the data on the history cards.
Although the standard Health Record provided a continuous history, it failed to serve the purpose of these cards in that only serious conditions warranting admittance to the sick list were entered in the health record, and at each re-enlistment the history sheets were removed and sent to the Bureau. The cards thus filled a void.
Submarine Medical Facilities and SuppliesFacilities for medical care of submarine personnel during World War II figs. (64, 65), were similar to those in small craft, but many
Figure 64.--Minor surgery aboard a submarine.
Figure 65.--Medical locker in a submarine.
problems of medical supply required solution. As an example there was need for a complete and exhaustive study of the medical supplies and equipment allowance for submarines. Replenishment of supplies for submarines should have been accomplished either from a submarine tender or a submarine base and not from a medical supply depot, because the smallest amount such an activity ordinarily issued was too large for a submarine where storage space was an acute problem. In the newer type submarines, such as the guppy-snorkel, the storage problem was even more critical. The pharmacist's mate in a submarine needed a handbook which outlined medical and surgical diagnosis and care, and described the pharmacologic action and indication for use of each medical item in stock. The handbook which was available during the war did not in any sense meet the requirements, and it was necessary to mimeograph and distribute to submarine pharmacist's mates all types of instruction for medical care as the occasion arose.
Air-Sea Rescue OperationsSubmarines rescued 549 survivors, in air-sea rescue operations. The part played by the pharmacist's mates in this undertaking was very important, for 48 percent of the rescued aviators required medical care because of serious injury. The following excerpts from patrol reports indicate how well the pharmacist's mate cared for his patients:
One man received a severe laceration of the forearm which required seven stitches. Two men were injured by misfire of the 20-mm. gun; in one it was deemed necessary to amputate two toes of the right foot. Due to a shortage of surgical instruments, a pair of sterilized side cutters were used to cut portions of the shattered bone. Because the "phalanges--were completely shattered, they were not sutured but left open to allow free drainage. A generous amount of sulfanilamide powder was used. The other man was wounded in the shoulder but no lead or foreign body could be located. This man was back to duty in three days.
The medical department, in the person of the Chief Pharmacist's Mate, did a particularly capable job in handling the Jap prisoner of war recovered after his plane was shot down. Though suffering from shock, second degree burns of the face and hands, and several other serious wounds from gunshot and the crash, he was brought around very well and will probably recover.
An injured German prisoner was treated for a dislocated left knee, broken right collar bone, badly lacerated mouth and nose, and three missing teeth. Recovery was satisfactory except that he succeeded in misaligning his clavicle after it was lined up properly.
The price of sinking one sampan, damaging one, and learning the use they are put to (as submarine traps) was three men wounded. One man received two .25 caliber hits in the left side, one bullet ranging upward, fracturing the rib and puncturing the left lung, the other bullet lodging in the diaphragm. A second man received five hits in the right shoulder; the third was struck in the right hip by a piece of flying metal. In view of the nature of the wounds, left the area 24 hours early, setting course for Midway at best speed. The Chief Pharmacist's Mate. . . . . . . . . . . . is particularly commended for his quick and efficient action in caring for these three wounded shipmates. By his proficient skill and painstaking efforts he prevented complications and enabled return of his patients to the facilities of a hospital, well on the road to recovery. He has been recommended for promotion and the Bronze Star Medal.
One man suffered a compound fracture of his right ring finger and a simple fracture of his index finger when a storeroom hatch cover fell on his fingers. The boat was dived to a hundred feet to furnish a stable platform for sewing up the fingers and setting the bones. While the finger tips are still stiff one month after the accident, they are healed nicely and PhM1c . . . . . . . . . . . . is to be commended for his efficiency and skill.
The . . . . . . . . . . . .. on her second patrol, established an all time record for the recovery of friendly aviators, when in five rescues she picked up a total of 30 men. The first man, recovered on 25 May 1945, had severe lacerations and second degree burns. Five days later 5 more men were recovered, all in good condition, 18 minutes after their plane had crashed. On 29 May, 16 men were rescued, 2 of whom were seriously injured; 1 had severe head and body injuries, the second had a possible fracture of the back and skull. One man of this group died.
Surgical Care on Wartime Operating SubmarinesInjuries aboard combat submarines were commonly sustained by personnel on the bridge, particularly during the lightning-like maneuvers necessary to clear the bridge in the relatively few seconds that elapsed between the time the diving signal was given and the submarine submerged. Crushed fingers, broken ribs, dislocations, bruised shoulders, and lacerations of various degrees resulted from the sudden exodus of men from the bridge through a
24-inch hatch and down the slippery and precipitous ladder into the conning tower.
Appendicitis Aboard Combat SubmarinesProbably no other single disease caused more anxiety to submarine personnel than appendicitis. Because medical officers were not carried on submarines, it became important to formulate and promulgate a policy governing the treatment of appendicitis. All pharmacist's mates in the submarine service and those in the "School for Pharmacist's Mates entering Submarine Service" were impressed with the fact that in untrained hands the diagnosis of appendicitis is difficult and that gastrointestinal disturbances and constipation which are common in personnel in submarines add to the difficulty in diagnosis. The order, "Never resort to surgery," and "Never give a cathartic to a patient suspected of having appendicitis," was put into effect toward the end of the first year of the war, and a conservative method of treatment was outlined.
Incidence and Mortality Rates of AppendicitisThe diagnosis of acute appendicitis was made 78 times in 1943 (8.9 cases per thousand) and 124 times in 1944 (9.2 cases per thousand), in personnel attached to submarines. Pharmacist's mates made the diagnosis of appendicitis (acute, chronic, or diagnosis undetermined and admitted for observation ) on 116 war patrols in 127 instances during the entire war. On 8 patrols more than 1 man was admitted with this condition. In 16 instances one case of appendicitis was reported from the same submarine on 2 successive patrols, presumably by the same pharmacist's mate. In 34 instances the patient was sufficiently ill to warrant transfer for treatment. Twelve men in whom the diagnosis of appendicitis was made during the patrol are known to have had surgical treatment upon arrival in port. Throughout the war in the submarine force, not one death from appendicitis was reported. Commanding officers were so impressed with the performance of pharmacist's mates in handling these emergencies that in 22 instances they were especially commended.
Appendectomies Performed Aboard Submarines on War PatrolsRegardless of the order not to perform appendectomy on personnel in submarines this operation was found necessary on several occasions. An appendectomy was done by a pharmacist's mate aboard the U.S.S. Seadragon, on 11 September 1942. Subsequent to the operation, which lasted about 3 hours, the patient was ill for 14 days. Higher authority observed in connection with this operation:
The incident . . . is believed to be the first of its kind in submarine history. While this case had a happy ending, it is pointed out that this particular pharmacist's mate had had considerable experience in assisting at surgical operations, . . it is hoped that his success will not encourage others to take . . . risks.
In another instance, on board the U.S.S. Grayback, in December 1942, the patient had been ill for about 48 hours before he was operated on. At the operation, which lasted about 11/2 hours, the appendix was found to be ruptured. Sulfanilamide powder was instilled, drainage was instituted (an elastic rubber band), and the abdomen was closed. Ether, administered by a submarine escape lung mouthpiece, was used as an anesthetic. Spoons were flattened for use as retractors, and long nose pliers from the engine room were also employed. The first assistant was a motor machinist's mate, first class.
