Chapter IIJoseph L. Schwartz, Captain (MC) USN (Retired)
Experiences in Battle of the Medical Department of the Navy
At about 0800 on 7 December 1941, the first wave of aircraft from a powerful Japanese force attacked the United States Naval Base, Pearl Harbor, T.H. (figs. 66, 67, 68). Magazines in ships exploded, burning fuel oil covered the water, fuel dumps went up in flames, buildings and runways were struck by bombs, aircraft were destroyed before they could take to the air, and military personnel and civilians were strafed by machine-gun fire as they sought cover on the ground. Even as the attack was still in progress, trained medical units of the Navy, ashore and afloat, went into action to collect and care for the large numbers of casualties.
Figure 66. Disaster at Pearl Harbor
Figure 67. Disaster at Pearl Harbor
Figure 68. Disaster at Pearl Harbor
At the Naval Hospital at Pearl Harbor all treatment and operating-room facilities were set up and ready for use by 0815. Within 10 minutes after the attack began, casualties were arriving at the hospital, and in the first 3 hours approximately 250 patients had been admitted and treated. Altogether 546 patients and 313 dead were brought to the hospital that day. In addition, more than 200 ambulatory patients were treated and returned to their duty stations. By midnight of 7 December, the hospital patient census was 960.
Despite the large number of patients and the great variety of injuries treated, the supplies at the hospital were sufficient to meet the unprecedented demand, shortages appearing only in stores of plasma and tannic acid, which became depleted in the treatment of the large numbers of patients who had been burned. Some 60 percent of all patients admitted had clinically significant burns, in many cases the result of exposure to the flash of ignited gasoline or high explosive. Every conceivable type of wound and injury was observed, including a number of bizarre traumatic amputations. Although treatment of burns was left to the discretion of the individual medical officer, tanning agents were used in most cases, and variations occurred only in the agent selected, principally tannic acid, picric acid, gentian violet, triple dye, and silver nitrate. A few received wet saline dressings, sulfanilamide in mineral oil, or simply a heat cradle. Although many patients had been in the water and were covered with fuel oil, the large case load precluded any attempt at removal of the oil before treatment was instituted. It was noted subsequently, that the presence of oil on the burned areas did not impair the efficiency of treatment and healing progressed in the same fashion as if the oil had not been present.
Compound fractures were debrided and sulfanilamide powder was sprinkled in the wound; a plaster of paris cast was then applied, after which a roentgenogram was made and the position of the fragments was outlined on the cast with indelible pencil. This method of marking the position of the fragments provided invaluable information to the medical officer subsequently treating the patient. Sulfonamides were also administered orally for from 4 to 10 days after the initial treatment. The absence of infection in wounds of patients so treated proved those agents to be of value in combating infection, and it was shown that with early use of these drugs the time between injury and initial surgical treatment could be extended, when necessary, beyond the first 6-hour period.
A record of the patients admitted could not be kept at first because of the urgency for treatment and the very rapid rate of admission. Later, when it became possible to record admission data, identification was often delayed, for none of the patients wore identification tags and in many cases clothing was marked with several names. The Naval Hospital at Pearl Harbor, staffed by 41 medical
officers, 54 nurses, and 331 enlisted men, treated more than 6,200 inpatients during 1942.
The hospital ship Solace, anchored in Pearl Harbor, was unharmed by the attack. By 0825, when the first patients began arriving, all was in readiness to receive a large number of casualties, which at the end of the day amounted to 132 admissions in addition to about 80 ambulatory patients who were treated and returned to their duty stations (fig. 69). The Solace received the Commendation Award from Admiral Nimitz for professional skill and devotion to duty.
Because of the large number of fleet units in the Hawaiian area and the need for additional hospital facilities there, the U. S. Mobile Base Hospital No. 2, was shipped to Pearl Harbor in November. This unit landed just 12 days before the Pearl Harbor attack, but had not yet been erected. Only the crew's quarters were up. Because of the experience in the erection of its prototype, Mobile Base Hospital No. 1, in Guantanamo Bay, Cuba, in the previous year, the packing and marking of the supplies and equipment and the arrangements for uncrating supplies for this hospital were so efficient that it was possible to break out needed items on short notice. As a result, even though U. S. Naval Mobile Hospital No. 2 existed only in crates, it provided personnel, supplies, and equipment to care for and treat 110 patients on 7 December. For this fine work, the Medical Officer in Command, Capt. William Chambers (MC ) USN received the Distinguished Service Medal. Mobile Hospital No. 2 continued to operate throughout 1942 and was decommissioned in 1943.
Immediately after the attack the medical departments of the First and Third Defense Battalions at Pearl Harbor jointly established 3 dressing stations and within 3 hours had also outfitted a collecting and casualty dressing station and were treating patients from units of the Fleet.
The Naval Hospital at Aiea Heights, under construction at the time the attack occurred, did not admit patients until 12 November 1943. (During 1944 this hospital admitted 42,721 patients, of whom 5,256 were from Saipan and 2,848 from Guam and Tinian. On one day (3 July 1944) 1,169 patients were admitted.)
Medical Department personnel in fleet units at Pearl Harbor required no alert when enemy bombs and torpedoes struck ships anchored at Pearl Harbor. Even as bomb and torpedo bursts wreaked havoc in the Arizona, West
Figure 69.--Patients being treated for shock aboard the U.S.S. Solace.
Figure 70.--Survivors after rescue at sea--sickbay of PCE(R)-851.
Virginia, Maryland, California, and other ships in the harbor, battle dressing stations were manned and the injured were treated promptly and effectively. The competence of the Medical Department personnel in first aid was, in many respects, equalled by that of the crew. Because of previous instructions and drills in first aid and transportation of the wounded, they rendered lifesaving service to their injured shipmates. The efficiency in treatment was not a matter of type or size of ship. It was of the highest order whether carried out in a battleship or destroyer (fig. 70).
The prompt and efficient manner of preparing for the treatment and evacuation of patients under fire, and the bravery and resourcefulness of Medical Department personnel in shore-based and fleet units attested to their high state of preparedness and training.
The early months of 1942 were fraught with disaster for the Allies in the Pacific theater, as in other parts of the world. Corregidor's valiant garrison had finally surrendered, Singapore had fallen, and landings had been made by a small force of Japanese in Western New Guinea, with the aim of taking Port Moresby, cutting our supply line to Australia, and bringing that continent under attack. In the last days of April 1942 a powerful Japanese naval force was reported entering the Coral Sea and all available American and Australian naval might was concentrated to meet this threat. The force consisted of warships and transports containing some thousands of troops for a landing in Papua. The memorable Battle of the Coral Sea, while costly to us in the loss of the aircraft carrier Lexington, was an important strategic naval victory in that the Rising Sun was effectively turned back from its mission.
The Solomons Campaign
A few weeks later, the Japanese sent an even mightier force to take Midway. Our own forces, at the cost of the aircraft carrier Yorktown, aborted the attack and routed the enemy fleet.
These victories, however, provided only a brief respite, for the Japanese forces in New Guinea were constantly being reinforced and a large base was being established at Rabaul in the Western Solomons. In addition, Japan was working feverishly to develop its gains in the East Indies and Malaya, and our supply lines through the Pacific to Australia and New Zealand were in imminent danger of being severed. Therefore, in order to consolidate our preliminary gains in the Southwest Pacific, to relieve some of the pressure on New Guinea and consequently on Australia, and to establish the first stepping-stone on the long march back to the Philippines, it was decided to mount an amphibious assault on Guadalcanal, a little-known island in the Eastern Solomons.
The first echelon of the First Marine Division reached New Zealand on 14 June 1942, and on 7 August 11,000 men, a few units of fire, and a mountain of supplies were landed at Lunga Point, Guadalcanal. In preparation for combat duty, the personnel of the First Marine Division had been carefully screened, and appropriate disposition made of men not physically fit. All hands had been instructed in first aid and immunized against smallpox, yellow fever, typhoid fever, and tetanus.
Prior to the landings in the Solomons, plans were completed for the medical care of the thousands of officers and men by the organization of the Medical Department into: (a) Battalion aid station units, composed of 2 medical officers and 20 hospital corpsmen, of whom 3 were detailed as company aid men, the remainder being assigned with the medical officers to the battalion aid station; (b) medical companies, consisting of 6 medical officers and 80 hospital corpsmen and divided into 3 sections: (1) collecting and sorting, (2) hospital, and (3) evacuation. Each medical company was capable of establishing a 72-bed hospital in the field (fig. 71).
The company aid men landed with and closely followed the initial assault wave, maintaining a position about 200 yards behind the front lines. They administered plasma and morphine, recorded on tags which were attached to the patient all treatment given, and applied necessary dressings and splints, thereby forming the first link in the elaborate chain of care established by the Medical Department (fig. 72). A few waves later, the battalion aid equipment and personnel were landed. On their arrival, stretcher parties (fig. 73),
Figure 71.--Sickbay on Guadalcanal
Figure 72.--First aid for wounded marines at a frontline battle dressing station in the Solomons.
formed largely from rear echelon troops, were dispatched to bring the wounded back to the battalion aid station, where additional lifesaving resuscitative measures could be instituted. Set up at a distance of about 600 yards behind the line, these stations were constantly being moved forward as the assault progressed inland.
Figure 73.--Collecting the wounded.
Soon the collecting party, the advance unit of the medical company, landed with ambulance jeeps (fig. 74) fitted to carry stretchers and semi-ambulatory wounded. These went inland to battalion aid, and evacuated casualties to the beach, where they could be loaded aboard boats (figs. 75, 76), and carried to transports anchored offshore. Because field hospitals early in the Guadalcanal campaign were targets for almost daily aerial bombing and/or artillery fire it became necessary to evacuate patients a distance of some hundreds of miles before operations and other definitive measures could be carried out.
Figure 74.--Continuing first aid during transportation by jeep.
Figure 75.--Carrying wounded aboard a landing boat for further transportation to an APA or hospital ship.
Figure 76.--Transfusion of wounded immediately upon arrival aboard a landing craft.
Figure 77.--Litter carry of wounded on Guadalcanal.
Evacuation and transportation of casualties
The usual method of evacuation of patients was by hand-carried stretchers (fig. 77) along the shortest trail to the rear. Men were then placed in the first available transportation--a jeep, an ammunition truck, or other vehicle--and taken back a distance of from 500 to 1,000 yards to be transferred to waiting ambulances, or else taken directly to a field hospital.
Early in the operation it was found that a litter squad of four men was inadequate to carry a casualty by stretcher over the type of terrain encountered, particularly in the heat of the day. This necessitated the employment of collecting section personnel as litter bearers from the front lines back to the first available transportation. To reduce the distance of hand carry, jeeps were sent to forward areas. Their small surface, low center of gravity, and ability to travel in difficult terrain made them especially valuable for evacuation, for with only slight alterations, the standard jeep could provide transportation for three or four stretcher patients and one ambulatory patient. The medical department did not, at that time, have control over these vehicles and frequently the lack of transportation made long carries by hand necessary.
Early in the campaign, lack of communication facilities and centralized control delayed the evacuation of patients from the beaches. Control boats had been provided for, but no communication existed between them and the beach medical section. Further, although arrangements had been made to station a medical officer in the control boat to direct medical supplies and the flow of casualties to the ships, this plan was for some reason abandoned. Perhaps one of the most unsatisfactory features of the early evacuations by sea was the lack of effective coordination of the evacuating ships. Great inequities occurred in apportioning casualties among the ships, resulting in the overcrowding of the medical facilities of some vessels while other ships were only partially used. Many ships failed to fly the Mike flag to indicate that they could take casualties. Some boats carrying wounded made unnecessary stops en route for other purposes, and frequently coxswains would automatically head for the nearest ship to unload their patients as quickly as possible.
With the establishment of the policy of
Figure 78.--Air transportation of the wounded.
evacuating from the island any patient who would not be fit for duty within 10 days to 2 weeks, evacuation by air as well as by sea was inaugurated. Although a few casualties had been flown out earlier in combat aircraft, the first transport plane, accommodating 18 stretcher cases or 36 ambulatory patients, arrived on 3 September 1942. By 18 September 1942, 147 patients had left Guadalcanal by this means.
Figure 79.--Evacuation of casualties by air.
As the war progressed and lines of communication became longer, air evacuation became of great importance, and both the Army and Navy increased their facilities for air transportation of patients. Further, nurses and corpsmen were specially trained for this duty and medical officers were assigned to screen those patients selected for transportation by air, with a view to assigning priority to those requiring specialized treatment in the fields of neurosurgery, ophthalmology, or plastic surgery, and to excluding patients with abdominal and chest wounds, who generally did not tolerate flight at high altitudes. Air evacuation was a tremendous boost to the morale of all personnel (figs. 78, 79).
During October and November 1942, more patients (2,879 ) were evacuated by air than by sea. Occasionally the transfer of patients from hospital to plane was even made while the field was under artillery fire.
Sanitation on Guadalcanal was a tremendous problem. The enemy, surprised by the well as refuse. This could not be burned because of the danger of inviting aerial attack. Further, all enemy latrines were unfit for use and had to be destroyed and new fly-proof facilities constructed. During the first few weeks, epidemic gastroenteritis occurred. Later, catarrhal fever, dengue, and malaria were the major medical problems. Fungus infection of the foot, groin, and intergluteal fold proved to be of minor importance only.
Malaria did not appear until about 2 weeks after the landing. Suppressive treatment with atabrine was begun on 10 September 1942. Although instructions for its proper use were put out as a division order, it was impossible to get complete cooperation in the distribution and ingestion of this drug even under bivouac conditions. Lack of supervision by the responsible line officers became apparent when hundreds of tablets of atabrine were picked up from the ground by messmen after they had been distributed to personnel. Thus, medical personnel were obliged, in most instances, to stand at mess lines not only to dispense the medication but also to look into the mouths of recipients to see that it was swallowed. Quinine was used as a suppressive drug only in those by whom atabrine was not tolerated.
The lack of mosquito nets during the early phases was a factor in the high incidence of malaria. Although each man had both head and bed nets on embarking, most men lost or discarded their nets during the landing operation. Further, line personnel had little regard for the practical value of anti-mosquito equipment and believed that this equipment was more of a hindrance than a help. Their philosophy was that a man operating in the jungle, through steaming heat and pelting rain, far from any base of supplies and obliged to carry his every need on his back, had neither the time nor the strength to bother about mosquito bars, head nets, and gloves. His attention and energy were directed to the more immediate and urgent matters of killing the enemy and avoiding being killed. It was not appreciated by the line that a man infected with malaria was a casualty as surely as though he had been wounded by enemy action.
It was well known that the natives of the Solomons were reservoirs of malarial infection, and cognizant medical officers strongly opposed the introduction of native labor into the combat area of Guadalcanal. The commanding general recognized the soundness of this advice, but the gravity of the tactical situation required all available troops on the firing line and therefore natives were employed to unload food, ammunition, and gasoline from the ships.
The combination of an infected native population and a suitable mosquito vector spelled infection for the troops. Later Guadalcanal became the staging area for troops moving to the front in other campaigns, and the men carried malaria to other combat zones, where there were no natives. In the 20 weeks following the arrival of the Second Marine Division on New Zealand from Guadalcanal, 9,215 men (63.8 percent of the entire division) had malaria.
