Once again the Navy finds itself planning and executing amphibious operations. Some, such as Inchon, are against opposition. Others, such as Wonsan, are merely landings across a beach which is in friendly hands. Still others, such as Hungnam, are in reverse, with a numerically superior enemy attempting to push our troops into the sea. Regardless of the pattern which develops, our World War II techniques have proved sound in current operations in Korea and it appears timely to publicize some of the lessons learned “the hard way” during World War II for the benefit of those who are now responsible for planning and executing these operations. For security reasons, some of these lessons must remain confidential. Because of its humanitarian character, however, the medical phase has never been so classified and this is the most difficult phase of an amphibious operation for which to train inasmuch as the troops invariably look upon such training as a joke and envy the “casualty” who is carried out of the mud and heat to a cool bath and a comfortable bed.
A review of the history of medical service in military operations shows that it is constantly changing and improving. This is due partially to the constant improvement in medical science or the “professional aspect” of the problem. But it is also due to the constant improvement in the “tactical aspect” of this task. Embarked in the ships of the Spanish Armada were 180 chaplains—- one for every 155 men—-and only 85 surgeons, doctors and their assistants—-one for every 330 men. From this it would appear that the Spaniards were primarily concerned with having a chaplain around who could administer last rites to the wounded. British history records that a lesson learned in the Crimean War, 1854-56, was the need for medical assistance in war—the fact that the sooner a casualty was returned to the front line, the easier it would be for an army to maintain its number in the field. This lesson seemed very important when the British were fighting in the Crimea and time consuming voyages were required to bring replacements out from England—much longer than was required to cross the English Channel with replacements when the final phase of the Napoleonic Wars was being fought in Western Europe forty years earlier. In our own Services, a man who had been shot through the stomach during World War I was given very little chance of recovery. In World War II, such a casualty was given better than an even chance to survive if he could be given definitive treatment within six hours. But World War II was an amphibious war. Our country had never participated in this type of warfare and no country had ever conducted this type of warfare on the scale which we did during World War II. A different type of medical service had to be devised. New and radical means had to be perfected to get casualties quickly into the hands of medical personnel who were equipped to take care of them. And the responsibility for the care of casualties usually passed from one service to another as the casualty was moved from the front lines to the rear. Planes were used to evacuate casualties during World War II as they are now being used in Korea. But many men who were wounded in Korea owe their lives to the helicopter which is used there to remove the wounded from areas where planes cannot land, thus speeding up the task of casualty-evacuation.
Why, it might be asked, are non-medical officers, such as the writer, concerned with the medical service in military operations? This question can be answered by citing three very important lessons that stood out during World War II. First, the fighting man will go farther and faster and in higher spirits if he knows that prompt and effective medical aid will be available when he is injured. In view of this statement, medical service takes on the appearance of a highly important morale factor—and morale is always a primary responsibility of command. Second, during the recent war, we experienced a condition in our country which very few had visualized prior to December 7, 1941. The needs of industry and agriculture as opposed to the needs of the Armed Forces caused a shortage of manpower. And current trends seem to indicate that, should another full scale war involving our country occur, this condition would be much worse than it was during World War II. The time that it takes to train the fighting man and the time required to transport him to the scene of action indicate that everything possible should be done to keep him where he belongs and doing what he is trained to do. This, of course, is the same lesson the British learned in the Crimean War. The third lesson was, to many, a surprise. Early in World War II, it became apparent that there was a dual aspect to medical service. The first was the purely “professional aspect”—the care of the patient by the medical man. Our medical personnel are well trained to carry out this assignment. In the execution of this task during World War II, our medical officers turned in magnificent performances. But there is a second aspect to the medical problem which might be called the “tactical aspect.” In the solution of this problem, the medical officer needs help. Ordinarily, his previous training and experience, together with the means available to him, do not qualify him to cope with this problem alone. The “tactical aspect” will be illustrated with specific examples later in this article.
Planning
The medical officers must be included in early planning conferences. That is the thesis which governs this section, and I shall attempt to support this blunt statement in the subsequent discussion.