In the third instance an operation for appendicitis was performed aboard the U.S.S. Silversides on 22 December 1942. The patient had been ill for about 12 hours prior to the operation, which was performed on the wardroom table, with the submarine submerged at 100 feet. The effectiveness of the spinal anesthesia having worn off, "Ether was administered, following the directions on the can. This anesthetized the operating staff as well as the patient. One hour after completion (the operation lasted about 4 hours) we tangled with a destroyer. The patient was convalescing the following morning to the tune of torpedo firing, two depth charge attacks, two 'crash dives' and an aerial bombing which knocked him out of his bunk. The conduct of the patient . . . was exemplary throughout the operation and the period following."
Comments made by the commanding officer of one submarine concerning the operation performed aboard his ship are pertinent.
It is recommended that all men who have a history or indications of chronic appendicitis not be sent out on patrol until their appendix has been removed. This also applies to any other ailment which may require an emergency operation at some future date.
Diseases of Personnel in SubmarinesNo health problems entirely peculiar to the submarine service existed. As in all other branches of the military forces, the most common ailments were acute infections of the upper respiratory tract, injuries, and diseases of the gastrointestinal system.
Infections of the Respiratory TractA high incidence of "colds" was commonly experienced during the first 3 weeks of a cruise, even in tropical waters. Protective clothing was inadequate for patrols in northern operational areas, particularly in the winter when the interior of the ship was cold and damp, and "colds" commonly occurred during the passage from warm to cool operational areas. The most practical prophylaxis was afforded by optimal atmospheric and living conditions while on patrol and carefully supervised recuperation at rest centers. The effectiveness of germicidal lamps aboard submarines warranted investigation. A battery of such lamps was installed in one submarine, but the ship's loss prevented adequate evaluation.
Acute upper respiratory diseases such as catarrhal fever, sore throat, and tonsillitis were reported on over 400 patrols. On 211 patrols they accounted for 1,068 man-days lost. Upon occasion the incidence of these diseases aboard submarines on war patrols assumed such proportions as to interfere with the operation of the ship. At times as many as 70 percent of the crew were affected.
TuberculosisProlonged residence in submarines where sunlight was absent and outside ventilation was limited to parts of each day was considered conducive to activation of quiescent tuberculosis and to droplet spread of the disease. Roentgenograms of the chests of submarine personnel were therefore taken periodically. It was found, however, that the incidence of tuberculosis in submarine crews, ranging from 0.41 to 0.43 percent, was the same as that in the crews of surface craft, but was higher than the 0.32 percent incidence in the fleet as a whole.
Gastrointestinal DiseasesDiseases of the digestive system accounted for 24.1 admissions per thousand. The four most common conditions noted on war patrols were acute gastroenteritis, chronic constipation, acute appendicitis, and "diagnosis undetermined (abdominal pain)." "Food poisoning" was reported on only 34 patrols. In nine cases, the food was definitely incriminated; the offending agents included canned orange juice, canned sardines, custard pie, beef, surveyed "Avoset" (stabilized cream), chicken, tinned ham, and tinned salmon. Food poisoning aboard an operating submarine, by incapacitating the crew, could cripple the striking force of a ship. As an example, a submarine sighted an enemy carrier on 10 July and the following comment concerning the attack was made:
Loss of depth on the one attack made was most unfortunate in that it prevented firing at carrier. The order to make ready the tubes was given rather late; this was combined with personnel errors in hurriedly preparing all tubes. At this time nearly all of the crew were handicapped by sickness from the food poisoning.
Constipation was an occupational condition among submarine personnel. It was most common in the first 2 weeks of a cruise. One pharmacist's mate during a 56-day patrol with a crew of approximately 75 men dispensed 3 quarts of mineral oil, 1 pint of castor oil, 2 pounds of Seidlitz powder, 3 bottles of cascara sagrada, and 20 soap suds enemas.
Urogenital DiseaseThe incidence of urogenital disease in submarine personnel on war patrols is presented in table 12.
TABLE 12.--Diseases of the urogenital system in submarine personnel on war patrol
Diseases Number patrols reported Number cases reported Number sick days reported Gonorrhea, urethra, acute 37 109 45 Urethritis acute, nonvenereal 33 67 26 Gonorrhea, urethra (diagnosis undetermined) 25 56 31 Prostatitis, unclassified 8 24 6 Penile lesions (diagnosis undetermined) 18 20 28 Syphilis 11 16 52 Renal disease (diagnosis undetermined) 10 15 22 Calculus, urinary system 12 13 35 Epididymitis, acute and orchitis, acute 10 11 25 Cystitis, acute 5 5 29 Balanoposthitis 1 1 0 Total 170 337 299
One man informed the pharmacist's mate that he had concealed venereal disease for a period of at least 6 weeks, including the period of the last refit. Examination disclosed the presence of multiple penile and perineal lesions, which proved to be syphilitic. Kahn tests of the rest of the crew were negative, however.
Skin DiseasesMost fleet-type submarines were equipped with two, 4-ton air-conditioning units installed in the ventilation supply lines. These were later supplemented by additional cooling and blower units. Without air conditioning and adequate ventilation, the habitability of a submarine on patrol would become so poor that skin diseases as well as lack of personnel endurance and efficiency would appear, and the safety and ability of the submarine to carry out her mission would be seriously compromised. The following excerpts from reports of war patrols describe the conditions encountered:
"Due to faulty air-conditioning units the boat was oppressively hot and humid . . . After 2 weeks of all day submergence all the bunks were wet and sticky. Clothing in lockers . . . was green with mildew. Temperature of well over 100° F. and high humidity levels made it practically impossible to get any rest while submerged. There were two cases of heat exhaustion. The entire crew had prickly heat--in some it covered the entire body. Thirty percent . . . had some type of fungus infection." Following repair of the air-conditioning system, the commanding officer commented: "At last we have found out that submerged time need not be a taste of hell--this is the first patrol that this boat has been anywhere near livable. General improvement in the condition of personnel and reduction of heat rash and skin diseases was quite noticeable in comparison with previous patrols."
On another ship when the air conditioning failed "90 percent of the officers and men had 'prickly heat,' 68 percent had 'Guam blisters,' 20 percent had boils, and 12 percent had fungus infections of the ears."
Disease and InjuryThe health of submarine personnel was generally very good, comparing favorably with that of destroyer personnel (table 13).
TABLE 13.--Incidence per thousand of disease or injury of submarine personnel (1944)
Class Submarines Destroyers Injuries15 39.9 39.6 Communicable diseases transmissible by oral and nasal discharges 33.9 40.8 Venereal diseases 24.1 23.4 Other diseases of infectious type 16.9 22.1
Serious illness or epidemic disease required the interruption of only 29 out of 1,471 patrols. The illnesses interfering with these patrols are listed in table 14.
TABLE 14.--Diseases limiting duration of submarine patrols
Condition Number of patrols Excessive personnel fatigue 9 Illness of commanding officers 6 Acute appendicitis 2 Battle casualties 5 Multiple asphyxiations 1 Serious injury 1 Pneumonia 1 Mumps 1 Mental disease 1 Copper sulfate poisoning 1 Diagnosis unknown (fever) 1 Total 29
Habitability of SubmarinesThe factors affecting submarine habitability included:
- The efficiency of ventilating and air-conditioning apparatus.
- Carbon dioxide accumulation, depletion of oxygen, and increased pressure and humidity.
