Medical Services in New Zealand and The Pacific
IV: Treasury Islands
IV: Treasury Islands
From the time of its arrival in Guadalcanal in mid-September 8 Brigade embarked on a series of battle exercises. On 16 October 1943 the Brigade Commander received orders from 1 US Marine Amphibious Corps to seize and hold the Treasury Islands, capture or destroy the enemy forces in the area, establish a long-range radar station in the north of Mono Island, and establish an advanced naval base with facilities for motor torpedo-boats and a staging refuge for landing craft. The first flight of the brigade was to land in the Treasury Group on 27 October.
At this time the brigade was camped on the north coast of Guadalcanal, 350 miles from the prospective scene of operations. Approximately 2000 American troops, who were to come under the command of 8 Brigade Group for the operation, were also assembled at Guadalcanal. A total force of 6574 was prepared for embarkation in five flights at five-day intervals. The medical units included were 7 Field Ambulance (244) and 2 Field Surgical Unit (11). Of the above force 3700 were to sail with the first flight.
This flight arrived at Blanche harbour, Mono Island, in the early hours of 27 October. The destroyers Pringle and Philip opened fire on the Falamai area at 5.45 a.m. and the first wave of infantry landed on the beach between the Saveke River and Falamai at 6.26 a.m. The landing craft came under enemy machine-gun fire from Mono Island and also from Cummings Point on Stirling Island. Eight men were wounded at this stage. A beach-head was quickly established by 29 and 36 Battalions, though it was not secure until later in the day.page 49
Meanwhile 34 Battalion, artillery units and Brigade Headquarters were established on Mono Island without opposition. Throughout the first day of the operation the brigade had excellent naval and air support.
At the end of the day's operations the brigade could not estimate the total casualties inflicted on the enemy, but 21 New Zealanders had been killed and 70 wounded, while the United States units under the brigade's command suffered 9 killed and 15 wounded.
By 31 October units had consolidated and patrols began to sweep Mono Island, routing out nests of Japanese who had taken refuge in the interior. Mono Island rises abruptly from the sea to a cone over 1000 feet high, with rivers cutting through it, and in the dense jungle are many caves and creeper-covered cliffs. Here the enemy hid until he was probed out, a slow and trying task which took days to accomplish. Enemy remnants were still being mopped up at the end of November and some Japanese eluded capture for months.page 50
The seizure of the Treasury Group went according to plan and on 1 November, when the American Marines landed at Empress Augusta Bay, Bougainville, the Treasury Islands were ready to ‘provide protection for future convoys’ to that area. This latter Allied move bypassed over 24,000 enemy troops stationed in south Bougainville and the adjacent islands of Shortland and Ballale. The enemy possessed in the area enough barges to transport 3000 men from Shortland to Mono (18 miles) in a night. However, the enemy reaction to the Treasury landing was ‘surprisingly supine’ and he made no attempt to reinforce or evacuate his garrison.
By 12 November 8 Brigade Group had accounted for 205 Japanese killed and had taken eight prisoners – the latter were either badly wounded or were captured by native scouts. The New Zealand casualties were 40 killed and 145 wounded and the American casualties 12 killed and 29 wounded.
The medical plan was limited by several factors. First, there was restricted accommodation for personnel – 128 for 7 Field Ambulance and 10 for 2 Field Surgical Unit was the allocation in the first echelon. This allowed for little more than half the personnel to be taken forward in the first lift. Second, there was a limitation on the tonnage of equipment which could be carried on the LCTs and also on the number of vehicles.
Briefly, the medical plan called for the establishment of an MDS or (more properly) a field hospital on Stirling Island at a spot in reasonable proximity to the landing beach, a bearer company to establish an ADS and beach evacuation station on Mono Island within the two-battalion perimeter, and a small detachment of one medical officer and four other ranks to accompany the Soanotalu force, where little opposition was expected. It was visualised that all casualties would be held until the LSTs of later echelons could evacuate them to Vella Lavella, where there would be an American hospital. Evacuation from the Beach Dressing Station to the MDS was to be by small surface craft across Blanche harbour.