The First Marine Division and supporting troops landed at the beginning of the campaign during the dry season. Malaria did not appear until some weeks later, but with rapid progression it threatened to become a critical factor in the success of the operation. The use of atabrine saved the military situation on Guadalcanal.
In table 20, the number of admissions to the sick list in the First Marine Division for malaria is compared with those for other diseases.
TABLE 20.--Number of First Marine Division patients hospitalized for malaria as compared with other diseases--Guadalcanal
Month 1942 Malaria Other diseases August 22 900 September 239 1,724 October 1,941 2,630 November 3,212 2,413 Total 5,414 7,667
The number of men who were infected with malaria on Guadalcanal may never be determined, but it is safe to assume that almost every man who served on the island during the period of 7 August 1942 to 9 February 1943 fell victim to the disease.
For the first 5 weeks after landing, water was obtained from the Lunga River and chlorinated by hand by Medical Department personnel. On 12 August a portable filtration and chlorination plant was set up on the west bank of the Lunga, providing 12,000 gallons daily. As the number of personnel increased and
more water was needed to assure an adequate supply for all hands, the original chlorination unit was replaced by a mobile unit with a daily capacity of 30,000 gallons. Six portable units, each capable of chlorinating 12,000 gallons a day, were set up at different points about the island. Headquarters, Second Marines, also set up a water distilling plant on Tulagi.
The food supply on Guadalcanal, inadequate at first, gradually improved as the operations proceeded, and enemy supplies captured in the first days added significantly to our limited stores. Food that was actually spoiled was surveyed but hunger often tempered the judgment of medical officers. As supplies arrived, the diet became adequate. Lack of equipment for the proper preparation of food was overcome by field and mess cooks, who showed great ingenuity in repairing and utilizing captured equipment. Had the enemy taken the time to destroy his ration dumps and equipment, the outcome of this operation might have been tragic.
On landing, the battalion and regimental medical sections were instructed to carry only combat medical supplies and equipment. In some instances individual groups disregarded this order and overloaded their medical personnel with other equipment. This disregard of a carefully planned operation order often proved to be a serious handicap and contributed to the loss of valuable medical supplies.
The sinking of the Elliott by falling enemy aircraft resulted in the loss of practically all the medical supplies and equipment for E Company, First Medical Battalion. Division of supplies had been so well executed, however, that no shortage resulted. By sharing available supplies and using those captured from the enemy, it was possible to reoutfit this company and enable it to function as a field hospital within 48 hours after landing.
Practically all medical supplies destined for Tulagi, with the exception of the units carried by personnel, were lost. Under the supervision of the senior medical officer, the supplies remaining were pooled and added to those captured from the enemy, so that there was no shortage of any essential material during the first week or 10 days. After this, it was possible to obtain re-supply from the division depots on Guadalcanal. When the naval forces withdrew on the night of 9 August, the physical occupation of Tulagi and Gavutu had been completed and a field hospital was in operation.
With the exception of a few items, medical supplies on Guadalcanal were adequate throughout the campaign. Deficiencies were rapidly corrected by air transport from the base depot at Noumea, New Caledonia. After the landing, this depot furnished all supplies except antimalarial drugs which remained under the control of Malaria Control Unit, South Pacific. The arrival of the Seventh Marines, reinforced, on 19 September, gave the First Division an additional regiment of troops and a completely equipped medical company. In spite of their reception by enemy gunfire and repeated air bombardments on their first night ashore, the medical company was operating a tent hospital just west of the Lunga River within 48 hours after arrival.
By 10 December 1942 there were more than 45,000 military personnel on Guadalcanal. The medical supply officer of the First Division obtained and distributed medical supplies to this entire group, and the First Division medical section was able to fill requisitions despite the needs of many of the new units that had arrived with only a few' days' supply. The Fourth Replacement Battalion was landed without any reserve supplies and the Eighth Regiment arrived with field units only. The Army was supplied from the First Marine Division reserves for the first 4 weeks of their action. Navy construction and aviation units had their own medical sections and the division medical supply officer was required to issue only supplementary supplies to them.
The First Marine Raider Regiment landed on 5 July 1943, about 500 yards up the Pundakona River on a sandy beach lined with mangroves. The battalion medical section, consisting
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1. Evacuation of the seriously wounded over jungle trails frequently resulted in their death.
2. Over such trails at least 6 men per litter were required, and they had to be rested for 15 minutes every 300 to 500 yards.
3. Plasma was required for every litter patient if shock was to be effectively prevented.
4. Morphine made a litter patient out of one who was ambulatory, and therefore had to be used with extreme caution in those with relatively minor wounds.
5. Dressings were not to be changed unless there was evidence of bleeding or infection.
6. First Aid Units Nos. 1 and 3 were found to be impractical. After removal of several battle dressings, the unit became a jumble. At times it was necessary to empty the contents on the ground in order to find a single item. A number of the corpsmen used the regular Navy battle pouches; these had a large flap which permitted rapid location of every item. They were also easier to carry because of the wide shoulder strap.
7. Special lightweight stretchers were provided but these were discarded because of their weight when wet. Stretchers made of lightweight waterproof material, with slots in the sides for poles, and weighing not more than 2 or 3 pounds when wet, were essential for long treks through the jungle.
8. Higgins boats equipped with medical supplies and fitted with brackets for holding stretchers would have been of great value in moving the wounded down rivers to the coast and out to ships. Often the rivers were the only means of transportation in the dense jungle.
Medical personnel were often handicapped in the treatment of casualties. No hospital facilities were available in the New Georgia area until 28 July 1943, 4 weeks after the campaign started, at which time a field hospital was hurriedly established on Kokorana Island. Previously, the nearest hospital was on GuadaIcanal, 200 miles away and 20 hours by boat. No air evacuation was available except by emergency Dumbo (PBY) until August 1943. By that time, however, 90 percent of the casualties had occurred.
First-aid measures carried out in the battalion aid stations included debridement, foreign body removal, and bandaging. Sulfonamides, both locally and by mouth, were used extensively. In the forward areas plaster of paris splints were used a great deal and patients so treated reached the rear area in good condition.
Medical supplies for most of the New Georgia operation were provided by the Army. The original plan called for supplies for a total of 60 days; a 30 days' supply was to be carried by units in the field and another 30 days' supply was to be forwarded as soon as practicable. Sulfonamides, dried blood plasma, intravenous saline and dextrose solutions, battle dressings, morphine syrettes, first-aid packets, plaster, tetanus-toxoid, and other items that were expended rapidly in combat were to be available in amounts approximately 10 times the normal allowances. Individual jungle medical kits were supplied on the basis of one per officer or enlisted medical man and one per four other enlisted men. A 60-day supply of atabrine was kept on hand at all times. Most of the necessary supplies came from the medical supply depot at Guadalcanal.
The Forty-third Division, which had sole responsibility for medical supplies for the entire operation from 30 June to 28 July, experienced great difficulty in carrying out its plans. Before moving to the combat area, the Division secured supplies far in excess of the need, the tendency being to take all they could get. Accordingly, only a small portion of the huge stores accumulated on the beach could be taken along, and in the confusion of embarking for combat many essential items were left behind. The result was that instead of 30 days' medical supplies accompanying the units, it was estimated that only 10 days' supplies were brought along. Further, because containers were not clearly marked to show their contents, medical supplies on being unloaded were frequently hopelessly mingled with those in ration, fuel, and ammunition dumps. In less than 3 days after landing, additional medical supplies were urgently needed.
Some medical units waited until their supplies were exhausted, then radioed to Guadalcanal
for air shipment. This same condition existed to a large extent throughout the campaign, and indicated a need for better medical supply handling.
Flies and mosquitoes were a serious problem throughout the campaign. Further there was a lack of screening, which in the tropics offered more protection to the health of personnel than armor plate. Because of these factors, combat units would often lose .25 to 50 percent of their combat efficiency from disease.
The Twenty-fifth Division showed a much more favorable malaria rate during the New Georgia campaign than it did at Guadalcanal during the noncombat phase. The commanding officer of that Division from the beginning had the advantage of the advice of a group of trained malaria control personnel regarding the pattern of the disease and methods of prevention. Equally important, the command consistently followed the recommendations made by the malaria control officer (fig. 80).
One of the most spectacular achievements of the Malaria Control Unit was their convincing proof that infected native laborers were the major factor in epidemic malaria and that they were responsible for a far greater loss of man-hours among the troops because of malaria than could be gained by their presence as laborers.
Infections and combat fatigue
Fungus infections occurred in about 25 percent of the entire New Georgia Occupation Force. In some units, notably Construction Battalions, the nature of their work was such as to prevent good personal hygiene. In one construction battalion 10 to 15 percent of the command appeared daily at sick call for treatment of fungus infections of the skin, and foot infection was seen in approximately 30 percent. The issue of socks was inadequate, bathing and laundry facilities were insufficient, and bathing at night was prohibited by malarial control directives.
The most serious medical problem in the New Georgia operation was the relatively high incidence of combat fatigue, exhaustion states, and "war-weariness." During the period from 30 June to 30 September, approximately 2,500 men were admitted with the diagnosis of anxiety reaction. Aviation units, which were
Natives under supervision of Malaria Control Unit personnel oiling the pools on Munda, New Georgia.
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Figure 82.--First aid in a foxhole in the jungle at Empress Augusta Bay.
Figure 83.--Transportation of dead and wounded via amphibious tractor from the front lines on Bougainvillea.
Figure 84.--Bomb shelter below sickbay on Bougainvillea.
The Solomons campaign was a joint Army and Navy operation, but on Bougainvillea the Navy Medical Department had the sole responsibility for the evacuation of all casualties from the Island. Under such centralized control, evacuation of casualties was carried out in a most creditable manner with a minimum of delay in transporting the sick and wounded to hospital facilities.
The incidence of disease on Bougainvillea was amazingly low and was the cause of no evacuations, although it was estimated that 50 percent of the troops were seeded with malaria. Mild diarrhea and dysentery were experienced by the majority of the personnel but the use of sulfonamides reduced the duration and severity of the attacks.
The diseases most prevalent in the First Marine Amphibious Corps were:
1 Among men previously stationed in Samoa.
Admissions Malaria 296 Dysentery 103 Filariasis 192 Psychoneurosis 140 Combat fatigue 749
In contrast to this, the morbidity rate among the 30,000 Japanese on the Islands was terrific; 13,000 died. Of these, 3,000 were killed in action and the rest died because of illness, predominantly malaria, tetanus, beriberi, and dysentery.
The low morbidity rate among American troops, only about 1 percent, was attributable to the following sanitary control measures (figs. 85 and 86).
- Administration of 100 mg. of atabrine to all troops.
- Lectures, pamphlets, and motion pictures used in indoctrinating personnel in preventive measures.
- Use of pyrethrum spray and mosquito-proof hammocks.
- Effective action of Malaria Control Unit personnel.
Figure 85.--Malaria Control Unit in action in the jungle.
Figure 86.--Mobile Malaria Control Unit in action.
A large number of men were evacuated from Espiritu Santo because of asthma and allied conditions caused by pollens and molds. Some of the fungi had a predilection for the stuffing of pillows and mattresses.
A dengue-like disease existed in epidemic form on the island. In some organizations it affected about 12 percent of the men.
In addition to the swamps and stagnant pools, there were numerous piles of tin cans, garbage, coconut husks and fronds, and other waste material, which served as breeding places for flies and mosquitoes. As a result, approximately 80,000 sick days occurred among Army and Navy personnel in 3 months, despite the efforts of the Sanitation and Malaria Control Units (figs. 87 and 88).
Figure 87.--Supply yard of Malaria Control Unit on Espiritu Santo.
Figure 88.--Malaria control on Espiritu Santo.
The natives were poorly nourished. Tuberculosis, yaws, malaria, filariasis, and intestinal parasites were common, and leprosy was seen occasionally. Physical examinations of a group of candidates for employment showed that 22 percent had filariasis and 18.5 percent showed positive smears for malaria. The natives from a nearby island had a filariasis rate of 51.5 percent.
On Espiritu Santo, naval medical officers organized the Espiritu Santo Medical Society, which was addressed by medical officers as well as local civilian physicians. Among the interesting lectures was that of Doctor Astaire, a Fijian physician who had graduated from the Fiji Medical School. He stated that he had never seen a case of measles or tetanus among the natives and only a few of cholecystitis, appendicitis, and leprosy. He believed that malaria, pneumonia, and mumps, of which there had been an epidemic two years previously, had been introduced by the white man.
During the early phases of the assault on Saipan (June 1944), the scene of sand, blood, and wreckage was intensified by an atmosphere of extreme confusion. Seabee, Marine, and naval shore party detachments had dug into foxholes over the entire area above the high watermark. Shelling of the beaches was continuous, and the nerves of both officers and men were strained to the breaking point. To add grimness to the environment, the dead, both Japanese and American, had been collected and laid out to await trucks for transportation to a burial ground.
Into this melee, medical units were landed in LVT's and LCT's (fig. 89). The first groups to establish medical order were the medical sections of the beach parties. Composed of 1 medical officer and 8 hospital corpsmen from each troop carrier, they constituted the link between medical organizations afloat and ashore. Working in highly exposed positions for as long as 48 hours at a time without rest and subjected to the added hazard of strafing Japanese planes, they gave emergency medical treatment and set up casualty evacuation stations in the sand. During the long hours when the invasion forces were confined to the beaches, battalion aid stations acted as forward emergency and evacuation centers on the beaches. From these stations the company aid men went out to administer first aid, exposing themselves to enemy fire in order to reach the wounded. Their bravery was reflected in the heavy casualties among Hospital Corps personnel. Their sacrifices were not in vain, however, for the most important factor in saving of lives had been shown to be the early transfusion of plasma or whole blood (fig. 90) and the removal of wounded from the beaches to ships where lifesaving resuscitative measures could be promptly instituted. In the Fourth Marine Division, 161 medical officers and hospital corpsmen became battle casualties because they were unable to utilize protection or seek cover from enemy fire. Casualties in personnel during the first 5 days of the operation were enormous. One shore party evacuation station treated and evacuated 1,009 casualties during the period from D-Day to D-Day plus 3 under the most difficult conditions. Jeep ambulances with their loads of wounded were often hit by artillery fire; the landing of ammunition and gasoline near casualty evacuation centers on beaches that were subjected to continuous shelling did not lessen the difficulties of rendering first aid.
Medical supplies for this campaign were packaged in blocks, each of which contained a 30-day supply for 3,000 men. Items such as the Wangensteen suction apparatus and a sufficient number of intestinal clamps, airways, and oxygen apparatus were lacking.
Shortages of litters, tetanus antitoxin, blankets, blackout tents, and penicillin developed. Always in demand, litters were frequently not returned from ships, while breakage and loss in the burial of dead added to the shortage. Fifty more litters per troop transport, where landing force evacuation lines were long and casualties heavy, were recommended by the senior medical officer.
Figure 89.--First-aid station being set up on the beach at Saipan.
Figure 90.--Blood and plasma transfusion on the beach at Saipan.
Figure 91.--Transporting the wounded in a rubber boat.
The presence of coral reefs and the loss of small boats during the assault made evacuation of casualties difficult. Unfortunately, the most effective evacuation ship, the LCVP, could not be beached because of the coral reef, but the DUKW was useful in the evacuation of casualties over the reefs. Rubber boats were also utilized to transport the injured (fig. 91).