- Hot weather.
- Deficiencies of the water supply and of sanitary tanks.
- Noxious agents such as chlorine gas and carbon tetrachloride.
- Material damage incident to depth charging and accidental flooding.
Improvement in habitability of submarines took place as the war progressed. As noted in table 15, the percentage of "excellent" reports was doubled after 1942 and the percentage of "poor" reports was reduced to one third in the last 3 years of the war.
TABLE 15.--Habitability reports of fleet-type submarines
1941 1942 1943 1944 1945 Total No. % No. % No. % No. % No. % No. % Excellent 0 0 8 8 24 16.5 41 14.1 33 16.5 106 14.2 Good 5 50 34 34 82 55.7 170 58.9 117 58.5 408 54.6 Fair 3 30 33 33 36 24.4 55 19.0 44 22.0 171 23.0 Poor 2 20 25 25 5 3.4 23 8.0 6 3.0 61 8.2 Total 10 100 100 100 147 100.0 289 100.0 200 100.0 746 100.0
Eight patrols were terminated because of environmental deficiencies, the nature of which included:
Number of submarines Year Factor limiting endurance 1 1942 Lack of air conditioning. 4 1942-44 Limitation of potable water capacity. 1 1942 Serious battery fire. 1 1942 Serious control room fire. 1 1944 Excessive copper-salt content of drinking water.
The relationship between the reports of "poor" habitability and the success of operation was not explicit. In 63 submarines experiencing "poor" habitability during patrol, 39 were successful. The majority of unsuccessful patrols were made in the early years of the war.
Ventilation and air conditioning were the subjects of critical comment in over 400 instances. Unequal distribution of air between the forward and after compartments of the ship and inadequate cooling capacity of the air-conditioning units were the most common defects. Other criticisms concerned material defects of the air-conditioning apparatus involving the hazards of outboard ventilation in heavy weather.
Poor living conditions often prevailed in cold-water operations. Metal fittings throughout the ship sweated constantly. Heaters had to be used sparingly in order to conserve the batteries. With sea water at temperatures of 27° F., single-hull portions of a ship were impossible to heat. There was ice constantly in the torpedo room bilges, and pipes containing water, such as shower drains, were frozen solid.
The P-------------- on her fifth patrol recounted an experience sometimes encountered on northern operations: "The first dive made . . . lasted longer than expected with no carbon dioxide absorbent spread. At the end of 14 hours all hands had difficulty in breathing, carbon dioxide concentration at the time being 2.5 percent. Eight hundred pounds of oxygen were bled into the boat with slight relief. Upon surfacing 2 hours later the concentration in the conning tower was 3.5 percent."
On the fourth patrol of the N-------- (1943): "Air-conditioning installations proved inadequate. The highest temperature and humidity level recorded was 124° F. and 98 percent during a period lasting about 13 hours. . . . Excessive heat and humidity reduced the efficiency of all hands to a marked degree after about 2 weeks of operation."
Excess Carbon Dioxide, Oxygen DepletionLimiting values of oxygen and carbon dioxide, after submerging, were theoretically not attained until the expiration of a period of hours calculated from a formula which, although adjustable, was derived on the basis of peacetime complements and operating conditions.
Adequate instruments to measure the amount of carbon dioxide and oxygen were not available and therefore the need for air purification was based on subjective evidence such as headache or dyspnea. When needed, varying amounts of carbon dioxide absorbent, which is caustic and irritative, was spread and the air was further revitalized by releasing oxygen or compressed air into the ship.
On several patrols excessive levels of carbon dioxide seriously affected personnel efficiency. The following comments were made:
The formula used for calculating the time-limiting values of carbon dioxide and oxygen was not always applicable during wartime operations; the time at which symptoms of intolerance became evident did not necessarily follow the calculated time. In 22 out of 26 reports, the time when the air became vitiated was from 1 to 6 hours less than the calculated figure. Half of the reports came from patrols made in Northern areas where, because of weather conditions and the long hours of daylight, prolonged submerged operations were common. Moreover, the ships were cold and damp, requiring exertion on the part of each man to keep warm. These factors and the increased complement made it necessary to revitalize the atmosphere frequently.
Air purification was a matter of particular concern aboard submarines used as troop transports. "On the fifth patrol of the N-----, when 109 Army Scouts (in addition to the crew of 96) were transported in the Aleutian area, high levels of carbon dioxide were experienced. This was particularly true when the Scouts were making ready to disembark. On the day when preparations were made to land the level was 4 percent."
Sanitary Tank-Head SystemSewage from the heads, washrooms, and galley was collected in sanitary tanks. Military security prevented emptying the tanks except upon surfacing and under cover of darkness. They could be flushed with sea water only with difficulty, and during a long patrol, despite frequent emptying and the use of various disinfectants, the tanks became mephitic.
Toxic GasesToxic gases were occasionally encountered in submarines. Carbon tetrachloride, when used as a cleaning agent, produced disabling physical effects and its use was abolished. Although chlorine gas formation was common, especially after flooding of the battery compartments, only two instances of serious effects from chlorine were reported.
Water SupplyIn the early days of the war, the limited supply of fresh water was at times the cause for great concern and was a factor limiting the duration of patrols. Later, evaporating units capable of producing an adequate supply of fresh water were installed. Condensate water from the air-conditioning apparatus was collected and used for bathing, in washing machines, and for cleaning purposes. Impairment of potability of fresh water sometimes occurred, On a number of patrols contamination with copper sulfate took place; in one submarine the level was sufficient to endanger health of personnel and the patrol was terminated.
FoodSubmarines had the deserved reputation of serving the best food in the Navy, but the supply of fresh meat, vegetables, and frozen foods was usually exhausted before the patrol was concluded. Occasionally, there occurred deficiencies in the quantity and variety of food because of unusually long patrols, inexperience in loading, poor quality of food, refrigeration failure, or accidental flooding of supplies. Considerable difficulty was sometimes experienced, especially at advanced bases, in the procurement of some types of food.
Typical comments in patrol reports were:
Food was lacking in variety--a deficiency which probably may be traced to the inexperience of commissary department personnel.
Inexperience in planning and procurement for such a long patrol made the diet unsatisfactory.
Quality of the food was good, but ran out of several items because of carelessness in loading.
About 85 patrol reports mentioned having used vitamins, particularly for the lookouts. That the vitamins in submarine rations were ample was evidenced by the fact that only on two patrols. and then under the most unusual
circumstances in the earliest months of the war, was there any evidence of avitamosis in the personnel.
One submarine, early in the war, reported that an average of 1.5 pounds of meat per man per day had been consumed. Total food consumed averaged 5.6 pounds per man per day on one 47-day patrol, 31 days of which were spent submerged. One commanding officer was of the opinion that serving a light lunch at noon "curbed the tendency to overeat from boredom, with a beneficial effect on the crew." Aboard another submarine, "food consumption was observed to fall off noticeably, the decline being most noticeable during the fourth week." Others reported that the men lost their appetite after prolonged periods of silent running and depth charging. Two commanding officers reported an increase in food consumption during patrols in cold weather and a third reported that cold weather operations tripled the consumption of coffee. Cooks observed difficulty in baking under conditions of increased humidity within the ship, and more than one cook on a war patrol complained bitterly of the collapse of his cakes during depth charge attacks. Two commanding officers encouraged the crew to chew gum; one of these was convinced that it accounted for a "noticeable reduction in the number of gastrointestinal complaints usually observed during the course of a long patrol."