A Company Movements
It was envisaged that after the initial unloading of the LCIs a Beach Dressing Station would be set up at the centre of the perimeter in close proximity to the beach. This was to be run by one medical officer and approximately eight other ranks, with a minimum of first-aid and ordnance equipment. The remainder of the company were to establish a more elaborate dressing station about 150 yards from the beach towards the left flank. The beach station was formed in a small creek bed, much as planned. Owing to the fact that the majority of casualties were occurring on the beach among ship-unloading parties and that the area chosen for the ADS was still under heavy fire, no endeavour was made to establish a fully functioning ADS before late afternoon. Runners readily made contact with the adjacent RMOs, but stretcher parties were not sent out until called for because they were needed more on the beach itself. At this stage there were no trucks and all carriage of wounded was by hand. Distances were short and four-men stretcher parties were sufficient. During the day only RAP treatment, including plasma, could be given on account of the exposed position of the Beach Dressing Station. Most casualties were evacuated direct to the LSTs until 4 p.m., but some casualties from early afternoon onwards were diverted to the MDS, largely to avoid over-burdening the LST. The number of men available (46) was only just sufficient to do the requisite stretcher-carrying from RAPs and on to the LSTs. By 4.30 p.m. all casualties had been evacuated and the beach station was moved to the site originally chosen for a dressing station. Foxhole digging for personnel had priority and was all that could be accomplished before dark. Heavy mortar and bombing attacks were experienced during the night. At daybreak an attempt was immediately made to set up a proper ADS consisting of tarpaulins and tents, one tent being dug three feet under the ground with a coconut log pallisade. Casualties that had occurred during the night commenced to come in about 8 a.m. and filtered through all day. All movement of casualties from forward positions ceased at dusk. During the night of 28–29 October extensive infiltration of Japanese took place into the ADS lines and there was a lot of desultory firing and grenade throwing throughout the night. Fortunately there were no casualties among the personnel, most of whom were armed. As a result of consultation with the Brigade Commander, the ADS personnel were withdrawn to the MDS site at dusk on the second page 52 night and a small Beach Dressing Station was set up on Mono at an early hour the following morning, the personnel returning thereafter to the MDS every night. This worked efficiently.
Headquarters Company Movements
Along with the Field Surgical Unit, Headquarters Company personnel and equipment belonging to each unit were disembarked on Stirling Island about thirty minutes after the first assault wave of troops had landed (approximately 6.45 a.m.). No opposition had been encountered there, which was fortunate as the infantry had not landed in the same place and no perimeter had been established. A track was hacked through some 150 yards of heavy jungle and equipment carried up from the beaching area. All the area had to be cleared by our own working parties, but by midday a skeleton dressing station was working and ready to receive the first casualties, which arrived about 1 p.m. Both Field Ambulance and Field Surgical operating theatres were in commission and were fully occupied until 10 p.m. or later. During the late afternoon further tentage was erected. On the following days a steady stream of casualties and sick came in for treatment. Five days after the initial landing when the second echelon arrived, fifty-one patients were evacuated with the outgoing LSTs. A new site had been selected for a hospital area and partially cleared, and with the evacuation of another thirty-seven patients on the third echelon LSTs a move was made with the remaining patients and all tentage and equipment were taken to the new area. This area was much more suitable, clearer, better drained and not encroached upon to the same extent by numerous other camps. In the initial stages tentage was in short supply. Owing to weight difficulties only a minimum was brought on LCIs in the expectation that within twenty-four to forty-eight hours the heavier tents and equipment would be transhipped across to Stirling Island. This movement did not occur and it was many days before all equipment was reassembled. Difficulties in unloading under fire were greater than was anticipated. There was marked confusion of unit equipment and some was destroyed by bombing and fire. When a fire broke out salvage parties pulled equipment to the outskirts and a great deal lay undiscovered in the surrounding bush for several days. By dint of a good deal of overcrowding all patients were under shelter, but one lesson learnt was that tentage accompanying personnel should not be reduced so much in future. One unfortunate result of overcrowding in the area was that sanitary arrangements temporarily broke down. Dysentery cases were admitted at an early stage from one of the units and unfortunately many of our nursing personnel contracted it, largely due to the general rush and proximity of the dysentery latrines to the general camp and cookhouse area.
This landing in the north of Mono was unopposed. From the third night onwards determined attacks were made by the Japanese on the positions of this force. Casualties in our troops were light and evacuation by LCM to the MDS presented no difficulty.
A large number of RMOs, both United States and New Zealand, were attached to the various units of the force. Liaison between these medical officers and the field ambulance was easy to maintain and supplies were kept moving forward without difficulty.
Battle casualties admitted to the MDS on successive days from 27 October to 1 November were 53, 19, 15, 9, 4 and 6, while there were nine cases of accidental injury and 62 admissions of sick for the same period. Up to 9 November there were 128 battle casualties (20 Americans) and 199 other admissions (including 22 Americans).
In general the medical plan worked out much as visualised. The handling of the first casualties by the American surgeons on LSTs allowed 7 Field Ambulance ample time to get the MDS adequately set up before having to cope with casualties. The construction of the MDS was no light work in heavy jungle with the minimum number of personnel, many of whom were temporarily lost to the unit in assisting with general unloading of cargoes. It was felt that the transhipping of wounded to the LSTs in no way prejudiced their chances, nor was it of any great moment that the journey was one of thirty hours back to Guadalcanal rather than six to nine hours to Vella Lavella.
One striking thing in jungle warfare was that no casualties arrived at an ADS or even an RAP after dark. The wounded man remained in his foxhole until dawn – a severe penalty on the casualty, but unavoidable where instructions were explicit that anyone who moved after dark was an enemy, and was treated as such. All stretcher parties were accompanied by armed guards from unit personnel and were occasionally subjected to sniping, though no casualties resulted.