No two areas are identical. The area in which we are planning to conduct an operation will have its individual characteristics and these characteristics will influence the planning of the medical officer as well as the tactician. Remembering the primary responsibility of the medical officer—“to maintain the health of the command”—there are many questions that must be answered before the medical officer can plan and provide the necessary personnel and equipment to execute this task effectively in the area under study. What kind of climate will we encounter? What kind of peoples and how many of them compose the local population? What provisions must be made to provide medical care for the sick and wounded among the local populace? What is the flora in this area? What kinds of animals, insects, and snakes are found there? What diseases are epidemic and endemic in this area? These are some of the questions which the medical officer will want answered. And now for some historical examples to support my thesis.
In every operation during World War II where the medical officers were included in the early planning conferences, they turned in splendid performances because they had been given time to plan and to assemble the proper personnel, equipment, and supplies. But the medical officers were not always included in the early planning conferences. In our early training exercises, they were not shown the study of the area in which the exercises were to be held in time to plan and equip for conditions existing in that area. In desperation, they prepared a list of medical equipment to take ashore, the same equipment being taken regardless of where the landing was to be made. The inevitable result of this method was illustrated during the landing exercise held on the North Carolina coast in August, 1941. An Army infantry division and a Marine division participated in this training exercise. A study of this area reveals that a number of different types of venomous snakes may be found there. But the medical officers had not seen the study of the area in time to prepare for this contingency. One evening a soldier was bitten by a cotton-mouth moccasin. As Beachmaster during these exercises, the writer canvassed every medical unit which was ashore at that time, both Army and Navy, and found enough serum to treat only four victims of snake bite. That was all that had been provided to protect approximately 20,000 men who were ashore in that area for a week.
Now let’s compare the performance just described with the planning for the execution of the Okinawa Campaign. Much had been learned since 1941, and these lessons were incorporated in the planning for the invasion of these islands. Early information indicated that a rare species of snake would be found in large numbers on Okinawa. This snake, called habu by the natives, was indigenous to no other country. Early reports regarding this snake were conflicting and some were quite terrifying. It was variously described as being green, gray, and white in color. The length of the snake was said to be seven feet. It was said to belong to the cobra family and there was no antidote for its bite, which was always fatal. But the medical officers had been included in the early planning conferences for the capture of Okinawa and they went to work immediately on this, as well as on many another medical problem. When the landing was executed, definite information had been obtained and a small pamphlet, describing the snakes on Okinawa, together with precautions to be taken to avoid being bitten and first aid measures to be taken if bitten, had been prepared and issued to all who were going ashore. The writer has made extensive inquiries of persons who participated in the original landing on Okinawa. Apparently a sizeable number of our men were bitten by the habu during the fighting on Okinawa but, so far as can be determined, no fatalities resulted from the bite of this snake. We had learned to include the medical officers in our early planning conferences. In this instance, it paid big dividends.
As a sidelight on this phase of the medical planning for the invasion of Okinawa, it should be pointed out that the medical officers were faced with an impossible problem. This problem was to provide an antivenom for the bite of the habu before any of our troops landed. No specific antivenom for the bite of the habu was available. A specific antivenom would have to be developed from captured snakes. But Okinawa was heavily manned by Japanese troops and snake hunting on that island prior to the invasion would be an exceedingly risky if not lethal sport. However, it had been determined well in advance of the landing that the habu belonged to the same family as our rattlesnake, and not the dreaded cobra family. There was available an antivenom which was an effective antidote for the bite of snakes of this type found in the United States. It was deemed advisable to use this until such time as specific antivenom could be developed from captured snakes. Details of the purely medical aspects of this problem will be found in the Naval Medical Bulletin of January, 1946. An article in this Bulletin, entitled “POISONOUS SNAKE (HABU) BITES,” reports eight cases which were treated by the Third Corps Medical Battalion of the U. S. Marine Third Amphibious Corps.