The rations provided submarines in World War II succeeded in meeting the requirements of limited bulk, keeping qualities, and ease of preparation. They provided a well-balanced diet, a maximum of food value, and a minimum of waste, but a master ration plan for the submarine service, flexible enough to allow for satisfying individual preferences, might with advantage have been prepared by Submarine Squadron Medical Officers. In addition, thorough training of the entire commissary team (commissary officer, commissary steward, cooks, bakers, and supply officer ) would have eliminated some of the problems related to the submarine ration.
The one single item of food most often unfavorably commented on by commanding officers of submarines was the large amount of boned beef issued. Other comments related to:
- The importance of ice cream in providing variety in the diet as well as nourishment. Ice cream rated high as a morale builder.
The necessity of giving submarines a high priority in obtaining supplies of frozen fruits and vegetables.
The importance of foods such as "Avoset," canned luncheon meats, sea food, "Nescafe," and jams,, particularly when available in small pack size in providing variety and enlivening what otherwise would have been a monotonous diet.
OvercrowdingBunking facilities aboard submarines were designed for peacetime complements. With increased complements and the addition of new apparatus, space became more and more critical, and at times serious crowding was experienced. Adequate provisions for bunking and personal needs could not be made, but overcrowding produced no lasting effect on personnel efficiency.
Protective ClothingTo maintain a reasonably long and alert watch in the most severe weather, bridge personnel must remain comfortable, warm, and dry. On cold-water operations the available items of protective clothing were often woefully inadequate.
Length of OperationsEarly in the war little was known regarding the length of time the personnel could endure the physical and psychologic discomforts in submarines on war patrols. Experience modified some of the earlier ideas. Submarines frequently remained on station for from 40 to 50 days, but this reduced the efficiency of the men and they were no longer on their toes.
A patrol carried out in good weather with plenty of targets, with good fire control, and without being subjected to depth charges, could last much longer than one in which these features were absent. The monotony of a submerged patrol without contacts was very fatiguing unless some change of pace or diversion was introduced. If lulls in activity occurred,
material reduction in efficiency would occur or fatigue become apparent. Although under such conditions aggressiveness and desire to close with the enemy had not slackened, the keen fighting edge of the crew was definitely impaired,
A high state of interest and aggressiveness was essential to the success of operating submarines and was closely related to personnel endurance and morale. The greatest single factor contributing to high morale was successful engagement with the enemy for then they ceased to be a "detail" and were instead a fighting unit. There was nothing quite so depressing to the crew of a submarine with a long record of success as a "zero run." As the war progressed and targets became less common, the "lethargy of long . . . days, rough sleepless nights, and limited exercise had to be mitigated by a clear portrayal of the part submariners were playing in the over-all strategical and tactical plans."
There were many comforts that were essential to maintaining morale. These included good food, mail, movies, books, magazines, phonograph records, adequate quantities of fresh water, mascots, church services, favorable publicity and the possibility of a period of "Stateside" duty. The great importance of adequate and comfortable facilities to permit rest and recuperation for the crew at the end of patrols contributed greatly to the sustained pattern of success that characterized submarine warfare in World War II.
Psychiatric Casualties in Submarine WarfareSubmarines made approximately 1,520 war patrols. Of these, the missions in 1,042 were "successful" and in 478 "unsuccessful." From these patrols 1,489 reports were available for study and the following conclusions were made: The psychic trauma sometimes experienced by personnel in the submarine service was as great, if not greater, than that experienced by any other group in the war. Being hunted, under forced inactivity in an environment of heat and high humidity (during the time when it was necessary to turn off all air conditioning and ventilation systems) were factors in emotional trauma. To this was added the strain of reconnaissance operations, mine laying, and days of patrolling without enemy contacts. The caliber of leadership of the commanding officers was very high. There were only three instances in which the men lost confidence in the commanding officers, or the commanding officer lost confidence in himself, or his ship.
The following excerpts highlight some of the factors in emotional trauma:
A terrific explosion jarred the boat. All hands not holding on to something were knocked from their feet. At 330 feet, fire in the maneuvering room, all power lost. Thick toxic smoke filled the maneuvering room and after-torpedo rooms. All hands aft were sick. We went up and down three times and had started down the fourth time before power was regained. In the maneuvering room the situation was bad. All hands were violently ill. For the first 2 hours we were in a mighty tough spot. Extreme discomfort was suffered from the accumulated heat and humidity. All hands stripped down to shorts and the men took off their shoes and socks. The predicament of the ship was fully recognized by the older and more experienced men. As the youngsters folded up, the others took over. The most startling effect was the apathy engendered by the combination of heat, pressure, physical effort, and mental stress. Some without permission, others after requesting relief, would seek the closest clear space on the deck, lie down, and fall asleep. Often following a depth charge attack men would have nausea, vomiting, abdominal cramps, or diarrhea.
Two instances of hysterical paralysis were reported and other manifestations of hysteria were observed during depth charge attack, as noted in the following report:
One man got hysterical and had to be held down by others. One man who had made 8 previous patrols became comatose for almost 2 days during which time he could neither talk nor understand what was being said to him. He would sit upright in his bunk for hours with all muscles tensed and during these periods had difficulty in breathing. When he recovered the only explanation he could give was that he had a bad dream. Anotihlerman during the first depth charging, who had had previous war patrol experience in Asiatic station "S" boats, broke down and later said that he had lost his nerve. On subsequent depth chargings this man proved unstable and broke down and cried on several occasions.
Despite the hazards under which submarine crews lived and fought, the actual psychiatric casualty rate was amazingly low (table 16). Out of 126,160 man patrols there were 62 psychiatric
casualties--an incidence of 0.00041 per man patrol.
TABLE 16.--Psychiatric casualties encountered aboard submarines
Diagnosis Number of
Psychoneurosis, anxiety 23 25 Psychoneurosis, hysteria 8 9 Psychoneurosis, unclassified 6 6 Psychosis, unclassified 5 5 Neuritis, unclassified 6 6 Paralysis, unclassified 2 2 Paralysis, facial nerve 2 2 Epilepsy 2 2 Migraine 2 2 Diagnosis undetermined: Syncope 2 2 Vertigo 1 1 Total 59 62
This low rate is probably attributable to the following: (1) Careful selection of personnel, (2) thorough and specialized training, (3) high morale associated with success of combat submarines, (4) adequate rest and rehabilitation facilities and frequent rotation of duty, and (5) medical examinations before and after patrol duty.
Deaths on PatrolIn nearly 4 years of war, only 62 deaths from all causes (including battle injuries) occurred aboard submarines on patrol (table 17).