As the battle for Saipan progressed, the lines of communication became longer and the need for vehicles increased. Not enough jeep ambulances had been provided‹only one was available for each medical battalion. When casualties were heavy, other jeeps were requisitioned, but frequently the requested jeeps were lost on the way.
Another important problem in evacuation during the early phase of the invasion was
Figure 92.--Second Marine Division Hospital in a captured Jap radio station.
that of segregation of slightly wounded patients from the more seriously wounded. Sorting was extremely difficult on the beaches, where hundreds of wounded arrived at one time and mud vied with enemy fire to frustrate attempts at first aid and casualty evacuation.
Field hospital facilities
Hospital facilities at Saipan functioned very well despite the heavy admission rate, but a number of difficulties were noted in the field. No provision had been made for a movable lightproof shelter in which the wounded could receive adequate treatment on the beach during the night. The maintenance of a strict blackout was essential, and it was almost impossible to diagnose a surgical lesion or treat a wounded man under the pale blue gleam of a flashlight. Each corps hospital, however, had portable operating rooms that were easily blacked out and were of immense value. One medical company took over a small field hospital captured at Charon Kanoa, which in the early days of the operation was the only facility for surgery.
The best hospital facilities were those of the Second Marine Division. A former Japanese radio building (fig. 92), constructed of steel and concrete and surrounded by 10-foot revetments was rapidly cleared of rubble and damaged machinery with the assistance of a company of Seabees, and a hospital of 1,000 beds for the seriously wounded set up. Patients
Figure 93.--Emergency surgery in a hospital on Saipan.
with minor wounds were housed in tents. Eight operating tables were manned by specialized surgical teams for orthopedic, chest, abdominal, and head and eye injuries. Eleven other operating tables were available for use in treating shock, giving transfusions, and caring for minor injuries. A major factor in the excellent functioning of this hospital was the strong centralized organization of the medical battalion (figs. 93 and 94).
Disease and combat fatigue
Figure 94.--Modern diagnostic procedures on a battlefield on Saipan.
Diseases and combat fatigue accounted for about one-third of the admissions. In the Fourth Marine Division, there were 409 patients admitted for dengue fever, 680 for dysentery, 26 for fungus infection, 414 for combat fatigue, and 169 for psychoneurosis.
The high incidence of neuropsychiatric illness appeared to be attributable to a number of factors, among which were: (a) Leaders of small units, on the whole, did not demonstrate the inherent qualities of leadership. Junior and noncommissioned officers were often the first to "break," and a needless sacrifice of manpower resulted when others became panic-stricken at the realization that their leaders were no longer able to direct them. (b) The lack of proper orientation was probably a contributing factor. The fighting man wished to know what was going on, what was expected of him, and what he could expect. He also had to have a definite objective. without proper orientation he was prone to absorb wild rumors and loose talk, and was thus subjected to constant mental stress. (c) It was likely that a loss of physical fitness contributed to the high incidence of anxiety reactions.
About 50 percent of those patients with a diagnosis of neurosis should have been diagnosed as combat fatigue. Another 20 percent were borderline cases in which fatigue and exhaustion contributed to the symptoms. Three or four days rest, a bath, and nourishing food resulted in complete recovery in from 75 to 80 percent of these patients.
Burial of the dead
One of the meat problems confronting the Medical Department was the speedy and
Figure 95.--U S. Marines pay final tribute to their buddies in the Solomons.
effective burial of the dead and the disposal of the decomposing bodies in block houses and bomb shelters. On Saipan thousands of United States and enemy dead lay on the beaches and the rugged inland terrain. Prior to the landing, careful plans were made for burial of the dead and details were trained and equipped for this work (figs. 95 and 96). Because of the intensity of the battle, however, there was often a delay of several days before burial or disposal of the large numbers of enemy dead could be started and the amount of sodium arsenite and oil for spraying the remains was frequently insufficient. Other factors that impeded the burial parties were: (a) Absence of identification tags with consequent delay in identification; ( b) shortage of litters on which to carry the dead; and (c) lack of adequate communication facilities bet ween burial parties and the Division Burial Officer.
Figure 96.--Bodies of Marines of the Third Division awaiting burial.
During the first week on Saipan, there were ample facilities in AH's and APA's for casualty evacuation. On D-day-plus-n, however, the APA's were withdrawn and there were then insufficient personnel and hospital facilities for the stream of wounded, averaging 500 per day.
Air evacuation was begun on D-day-plus-9 860 patients were evacuated, but because there were no flight surgeons to screen the patients and no medical attendants to accompany them, some died en route. At times, men wounded in combat who had been without food for days were evacuated without being fed, Further, on arrival at Eniwetok or Kwajalein, inadequate preparations had been made to care for these air evacuees.
Medical planning for the Iwo Jima campaign began in October 1944. In preparation for the operations, Medical Department representatives of the Navy, Marine Corps, and amphibious units that were to participate, held numerous conferences to discuss the tactical and logistic problems. The nature of the terrain on Iwo Jima was such that there could be no tactical surprise; the Marines had to land on the southeastern beaches, and make a frontal assault. Under the circumstances, heavy casualties were anticipated. For purposes of computed anticipated casualties, it was assumed that the period of active combat, from the beachhead landings to seizure of the objective, would be 14 days; that 5 percent of the entire attacking force would become casualties on the first and second days, 3 percent on the third and fourth days, and 1.5 percent on each of the remaining 10 days.
Casualty estimates, arrangements for hospital beds, and assignment of hospital and other ships for the evacuation of the injured from combat area were responsibilities of the Medical Logistic Section of CinCPac-CinCPOA.
On the basis of the Army Field Medical Manual, as modified by recent experience and the most reliable evaluation of enemy potential to be gained by aerial observation and combined intelligence, it was estimated that our losses would approximate 20 percent of the forces engaged. Of these 25 percent would be killed in action, 25 percent would be returned to duty locally, and 50 percent would be evacuated. Taking into consideration civilian casualties and enemy wounded to whom we were likely to be required to furnish medical care, definite plans were formulated with regard to evacuation policy, the number of beds and ships required for hospitalization and evacuation, and the volume of medical supplies to be ordered.
Each medical company and corps medical battalion had equipment for a 144-bed hospital, twice the number allotted prior to the Marianas campaign, making available approximately 3,592 beds. It was also planned by the Eight Field Depot, scheduled to arrive about D-day-plus-10, to add to their stock a sufficient amount of cots, tents, blankets, and mess gear for another 1,500 beds.
The chain of evacuation of casualties included 4 LST(H)'s or evacuation control LST's, specially equipped with medical personnel] and supplies and designated to make preliminary "screening" examinations of casualties and distribute them equally among the transports and hospital ships. One LST(H) was available for each of the invasion beaches, making two for each Marine division. All ships, LVT or DUKW, that evacuated wounded from beaches were to proceed to their respective evacuation control LST(H). Those casualties unable to endure the trip to a transport or hospital ship were to be transferred immediately to an LST(H) for treatment, while less seriously wounded patients were unloaded onto a barge alongside the LST(H) and then transferred to LCVP's for further transfer to transport or hospital ship.
Aboard each LST(H) were 4 surgeons and 27 corpsmen, increased on arrival at the objective by the transfer of one beach party medical section (1 medical officer and 8 corpsmen)
from an APA, giving each LST(H) 5 surgeons and 35 corpsmen. At all times these beach party medical sections were on call by the Transport Squadron Commander.
Two hospital ships and one APH were designated to evacuate patients to Saipan, where 1,500 beds were available, and to Guam, where there were 3,500 beds. Air evacuation of casualties to the Marianas was to begin as soon as field facilities would permit. Experience gained in the Marianas campaign had emphasized the necessity of having the casualties screened by a qualified flight surgeon to insure proper selection of patients for evacuation by air. Medical personnel and adequate medical supplies and equipment were to be aboard each plane.
SanitationBecause there was a possibility of epidemic typhus, scrub typhus, cholera, and plague at the objective, all personnel were inoculated against these diseases, in addition to the usual immunizations. The clothing of personnel of the landing force was impregnated with dimethylphthalate and DDT powder. As a means of controlling flies, which had been such a nuisance and a hazard to health in previous operations, the area was sprayed with DDT by carrier-borne aircraft and later, by land-based planes. A medical officer familiar with the procedure was detailed aboard a carrier as technical advisor, and the malaria and epidemic control team of the Fourth Marine division was designated to furnish the technical ground supervision.
SuppliesThe medical supply plan for the operation included an initial 30-day allowance carried with the assault forces, plus medical and sanitary supplies for 1,500 civilians, as well as the provision for "block" shipments which were to arrive at regular intervals. Approximately 50 percent of the supplies of the assault forces and all of the "block" shipments were to be palletized (packaged) and waterproofed. Plans also provided for adequate emergency resupply that could be sent by air if necessary.
Experience gained in previous operations had shown the great need for a blood bank. With the establishment of Whole Blood Distribution Center No. 1 at Guam, it became feasible for the first time to set up a blood center at the target area and plans were made accordingly. Up to this time whole blood had been obtained from hospital corpsmen, Marines, and occasionally from patients. LST(H) 929 was designated to carry the whole blood bank for distribution to the forces both afloat and ashore. When the military situation permitted, the blood bank was to be landed and
Figure 97.--One of the most important phases of military medicine was the rapid distribution of whole blood to every fighting front.
established ashore. All ships were ordered to receive whole blood in the quantities shown: Each APA, 16 flasks; LSV Ozark, 500 flasks; LST(H) 929, 1,100 flasks (whole blood bank); each AH, 812 flasks; and LST(H)'s 930, 921, and 1033, 16 flasks.
Additional whole blood was to be furnished by incoming AH's, or was to be flown in from Guam when air facilities were organized.
EmbarkationPrior to the operations, medical battalions were instructed to carry an additional 1,500 blankets, 5 million units of gas gangrene antitoxin, and 50 million units of penicillin. An inspection was made of the jungle kits and identification tags of each man in the division of all Medical Department supplies and equipment. All shortages were corrected. Medical personnel were given additional instructions in first aid, in the keeping of medical records, in the automatic exchange of litters, and in the handling of casualties in and out of boats. At the close of the training period, a practice landing was made to give the medical personnel an idea of what to expect when landing on the target.
A serious problem was the fact that surgeons who were to be called upon to perform operations during the battle had had little opportunity to perform any surgery during the 6-month period prior to the campaign. To correct this situation, a division hospital was operated during the preparatory period.
The medical personnel were embarked with the regimental combat team, as designated by the unit medical officers. When practicable, hospital sections of the medical companies were embarked on ships with the largest bed capacity in order to facilitate the care of casualties during the initial stages of the battle. Basic vehicles were combat-loaded with essential items of equipment and supplies to supplement those designated as "hand carry." Seabags were packed with battle dressings, plasma, serum albumin, and other items essential during the early stages of the assault. These were to be carried ashore by the assault medical company. Two and one-half ton 6 by 6 trucks, for the first time part of the medical
Figure 98.--Landing medical supplies on Blue Beach at Iwo Jima.
battalion, were combat-loaded with equipment and supplies necessary to establish surgical units ashore.
Landing of medical unitsThe Fourth and Fifth Marine Divisions, supported by the Fifth Fleet, began landing on the southeast shore of Iwo Jima at 9000, 19 February 1945. The Third Marine Division, which had been held in reserve, was landed on D-plus-2. Company aid men were debarked with platoons, battalion aid station personnel with battalion command posts, and regimental aid station personnel with the regimental command posts. Shore party medical personnel in support of battalion landing teams were debarked prior to H-hour. Four medical shore party evacuation teams were landed between H-plus-30 and H-plus-120 minutes (0930 to 1100). Other division and corps medical units were landed as rapidly as the military situation would permit. In the early phase of the assault, aid-station personnel were separated into small groups and worked in shell craters or foxholes in the sand.
Figure 99.--Administering blood plasma in a foxhole on the invasion beach at Iwo Jima.
The grueling experience of all battalion corpsmen and medical officers was typified by the following account:
"Landing with the troops, immediately following the assault group, the chief pharmacist's mate was shot in the jaw as he stopped out of the landing boat. The medical party, carrying seabags filled with medical supplies, pushed inland some 75 yards and picked a spot for their station in an antitank ditch. They left some of the bags on the beach on that first trip, and when they returned to get them, many of the bags had already been ripped by shell bursts. Boxes of valuable plasma were smashed, but the worst blow came when the boat carrying all the litters was sunk on the way in.
Wounded men were lying all around. It was impossible to stand erect on the beach, and the corpsmen crawled from casualty to casualty to bandage wounds and administer morphine and plasma. Within an hour after the aid station had been set up, a shell exploded on one side and fragments injured several of the men. The medical officer, realizing that the revetment, though appearing to offer good protection for an aid station, was a logical target for Jap guns, ordered the men to pack up equipment, and to move to a large bomb crater, where the medical personnel continued their work."
Figure 100.--First aid on the invasion beach at Iwo Jima.
In the fury of the battle there were many dramatic instances of rescue and treatment. A Marine who had been blinded and had both hands blown off, was groping his way toward the beach when a corpsman saw him and ran a gauntlet of fire to get him to safety. A corpsman in battle for the first time sewed up four chest wounds under fire and undoubtedly helped save the lives of the four injured men. A corpsman crawled to the aid of Captain Dwayne E. "Bobo" Mears, who had been shot through the neck and was in shock from the loss of blood. He buried the lower part of the Captain's body in the sand so that he would offer a smaller target for the Jap riflemen. It helped, but the captain died later aboard a hospital ship.
Care and evacuation of casualtiesThe care and evacuation of casualties during the Iwo Jima campaign was handled better than in any previous operation in the Central Pacific area. Notwithstanding the extreme bitterness of the combat and a casualty rate in excess of 1,000 per day during the first 21 days, evacuation functioned as a well-integrated and coordinated operation and the wounded received the best medical care commensurate with the military situation. By
Figure 101.--First aid and physical assistance to the wounded on Iwo Jima.
D-day-plus-33, a total of 17,677 casualties had been treated and evacuated.
Casualties were assisted in walking down from the firing line, or were brought by hand-carry, jeep, ambulance, half-track, or weapon carrier. Because of the rugged terrain, hand-carry frequently had to be employed to move the wounded to the beachhead over the rough lava cliffs and sharp-edged blocks of stone and lava. While the beachhead was being secured, casualties were evacuated from battalion aid stations directly to the beach, where they were turned over to shore and beach party installations set up in shell holes or in small pits dug in the volcanic sand. Plasma and other first-aid measures were administered while bullets sang overhead and mortar shells burst in close proximity.
After the troops were well established on the beach, the distance from the battalion and regimental aid stations to the beach was so short that casualties were evacuated by sea. When division and corps hospital installations were established on D-day-plus-9, evacuation was from battalion and regimental aid stations to the division hospital and from there to the beach or to the corps hospitals. Casualties were so high and space to set up hospitals was so limited that many of the hospital sections of the medical companies supporting the regimental combat teams that were landed early, remained on the beach to assist in the shore party evacuation stations until division and corps hospital installations were functioning. Initial treatment of casualties in regimental and battalion aid stations was so efficient that many casualties who would otherwise have died reached the shore evacuation stations and corps hospitals in excellent condition. Serum albumin was exceptionally well suited for use by frontline medical units, because of the ease of administration, small bulk, and the excellent
Figure 102.--A wounded marine brought to the beach by jeep ambulance from the fighting front on Iwo Jima. Fifteen minutes later he was on his way to a hospital ship off the shore of the island.