We have a national characteristic which has caused us trouble in the past and may well do so again. That characteristic may be described by the quotation from Pope’s “Essay on Criticism”: “Fools step in where Angels fear to tread.” Specifically, it is the belief that, if we enter an area, we will be immune to the unknown danger which lurks there after being warned by the natives, who have learned the hard way, that this danger is real. Two examples will illustrate this point.
For many years it has been known that the natives in certain areas in the West Indies would not eat a fish that was over twelve inches in length. The natives had learned by bitter experience that they became very ill if they ate larger fish. They did not know why. While serving on a battleship in this area many years ago, the writer was one of a fishing party that landed a magnificent barracuda. We knew that the natives in this area would have thrown this beauty back into the sea with no thought of eating it. Notwithstanding, this fish was taken back to the ship and served in the Officers’ Mess. Every officer who ate any of that fish was on the Sick List the following day. The symptoms were not all similar. Some had headaches. Others had aching joints. Still others had high temperatures. We were learning the hard way.
At this time, one of the islands in this area had a rear admiral in the U. S. Navy as Governor. On the Governor’s Staff was a naval medical officer who was an ardent fisherman and he decided to get a scientific answer to this problem. In a book, which he published later, he set forth his findings. In the Caribbean Sea there are numerous patches of ocean bed which contain heavy copper deposits. Fish which live in these areas continuously absorb some of this copper. By the time these fish have attained a length of twelve inches, they have absorbed enough copper to give anyone who eats them copper poisoning. The conclusion reached many years ago by this naval medical officer has recently been substantiated by another medical officer who is also an ardent fisherman and a native of Puerto Rico.
The second example illustrating this point—-that fools step in where angels fear to tread—occurred in the Southwest Pacific during World War II. A unit had selected on the map a new location for its headquarters. As the time neared for moving the headquarters forward, an attempt was made to obtain some New Guinea natives to act as guides. When the natives learned where they were to lead this outfit, they refused to go. “This taboo, this taboo,” was all that they said. They knew that it was dangerous to go into this locality but they did not know why. Without investigating the cause of the natives’ fear of this area, the move was made. The result—many cases of scrub typhus. It is well to remember that the aborigine is smarter in his own environment than the best educated white stranger, and a native tabu is something to respect in any part of the world.
As later newspaper articles showed, our medical officers were not too familiar with scrub typhus and its treatment at this time. It will be recalled that VJ-Day was September 2, 1945. In the Washington Post in February, 1948, a United Press article stated:
“The Army Medical Department yesterday announced discovery of a new drug for combating scrub typhus. It said it may mark one of the important landmarks in 'medical history. Dr. J. E. Smadel, Army director of virus research, will fly to the Malay States early this spring to test the drug on native plantation workers who have been dying by the scores. The drug is called Chloromycetin. The Army said it is the only weapon thus far discovered that is highly effective against rickettsiae—organisms causing such diseases as typhus. Typhus is carried by mites or fleas, which infect rats. When the flea bites a human being, it injects the virus into his blood stream. The war forced abandonment of many big plantations in Malaya and heavy brush overgrew them. Big populations of infested rodents thrive in this brush. Workers sent in to clear the plantations have suffered a heavy mortality rate, the Army said.”
An Associated Press article in the Washington Post, dated April 11, 1948, states:
“Some Naval medical research at Bethesda, Maryland, holds promise of a vaccine against scrub typhus, a disease prevalent in Burma, Malaya, Formosa and Japan. During the war, nearly 7,500 United States soldiers and sailors got the disease, and more then 300 died of it. It’s caused by a tiny organism carried by mites. A group of researchers, headed by Lt. (jg) Charles A. Bailey at the Naval Medical Research Institute, developed a method of preparing a purified suspension of the organisms. Animals vaccinated with it have survived injections of the living organisms. A human vaccine is being sought.”