TABLE 17.--Deaths occurring aboard submarines on war patrols
Cause of death Number of men Patrols reporting Asphyxiation 26 1 Drowned--lost, over the side 17 13 Killed--battle injuries 12 10 Killed--accidental 3 3 Suicide 1 1 Malignancy 1 1 Pneumonia 1 1 Unknown 1 1 Total 62 31
Personnel Selection ProceduresAt the onset of the war, the only physical examination of personnel prior to assignment to duty in submarines was that prescribed in the Manual of the Medical Department (1939). Intelligence quotient and psychological fitness were not considered. These factors were later found to be of great importance. Under prewar conditions some of the requirements for selection of personnel for submarine duty were automatically covered by the performance of satisfactory duty afloat for 3 years. This automatic screening became inoperative when large numbers of personnel were received fresh from civilian life. The rapid influx required the modification of some of the physical requirements for enlistment--notably those of the teeth. Dental officers unfamiliar with the necessities of the submarine service had been rejecting almost 50 percent of the candidates because of slight underbite or overbite or missing incisors, because of the erroneous concept that the mouthpiece of the submarine escape appliance, the "lung," must be gripped firmly with the teeth. (The mouthpiece is gripped with the lips, primarily. ) As a matter of fact the dental requirements for duty in submarines could be met, in the absence of marked overbite or underbite which made lip gripping of the mouthpiece difficult, if the applicant had sufficient number of opposing teeth for biting and mastication.
Night Vision TestingTesting night vision became necessary in order to properly select night lookouts, or at least eliminate the night-blind. The first work on this problem began in April 1941 and was continued and greatly expanded during the war. The experimental phase was carried out at the Medical Research Laboratory, Submarine Base, New London, Corm. Submarine personnel were also tested for their visual acuity as radar operators. Requirements were found to be normal near-vision acuity
Sonar TrainingOne of the most important contributions made by the Submarine Force was the early development and application of selection procedures for sonar operators. The pioneer work of the staff of the Medical Research Laboratory of New London, formed the basis for the procedures developed for the selection of sonar operators for Fleet units.
Psychological TestingPsychologic testing (using paper-and-pencil test) was used extensively in the selection of personnel for submarine duty. The early impetus for the development and application of these tests came from civilian research groups, such as the NDR Committee of Brown University Division. Many of these tests proved to be of great value in eliminating psychologically unfit personnel.
The submarine service became interested in intelligence tests early in 1942. This was necessary in order to assure the selection of persons of average or above average intelligence for submarine duty, In the beginning, however, selection interviews were conducted by Medical and Hospital Corps personnel who were not trained in psychiatry. The psychiatric selection interview by a psychiatrist with the Medical Examining group at New London was instituted in 1943. The combination of paper-and pencil tests and psychiatric interview was employed. At first psychiatrists at the training centers had to interview as many as 20 to 30 men per hour throughout the day. This obviously was not only impracticable, but practically impossible. Much more effective service was rendered by using the paper-and-pencil psychological test for the original screening, and referring only those in the "failing" or "doubtful" categories to the psychiatrist.
In 1943, an "Interview Board" was established. This Board consisted of a representative of the staff of Commander Submarines, Atlantic Fleet, a representative of the submarine personnel division of Bureau of Personnel, and a medical representative from the staff of the Medical Research Laboratory at New London. These Boards traveled to various officer indoctrination units, where in cooperation with the medical departments they studied the records of the volunteers for submarine duty and interviewed the likely candidates. After this interview system was established, men selected for submarine duty were found to be much more likely to pass the detailed and rigid examinations than had been the case when groups of unscreened volunteers were selected. Many man-hours were thus saved and much disappointment and resentment in personnel was spared. Previously, candidates had been selected at one station and after traveling to another activity and being interviewed had often been found not qualified.
Personnel selection procedures at first did not always function well. Frequently selection officers failed to work together or did not know the part played by others in the selection system. Physical examinations were often done by untrained personnel, and examining facilities were lacking or inadequate in many instances. In fact, the situations encountered led one to wonder how anyone was properly selected for submarine duty. When a statistical accounting system was set up in 1944 and complete monthly reports of selection results were forwarded to all stations furnishing candidates, the efficiency in personnel selection improved to a great extent.
A representative of the submarine medical examining section of the Submarine Base, New London, visited activities throughout the United States and held indoctrination conferences with the classification and selection officers. Following these conferences, the type of men selected for submarine duty consistently improved and attrition dropped as much as 75 percent.
The Submarine Escape Training Tank was used by the selection group at New London to identify the emotionally unstable and psychiatrically unfit candidates. It was assumed, and at least partially established, that men who failed in the adjustment necessary for proper performance during lung training would be unlikely to make the adjustment essential for duty in a submarine.
Lookout TrainingThe submarine service was the first in the U.S. Navy to inaugurate night lookout training. This training was developed under the auspices of the Medical Research Unit at Submarine Base, New London, Corm. Following receipt of reports from the British concerning the importance of such training in lookouts, the Commander Submarines, Atlantic Fleet, became interested in the possibilities of this
training for the submarine service and a night lookout training table similar to that used by the British was set up in 1941. From the beginning, commanding officers were enthusiastic about this training, and the program was very popular with men.
The original trainer provided by varying lighting effects a reasonably realistic horizon simulating that at sea. A greatly improved version of the "Lookout Stage," embodying several improvements, was constructed early in October 1942. Similar stages of a "portable" type were constructed and distributed throughout the Navy for the training of all personnel. These had a realistic horizon, and moonlight, recognition lights, and sounds of distant gunfire could be simulated. Its advantages as a training device lay in its realism and the interest which it aroused in the student. Its value in indoctrination and preliminary training of beginners was unquestioned.
In March 1943, the Commander, Submarine Force, recommended the establishment of the Renshaw Recognition Trainer at submarine activities. This training, which was modified to fit submarine service needs, was included as a part of the night-lookout training program already in operation at the Submarine Base, New London. As the work in night visual, general lookout, and recognition training began to increase, it was obvious that a lookout school should be organized. This was established in February 1944. Later the Bureau of Personnel established lookout training schools in conjunction with recognition training at all training centers.
Officers assigned as instructors in these schools were given additional training in lookout work at the Medical Research Department, Submarine Base, New London, in order to enable them to train men in either basic training schools or in "L" divisions aboard ships. A course in lookout procedures had been added to the curriculum of the Naval Training School (Recognition) at Ohio State University early in July 1943. This obviated the need for transferring graduates to New London for additional instruction.
Interior Voice CommunicationOn 1 May 1944, the Bureau of Personnel authorized the establishment of Telephone Talker Schools in all Class A, B, and C Schools, and assigned the operation to the Medical Research Department. Later the name of this school was changed to "Interior Voice Communication School."
It was found necessary to give training in the following:
- How to increase intelligibility when using communication instruments.
How to formulate brief, efficient orders, and report the execution of orders.
How to efficiently operate and handle voice transmitting equipment.
The use of standard phraseology and procedures for interior communications,
Organization of sound-powered and broadcasting circuits unclear various battle and operational conditions.
Standard terminology for use on stations or submarines.
The following manuals were used in training:
- "Submarine Telephone Talkers' Manual."
"Suggested Ship's Organization: "Chapter on Interior Voice Communications of fleet type submarines."
"Standard Submarine Phraseology."
"Standard Submarine Phraseology and Procedures."
"Instructors Handbook for Instruction in Submarine Interior Voice Communications."
One of the most important parts of the training program was teaching the use of standard procedures. A practical drill was developed that greatly facilitated instruction in voice communication procedures, phraseology, and terminology for the submarine crew. Scripts of orders and messages were used to force the student to utilize correct procedures, phraseology, and terminology, while simulating actual submarine operations.
Submarine Escape ("Lung") TrainingIn 1930 a submarine escape training tank was put into operation to permit the thorough training of all submarine personnel in the use of the "lung" under conditions that exist during an actual escape from a disabled submarine. All submarines were equipped with this escape apparatus. With the advent of World War II, "lung" training facilities were expanded, in order to handle the large numbers of men entering the submarine service. In spite of a great expansion in such facilities, many men who entered the submarine service at advanced bases did not receive "lung" training.