Figure 103.--Marine stretcher bearers carrying the wounded into a foxhole for first aid.
Figure 104.--Corpsmen bringing the wounded from the front lines to evacuation ships on the beach.
clinical response. Its therapeutic effect was equal to that of plasma.
Casualties in Hospital Corps personnel were very high. In moving about to care for the wounded, corpsmen were subject to intense enemy fire and frequently were shot down alongside their patients. Although each division was assigned approximately 5 percent more corpsmen than were provided for by Tables of Organization, this was often insufficient. In the Fourth Marine Division the casualty rate among corpsmen was 38 percent. Often, because of urgent need for replacements, personnel were obtained from medical companies. In one division this policy was carried to such an extreme that on D-day-plus-8 one medical company had been reduced to a point where it was almost inoperative. This practice was contrary to established doctrine and in some instances left in sufficient personnel in other areas to render proper care to the wounded.
Close liaison between the attack force surgeon and the landing force surgeon resulted in
a well-coordinated chain of evacuation from shore to ship. On D-day, 19 February 1945, 30 APA's, 12 AKA's, LSV Ozark, and 4 LST(H)'s were available for the evacuation of casualties. The general plan for sea evacuation provided that an LST(H) be stationed 500 to 2,000 yards off each of the 4 beaches and that all casualties be evacuated to one of these ships.
During the early phase of the assault, prior to the establishment of fully functioning shore evacuation stations, the primary duty of LST(H)'s, was to render emergency treatment and receive casualties at night. In previous operations, casualties had been known to ride all night in open boats before finding a ship to receive them. After shore evacuation stations were established, the main purpose of the LST(H) was to effect an equitable distribution of casualties to APA's and AH's.
Figure 105.--Surgical care in an abandoned Jap dugout.
The work performed by LST(H)'s can be appreciated by the following: LST(H) 931 was stationed approximately 400 yards offshore. A pontoon barge was tied alongside for receiving casualties. A Jacob's ladder led from the barge to the main deck of the LST. On the barge was a small covered area that served as a supply shack. A number of litter bearers, two medical officers, and a talker to communicate with the control tower of the ship were stationed on the barge. LCVP's, LCM's, and Amtracs bearing casualties, temporarily tied up alongside the barge while the medical officer on duty went aboard to examine the wounded. Casualties requiring immediate attention were taken aboard the barge, where emergency treatment was carried out. To load patients in need of immediate surgery aboard the LST(H) a metal frame accommodating 3 stretchers was lowered to the barge by a tractor crane mounted on the main deck, just aft of the cargo hatch. The patients where then brought up and lowered directly into the tank well through the cargo hatch, which was always open and was outlined by luminous painted lines to prevent accidents during blackouts.
About 220 patients could be cared for on the tank deck and another 150 to 175 in the troop; quarters. Patients requiring an operation were moved from the tank deck through the open hatch forward to the operating room. The normal complement of an LST(H) was 4 medical officers and 26 corpsmen, but often this was insufficient. The use of LST(H)'s as evacuation control ships although representing an important step forward in the chain of evacuation, left much to be desired. Use for the transportation of LVT's to the target, they were converted for casualty handling only after these had been discharged, and as a result, were often covered with dirt and grease when turned over to the medical department. The illumination on the tank deck was usually very poor and the medical facilities were unsatisfactory. The number of medical personnel assigned was insufficient to care for the large number of casualties, even when the staff worked day and night. On D-day, between 0900 and 1530, a total of 2,280 casualties were evacuated by LST(H)--an average of slightly less than 6 casualties per minute.
Figure 106.--Administering intravenous fluids in an abandoned Jap dugout.
The organization of LST(H) casualty evacuation control ships was as follows:
EVACUATION CONTROL LST's FUNCTION
1. The primary functions of these ships are: (a) To control evacuation of casualties to available ships, maintaining adequate distribution for proper early treatment of casualties. (b) To act as a transfer station for transfer of casualties from LVT's and DUKW's to LCVP's where reefs intervene between ships and beach, in order to release LVT's and DUKW's for military operations. (c) For emergency evacuation from beaches when other ships are not available. (d) To expedite speedy resupply of strategic medical supplies to beaches and landing force. (e) To maintain an accurate record of evacuation, for Force and Corps Commands. (f) To render shock therapy to those casualties whose condition is so critical as to prevent further progress in the chain of evacuation.
2. Each squadron of transports carrying assault troops will be provided with two evacuation control LST's. These ships are stationed 1,200 yards ahead of LST formation and 300 yards seaward of the TransDiv Control vessel centered off the colored beach it is serving and directly ahead of the transport division to which it evacuates. Each evacuation control ship
is provided with a 3 by 12 pontoon barge alongside as a casualty transfer platform and unloading station for those casualties to be retained aboard the LST for treatment until their condition warrants transfer.
3. The TransDiv Commander will keep each evacuation control LST, serving his beaches, informed of ships available for casualty reception, notifying them 1 hour in advance of those ships departing from transport area, insofar as practicable.
4. Two LCVP's equipped as ambulance boats will be sent from each assault TransDiv to its casualty evacuation control LST as soon as assault troops are landed. These boats together with the two LCVP's on each evacuation control LST will serve as ambulance boats. Ambulance boats will fly a VICTOR flag at all times. One ambulance boat shall be sent to each beach area after assault troops have landed to stand by to land and receive casualties when directed by the Beachmaster. Litter and splint exchange should be made at each ship to which casualties are evacuated. All other resupply items for these boats will be made at the evacuation control ship except on request of Evacuation Control Officer.
These boats shall be equipped with the following prior to leaving the mother ship:
Tarpaulin 1 Life jackets 17 Water canteens 8 Struts for litter loading --- Hospital corpsman with first-aid kit --- Bandages, 3-inch 36 Bandages, 2-inch 36 Plasma, units 10 Morphine syrettes 20 Cotton rolls 6 Sulfadiazine, bottles 2 Flashlight 1 Litter units 10 Tongue blades, box 1 Scratch pad and pencil 1
5. The evacuation control LST duty officer will keep an up-to-date record of location of all ships assigned him for casualty reception. He will direct coxswains of ambulance boats to ships assigned by the Evacuation Control Officer. He will also direct coxswains of ambulance boats to exact location on the beach to deliver medical supplies and receive casualties as shown by beach markers (VICTOR flag).
6. Each evacuation control LST is recognizable by a large white "H" painted amidships on both sides. They are located 300 yards directly seaward of their corresponding TransDiv control vessels. They fly an oversize VICTOR flag and display a GREEN light at night. They have pontoon barges alongside and stand out 1,200 yards ahead of the LST formation.
7. Four surgeons and twenty-seven corpsmen are attached to each evacuation control LST. The senior surgeon is designated as the Evacuation Control Officer and is responsible for proper distribution of casualties to available ships assigned by the TransDiv commander. Two-section 4-hour watches will be maintained, beginning at 0800 on D-day, until ships are relieved by orders from Attack Force Commander, relieving at 0800, 1200, 1600, 2000, 2400, and 0400. The appended watch bill will serve as a guide giving titles, number of personnel, and times of watches.
8. Evacuation Control LST's shall make a dispatch report to Squadron Commander and Attack Force Commander at 0900 and 1700 daily, giving a report of casualties on board at that time, using the following form:
(Example: Bed 65 X NE 20 Total 150 X Dead 7 X 0900)
9. Copies of Form A (copy appended) giving date, name, rate, serial number, and disposition of each casualty evacuated will be sent to Landing Force Commander (Corps Hdqts.).
The casualty evacuation officer on the casualty evacuation control LST(H) endeavored to distribute the casualties among the different ships so that no one transport would be overburdened at any time. Unfortunately, this did not always work out. Sometimes the coxswain failed to heed the directions given him or misunderstood the, and sometimes when he arrived at a designated location the ships were not there. Some casualties spent as many as 8 hours in small craft before being taken aboard a ship.
The APA, although not designed for casualty handling, or properly equipped for this purpose, often bore the brunt of the initial casualty load from the beach assault. In the Iwo Jima operation, they received 4,956 wounded by 1745 of D-day-plus-2. The experience of APA 118 was typical of the transports in casualty evacuation. APA 118 dropped anchor about 20,000 yards offshore on D-day and unloaded its troops on schedule. It then moved in to about 4,000 yards from shore and began discharging cargo and supplies. At 1400 on D-Day casualties were received aboard, the majority of whom were severely injured and required emergency treatment. During the next few days, casualties were loaded aboard the ship in groups of from 8 to 75. Throughout much of this period, the medical staff worked day and night operating on and caring for the wounded. As a general rule the ship withdrew out to sea at night, but on two occasions she
anchored about a thousand yards offshore and obtained protection by a smoke screen.
The large number of wounded at Iwo Jima emphasized the need for hospital ships, two of which were originally scheduled for the operation. Commencing on D-day-plus-1, these ships, the Samaritan (AH 10) and the Solace (AH 5), augmented by the Pinkney (APH 2), and Bountiful (AH 9), and the reserve hospital ship, Ozark (LSV 2), inaugurated a series of shuttle trips from Iwo Jima to Saipan and Guam. By 21 March (D-day-plus-30) a total of 4,879 casualties had been evacuated on these ships.
The only function of the hospital ships was the transportation and care of the sick and wounded, and if some of them could have remained in the area during the early phase of the operation to care for the slightly wounded, many casualties could have been returned to duty in a few days. The loss of manpower occasioned by their departure aboard hospital ships and transports to Saipan or Guam, would have been obviated.
Some hospital ships lacked proper equipment for taking patients aboard. These ships received many boatloads of injured men from LCVP's, but some had no Welin davits with which to lift the boats to the ship's deck level, and the transfer of patients had to be made over the ship's gangway. This slowed the rate of transfer of patients and as a result, boats loaded with wounded gathered off the gangways of the hospital ships and were obliged to stand for hours in the hot sun with their patients unprotected.
Figure 107.--Hoisting a patient aboard the U.S.S. Solace.
Figure 108.--Transferring patients from an LCV to Hospital Ship H.M.S. Lancaster.
Air evacuation from Iwo Jima to the Marianas, which supplemented evacuation by hospital ships and transports, was initiated on D-day-plus-12 and was originally planned for 350 patients per week. The very high casualty rate, however, together with the shortage of ships for transporting casualties, necessitated revision and as many as 200 a day were evacuated by air. There were times when, because of unfavorable sea conditions or lack of facilities afloat, air evacuation was the only means of getting casualties off the island. With the first casualty evacuation planes, there was an air evacuation unit, consisting of tow flight surgeons and several hospital corpsmen who screened all casualties to be evacuated by air. By 21 March (D-day-plus-30), a total of 2,393 patients had been evacuated by air. The casualty evacuation planes also brought in whole blood from Guam.
The weakness of a fixed policy for evacuation was again demonstrated at Iwo Jima where a "15-day evacuation" policy had been established. In the early stages of the invasion, there was no place to segregate casualties who would be ready for duty in 15 days or less, and when hundreds of casualties were being evacuated over beaches that were under heavy enemy fire and clogged with vehicles and equipment of all kinds, sorting was not feasible. Time, space, and the combat situation did not permit convalescent camps to be established and sushi beds as were available ashore were needed for those seriously wounded.
There were a number of ways in which the effectiveness of the chain of evacuation might have been improved. The communication system could have been more efficient during the first days. Casualty evacuation officers aboard the LST(H) often did not receive reports as to which transports were available for loading casualties, with the result that some ships received more than their share while others received very few. Ambulance craft experienced great difficulty in finding the proper vessels. In many cases, the APA stood well offshore,
and during rainy, rough, or foggy weather they were difficult to contact. It sometimes occurred that by the time the ambulance craft had reached the approximate station where the transport was supposed to be anchored the ship had already moved.
Despite difficulties such as these, the chain of evacuation operated more smoothly than in any previous action in the Central Pacific. The use of LST(H)'s as casualty evacuation ships represented a most important factor in medical care and unquestionably saved many lives.
HospitalizationThe establishment of hospital facilities on Iwo Jima was delayed because of limited space, difficult beach conditions which interfered with the landing of supplies and equipment, and the constant hazard of enemy artillery and sniper fire. As a result, until D-day-plus-9 nearly all hospitalization was provided by the units afloat. During the early days of the operation, effective hospitalization was provided by four LST(H)'s.
Medical Battalion, Company A, landed on D-day-plus-6, just south of Green Beach, and began to set up an operating room and hospital facilities with provision for expansion. Within 8 hours a hospital unit with 110 beds was established and began to receive casualties. During the next few days, hospital facilities were expanded.
A neurosurgeon, an ophthalmologist, and a neuropsychiatrist were included in the staff of the corps medical battalion and the services of these specialists were made available for all troops engaged in the Iwo Jima operation.
A detailed account of the activities of the Fourth Marine Division Hospital will illustrate the work of hospital units at Iwo Jima. On D-day-plus-6 the division surgeon and commanding officer of the medical battalion located a site for the Fourth Marine Division Hospital, near a good road leading to the front lines and to the evacuation beaches. The Fourth Engineer Battalion bulldozed 5 long trenches, providing space for batteries of 6 storage tents each, 1 battery of 3 storage tents, and the division medical dump. On either side of the road were uncovered water reservoirs. Two of these were used as operating rooms, one as a receiving room, and the other two for Headquarters and Staff Medical Battalion and for the malaria and epidemiology control team. Many times while mortar shells were landing nearby, surgical operations were going on. The engineers had constructed an entrance ramp and erected a wooden framework over each reservoir, with a tarpaulin stretched over the framework. The hospital was receiving casualties on D-day-plus-9, and 6 operating rooms
Figure 109.--The U.S.S. Samaritan anchored off Okinawa. Transferring a patient from a small boat via an elevator rigged over the side of the ship.
Figure 110.--Refrigerator units for the storage of blood plasma and vaccine sera.
and 350 beds were available on D-day-plus-15. It was staffed by 3 medical companies and surgical detachments from 2 companies.
A division central medical supply room was established in the hospital area and the surgical instruments of all five medical companies were pooled, permitting simultaneous sterilization of many sets of instruments, thereby materially lessening the delay between operations.
SanitationBecause of the porosity of the soil, sanitation presented no major problem. Sunken barrels with prefabricated tops served as heads. The water supply was adequate, being obtained from water trailers.
No outbreaks of intestinal or communicable disease occurred and there were no epidemics. Neither the interrogation of prisoners nor the study and laboratory findings of malaria and epidemic control teams revealed evidence of malaria, dengue, filariasis, typhus fever, cholera, plague, yellow fever, smallpox, diphtheria, or venereal diseases in serious proportions.
Supplies and equipmentOne of the innovations was the mobile blood bank facility. The main items of equipment were two 150-cubic-foot refrigerators, one flake ice machine, three electric generators, one 21/2-ton truck, and one 1/4-ton truck. The initial supply of whole blood was received aboard on 14 February at the Saipan staging area. Guam furnished 1,456 units, and ships departing from the area furnished an additional 406 units to the bank. Beginning on D-day, the facility furnished whole blood on request to all units ashore or afloat. At all times throughout the operation, the supply of whole blood was ample. This was undoubtedly a material factor in saving many lives.