The foregoing is not to be considered a criticism of our medical officers. The conditions threatening the health of those in the areas just described were not duplicated in the United States. Consequently the doctors, who probably never thought that they would be working in those areas, had not been trained to combat these conditions. Today, we know that men in uniform may be called upon to work anywhere. To prevent recurrences of incidents such as those just described, the area under consideration should be examined carefully prior to our entry not only by the tactician but also by the medical officer. In this connection, a delicacy in one area may prove to be a deadly poison in another area. The following article appeared in the Washington Post under date of May 15, 1949:
“An eel that caused the serious illness of 43 Filipino feasters on Saipan was identified today as a poisonous type of moray.
“George E. Taggart of the Pacific Trust Territory Fisheries Commission made the identification by showing colored pictures of the eel to some of the stricken Filipinos.
“Taggart said an eel of the same general type in the Philippines is not poisonous.
“The United States Army Twenty-second General Hospital reported 13 Filipinos there still were unconscious and two were in critical condition. Four other patients were conscious and improving.”
The Tactical Aspect
Early in 1941 amphibious training exercises were conducted in the Caribbean area. During one of these exercises, the “front lines” and the Beach Evacuation Station were separated by a small but steep and heavily wooded hill. Carrying a “casualty” on a stretcher from the “front lines” over that hill to the Beach Evacuation Station was an exhausting and time-consuming procedure under the prevailing conditions of brush, dust, and heat. It soon became apparent that the “casualties” were making the trip from the “front lines” to the Beach Evacuation Station in remarkably fast time and the stretcher bearers were in a surprisingly fresh physical condition upon arrival. Observers were placed along the route to see how these excellent results were being attained. Two stretcher bearers left the “front line” with a “casualty” on a stretcher. As soon as they had entered the brush at the foot of the hill and when no longer visible from the “front lines,” they placed the stretcher on the ground. One of them said to the “casualty”:
“Get off that stretcher, you lug. If you think we’re going to carry you over that hill, you’re nuts.”
As soon as the “casualty” was off the stretcher, the three started walking over the hill, the “casualty” carrying the stretcher. After crossing the hill and just before emerging from the brush where they would be visible from the Beach Evacuation Station, the “casualty” put down the stretcher, climbed on it, and the stretcher bearers carried him the short distance to the Beach Evacuation Station.
During this same training it was noticed that when a private was designated for evacuation he occasionally arrived at the Beach Evacuation Station wearing corporal’s or sergeant’s chevrons. Observers stationed along the route which this casualty. had to travel discovered that, in such cases, petty officers were “pulling rank” on the “wounded” private. This is understandable when one realizes that a “casualty” in this situation returns to the ship, takes a bath, has hot food, and can attend the movies. The “non-casualties” must stay ashore in the dust and heat and live on field rations until the exercise is completed.
The two foregoing incidents illustrate the “tactical aspect” of medical service in amphibious operations. While humorous, they strengthen the statement made earlier that the most difficult phase of an amphibious operation for which to train is the medical phase. It is extremely difficult to have a red- blooded American, who is keyed up both mentally and physically for combat, simulate a casualty. However, performances such as these are dangerous. They do not give us a true study of the time required to get an actual casualty from the point where he has been injured into the hands of medical personnel who have the proper facilities available for treating his wound. In addition, such performances give us misleading figures upon which to estimate our requirements for medical personnel—and especially stretcher bearers—during combat. These two incidents illustrate the “tactical aspect” referred to earlier. It is in this task that the medical officers need assistance. They are neither trained nor equipped to execute it without outside assistance.
The Medical Plan for an amphibious operation is quite likely to be bulky and detailed. No one can read it all and remember every detail of what he has read. In addition, security would make it inadvisable to allow everyone to read such a plan prior to embarkation. And yet everyone must know what medical facilities are available and where they are located so that casualties can be moved quickly to medical installations and treated promptly during combat. The answer to this problem is—let them see what it looks like before going into combat. Hold a realistic rehearsal. Failure to do this has cost us dearly in the past.