Although it was considered unlikely that the "lung" would be used for escape in wartime disasters, training in its use was continued throughout the war for the following reasons: (a) It was considered to be an excellent morale factor, (b) it gave a sense of security and comfort to the families of the men, and (c) it was used by the Medical Research Department of the Submarine Base, New London, Corm., in their selection program as a means of eliminating the emotionally unstable. Men who became excessively nervous during the training were disqualified for submarine duty on the grounds of emotional instability. If they "could not take" "lung" training, what could be expected when the depth charges were rolling? The "lung" was used by the men of one disabled submarine for a very dramatic escape, and the training given at New London enabled two of the men to make successful "free escape" without a "lung."
In order to escape from a sunken submarine, it is necessary to raise the pressure within a compartment of the ship from which egress is to be attempted, until it equals the outside water pressure. To do this, the compartment is flooded by admitting water. As the water rises, it compresses the air in the upper part of the compartment. When the water has risen to the top of the escape door, a hatch can be opened by hand and a buoy with an ascending line released through the hatch. Escape to the surface is made with the use of the lung.
Escape tank training included the following:
- A pressure test of 50 pounds per square inch in the decompression chamber;
a lecture on construction, operation, safety features, and precautions in use of the lung;
shallow water training for confidence in breathing under water;
12-foot training to attain proper relaxation and confidence; and
18- and 50-foot training to permit the student to become skilled in the use of the lung so that should he be called upon to use this device to save his life, he would have no doubt as to its lifesaving qualities.
The number of men trained and qualified in "lung" escape is noted in table 18.
TABLE 18.--Number of men trained and qualified in "lung" escape
Fiscal year Qualifications Total 18-foot 50-foot 100-foot 1930-31 556 405 338 1,299 1931-32 770 189 179 1,138 1932-33 490 244 216 950 1933-34 562 252 141 955 1934-35 264 104 104 472 1935-36 454 84 84 622 1936-37 637 41 41 719 1937-38 1,813 121 121 2,055 1938-39 1,321 62 62 1,445 1939-40 1,375 189 149 1,713 1940-41 3,695 123 13 3,831 1941-42 4,621 2,231 1,405 8,257 1942-43 8,014 6,463 1,882 16,359 1943-44 13,569 12,590 811 26,970 1944-45 8,895 6,710 786 16,391 Total 47,036 29,808 6,332 83,176 On 7 December 1941 there were 759 dental officers (including 369 Reserves on active duty) to provide dental care for a combined Navy, Marine Corps, and Coast Guard of about 486, 000 men. Three hundred and forty-seven dental facilities were in operation. These varied in size from the one-dental-officer clinic at the smaller stations to such large, superbly equipped dental clinics as that at the U. S. Naval Training Station, Great Lakes, Ill., which had 155 dental officers on duty.
The Dental Situation
After 4 years of war, on 14 August 1945, 7,026 dental officers (including 6,457 Reserves) were on active duty. They provided dental care
for a Navy of about 4 million men and women. Of these there were 4,470 dental officers in the continental United States, 1,350 at foreign stations, and 1,206 afloat. There were 1,545 dental clinics in operation at Naval and Marine activities throughout the world, ashore and afloat. These stations included those listed in table 19.
TABLE 19.--Dental facilities as of August 1945
Type activity Number Dental officer
Ashore: Operating bases 70 1-12 9 Repair bases 4 1-29 3 Construction battalions (centers) 3 3-53 1 Supply depots 15 1-4 0 District dental officers 12 161 0 Naval hospitals 55 1-20 27 Dental schools 3 4-23 3 Pre-flight schools 4 1-8 0 Air stations 128 1-42 19 Training centers 13 65-353 13 V-12 units 31 1-2 0 Navy yards 5 10-46 4 Miscellaneous 65 1-24 10 Afloat: Fleet hospitals 9 3-8 7 Naval ships: Flag 13 161 0 Battleships 23 163 0 Carriers 36 1-3 2 Cruisers 72 1-3 0 Hospital 12 1-3 9 Transport 77 1-2 0 Transport for wounded 3 161 0 Tank and repair 89 1-5 12 Transport attack 241 1-3 0 Cargo attack 26 161 0 Miscellaneous 17 161 0 Amphibious forces: Base hospitals 13 1-13 ? 9 1-24 4 Marines: Aviation 13 1-16 2 Training 8 1-113 6 Divisions 6 1633 161
Dental Personnel and Other Dental MattersAbout 1,000 dental technicians were on active duty at the outbreak of World War II. On 14 August 1945, 44 Dental Repairmen, 2,142 Dental Prosthetic Technicians, and 8,153 Dental Technicians, General, were on duty. Of these more than 1,200 were WAVES.
Generally, dental technicians were trained in the Navy; however, because of the need for experienced dental prosthetic technicians a number of qualified technicians from civilian life were rated as Pharmacist's Mates, Dental Technicians, Prosthetic, upon enlistment. (Bureau of Naval Personnel directive of March 1944.)
Prior to 7 November 1941, the course of instruction given at the Naval Dental School, Bethesda, Md., for Dental Technicians, General, was of 4 months' duration. A 5 months' course for Dental Technicians, Prosthetic, was given at all naval dental prosthetic activities. All ratings were eligible for the General Technician course, but only PhM1c, PhM2c, and PhM3c were eligible for the Prosthetic Technician course. In November 1941 these courses were shortened to 10 weeks for the General and to 4 months for the Prosthetic, and HAIc was also included in the ratings eligible for the General course. At this time the latter course was given only at designated naval training centers and at the Naval Dental School, Bethesda, Md. In January 1945, 102 naval dental clinics were also designated to train hospital corpsmen in dental specialties.
With the great increase in the size and number of dental clinics, maintenance and repair of dental equipment became a problem. To meet this need enlisted men had to be trained in such maintenance and repair work. A Dental Maintenance and Repair School, the first of its kind in the Navy, was established at the U. S. Naval Training Center, Bainbridge, Md., on 25 February 1945. Men completing this course were rated Dental Technician, Repair.
The peacetime dental standards for enlistment in the Navy established a requirement of at least 20 serviceable teeth; four opposing molars (two on each side), and four opposing incisors (two on each side). Gingival diseases, carious teeth, oral tumors, extensive periodontal disease, malocclusion, and wide edentulous spaces in either the maxillary or mandibular arches were considered disqualifying. These standards were rigidly applied in the cases of officer appointments, and in enlistments for aviation and submarine duty.
The reason for specifying 20 serviceable teeth, the presence of opposing molars and incisors, was to reduce workoad and costs, if subsequent prosthetic restorations were required.
Application of the peacetime dental standards resulted in the rejection of 1 out of every 56 selectees for the Army in 1941. In that same year, out of 340,000 applicants for the Navy,
7.8 percent were rejected for dental defects. The percentage of men with disqualifying dental defects was probably higher than that recorded, because in many instances, if a man was found physically disqualified, a dental examination was not conducted.
Because so many applicants could not meet the peacetime dental standards, the Bureau of Personnel and U. S. Marine Corps Headquarters jointly modified the dental requirements, specifying 18 serviceable teeth instead of 20, two opposing molars instead of 4, and not more than 4 missing incisors satisfactorily replaced. A carious tooth which could be restored by fillings was considered a serviceable tooth. Applicants with extensive dental infection, or who required immediate prosthetic or orthodontic treatment, however, were still not accepted for the services.