The field medical unit was of high quality. Oxygen units were extremely valuable because of the high incidence of penetrating chest wounds. Improvised portable fracture tables were used to great advantage. Portable plywood operating rooms proved extremely useful; when water seeped into some of the medical installations at high tide, the slightly elevated deck in these huts kept them dry.
The carbine which was issued to Medical Department personnel in the field for defense purposes was not satisfactory. It was impossible to treat a patient and handle a carbine at the same time; .45-caliber pistols were better suited for this purpose.
The jeep ambulance proved to be the most valuable single piece of motor transport in the medical organization. The Army's 3/4-ton ambulance, used by the 38th Field Hospital,
Figure 111.--Portable electric refrigerator for storage of biological, blood, and plasma.
demonstrated its superiority over the Navy's 1/2-ton ambulance for casualty evacuation. The Army ambulance could go anywhere that the Navy ambulance could go and transported the casualties in much greater comfort. the Weasels were most valuable in the early stages of the operation; they were among the few vehicles able to get off the road and negotiate the soft volcanic sand. Many DUKW's were also used in the evacuation of casualties, but not enough were available in the early period of the campaign. They were capable of negotiating heavy surf without difficulty and were more manageable alongside a ship than were the amphibious tractors. for days at a time, when no small boats were able to get through the surf, nearly all casualties had to be removed by means of amphibious vehicles, for the most part DUKW's. In almost every operation undertaken in the Pacific area, the DUKW saved the day for casualty evacuation.
Medical recordsDeficiencies in the handling of medical records in earlier operations led to a reorganization of this work prior to the Iwo Jima landing. A program of indoctrination for personnel handling records under combat conditions was inaugurated and the importance of making legible entries on emergency medical tags and in aid-station logs and reports was stressed. Nevertheless, reliable records could not be maintained during the first few days because the battle was so intense and loss of personnel and equipment so great that it was difficult or impossible to maintain complete records at regimental and battalion aid stations or at evacuation stations.
Dental serviceAt Iwo Jima, as on all combat operations, the work of dental officers and technicians was invaluable. Dental officers, in addition to carrying out their regular duties, also assisted in the sick bays and operating rooms. They administered supportive therapy, gave anesthetics and aided in identifying the dead.
CasualtiesTable 21 lists casualty and evacuation figures.
On 24 March (D-day-plus-33), there had been a total of 24,244 casualties (20,950 incident to battle), including 4,893 deaths. Of these casualties, 17,677 had been evacuated. Casualties among medical personnel were very heavy;
in one division alone, casualties of hospital corpsmen in each of 6 battalions exceeded 50 percent. In 4 battalions, casualties exceeded 60 percent, and in 1, they were in excess of 68 percent. Battle casualties for all division medical personnel exceeded 25 percent.
Table 21.--Casualties and evacuation--Iwo Jima
1. Casualties to 13 March 1945 (D-plus-22):
KIA WIA MIA Total Officers Enlisted Officers Enlisted Officers Enlisted Officers Enlisted 3d MarDiv 35 633 127 2,673 2 120 164 3,426 4th MarDiv 84 1,481 272 5,647 1 95 357 7,223 5th MarDiv 78 1,390 225 5,185 4 197 307 6,772 Corps Troops 1 7 10 83 0 3 11 93 Corps Artillery 0 5 0 11 0 0 0 16 Total 199 3,516 634 13,599 7 415 839 17,530 Grand total 3,714 14,233 422 18,369
2. Total battle casualties to 1800, 21 March 1945 (D-plus-30):
Strength KIA WIA MIA Total Percent of
3d MarDiv (less 3d Marines) 15,681 316 3,182 92 4,070 25.9 4th MarDiv 21,737 1,731 6,058 74 7,883 36.1 5th MarDiv 23,218 1,893 6,188 180 8,261 35.5 VAC LanForce (less 3d, 4th, 5th MarDiv) 9,491 63 324 7 394 4.1 Total 70,127 4,503 15,732 353 20,588 29.3 Percent of total casualties --- 21.9 76.4 1.7 100 ---
3. Evacuated by water to 21 March 1945 (D-plus-30):
Stretcher Ambulatory Total
Samaritan 1st trip 400 212 612 11 623 Samaritan 2d trip 400 201 601 8 609 Samaritan 3d trip (1) (1) (1) (1) 608 Samaritan 4th trip (1) (1) (1) 5 603 Solace 1st trip 400 147 637 3 640 Solace 2d trip 400 269 669 9 678 Solace 3d trip (1) (1) (1) (1) 568 Bountiful (1) (1) (1) (1) 555 Pinkney (APH) 390 232 622 8 630 Ozark (LSV) 199 208 407 1 408 LSTs (H) 7 1 8 5 13 Transports (APA) 2,606 2,213 4,819 18 4,837 Other ships (1) (1) (1) (1) 4,240 Total 4,892 3,483 8,375 68 15,007
4. Evacuated by air to 21 March 1945 (D-plus-30): 2,393 casualties.
5. Summary of casualty evacuation to 21 March 1945 (D-plus-30):
Hospital ships 4,879 Other ships 10,126 Air 2,393 Total evacuated 17,398
1. No breakdown available.
The offensive against the inner defenses of the Japanese Empire which began with the attack on Iwo Jima in February 1945 was carried a step further in April with the launching of the mighty amphibious attack on Okinawa. The personnel of the Medical Department in the attack on Okinawa now included many veterans of earlier campaigns, who had learned much in the hard school of war; now they had ample opportunity to apply their techniques and skills.
As in previous campaigns, careful medical planning preceded the Okinawa operation. This provided for: (1) Care of the sick and wounded
Figure 112.--Hospital tent on an Iwo Jima airfield. Note the 2 flasks of blood being administered simultaneously.
(including medical care for the civilian population); (2) evacuation of the sick and wounded; (3) sanitation; and (4) medical logistics. Numerous conferences were held by the surgeons of the Fleet Marine Force, Pacific (First and Sixth Marine Divisions), the Amphibious Forces, Pacific, the III Amphibious Corps, and the Tenth Army, in order to coordinate the medical mission of providing care for nearly 500,000 men of the expeditionary force and 350,000 naval personnel aboard the more than 1,600 ships.
Figure 113.--Advanced hospital at Koza, Okinawa. Many casualties were treated here and returned to duty.
Corps to provide specialists' care for wounded and to assist in the evacuation of casualties. Eight LST(H)'s were to be equipped as beach evacuation control vessels, 4 to be assigned to the Northern Attack Force (the III Amphibious Corps), and 4 to the Southern Attack Force (the XXIV Army Corps). Evacuation from the beaches at Kerama Retto by the Western Islands Attack Group was to be by LCVP directly to 6 hospital ships, 2 APH's, and 2 APA's converted for casualty evacuation. Two of them were to remain at the objective at all times to receive the critically injured. Casualties were to be moved to rear area hospitals in the Marianas, Hawaii, and the United States as rapidly as circumstances would permit. Adequate supplies of whole blood were to be provided for each transport.
Medical planning was based upon experience gained in previous operations. The First Marine Division assigned a medical officer of wide experience in clinical medicine as the representative of the Division Surgeon to investigate health conditions during the operations on Leyte, Guam, and Saipan. Since many of the diseases expected on Okinawa had already been encountered in the Marianas and Philippines, a study of the medical department's experiences in those places proved of great value.
All units of the First Marine Division were instructed in the value of sanitation and the need for sanitary measures during combat. Sanitary squads were trained to operate with each combat team, and to assist in mosquito and fly control. Their work was to be supplemented by that of a malaria and epidemic control unit. Latrines were to be provided by burying 50-gallon drums to about three-quarters of their height and fitting them with prefabricated seats in such a manner as to keep out the flies.
The necessary equipment and supplies to bring all units of the First Marine Division up to standard strength were obtained from the medical supply facilities at Guadalcanal and Espiritu Santo. In numerous instances, however, probably because of a lack of coordination between the various supply facilities, shortages made it necessary to request supplies from Pearl Harbor. First-aid jungle kits, which had been found to be far superior to the standard first-aid packet used at Cape Gloucester and Peleliu, were available for most of the combat troops, but there were not enough vials for salt and atabrine tablets, or bottles for fungicide solution. It was only with great difficulty that sufficient supplies were finally obtained to equip approximately 7,000 jungle kits. Efforts to obtain adequate supplies of brandy, which had been found to be valuable in the treatment of combat fatigue, shock, and exposure were unsuccessful because of disapproval of requisitions by higher medical authority. Plans were made for the extensive use of serum albumin. All supplies and equipment not carried by combat units were dispersed in the five medical companies. Each infantry battalion was assigned 40 hospital corpsmen, permitting the use of two corpsmen to each platoon. Members of each combat unit were assigned as litter bearers. These litter bearers, who were dispersed among the various rifle companies, were trained in first aid and the evacuation of casualties from the frontlines to aid stations.
The Sixth Medical Battalion (Sixth Marine Division), debarked at H-minus-2-hours, and units began landing at H-plus-2-hours. Negligible enemy opposition was encountered. Installations for the emergency handling of casualties under field conditions were set up within 1 hour. All medical equipment was ashore and the Sixth Marine Division hospital was established and functioning by L-day-plus-2. After landing, all organizations dug in, and made preparations against air attack and sniper fire. During the first few days the food consisted of K rations, and the water supply was limited. An insufficient number of blankets had been provided, and some discomfort was experienced by the men because of the rapid change from a tropical to a temperate zone.
A mobile surgical trailer (fig. 114) which had been constructed by medical officers in the training area, proved of great value many times during the Okinawa operation.
The experiences of the III Corps Medical Battalion, Corps Evacuation Hospital No. 2, and Corps Evacuation Hospital No. 3 during the debarkation and landing were unfortunate.
Figure 14.--A mobile operating room directly behind the front lines on Okinawa.
As a precaution against enemy air or surface action, personnel and equipment of each of these units had been embarked in three sections on different ships. In following the loading plan it had been impossible to embark the desired number of personnel with their equipment, and on several ships, only a small percentage of those originally assigned could accompany their supplies. In consequence, there was an insufficient number of men to safeguard medical property effectively when it was discharged on the beaches, previous experience having proved that unloading on the beach, unless supervised, would result in extensive loss of materiel. Notwithstanding urgent requests by the units involved and by the corps surgeon, medical supplies were dispersed on numerous landing beaches, which necessitated the expenditure of much effort on the part of medical personnel in attempting to locate and collect their equipment and supplies. It also entailed the loss of valuable time in setting up hospital facilities, nullified the purpose of combat loading, and retarded the employment of medical members for the care and evacuation of wounded.
The Okinawa operation proved the need for a large pool of trained Hospital Corps personnel replacements. The First Marine Division had 478 casualties among Hospital Corps personnel during the campaign in southern Okinawa. Of these, 49 were killed in action, 226 wounded in action, 17 injured, and 186 were sick. Dispatches for urgently needed replacements of medical personnel resulted in some replacements being obtained, of whom only a few had been in combat and had any idea of the duties expected of them. lt was the consensus of the medical staff that the best solution was to order a minimum of 100 extra hospital corpsmen to each Marine division at least 2 months prior to an operation. These men could then be trained under experienced personnel. After training with line regiments, the corpsmen could be transferred to the medical battalion where they would be immediately available as replacements.
Battle afloatMedical units of the fleet also made plans for participation in the operation. Not only Hospital Corps personnel but also entire ships' crews were trained in first aid and the handling of casualties. Battle dressing stations, first-aid stations, and supplies were widely dispersed throughout each ship. Ample medical supplies to meet all anticipated needs were provided aboard the ships and concrete barges, AK's,
and AKS's were available for replenishment. Careful preparations to provide the fleet with fresh whole blood in ample quantities throughout the operation were to pay liberal dividends in lives saved during the "kamikaze" attacks by Japanese planes, for these attacks resulted in the largest number of casualties the fleet had experienced during the entire war (fig. 115).
During the initial landing and assault phase of the Okinawa operation, while combat units were experiencing only light opposition, the ships of the Fifth Fleet and supporting units were being subjected to heavy and persistent Japanese "kamikaze" air attacks. The careful plans which the medical staffs had made prior to this operation, while valuable, could not be designed to cope with "kamikaze" attacks directed against small ships.
Figure 115.--Hangar deck, U.S.S. Bunker Hill--264 men were wounded and 392 killed when hit by two "kamikazes."
Aboard destroyers the medical department could not function as a well-trained, carefully drilled unit because each man was required to render first aid when and where he could. As an example, the U.S.S. Morrison, a radar picket and a popular target for the "kamikaze" pilots, was hit by four of them in a period of 10 minutes and rapidly began to go down. Any attempt to establish the main dressing station in a safe area on that ship was futile since such an area did not exist and consequently medical personnel and materiel had been dispersed. The chaos and annihilation were indescribable. The wounded were given such first aid as was possible. Arresting hemorrhage was the sole objective. Only one man was taken to a dressing station and he was trapped there. During the 2 hours that the survivors spent in the water, little more than encouragement could be administered by the medical staff. The heavy layer of fuel oil covering the survivors masked injuries. The medical officer and the uninjured corpsman (one corpsman was killed, another had a compound fracture) swam from group to group giving medical aid where possible. Even after rescue by an LCS, only emergency treatment could be given to the Morrison's 90 wounded, because the rescue craft was immediately called upon to take aboard an additional 25 casualties from an LSM(R) which had also been sunk by "kamikaze" planes. The experiences of the medical staff of the U.S.S. Morrison and LCS were repeated over and over in units of the battle fleet, as the Japanese made a desperate attempt to force its retirement. Enemy planes made attacks on 3 hospital ships during the operation. The U.S.S. Relief was attacked on 2 April 1945 and the U.S.S. Solace on 20 April, but no
damage was done. On 28 April the U.S.S. Comfort was hit amidships by a "kamikaze," killing 29 and wounding 33. On the same day that the Comfort was attacked, the U.S.S. Pinkney (APH-2) was also hit amidships by a "kamikaze" resulting in 22 killed, 11 wounded, and 19 missing. Notwithstanding these attacks, the hospital ships carried on their mission and maintained regular shuttle trips from the target to the hospitals in the Marianas. During the early stages of the Okinawa operation, as a result of repeated "kamikaze" attacks, naval casualties exceeded landing force casualties. Then it became apparent that floating hospital facilities were urgently needed at the objective during the night to care for the wounded men from ships bombed or struck by suicide planes. Hospital ships, under orders to retire each night, were not available. When the two converted APA's, the U.S.S. Crescent City and the U.S.S. Gosper, arrived, they were designated as casualty ships and were stationed offshore to provide hospitalization at night. Four PCE(R)'s, also available for casualty evacuation from screening ships, proved well suited for rescue purposes.
CasualtiesCasualties in the Okinawa operation through 27 May 1945 totaled 38,420. Of these, 28,447 were incurred by Marine and Army combat troops and 9,973 by Navy. The ratio of Marines killed to wounded was 1 to 5; Army, 1 to 4.25; and Navy 1 to 1. The fleet, under constant enemy air attack, including almost daily "kamikaze" attacks, suffered severe casualties. Probably for the first time in naval history the number of killed and missing exceeded the number of wounded.
Medical and surgical problemsDisease and non-battle casualties ashore were never a serious factor on Okinawa. About 6 percent of the complement became ill. The surgeon, Tenth Army, during the month of April, evacuated personnel for the conditions listed in table 22.