During one of the early landings on the north coast of New Guinea, the beachmaster was a lieutenant commander. In addition to being a fine shipmate, he had been a tower of strength during the preparations for the first landings in this area. As he walked across the ramp of a beached landing craft shortly after H-hour, a Jap sniper shot him through the stomach. With the senior naval officer on the beach wounded, no one seemed to remember the Medical Plan. The sole idea seemed to be to get this wounded officer off the beach.
Shortly after the beachmaster was wounded, several LCI’s (Landing Craft, Infantry) beached and the wounded officer was placed in one of these vessels. These small ships have no facilities for major surgery and this particular group of ships was starting back immediately to our loading point to bring forward more troops. The trip to the loading point took twenty-four hours. Upon arrival, the wounded officer was taken in an ambulance to a hospital which was two hours driving time away. It was twenty-six hours after he was wounded before the beachmaster was finally delivered to a surgeon. It was then too late.
Our doctors had told us that a man with a “belly wound” had a good chance of living if he could be treated within six hours after he was wounded. On the beach where the beachmaster was wounded, a Portable Surgical Team was performing major surgical operations three hours after he was hit.
The easiest and surest way to familiarize all concerned with the “tactical aspect” of the medial problem is to hold a realistic rehearsal. And during these rehearsals the medical officers definitely need help.
The writer was senior beachmaster at Fedhala, French Morocco, during the Casablanca landing on Sunday, November 8, 1942. In accordance with doctrine, casualties were delivered by the Army to the Beach Evacation Station shortly after the landing. These men had been hurt so badly that their medical officers had marked them for evacuation from the battle area. After they had been delivered to the Beach Evacuation Station, it became Navy responsibility to move them out to the ships and transport them back to United States hospitals, rendering medical aid en route. One of the early casualties was delirious and kept screaming: “I can’t stand this. Won’t somebody shoot me?” I asked the Naval Medical Officer in Charge of the Beach Evacuation Station if he could not do something to ease this poor devil’s suffering.
“No, I cannot,” he replied. “There is iodine on his arm and in it is the mark of a hypodermic. But there is no written record with the patient to indicate how much of what drug has already been given. If I were to give morphine, the accumulative effect might be fatal.”
Our peacetime practice had been to tie a paper shipping tag to the patient’s clothing, writing on it all treatment which had been given to the patient as he was moved to the rear. But the writing on these tags soon becomes illegible if the tags get wet. Also, the tags are torn off quickly when a patient is carried through bushes or jungle. We soon learned that the surest way of having a complete record of treatment arrive with the patient was to write what had been done on the patient's body using indelible pencil, iodine, mercurochrome, or other dye.
This gruesome bit of history has been related to point out a responsibility for our medical personnel. And this responsibility has great future applicability. In the past we have had considerable trouble convincing our medical personnel that complete, accurate records must accompany all casualties. This is understandable when we realize that very little, if any, of the written records in civilian hospitals are prepared by doctors. Such tasks are assigned to nurses and internes. But, in uniform, these records are extremely important. They are not “red tape.” They prevent occurrences such as that just described. A complete medical history protects the patient and assures him of the rights to which he is entitled under existing law. Should he die, this record also protects his “next of kin.” In addition, the government is also protected inasmuch as this record prevents an impostor from obtaining from the government rights and privileges to which he is not legally entitled.
The foregoing are some of the lessons learned in this field during World War II. With very meager historical data available for study or duplication, work in this field started from scratch in 1941. In the writer’s opinion, greater effectiveness was attained in this field during World War II than in any other single phase of amphibious operations. 1 his belief is supported by a paragraph from the annual report of the Secretary of the Navy for the fiscal year 1943-44 which states:
“Because 1943-44 was a year of invasions, the predominant problem in caring for the health of the men in the Navy was the task of taking medical care into the beachheads. The solution was the creation of Amphibious Medicine. The Navy evolved a chain of medical facilities reaching from the hospital corpsmen on the beachhead to aid stations, to field hospitals, then to special hospital ships, and finally to fleet and advance base hospitals. Through this chain of medical care, Marines and Navy men wounded in combat moved to safety with such success that, out of every hundred wounded, ninety-eight recovered.”