On 29 May 1943 the Bureau of Medicine and Surgery lowered the dental requirements so as to agree with the mobilization requirements of the Army. Only severe and irreparable dental defects were to be considered as disqualifying for inductees. Edentulous upper and/or lower arches, corrected or correctable by dentures, and malocclusion not interfering with minimum mastication and not resulting in pathologic dental changes were not considered disqualifying.
Dental TreatmentThe lowering of dental standards marked the start of a vast dental rehabilitation program. To provide the necessary facilities, 97 dental activities were designated in October 1943 to give dental prosthetic treatment. Such treatment, without prior approval of the Bureau of Medicine and Surgery, was authorized, and dental prosthesis became the responsibility of the cognizant dental officer. Previously, prosthetic treatment without prior Bureau approval had been permitted only for personnel on sea duty or for those outside the continental United States.
This dental rehabilitation program attempted to make all Navy and Marine Corps personnel dentally fit, regardless of their dental condition. It was an extremely difficult assignment for the Dental Department because enlisted men were to be considered not physically qualified for transfer beyond the continental United States if they required prosthetic dental treatment. Later in the war, no personnel were to be considered qualified for duty overseas, until all dental treatment (operative and prosthetic) was completed. The responsibility for carrying out such treatment rested with the dental clinics at the naval training centers and at ports of embarkation. Dental treatment was given to personnel of the United Nations eligible for lend-lease aid, when they could not obtain adequate dental care otherwise, and to Army personnel in areas where no Army dental facilities were available.
Examples of the work accomplished during the war are the following:
29,654,343 restorations of all kinds
509,292 dentures--all types
27,232 bridges--all types
4,229,809 teeth extracted
In 1942, 646 fractures of the jaw were treated, 570 of them mandibular. In 1943, the total was 3,096, of which 2,780 involved the mandible and 316 the maxilla. In 1945, the grand total reached 4,355, including 3,304 mandibular, 409 maxillofacial, and 642 maxillary.
MaterielThe problem of obtaining dental supplies and equipment at the beginning of the war was acute. Facilities and equipment for dental treatment were not available to meet the increased needs. In lieu of new dental burs, used burs were saved, cleaned, oiled, and sent to the U. S. Naval Medical Supply Depot, Brooklyn, N. Y., for resharpening and reissue. By October 1942 the dental bur supply was further curtailed. Only certain angle and straight handpiece burs could be manufactured and of these only a limited quantity was produced. Because of the curtailment in supplies, dental facilities in continental United States could requisition supplies on a 3-month minimum, 6-month maximum basis. This held true throughout the war.
In December 1942 the Bureau directed conservation of all critical materials. These included amalgam scrap, precious-metal bench sweepings and trimmings, and polishing residue.
The equipment for dental clinics at the various advanced bases was standardized, depending
upon the medical components of the base. The Dental Branch of the War Plans Section determined the dental materiel and personnel needs for each advanced base and specified the standard equipment. When dental components were required for an advanced base, commensurate dental personnel and equipment could be readily ordered.
Because of the shortage of dental equipment, a "shift" system was devised to keep available dental equipment in service 12 to 16 hours a day. This was particularly necessary at the larger training centers and navy yard dispensaries. In December 1945 this system was discontinued, because with demobilization in progress, personnel and equipment were in excess of immediate needs.
New types of dental facilities were built during the war. To provide dental treatment for small groups of naval personnel at isolated stations and at training schools, nine self-contained mobile dental operating units and one mobile dental prosthetic unit were built. The first mobile unit was placed in operation in the Eighth Naval District on 18 February 1945. The construction of "dental clinic ships" was recommended by Commander, Service Forces, Pacific Fleet, in June 1945, and construction of four such ships was authorized in August 1945. With the cessation of hostilities, however, this plan was abandoned.
TrainingPrior to November 1941 dental officers had been assigned to civilian educational institutions, as well as to the Naval Dental School, Bethesda, Md., for postgraduate instruction in oral surgery and prosthodontia. During the war the number of short postgraduate courses in oral surgery at these activities was increased and a course in ocular prosthesis was added to the curriculum at the Naval Dental School.
On 1 January 1942 the Surgeon General directed all dental officers to become proficient in the administration of first aid, treatment of burns, shock, and hemorrhage, disposal of the dead, and other duties related to the Medical Department, in order to assist the medical officers when occasion demanded. Aboard ship, dental officers also assisted medical officers in teaching first aid to the ship's company. First aid training was made available to all dental officers, at naval hospitals, naval training centers, and at the Naval Dental School.
Dental Division, Bureau of Medicine and SurgeryA number of organizational changes were made in the Dental Division of the Bureau during the war. On 16 October 1942 the Surgeon General established offices of district dental officers. Although some of the larger naval districts then had a District Dental Officer, it became necessary to assign a dental officer to each naval district to coordinate dental activities. This officer was to advise the Commandant and the Bureau regarding dental installations and assignments of personnel within the district, and to make reports to the Bureau and the Commandant.
A reorganization of the Dental Division was directed by the Surgeon General on 8 February 1943. This charged the Dental Division with "cognizance of professional standards for dental practice in the Medical Department," with conducting "inspections and surveys for maintenance of such standards," and with advising the Bureau on expansion of dental facilities, on Dental Corps personnel, on dental equipment and supplies, and on special authorizations for dental treatment. In order to carry out these functions, the Dental Division was divided into a Standards Section and an Inspections Section. The former had cognizance of professional standards; the latter was to conduct inspections and surveys for maintenance of established standards.
A Force Dental Officer was assigned to the staff of Commander South Pacific Forces on 1 June 1943.
The Office of Fleet Dental officer was established in the Fleet on 17 January 1944 and on the Staff of CincPAC-CinPOA in December 1944.
In 1944 a Dental Section was established in the Headquarters and Service Company of the Medical Battalion of Marine Divisions of the Fleet Marine Force, with the senior dental officer acting as Division Dental Officer.
On 18 September 1944, the Dental Division of the Bureau was again reorganized. The Dentistry Division was directed to "study, evaluate, advise, and make recommendations on the dentistry needs, policies, standards, practices, and performances of dental activities in the Medical Department ;" to make recommendations "pertaining to complements, appointment, promotion, advancement, training, assignment, and transfer of dental personnel ;" and to "maintain liaison with such other BuMed offices or divisions or such other military and civilian agencies as may be required." An Office of the Chief of Division, a Dental Standards Branch, and a Dental Personnel Branch were set up to carry out the directive. The Chief of the Division was held responsible for the performance of all functions assigned to the Dentistry Division, and was directed not to adopt "major policies, methods, or procedures without the approval of the Chief of the Bureau of Medicine and Surgery,"
Other changes of interest in the Dental Corps included the following: Capt. Alexander Gordon Lyle (DC) USN was nominated in March 1943, as the first Rear Admiral in the Dental Corps. The first woman dentist to be commissioned was Lt. Sara S. Krout (DC) USNR, WAVES. She reported to the U. S. Naval Training Center, Great Lakes, Ill., in June 1944. The first woman Dental Hygienist to be commissioned was Ensign Jessie Rathbone, USNR, WAVES. The Office of Inspector of Dental Activities and the Office of the Assistant for Dentistry were established in the Bureau of Medicine and Surgery on 18 September 1944 and 24 May 1945, respectively.