TABLE 22.--Disease conditions requiring evacuation from Okinawa
Diagnosis Number Percent Dermatosis 130 10.6 Diarrhea and dysentery 80 6.5 Psychoneurosis 115 9.4 Combat fatigue 305 24.8 Hepatitis 106 8.6 Insect-borne disease 20 1.6 Meningitis 3 0.2 Others 470 38.3 Total 1,229 100.0
Ample fresh whole blood was available to fleet and shore units throughout the Okinawa operation. During April and May a total of 36,684 pints of blood were distributed to base
Figure 116.--The bush master. An amphibious tractor equipped as a mobile amphibious operating room.
and fleet hospitals. Of this amount 12,500 pints were shipped by air. In the field hospitals alone, 1,273 surgical operations were performed and 1,057 pints of blood were used.
The First Marine Division in this operation converted amphibious tractors into mobile operating rooms (figs. 116 and 117). One of these mobile operating units was ambushed, but its armor prevented damage to personnel or equipment. The ease with which the mobile operating unit could be effectively blacked out proved invaluable, for it permitted the surgeon to take the patient into a well-lighted operating room at once instead of trying to work with a flashlight under a tarpaulin or in a small crowded blackout tent. During heavy rains and in deep mud they afforded a dry, protected room, and the surgeon had a clean, dry deck on which to stand, in contrast to standing ankle deep in mud and water. Another possible use of these amphibious operating rooms as visualized by the medical staff (although not employed in the Okinawa operation) was to bring surgical facilities to the patient, when evacuation of the patient to a surgical facility was not possible because of terrain, heavy fire, or the accumulation of a large number of seriously wounded in a small area. Utilization of the amphibious tractor as a surgical facility received the enthusiastic support of the line as well as of medical personnel. The amphibious tractor was also found to be useful for moving the collecting station or aid stations (fig. 118); equipment and personnel could be placed in the tractor which could then proceed to the new site across any type of terrain.
The III Corps Medical Battalion, with the aid of a Seabee medical section, converted a discarded radar trailer into a mobile operating room, and on L-day-plus-1 the unit was landed on BLUE Beach No. 2 where it functioned as an adjunct to the shore party medical section. It later rejoined its parent organization, to render continuous service throughout the remainder of the Okinawa operation.
Figure 117.--The bush master's operating room in use.
A valuable supplement to the hospitalization program was the operation of a rest camp in a nearby area during the final 3 weeks of the campaign. This camp, an annex to the III Corps Medical Battalion, provided a place to which physically exhausted men could be sent to recuperate. They were thus removed from a hospital atmosphere, and often after a few days' rest could return to their regiments in the line. Care and evacuation of casualties The care and evacuation of casualties at Okinawa was well handled. No serious delays occurred at any time, even though transportation
Figure 118.--Transferring the wounded men from amphibious tractor to a landing barge.
of casualties was complicated by bomb craters, blown-out bridges, and torrential rains that made the roads almost impassable. Ordinary vehicles bogged down in many instances, and DUKW's and Weasels were required to keep the evacuation moving. Throughout the campaign, evacuation over the primitive roads of Okinawa was slow, bumpy, and shock-producing. In some instances, casualties had to be transported 30 miles to a hospital from an evacuation beach, but in spite of such difficulties, the Sixth Marine Division reported that not once did the elapsed time in transporting a patient from the front to the division field hospital exceed 5 hours, with an average of only 2 hours.
In order to obviate the necessity of bumping patients for miles over bad roads, the Sixth
Figure 119.--Evacuating casualties from the front lines by a cub plane.
Figure 122.--Wounded aboard a transport plane being evacuated to a hospital.
undoubtedly saved many lives and did much to boost morale.
Daily air evacuation from Okinawa to Guam was put into operation by the Naval Air Transport Service and the Army Transport Command early in April. The majority of the seriously wounded were evacuated by hospital ships, but thousands of other casualties were flown out (figs. 121 and 122). Thus local hospital facilities were never overtaxed.
Number of casualties evacuated by hospital ships 11,731 Number of casualties evacuated by surface vessels other than hospital ships (APA, APH, BB) 1,405 Number of casualties evacuated by air (NATS, ATC) 11,771 Total 24,907
SanitationMedical intelligence regarding Okinawa placed undue emphasis on the menace of scrub typhus, malaria, schistosomiasis, and snake bite, and underestimated the danger from filariasis. Filariasis was present in the blood of 20 to 35 percent of all natives in every age group. Scrub typhus was not observed, which was surprising because the natives were infested with body and head lice. An extensive investigation of snails, flukes, and leeches on Okinawa failed to reveal any cercaria. Malaria vectors were found. The snake menace failed to materialize; only about a dozen cases of snake bite were reported, no fatalities occurred, and the systemic reactions were not serious.
Okinawa presented many features of medical importance and interest, because practically every disease known in Japan was found there. Had the military forces been called upon to invade Japan, the knowledge gained at Okinawa regarding malaria, dengue, filariasis, diarrhea, dysentery (amebic and bacillary), the venereal diseases, leprosy, tuberculosis, encephalitis, meningitis, Weil's disease, hepatitis, and others would have proved of great value.
At the very outset of the Okinawa operation, effective sanitary measures were instituted. Beachheads were sprayed with DDT from carrier-based planes, beginning on L-day-plus-3. Attached to the combat teams were sanitary squads consisting of 1 hospital corpsman and 19 Marine enlisted men, assigned duty which included sanitation and insect control in the combat area and disposal of enemy dead. The malaria and epidemic control units attached to the Marine divisions performed a valuable
service in epidemiologic investigation and in the control of flies and mosquitoes.
Devotion to dutyExamples of conspicuous heroism of medical personnel on Okinawa were numerous. The gallantry and devotion to duty of the hospital corpsmen was stirring, and their heroism under fire was recognized by appropriate awards. As examples are the following men who received the Congressional Medal of Honor:
Bush, Robert Eugene, Hospital Apprentice, First Class, USNR.
Willis, John Harlan, Pharmacist's Mate, First Class, USN.
Halyburton, William D., Pharmacist's Mate, Second Class, USNR.
Pierce, Francis J., Pharmacist's Mate, First Class, USN.
Whalen, George Edward, Pharmacist's Mate,Second Class, USNR.
Williams, Jack, Pharmacist's Mate, Third Class, USNR.
Lester, Fred Faulkner, Hospital Apprentice, First Class, USNR.
Medical Department personnel of fleet units gave efficient care to the wounded under the severest handicaps imaginable. Both during the Philippine invasion and off Okinawa, under bombing and "kamikaze" attacks that smashed their dressing stations or sank the ship on which they were working, they rendered heroic service (figs. 123 and 124).
Medical Action Afloat
The U.S.S. Pecos, the last source of fuel for ships in the Tjilatjap area was ordered to intercept two destroyers that had picked up the Langley's 450 survivors. Transfer of the survivors from the destroyers took place at 0400 under adverse weather conditions. The boatswain had an especially difficult task in keeping the motor launch steady in the heavy seas while the wounded were hauled aboard. Practically all the survivors were suffering from shock or exhaustion; many were injured. In the sickbay the medical officer and five corpsmen worked unceasingly treating shock, applying splints, and bandaging wounds.
Within 6 hours after the injured had been taken aboard, enemy bombs tore a great hole amidships and started a fire in the Pecos. The ship began to sink. Injured men in the forward part of the ship could not reach the main dressing station, and the pharmacist's mate
Figure 123.--First aid aboard U.S.S. Nevada after Jap "kamikaze" attack.
Figure 124.--U.S.S. Franklin after "kamikaze" attack--patients being transferred to U.S.S. Santa Fe.
there carried on alone. To an already overcrowded sick bay were brought newly burned and injured patients. The medical officer describing his experience said:
When I heard the machine and antiaircraft guns rattle, I knew that we had about 30 seconds before we would sustain another hit or near miss. We would treat a patient for a few moments and then drop down alongside him, the pharmacist's mate on one side and I on the other, and wait for the ship to jump. As soon as the ship stopped shuddering we would again attend the injured until the next bomb burst. Often the interval was less than a minute.
After 4 hours of this we were ordered to abandon ship. The injured officers and men were carried from the sickbay up the slanting deck to the side of the ship. Kapok-filled mattresses were lashed to those most severely injured and then lowered over the side A well man accompanied each injured man in the water. Men tore down doors and broke out wooden panels to obtain floatable supports. Others made use of bamboo poles which the commanding officer had taken aboard before leaving Tjilatjap; one 10-foot pole gave support to 4 men.
The Pecos went down at 1355, with no other vessel in the vicinity. In response to a flare set off by the men in the water, one of the destroyers that had given the Langley's survivors to the Pecos that morning, arrived at the scene. When the medical officer and the corpsmen got aboard the destroyer, the chief pharmacist's mate in that ship had already laid out all medical equipment on the table in the officers wardroom. It was about 0100 the next morning before all the men had been taken aboard and cared for. "A destroyer with 350 men aboard in heavy weather is not the most comfortable ship in the Navy, but the sick and injured received adequate treatment and were secure in their bunks."
Casualties in fleet units at sea occurred not only from torpedoes, aerial bombs, and gunfire, but also, later, from the unique Japanese weapon--the "kamikaze"--the first of whose attacks was delivered in April 1945.
When the Princeton was struck by a heavy aerial bomb carried by a "kamikaze," flames from the explosion caused terrific damage. Both the forward and midship battle dressing stations were rendered useless; the main battle dressing station in the sick bay and the after battle dressing station also had to be evacuated. Casualties included 7 deaths, 92 missing, and 191 wounded, but all patients received prompt, effective treatment. About 1530 the same day, the U.S.S. Birmingham came alongside to aid in salvage. A few minutes later a terrific
explosion from the after part of the Princeton blew off her stern; blast, flames, and debris swept the Birmingham. Over half of the Birmingham's personnel were wounded or killed by the Princeton's explosion. On the main deck alone about 150 men were seriously or critically injured. The executive officer wrote:
I really have no words at my command to describe adequately the splendid conduct of all hands, wounded and unwounded. Not only was there not the slightest evidence of panic, but there was not a single instance where anything but praise could be given the men. Men with legs off, with arms off, with gaping wounds in their sides, with the tops of their heads furrowed by fragments, would insist, "I'm all right, take care of Joe over there" or "Don't waste morphine on me, commander, just hit me over the head."
At the time of the explosion, the Birmingham's senior medical officer was in the U.S.S. Santa Fe assisting in the performance of surgical operations. The dental officer was among the first killed, and only the junior medical officer was available. He and the 14 hospital corpsmen, assisted by the officers and men of the ship's company, not only rendered first aid but also performed many surgical operations, including exploration of 5 patients with perforated abdominal wounds, of whom 2 died. Of the 420 wounded patients treated, only 8 died.
On the U.S.S. New Mexico, a "kamikaze" landed on the superstructure killing 30 men and wounding 129 others. It was not possible to evacuate the wounded until 13 days later. For the first 4 days following the explosion, the personnel were almost constantly at general quarters and under repeated air attack. This condition placed medical department personnel under a serious strain. Battle dressing stations had to be fully manned during the day to provide first aid for casualties; definitive treatment, for the most part, could not be carried out until night. Critically wounded were put into an air-conditioned ward, but many of the seriously wounded, as well as those with mental illnesses, were of necessity placed in poorly ventilated compartments. The repeated gunfire produced a state of anxiety among the wounded, and their retention aboard the battleship had an adverse effect upon the morale of the crew. "Too much emphasis cannot be placed upon the importance of early evacuation of the wounded from a combatant ship," reported the New Mexico's senior medical officer. This, he considered, was as essential as rearming or refueling.
As a direct result of the increased "kamikaze" attacks, nervous tension was high in personnel in ships. Increasing numbers of men had "vague mental complaints," exhibiting irritability, depression, anxiety, and fatigue. The senior medical officer of the aircraft carrier U.S.S. Cabot observed that the time required to complete various tasks had increased by as much as 50 percent. Continuous action, "kamikaze" attacks, lack of recreation and rest, and lack of replacement of personnel were all contributing factors in the occurrence of "nervous fatigue." "The action in Lingayen Gulf," wrote the commanding officer of the U.S.S. Southard, "was the severest that the present ship's crew had ever experienced. The numerous calls to general quarters, the sight of suicide attacks on ships in company, the necessity of staying at general quarters during daylight hours for 3 days prior to S-day, and a suicide dive on our own ship, all contributed to the severe nervous strain. As a result, a few members of the crew 'cracked up.' Those who were unable to continue under the nervous pressure were not 'green' and untried personnel, but were men who had been on board ship for a long time."
When the U.S.S. Maryland was struck by bombs 29 November 1944, practically all her major medical department installations and equipment were destroyed. However, because of adequate distribution of supplies to the four battle dressing stations, the ability to render efficient and effective treatment was not jeopardized and Medical Department personnel carried on, often despite their own serious injuries. The senior dental officer, who had received second degree face burns, administered to the wounded until ordered to bed.
On 7 April 1945, a Japanese dive bomber crashed into the U.S.S. Maryland. At the moment the plane struck the ship, medical officers and hospital corps personnel at their battle dressing and collecting stations were ready to receive casualties. Operating tables were set up. Blood, plasma, serum albumin, sulfonamides,
morphine, petrolatum, splints, bandages, dressings, and instruments were ready. Medical Department personnel wearing flashproof clothing immediately proceeded to the scene of damage and fire regardless of exploding 20-mm. shells, cared for the injured, controlled hemorrhage, applied splints, and administered morphine while stretcher bearers filled out casualty tags. Even before the fires were extinguished, the injured had received first aid and had been evacuated to collecting stations where transfusions of blood and plasma and other supportive treatment were administered. At the battle dressing stations, a well coordinated surgical operating team was ready to carry out definitive care and treatment for the seriously injured.
The reaction of personnel during emergency at times was unusual. "During all of the excitement of being hit, firing at the enemy, seeing mangled bodies, and wounded shipmates," wrote one senior medical officer, "no one exhibited any hysterical reactions or maniacal tendencies, nor was there any unnecessary shouting. Everyone rose to the occasion and performed his duty. The hospital corpsmen behaved with admirable calm and were too busy aiding the wounded to become excited. So strong was the fighting spirit and sense of duty of the men at gun stations that cases were reported of clinically injured personnel, with a hand or foot blown off, carrying on at their stations."
When the U.S.S. Pensacola was hit, 3 officers and 14 men lost their lives and 120 officers and men were wounded. Medical care and treatment were so prompt and thorough that not one death occurred among the wounded who survived the first hour. Medical Department personnel were tireless in their efforts and rested only when exhaustion made rest mandatory.
When the U.S.S. Terry was hit, the crew showed great proficiency in giving first aid to the wounded. Medical officers who subsequently received the wounded found them in excellent condition--hemorrhage had been checked, shock treatment had been given, and wounds efficiently dressed. This efficiency in first aid was achieved because of the continuing instruction given the crew.
Figure 125.--First aid to Filipino mother and her child on the invasion beach at Leyte, Philippine Islands.
Figure 126.--Hospital corpsmen with a Marine division on Saipan administering first aid to civilians.
The military operations on the islands of the Pacific, particularly on Saipan, Tinian, Guam, Philippine Islands, and Okinawa, presented the medical companies of assault battalions with the problem of providing medical care not only for military personnel but also for the thousands of civilians on these islands, many of whom had been wounded. About 10 percent of
Prisoners of War and Enemy Civilians
Figure 127.--Hospital facilities for enemy civilians were established at the earliest opportunity.