It was learnt that if a medical establishment was to be placed in a perimeter of defence, then it must be a perimeter in more than name only. On Mono Island the perimeter was evidently so extensive that large gaps were left through which the enemy could infiltrate with impunity. Where perimeters appeared difficult to establish and maintain, it was felt that all medical personnel should page 54 be armed if they wished and grenades appeared to be the most effective weapons. In any case, medical establishments at night in close proximity to defended areas served little useful purpose as casualties were never handled at night, except at their final destination, and with reasonable evacuation facilities an ADS would be cleared by nightfall and remain empty until morning.
The vast majority of wounds were multiple – occurring from grenades, tommy guns or mortars. Second Field Surgical Unit attached to 7 Field Ambulance carried out the major surgery. The field ambulance operating theatre dealt with the less severe wounds and eased the strain on both personnel and equipment of the surgical unit. A resuscitation team had previously been organised, with a medical officer controlling this department and, in addition, determining the priority of cases for operation. Use was made of plasma and, when necessary, of blood transfusions.
The surgical unit, 2 FSU under Major Waterworth,1 performed its first operation at 2 p.m. on the day of assault. The hospital was situated only a quarter of a mile across the water from the fighting zone and barges brought wounded from the ADS without great loss of time, so that the majority of operations were performed within twelve hours of a man being wounded. The Trueta technique of excision of wounds was used, frosting with sulphanilamide powder and leaving the wounds open and packed lightly with vaseline gauze.
It was noted that there was a very low proportion of abdominal wounds compared with Middle East figures. In the short range of jungle fighting, often 25 yards or so, such wounds were generally fatal and accounted for many of those killed in action.
All New Zealand casualties passed through 2 CCS at Guadalcanal. After treatment only 61 per cent required to be evacuated to 4 General Hospital on New Caledonia for further treatment. The others were well enough to return to their units.
Plasma was of great value for resuscitation but a need was felt for whole blood. In only two cases was whole blood given as it was considered unjustifiable to utilise donors under the prevailing conditions.
Water filters (Italian and German varieties) were received by 7 Field Ambulance just prior to departure from Guadalcanal and were of immense value. It was seventy-two hours at least before a water point was established on Stirling Island, as a road had to be driven two miles through to the lakes by a bulldozer. The unit dug a small hole ten yards from the edge of the sea and was able to pump water out with a German filter to meet its immediate needs. It was slightly brackish but otherwise quite suitable. Filters were likewise of great importance to the ADS company. It was felt that the number of filters on issue to the Division should be greatly increased, as water points would always be difficult to establish in unroaded island country. Halazone and water sterilising tablets were available but they were not used, and it was felt that a number of the cases of dysentery could have been prevented as units drank untreated water from foul streams.
The operation on the Treasury Islands provided most valuable information in regard to equipment. A jungle medical kit in a tin containing atebrin, iodine, sulphaguanidine, water sterilising tablets, morphia syrette, extra dressings and meta fuel was recommended for personnel in assault groups. It was found that the only equipment that the ADS, MDS and Surgical Unit could depend on getting for the first forty-eight to seventy-two hours was what the personnel could carry off an LCI. Heavy equipment packed on an LST might reach them quickly, but more often than not it would be three to four days before it was procurable, especially as unloading was going on under enemy fire. Moreover, LCI equipment should be literally ‘hand carries’, that is, stout boxes with rope handles, weighing not more than 120 pounds. Heavier packages were encumbrances and unduly slowed up unloading. They might have to be carried ashore through three to four feet of water. Seventh Field Ambulance had provided itself with over 100 well-made boxes, but even then a percentage of the equipment was carried in unsuitable crates.
It was noted that for the task allotted to it the bearer (ADS) company carried far too much equipment. All that was needed were stretchers, tarpaulins (four of 30 ft. by 18 ft., and possibly one tent), Thomas splints, two-gallon water containers, a hydra burner, medical comforts, morphia syrettes, phenobarbitone, plasma, elasto-plast in large quantities, a surgical haversack and spare field dressings. In regard to the first field dressings, there was a big call on these as in the Vella Lavella action. The explanation was that, with multiple wounds, the wounded man's own field dressing could not page 56 possibly cover all his wounds and his fellow soldiers had to supplement it with their own supplies. The medical services had to carry extra field dressings in large quantities. The small tin United States field dressing appeared more suitable than the British pattern.
Field ambulance panniers had been revised in New Caledonia, but there were still a number of articles in them which appeared to be of little value in the early stages of the operation, and items more in demand could have been substituted. Medical supplies came forward without difficulty. Requests sent back on returning LSTs of one echelon were fulfilled on the echelon arriving ten days later. In addition, signals could be sent for urgent supplies.
Under brigade instructions the vehicles allowed on the first echelon were one 30–cwt truck and four jeeps. Prior to leaving New Caledonia 7 Field Ambulance had constructed a simple frame which could be attached to the jeeps to enable them to carry three stretchers. This adaptation was very useful and the jeeps were the only ambulance vehicles the unit had. The need for a closed ambulance was not felt in the prevailing conditions.
Attached as an appendix at the end of this chapter is a list of the equipment carried by 7 Field Ambulance and 2 Field Surgical Unit at the landing on the Treasury Islands, together with comments by the respective commanding officers.