ResearchDental research had been carried on under the cognizance of the Naval Dental School for many years prior to World War II. During the war, research was accelerated and was closely coordinated with that of the Medical Department. As a result, valuable contributions were made to both medicine and dentistry. Of particular importance was the Dental Department's participation in rehabilitation. The results of the research project "Esthetic and Functional Hand and Digit Prosthesis and Eye Prosthesis," which was started 11 May 1945, made possible the development of prosthetic devices for the amputee and the acrylic eye for the blind. Other dental research included the following:
- "Efficacy of penicillin in the treatment of oral fusospirochetosis." This was the first attempt in the Navy to determine a method whereby large numbers of men could be treated quickly and still be kept at their duties.
"Study of occurrence of caries in the same surfaces bilaterally and/or adjacently."
"Presence of Vincent's organisms in the mouth of patients being treated for syphilis."
"A portable dental operating light for field use."
"Effect of methyl methacrylate fillings on pulp tissue of dogs" (study incomplete).
"Relationship of dental occlusion to ear block" (carried out in the low-pressure chamber).
"Results of dental therapy in 50 cases of aerotitis media in submarine personnel based upon a new functional concept of eustacian tube blockage."
"A rapid dental treatment for the prevention of aerotitis media."
"Evaluation of a concept of dental treatment based on a functional classification of malocclusion."
"Dental treatment of trismus, tinnitus, otalgia, and obscure neuralgia."
Successes and Failures in Field DentistryThe following observations were made by dental officers on duty in the various theaters of war:
- "Insufficient prosthetic facilities were available in the forward areas. The trailer or truck type operating units would have been a solution had they been developed soon enough."
"Dental officers with administrative and organizational ability as well as battle
experience should be in charge of dental facilities in forward areas or large dental activities."
"Dental officer personnel fresh from civilian practice with little or no experience in handling officer and enlisted personnel should not be in charge of large dental installations."
"The hurried and selective form of dentistry, although objectionable, was the only solution during wartime."
"During the war it was absolutely necessary for medical and dental personnel to function as a unit rather than as separate entities."
"Maxillofacial teams made up of medical and dental officers and corpsmen were needed to efficiently treat the large number of patients with head and neck injuries."
"There was a need in the Dental Corps for enlisted personnel with stenographic and bookkeeping experience to handle records more intelligently and efficiently and to maintain files according to standards."
"The clinical and instructional phases of naval dentistry at those activities where instruction was given should have been separated to a greater degree. To obtain competent naval dental instructors, a number of dental officers should be trained in this field."
"There was a need for a large Reserve dental officer group trained in military dentistry. The time required by Reserve officers to make adjustments during war and the resultant discontent and misunderstanding might have been avoided to a large extent had a more active Reserve training program during peacetime been possible."
"Regular rotation of duty between continental United States and extracontinental stations ashore and afloat should be stressed during time of war. When this was initiated in the Pacific, morale among dental officers was considerably improved. A l-year tour of duty in an active battle area was considered sufficient."
"Air conditioning was a necessity in ships' dental offices in the Tropics. In such environment, perspiration of the hands caused slipping of dental handpieces and instruments, and soft tissue injury occurred on several occasions because of this."
"A small prosthetic outfit should be available aboard all ships for emergency dental prosthetic service. This should include a small acrylic outfit to quickly construct acrylic crowns."
Table of Contents ** Previous Chapter (Foreword) * Next Chapter (2)
 Bureau Divisions:
Physical Qualifications and Medical Records, Personnel, Dentistry, Aviation, Medicine, Planning, Research, Inspections, Publications, Materiel and Finance, and Administration.
 Maximum patient census, 12,068, January 1945.
 Decommissioned 1942.
 This was a subordinate command of the National Naval Medical Center commissioned 3 February 1942, and replaced the U.S. Naval Hospital, Washington, D.C., originally commissioned October 1906.
Also included in the National Naval Medical Center were the following activities:
U.S. Naval Medical School (originally established 1822).
U.S. Naval Dental School (originally established 1923).
U.S. Naval Medical Research Institute (established 1942).
U.S. Naval School of Hospital Administration (reorganized and established 1945).
U.S. Hospital Corps School (Women's Reserve) (commissioned 1944; decommissioned 1946).
The cornerstone for the Center was laid by President Roosevelt on 11 November 1940. Rear Admiral Charles M. Oman (MC) USN was the first commanding officer of the Center.
 In August 1943 the designation Mobile Hospital was changed to Fleet Hospital; new serial numbers were assigned by adding 100 to the old number, except for Mobile Hospitals 1 and 2, which became Fleet Hospitals 1 and 2 respectively.
 The floor space of the quonset hut was 16 by 36 feet and of the Iceland hut 24 by 36 feet.
 Base Hospital No. 2, Efate, New Hebrides, arrived at Villa, 4 May 1942. It was the first base hospital established in the Southwest Pacific. During the period 4 May 1942 to 31 December 1942 this hospital admitted 2,949 patients with malaria. Casualties from Guadalcanal were admitted to Base Hospital No. 2, usually within 36 hours after they were injured. Most of the patients were brought by air to an airfield 6 miles from the hospital. A quonset hut for the reception of patients was placed near the landing strip of the airfield and a medical officer supervised the transfer of patients from airplane to ambulance. In 1944 this hospital was moved to Noumea and in July 1945 to Subic Bay.
 Mobile Hospital No. 3, in American Samoa, was one of the hospitals established in the Pacific in 1942 that did not receive a large number of battle casualties. In Samoa, filariasis was a major problem. Up to 1 January 1944, this hospital evacuated 2,904 patients with filariasis to the United States.
 Mobile Hospital No. 5, later Fleet Hospital No. 105, arrived in Noumea in September 1942 and received its first patient on 22 April 1943. During the period from September 1942 to December 1945, 23,566 patients were admitted. The maximum patient census was 2,100.
 Mobile Hospital No. 8, arrived on Guadalcanal in April 1943. It was commissioned August 1943 and designated as Fleet Hospital No. 108 in 1944. By December 1944 this hospital had treated 39,395 patients, During 1943, 2,208 patients were admitted for some form of psychoneurosis.
 Mobile Hospital No. 12 was commissioned in September 1943 and decommissioned in November 1945. By receipt and transfer, about 1,400 officers and men served with this unit, but it never operated as a hospital and never admitted a patient. This hospital arrived at Noumea in May 1944; from there it was shipped to Guadalcanal, Espiritu Santo, Eniwetok, and finally Okinawa. It was never erected.
 Fleet Hospital No. 114, a 1,000-bed unit, arrived at Samar, March 1945, and was expanded to 3,000 beds by incorporating Fleet Hospital No. 109. The hospital was operating on 2 July 1945 and 5,684 patients were admitted during the 2 months of July and August. This hospital had a strikingly high incidence of admissions for ureteral calculus, 117 admissions in 2 months. The widespread use of sulfonamides may have been a factor in this.
 Adapted from the BuMed publication "The History of Submarine Medicine in World War II" by Capt. C.W. Shilling (MC) USN and Mrs. J. W. Kohl.
 To give recognition to submarine medicine, those medical officers qualified in submarine medicine were authorized to wear the distinctive insignia in 1943.
 Exclusive of combat injuries.