Figure 128.--Sick call for natives in the Solomons.
the population were sick and required treatment (figs. 125 and 126); tuberculosis, pneumonia, diseases of the eye, and helminthic infections were common, as was malnutrition. On Tinian a 100-bed G-6 unit for civilian use was to have been landed between J-4 and 6, but this was delayed. Therefore, the 2d and 4th Marine Medical Battalions jointly set up a hospital to accommodate 1,250 patients and made use of 2 surgical LST's for operating room requirements.
On Saipan, no hospital facility was available for enemy civilians until 2 months after the island was secured, at which time the Army set
Figure 129.--Hospital facilities for enemy civilians were established at the earliest opportunity.
Figure 130.--Dental care for a young Majuro.
up a 500-bed hospital. In the meantime an average of 950 patients a day sought treatment the military government sick bay. A Civilian Public Affairs unit was landed, but the Public Health Surgeon and the pharmacists accompanying him had no equipment or supplies
Figure 131.--Hospital care for natives on Majuro landing.
other than two field medical kits. To provide medical care for civilians required medical personnel in the ratio of 2 medical officers and 8 corpsmen for each 6,000 population.
Japanese propaganda had convinced the native population that the landing of United States forces on the island would result in their death or torture, but the highly efficient and humane treatment of the natives by medical personnel attached to combat troops or Military Government hospitals (figs. 127 and 128) provided most effective counterpropaganda. On Okinawa, many native children and women had self-inflicted wounds, which had been made in a desire for death in preference to capture. The natives were both astonished and grateful for the merciful attention given them.
Prisoners of war requiring medical care (fig. 129), were given the same treatment as our own casualties, and were evacuated to a Corps Medical Battalion, hospital ship, prisoner of war ship, or other ship, for further care and disposition.
For the civilians in these islands, adequate hospital facilities were erected with the assistance of native labor (figs. 130 and 131) and native women, instructed in nursing care, proved to be excellent nurses.
The invasion of Normandy on 6 June 1944 heralded the beginning of the largest amphibious landing in history. The medical logistic plan provided that the care of casualties from enemy action during the invasion was to be an Army commitment. Naval medical activities were to care for casualties resulting from loading accidents or near-shore enemy action; they were to receive from the Army any naval casualties returned from the far shore and any patients who were in poor condition on arrival at a near-shore unloading point. The return of casualties from the far shore was to be a Navy commitment for which purpose LST's were to be used (fig. 132). Alterations were made in the 106 LST's allotted to make them suitable for casualty handling, and each had sufficient medical supplies and equipment to provide surgical
Figure 132.--LST landing men and supplies on the beach in Southern France.
and nursing care for 200 patients on the return trip to the United Kingdom. To resupply them, medical supply dumps were established at Southampton, Portland-Weymouth, and Brixham.
It was estimated that 0.17 percent of the landing force would become casualties and it was planned that initially all ineffective, except nontransportables, were to be evacuated. Later there was to be established a policy of holding casualties ashore for 7 days, then if conditions permitted, for 15 days, and eventually for 30 days or longer. The plan of evacuation further provided that: (a) Except for ineffective occurring in landing craft en route to beaches, for whom first aid was to be given, no casualties would be evacuated seaward until the assault battalions had landed; and (b) all seaward evacuation of wounded was to be controlled by navy beachmasters, who were to determine the means and the ships to which they should be sent. During the early hours of the assault on D-day, medical personnel functioned as independent units wherever and whenever they reached the beach, no attempt being made to contact each other. Initially, 6 medical sections of the Sixth Beach Battalion and 3 medical sections of the Seventh Beach Battalion were committed to the OMAHA Beach, and 6 medical sections of the Second Beach Battalion were committed to the UTAH Beach (casualties among the latter: 1 officer and 7 men killed and 12 men wounded). By D-day-plus-1, all remaining medical sections of the beach battalions had landed on the designated beaches.
The first naval medical elements landed at H-hour-plus-40 minutes. On OMAHA Beach the military situation was such as to limit medical service to primary first aid. This situation prevailed until late on D-day. The initial casualties on UTAH Beach were relatively light and general organization was more readily established. During the early hours of D-day on UTAH Beach, all possible means of seaward evacuation were used, including DUKW's, LCVP's and LCT's (figs. 133, 134, and 135). Jeeps fitted to carry litters were used to transport patients to evacuation craft; as many as 200 casualties per hour were loaded in this way. Most of the casualties were transferred to LST's, although
(Foreground) Casualties being carried aboard an LST on an invasion beach in France.
Figure 134.--Casualty loading station on a beach in Southern France.
in some instances patients were conveyed to hospital carriers and other ships, particularly during the early hours when LST's could not beach. At times it was necessary to transfer casualties from DUKW's to LCT's offshore.
In the shore-to-ship phase any boats used in the amphibious operations were to be used to evacuate casualties from the beach, while LST's were to provide the main casualty lift for shore-to-shore evacuation. LCT's were to carry ambulatory patients; transports were to provide casualty lifts as the military situation permitted;
Figure 135.--Bringing the wounded, including German prisoners, to U.S.S. Texas.
hospital carriers were to be available after D-day-plus-1; and hospital ships were to be used for evacuation to major ports in the United States.
Converted assault LST's were the principal casualty carriers. The conversion was evolved from experiments conducted during the fall of 1943 by the Planning Division of the Bureau of Medicine and Surgery jointly with the Sixth Amphibious Force. The. basic structural changes provided for were: (a) Remountable brackets (fig. 136) to accommodate 147 litters arranged in tiers 3 high--24 tiers along the starboard bulkhead and 25 along the port bulkhead of the tank deck; (b) in the afterport corner of the tank deck one slop sink, a light over the sink, double electric outlet, and folding counter for portable sterilizer and trays, all enclosed by a removable metal cage; (c) suitable stowage facilities for litters and bracket arms on lateral bulkheads; (d) two mounting brackets for operating lights mounted in a suitable location over a mess table in the crew's mess room.
Special equipment for each converted LST included:
Item Number per LST Litter, metal pole 300 Special Unit A, Emergency surgical dressing 16 Special Unit B, pouch, medical officer's individual equipment 4 Special Unit C, pouch, hospital corpsmen's individual equipment 40 Medical resupply unit for beach battalion (beach bag) 16 Bunk strap 400
On D-day, there were 103 LST's in the task force. Of these, 54 had been structurally converted for casualty handling, the remaining 49 being implemented only with additional medical personnel and supplies. The concept of providing all LST's with the means to treat casualties proved invaluable during the initial period of the assault. As evacuation became organized, only designated LST's were assigned the evacuation task.
Figure 136.--LST showing the remountable brackets.
Hospital carriers proved to be unsatisfactory for evacuation of casualties largely because they had to anchor far from the shore, were furnished no casualty-handling equipment, and medical personnel embarked had had no special training in the evacuation of casualties. British hospital carriers were available but some difficulty was experienced in transferring casualties to them because the United States-type litters did not fit well in their Higgins-type ambulance boats.
The near-shore medical facilities at Portland, Plymouth, Falmouth, and Southampton functioned satisfactorily for the most part. One exception occurred at Portland, from D-day-plus-4 to D-day-plus-7, when 67 LST's waited to unload patients. Operational units responsible for the military success of the Normandy landings insisted on the priority of loading, regardless of casualties. Because of this, the LST's were retained outside the breakwater, necessitating unloading of casualties to LCT's from which they were transferred to other LCT's made available specifically for this service. In one period of 3 hours, 1,100 patients were disembarked in this manner. Approximately 12,834 patients were unloaded at Portland by D-day-plus-22, and 6,065 at Southampton.
Battle casualties were efficiently recorded, and information was supplied to the central recording section within a few hours after debarkation. By 5 July (D-day-plus-29), 23,377 casualties had been reported to the Service Force Casualty Section; 22,455 were known to have debarked in England. A breakdown of the 23,377 casualties showed: U.S. Navy, 2,078; U.S. Coast Guard, 76; U.S. Army, 17,247; Allies, 1,298; and prisoners of war, 2,678.
Casualties on D-day-plus-114 included: U.S. Navy, 2,433 (363 dead and 2,070 wounded); U.S. Coast Guard, 117 (25 dead and 92 wounded); U.S. Army, 41,147 (124 dead and 41,023 wounded); Allies, 1,899 (5 dead and 1,894 wounded); and prisoners of war, 9,911 (4 dead and 9,907 wounded). Of these, LST's carried a total of 41,035, the average casualty lift being 123.
The ratio of Army to Navy wounded was approximately 11 to 1. The Navy received slightly more wounds per man, and of the Navy wounded a higher percentage had severe wounds. Burns and blast injuries, wounds of the head, face, and neck, and simple fractures were higher among Navy personnel. In the Army, wounds of the extremities were 13 percent higher than in the Navy. Accidental injuries of the extremities were approximately four times higher in the Navy than in the Army. The percentage of chest wounds among Army personnel was nearly twice that of the Navy. The incidence of disease in the Army was approximately double that in the Navy.
The Medical Department plans for the invasion of Sicily included the following: (a) Provide medical and surgical care for all personnel on Navy vessels from the time of embarkation until they landed on the invasion beaches, (b) evacuate the sick and wounded from the beaches during the assault phase, until adequate medical facilities were established ashore, and (c) thoroughly indoctrinate boat crews in first-aid procedure.
The wounded were evacuated to AP's, APA's, and AKA's. The average number of casualties for each AP and APA was 40 to 45. Army hospital facilities were operating ashore by D-day-plus-2.
About 15 hospital ships and hospital carriers were available in the Mediterranean; 2 of these were Army hospital ships and the remainder British and Canadian. The plan for their operational control by higher echelon was complicated and therefore a certain amount of confusion resulted. These ships had to be used for the evacuation of casualties after the transports left the combat area, and often too much time was required to obtain their services or they failed to arrive at the appointed hour. As
a result, Army hospitals in Sicily became overloaded awaiting their arrival.
The experience with hospital ships in the Sicilian operation prompted the inauguration of certain changes concerning their use, and all, regardless of nationality, were placed under the operational control of Allied Force Headquarters. They operated on a prearranged schedule during the crucial period of D-day to D-day-plus-5.
Army transport planes began the evacuation of patients from Omaha Beach on D-day-plus-4, 10 days ahead of schedule. By D-day-plus-10 there was little need for hospital ships and LST's, and air transport proved adequate. During a storm from D-day-plus-13 to D-day-plus- 16, when it was impossible to evacuate patients by sea, the air transports succeeded in evacuating about 1,890 patients. By D-day-plus-17, air evacuation was used almost exclusively, except for ambulatory patients who were evacuated by ship.
The Commander of the Sixth Amphibious Force made the following comments regarding Medical Department facilities in the Sicilian invasion:
- The methods of handling casualties seemed adequate.
- Further training of boat crews in the use of casualty handling equipment was indicated.
- First-aid training seemed adequate‹the majority of patients received on board were in good condition.
- The number of medical personnel in all echelons was adequate.
- Medical personnel in transports, although very busy during and immediately following the action, could possibly have handled more casualties.
- Dental officers were not fully utilized in the team play.
- The number of Hospital Corps ratings was sufficient for this operation. With a capacity load of casualties, their services, of necessity, would have been more restricted.
- Evidence of the need for more intensive training of hospital corpsmen in transports was apparent. Every vessel carrying a medical officer should have one operating room technician and each APA should have two. These technicians should receive their training prior to being assigned to duties afloat.
- Medical supplies and equipment on hand were adequate for needs, and in most instances would have been adequate for a capacity load.
- Medical preparations for this operation were generally excellent throughout the force.
- What few deficiencies were noted or complained of in the vessels afloat, could be traced to a failure on the part of the senior medical officers to comply with directives. In a few instances, there appeared to be lack of foresight and imagination.
The following comments regarding converted LST's were made by the Force Surgeon:
- Toilet facilities on the tank deck were inadequate.
- Structural factors made transporting of patients in litters into troop spaces difficult.
- The top tier of stretcher racks was inaccessible owing to its height from deck.
- The platform at the after end of the tank deck was located directly below the forced draft ventilators; this created undesirable air movement and precipitation of moisture in the surgery area.
- Future alterations should include openings from the tank deck into the troop spaces.
- Improvement should be made in sanitary facilities.
- Better access should be provided for the handling of litters.
- The receiving ward, wash room, and operating room should be located in the troop spaces with entry and egress provided to the tank deck.
- Remountable ladders should be provided to the escape hatches.
- Permanent stowage space should be allocated in each ship for such supplemental medical materiel as may be authorized.
Hospital carriers (British type)Comments:
- Attached ambulance boats were not adapted to carrying Navy standard pole litters and were difficult to load.
- These vessels had no casualty-handling equipment other than that which was required to hoist their own special ambulance boats for unloading casualties.
- Medical personnel in these vessels had no special training for the task.
- In the operation, their movements were controlled by the British Ministry of War Transportation, a fact which led to much confusion and materially interfered with efficient employment.
- In spite of the difficulties listed above, between D-day and D-day-plus-n, these vessels completed 6 trips, evacuating approximately 2,272 casualties.
The following observations were made during the operations at Salerno (fig. 137):
- The long distance to the medical storehouse at Casablanca made barter with the Army and other ships in the vicinity the most feasible method of securing supplies. Fortunately, an excess of materiel at Arzew was sufficient to meet some of the immediate needs.
- Commanding officers in some instances failed to acquaint the medical officer with the plan to be followed.
- Medical reports were not always received after the operation, and often those received showed a complete lack of familiarity with the reports.
- There was marked congestion on the beaches. In some instances the medical beach party was set up too close to the main road, and too near the unloading areas, which might draw aerial attacks. The only marking, a vertical red cross which had been promptly spread on the ground near the shelter, made the medical station even more readily discernible from the air.
- Sandbag protections should have been more substantial and high enough to protect a man seated on the ground. These protective areas should have been large enough to enclose 20 patients and all medical personnel. Multiple small enclosures were found to be preferable to larger single barriers.
- The work of the beach medical officers (fig. 138) was carried on with a high degree of skill and courage. Prompt treatment was accorded all patients, including some civilians, all of whom should have been treated ashore
Figure 137.--Landing supplies on the beach at Salerno, Italy.
Figure 138.--Rendering first aid on the invasion beach.
and not aboard ships, as happened in a few instances. Patients often were sent to ships not equipped for their care. The evacuation of patients to any ship available was not good practice, because on a small ship with limited personnel and equipment the care that could be given was no better than that available on the beach. Evacuation of patients from shore to ship during the period between the departure of transports and the arrival of hospital ships was considered undesirable, and beach medical officers should have been prepared to provide treatment for patients until proper facilities for evacuation became available.
During the war dental officers showed great professional capability and ingenuity under all environments. When they were prisoners of war, they made alloy for dental amalgam by filing the Philippine pesos (these had to be smuggled in), and extracted mercury by heating calomel. Sterilizers, chairs, and cabinets were constructed from junked material, and dental instruments were fashioned from many items in everyday use.
Dental Officers' Experiences in Battle
The professional abilities of the dental officer are exemplified in the following excerpts from their letters to the Bureau:
During the battle, the sick bay was destroyed by gun fire and the senior medical officer and all the corpsmen except one were killed. It is of interest to note that the man on the operating table receiving treatment at that time escaped from the compartment and survived. Casualties of various types came to my dressing station for medical treatment. Many were burned, one was without an arm, one crawled in with his leg dangling and his face and arms burned.
While we were administering first aid (which consisted mostly of supplying battle dressing, stopping hemorrhage, and relieving pain), our compartment received direct hits from enemy shells. Later, the ship listed and the compartment began filling with water. I sent a metalsmitih, who had just been treated for minor burns, to find an escape hatch while the one remaining corpsman and I moved the medical supplies and the patients away from the inpouring water. An escape hatch was found in the compartment forward and through it we hoisted all the unconscious patients. Upon my arrival topside, I found that the ship had been abandoned. I walked across the starboard side of the ship, which was now facing skyward, and slid down into the water. Upon looking back and before a minute had passed, I could see the ship's stern pointing sharply into the air and then it quickly disappeared beneath the surface of the water.
Later, on finding a raft, many wounded were lifted aboard and given first aid. Before abandoning ship, I had pocketed morphine syrettes and burn jelly, both of which were used to treat the wounded aboard the raft. Soon after daybreak we were rescued by the destroyer Mug ford. The wardroom in this ship was converted into an emergency operating room and the seriously wounded were treated. All members of the Medical Department who were not seriously injured gave treatment to men.
This report will deal briefly with maxillofacial injuries. A few statistics will be presented, although the figures represent an unfair minimum, for there were considerably more maxillofacial injuries embarked on this vessel than the figures indicate. The reason for the discrepancy was that frequently casualties were brought aboard with a diagnosis of multiple wounds, and in these patients the treatment of thoracic, abdominal, or intracranial wounds took precedence over the maxillofacial injury. Critically ill men were given minimum or no maxillofacial treatment; in many of these patients the dental officer didn't even see the patient because the maxillofacial injury was of secondary importance.
The figures in table 23 indicate the number of maxillofacial injuries treated in the Solace.
TABLE 23.--Maxillofacial battle casualties treated in the "Solace"
Operational theater Mandible Maxilla and/or malar bone Tarawa 11 3 Kwajalein 3 1 Eniwetok 11 3 Saipan (2 operations) 14 4 Guam (2 operations) 13 4 Iwo Jima (3 trips) 28 10 Okinawa (7 trips) 23 9 Total 103 34
Mandibular fractures were three times more common than maxillary fractures. Often, a patient had extensive lacerations of the face, with exposure of the antrum of Highmore or a parotid fistula, and yet the maxilla escaped fracture. Simple fractures of the alveolar process usually presented no problem other than the decision whether to extract the teeth involved in the fracture, The most difficult to handle were comminuted fractures of both jaws. Fortunately, these were relatively uncommon. Chemotherapy was routinely employed; an attempt was made to maintain an optimal blood level of penicillin and sulfadiazine, using 20,000 units of penicillin intramuscularly every 3 hours, supplemented by sulfadiazine, throughout the critical period. Penicillin and the sulfonamides were in a large measure directly responsible for the great reduction in infections. Even where infection could be anticipated because of the necessity to work with only the most meager asepsis, little serious infection occurred.
When this vessel functioned as a fleet station hospital (at Manus and Ulithi), the dental service and EENT were the most overworked departments. One of the most frequent messages received was a request for so many dental appointments for such-and-such ship. It became quite obvious that here was an excellent indication for the expansion of operative and prosthetic facilities. More of this type of dentistry might have been concentrated at fleet anchorage; at no time were there enough dental officers in this area to meet the demand.
The maxillofacial surgeon was particularly useful in a hospital ship during the embarkation of fresh casualties and the subsequent evacuation trip to the nearest base hospital. He could institute early treatment; this was particularly important. He was needed on hospital ships but the greatest need for his services was at base hospitals established near the action theaters. Here elective treatment could be instituted, and definitive work could be carried out at a State-side hospital. It was important fully to organize early treatment in maxillofacial injury.
Over 60 percent of our patients were victims of one form or another of high explosive fragmentation shells. Other types of traumatizing agents were: (a) Bullet wounds (about 30 percent) ; (b) operational trauma (about 3 percent); and (c) miscellaneous trauma, such as from booby traps (about 21/2 percent).
I was impressed with the many tracheotomies performed right on the beachhead in the instance of maxillofacial injury. The uneventful manner in which these patients recovered from tracheotomy sold me on the benefits of this operation. All patients who had a tracheotomy were comfortable and resting well in spite of gross swelling and damage to facial tissues.
Another and more dramatic first-aid surgical procedure frequently instituted by the battalion medical officer in the frontline, to check severe hemorrhage in facial injury, was the ligation of the common carotid artery and the internal jugular vein. I thought the ligation of the external carotid might have solved the problem in a patient brought to my attention, but I didn't fully realize the difficulty of dissecting and identifying anatomical structures in a bleeding patient while both the physician and the patient were under enemy gunfire. It was considerably more expedient to locate and ligate the common carotid artery than it was to dig for the external carotid branch. After all, the operation was a heroic, lifesaving gesture. In two of these patients I saw the clearly defined signs of Homer's ocular syndrome and throughout my entire period of observation the symptoms did not improve. However, the patients were very much alive and were undergoing maxillofacial treatment.
In the large majority of comminuted fractured jaws, it was the general policy to establish adequate drainage
as soon as possible. For this purpose a Penrose drain (rubber, through and through) was usually the method of choice. When a facial bone was exposed, the tissues were not sutured.
It was particularly desirable to have all dental patients concentrated in one ward. The psychological benefits alone were indications for setting up such a ward. These patients prefer to remain together. They wear similar types of appliances and bandages and submit to similar types of treatment and medication. A nurse or senior corpsman is always on watch to supervise medication and diet, and in other ways follow out the maxillofacial surgeon's orders.
The Navy Dental Corps has accomplished in a creditable manner a task never before attempted. However, it is suggested, in the event of future emergencies, that: (a) A larger Reserve Corps be maintained; (b) essential dental treatment be accomplished in the training and embarkation areas; and (c) greater attention and more practical instruction in oral hygiene be given naval personnel.
At the time of the explosion I was sitting at my desk in the dental clinic, situated far forward on the starboard quarter below the main deck. My dental assistant was preparing a tray for surgery. At the sound of the first explosion no one moved; we were too stunned. Somehow one got the feeling that the bulkheads were caving in.
After the second explosion I thought the ammunition magazine directly below the next compartment forward (sick bay) had exploded. The explosion was so loud I was certain that it was somewhere within the ship. I dashed out into the main passageway; it was jammed with men. Then came the third and fourth reports in rapid succession. I had expected at any second to hear the general quarters sounded. I started for my battle dressing station below deck just forward of the fantail. When I reached the ladder leading up from the crew's forward berthing, I could go no further. The passageways were packed with men. I dashed up the ladder and started running over the topside. As I ran I noticed big holes in the deck where 8-inch shells had struck. I saw a seaman, a young man who had sung with our orchestra, lying near the ladder leading to the sickbay. He had been decapitated.
Not until I had reached the quarterdeck did I know what had happened. I looked across the bay; the Mount Hood had disappeared beneath the surface--14,000 tons of steel had sunk in less than 6 seconds.
The medical supplies from the midbattle dressing station locker were broken out. I set up a first-aid station near the gangway on the quarter-deck, using a fire and rescue gear chest for a table and electrical outlet boxes for medicine and bandage trays. Patients began coming over the side in a steady stream, some on stretchers, some ambulatory.
The most critically ill patients were sent forward to the sickbay where our ship's surgeon was already busily operating. The slightly injured were treated at the first-aid station. TWO pharmacist's mates from Ships alongside were designated as my assistants. In a very short time word was passed that the sickbay, the treatment room, and the medical passageways were filled. Patients were then laid out on deck in the Chief Petty Officer's mess, and soon that too became filled. Finally no more patients could be accommodated below.
The first major injury treated at our first-aid station was a fractured femur. An "M" on the forehead indicated that morphine had already been administered, so the leg was slipped through a Keller-Blake splint and made secure. The patient was then removed from the improvised operating table and placed on the deck.
The next patient had a long scalp wound. His face looked chalky. His mouth twitched a little and he died.
Many of the victims were so caked with dried oil as to be hardly recognizable as human beings. Some had been blown off the decks of their ships, later to be lifted into lifeboats from the sea of oil. At one time I had two patients lying on the deck with tourniquets about their legs-each had severed arteries. One man had an ear missing, another a leg severed at the shoe top. Facial and head injuries were numerous. All wounds were cleaned, painted with merthiolate, dusted with sulfanilamide powder, and dressed.
U.S.S. Cascade (Destroyer Tender)
Aboard the Cascade, a space of 24 by 14 inches with three ports was provided on the portside amidships, main deck, for the dental department. The office was equipped with two Ritter Units, Ritter chairs, Weber x-ray, air compressor, Castle lights, two desks, and a large steel cabinet,.An extra steel locker was obtained so that all dental material could be stored and secured in the dental quarters.
We arrived in Pearl Harbor 19 June 1943. The tremendous amount of dental treatment needed by destroyer personnel was immediately apparent. The crews of destroyers and personnel of shore based ComDesPac were cared for.
The ship left Pearl Harbor in November 1943 and proceeded to Funafuti in the Ellice Islands. Here the need of dental treatment for personnel of destroyers, tankers, AK's, LST's, and shore based SeRons was tremendous. The lack of small boats for transportation from those ships without dental officers to the three or four ships that did have dental facilities prevented or delayed the treatment of personnel badly in need of dental care.
At Kwajalein, Marshall Islands, the same situation as to dental treatment prevailed. We left Kwajalein on 20 May for Majuro, where six Japanese civilian prisoners were brought aboard for dental treatment
(surgical). It was apparent that they had received no dental care whatever.
On the Wisconsin, which had a complement of 2,739 officers and men, it was interesting to note that 197, or approximately 7 percent, showed oral fusospirochetosis, and 119, or about 4 percent, showed gingivitis in varying form. A reduction occurred in the ensuing months; other factors than treatment and educational procedure were considered responsible for this. Among the factors were: No contact with civilians, mineralized water, and alcoholic beverages.
A system of sterile treatment procedure had been adopted in the Dental Department. Although it was agreed that this method was not perfect, it still was considered to be superior to routine procedures previously employed. This was one factor that led to the decision to use the dental office for the treatment of minor head and neck injuries, in addition to jaw fractures. By so using the dental office, the sick bay could be relieved of much congestion during the times when hits were being made on the ship.
At the time of the Pearl Harbor disaster, I was with the First Marine Division, Fleet Marine Force, then encamped in tents at New River, N. C. At this time the tables of organization allowed one dental officer to each regiment and medical company, and one for Headquarters Company, Headquarters 13attalion. With a full division of three infantry and one artillery regiment and five medical companies, this allowed 10 dental officers for a reinforced division of 20,000 men. There was no allowance for a division dental officer, so I was attached to Headquarters Company, Medical Battalion, as a spare.
The equipment, both medical and dental, consisted of World War I field units in a sad state of depletion and disrepair. A new supply table had been issued, however, and the task of disposing of the old units and fitting out the medical and dental departments with full field equipment according to the new supply table was given to the Division Dental Officer. The new supplies were very difficult to obtain, and it was not until just before embarking for overseas in July 1942 that all medical and dental units were completely equipped and adequate reserve materiel was on hand.
Later, a field operating light was added to the dental unit, and each dental officer was also equipped with a field unit which included an electric engine, a Castle field light, and a foot engine for use in case of current failure. A portable field generator supplying current was included in t!he units issued each Regimental Medical Unit, Medical Company, and Headquarters Company, Headquarters Battalion.
The dental condition of the troops was deplorable. The few dental officers attached, even by working continually, could not hope to correct the condition of the large percentage of the personnel. The situation was not to improve, for with the entry into the war, emphasis was on training, movement overseas, and combat conditions. Arrangements were made with the Army at Camp Davis, 50 miles south, to care for the few prosthetic dental cases, because a field prosthetic unit was not included in the Division medical equipment at this time.
Arriving in Wellington, New Zealand, in June, two dental units were set up in a small temporary hospital near the docks, which had been taken over from the New Zealand Army, most of whose personnel were in the Far East.
Two more units were put in operation at Paekakariki, 40 miles to the north, where feverish construction of a camp was underway in the cold rains and mud. Only emergency treatment could be attempted, because all hands were busy day and night moving gear from ships to camp‹only to reverse the procedure when the rest of the division arrived and we were all embarked for Guadalcanal (22 July 1952). A typical tent-type dental clinic is shown in figure 139.
The dental officer attached to Headquarters Battalion was left with the rear echelon at Wellington. The dental officers attached to the First, Fifth, and Eleventh Regiments and A, B, and C Medical Companies; in addition to the Division Dental Officer, embarked. An accident aboard ship on 3 August prevented the B Company Dental Officer from landing, leaving six dental officers to hit the beach at Guadalcanal on 7 August. After 3 weeks the failing eyesight of the dental officer in A Medical Company necessitated his evacuation. The five remaining still proved ample to man the three offices we managed to set up and keep in operation through the ensuing months of bombings and shellfire.
The Division began withdrawal from Guadalcanal on 9 December 1942. The following 6 weeks in the brush outside Brisbane, Australia, were a nightmare of rain, mud, lost and misplaced equipment, and inadequate supplies. Sufficient equipment was finally located in the scattered dumps to establish offices in five areas. Some supplies were secured from the Army, including a field prosthetic unit. Then came the order to pack up for Melbourne, and the usual loss of equipment recurred.
At Melbourne, camps were established in and around the city and dental officers assigned accordingly. The rear echelon, still well supplied and equipped, had rejoined the dental officer. All division reserve medical and dental supplies and equipment originally left in Wellington, New Zealand had been moved to Noumea, New Caledonia, and were now unavailable to us. It was during this noncombat status of the Division that a need for dental officers to take care of the great load of work became apparent, Recommendations made through the Division Surgeon later resulted in the increase by 20 of the Marine Division Dental Officer Complement, the official recognition of a Division
Figure 139.--Navy dentist administering dental treatment in one of the typical tent-type dental clinics at an advanced base.
Dental Officer, and the addition of one field prosthetic dental unit to the equipment of a Division.
Another Marine ReportReported to Medical Field Service School, Camp Lejeune, New River, N.C., 1 June 1943. The instruction received here aided immeasurably in understanding problems--military and medical--to be met, in the field. Reported to 'E' Company, Fourth Medical Battalion, Fourth Marine Division, 24 July 1943, leaving North Carolina for Camp Pendleton, Calif., 11 August 1943. An extensive training program was undertaken during the remaining months in the states. Working in conjunction with the medical officers, the dental officer instructed corpsmen in first aid, field hospital organization and function, and medical problems to be faced in combat.
Debarked from San Diego for Roi-Namur, Kwajalein, Marshall Islands. Medical companies functioned on ship because of the lack of land area during this operation. Transports in the lagoon received wounded from the beach evacuation stations. Dental officer screened patients and cared for all oral and facial injuries, and treated preoperative shock.
Duties With the Marine CorpsThe following observations were made:
- Dental officers assigned to the Marines should have a good working knowledge of anesthesia.
- Dental needs of personnel in Marine Divisions should be completed before their assignments in the field. Because of the constant movement of these divisions, innumerable difficulties were encountered in setting up dental facilities. If all necessary work were done prior to leaving the continental limits, the number of dentists assigned to a division could be reduced.
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