Medical Services in New Zealand and The Pacific
V: Landing on Nissan Island
V: Landing on Nissan Island
From November 1943 to February 1944 was a time of consolidation for 3 Division while the ground was prepared for another northward move. On the right flank of the central Pacific battlefield United States forces landed on Tarawa and other islands of the northern Gilberts in November, and a further thrust carried them to Kwajalein, in the Marshalls, and into the inner ring of the Japanese defences. On the left flank successful landings had continued along the northern coast of New Guinea and on New Britain in the plan to immobilise the big enemy bases of Rabaul and Kavieng. New Zealand troops were concerned with the central thrust up through the Solomons which was to end with the capture of the Green (Nissan) Islands.
These islands, only four degrees from the Equator, lie north-west of Bougainville and only 135 miles from Rabaul. Their capture was to assist in completing the Allied ring around New Britain and New Ireland and it disrupted all traffic between Rabaul and Kavieng and Bougainville and Buka. A vital reason for the seizure of the group was the need there for airfields from which pressure could be maintained on enemy bases.page 57
The coral atoll called Green Islands is frequently referred to as Nissan because Nissan Island represents 90 per cent of the land area. Nissan is an elliptically shaped ribbon of land, less than a mile in width, surrounding a lagoon about eight miles long and three miles wide. The open sea enters the lagoon through three small gaps in the ellipse of land, thus making the two small islands of Sirot and Barahun at the north-west of Nissan. The main channel, which is between Nissan and Barahun, is only 15 feet deep, so that although the lagoon is deep, only shallow draft vessels may enter. There are no high hills and no watercourses on these islands, but the jungle is thick and substantial areas are covered by coconut plantations.page 58
Aerial reconnaissance of the islands showed that the enemy was using them constantly as a barge staging base between Bougainville and Rabaul. The enemy did not appear to be maintaining large numbers of men permanently on the islands, and it was expected that the opposition 3 Division was likely to meet would fluctuate considerably with the visits of the enemy barges. A commando raid obtained an estimated figure of Japanese strength as about 100 men.
The date of the assault by 3 Division on the islands was fixed for 15 February 1944 and units of 14 Infantry Brigade Group and United States units on Vella Lavella and Guadalcanal prepared for the initial landing. The medical units involved were 24 Field Ambulance (Lieutenant-Colonel Fea1), 1 Field Surgical Unit (Major Brunette2), and parts of 6 Field Hygiene Section (Major Irwin3), and 1 Malaria Control Unit (Major Ferguson4). The total force was 5782, of whom 4218 were New Zealanders. They sailed for the Green Islands in thirty-four shallow-draft landing craft. The convoy was attacked several times by enemy planes during the approach to the islands.
At daylight on 15 February the landing began. Thirtieth Battalion landed on the lagoon side of Pokonian plantation and 35 and 37 Battalions landed on the lagoon side of Tangalan plantation, opposite the channel. The enemy had not laid mines, nor had he ranged weapons on the entrance, and the landing was not opposed by ground forces. Allied fighter-bombers shot down six of fifteen enemy bombers which attempted to disrupt landing operations. A Company of 30 Battalion struck an enemy pocket of resistance on the north of Sirot Island on the third day and suffered five killed and three wounded in accounting for fifteen Japanese. On 20 February Japanese were attacked in entrenched positions at Tanaheran village in the south and 30 Battalion here accounted for sixty-two enemy dead, its own casualties being five killed and seven wounded. There was no further action on Nissan Island. On 23 February small enemy groups were cleaned out on the neighbouring Pinipel and Sau Islands to end organised resistance to 3 Division's seizure of the islands.
Important features of the operation were the provision of water by distillation and the exceptionally careful regard for sanitation and malaria control. Each man landed with his water bottle full and units carried two gallons for each man in bulk. The distillation plants began to work at the end of the first day, but there was an acute shortage of water for some days, troops drinking coconut milk. The fighting troops had to be meticulous as regards sanitation because the atoll was so small that battlefields were likely to become the sites of permanent camps. Within a month of the initial landing 16,448 troops were stationed on Nissan and the American engineers had cleared a considerable portion of the island for an airfield.
Medical Operations on Nissan
Detailed medical arrangements were made by the Americans aboard the LST flotilla to deal with heavy casualties from the initial landing, but as the landing was unopposed the surgical teams on board were not required to function prior to the departure of the convoy on its return journey on the afternoon of 15 February. During the morning 24 Field Ambulance and 1 Field Surgical Unit were fully occupied in establishing an MDS, delay being occasioned by an LST landing the heavy medical equipment at the wrong beach. Consequently, equipment weighing about 20 tons had to be manhandled some 400 yards north to the site originally selected. The MDS, however, was ready to receive casualties at 2 p.m.
The site of the MDS was in a swampy and necessarily restricted area in Pokonian plantation in 30 Battalion zone. It was originally understood that this confined area was to be occupied for security reasons for the first night only. This was a gross underestimate, and when the move to a permanent site was eventually possible five days later, this initial area had become a morass. The new site was in a drier area about one mile south of Pokonian plantation on the lagoon shore. Work with a bulldozer and much blasting of coral, which was very near the surface, was necessary to prepare the site for the MDS. On 20 February 1 Field Surgical Unit moved to the site and set up its theatre, resuscitation tent and hospital tents. By 22 February the whole of the MDS and patients had been transferred to the new site.
Three beach dressing stations from 24 Field Ambulance, one for each battalion, were functioning soon after the landing on 15 February, but later that day two of these moved forward with the advancing infantry battalions. During the following week the sporadic encounters with the enemy produced few casualties, which page 60 were handled without difficulty. Twenty-eight battle casualties, mostly with gunshot and grenade wounds, were admitted to the MDS up to 25 February, 26 operations being performed.
On 20 February an evacuation of twenty-two patients, including sick, was made by LST to Guadalcanal, and a further evacuation of thirty-three patients was made on 25 February, the patients having first to be transported across the lagoon for embarkation at Tanga-lan plantation. Evacuation by air began on 13 March, 24 Field Ambulance establishing a holding hospital at the airstrip itself to enable patients to be loaded promptly.
In the meantime 22 Field Ambulance (Lieutenant-Colonel Barrowclough1) arrived and established itself at a selected site on the south coast, opening an MDS on 1 March near Tanaheran. Shortly after their arrival the men captured a wounded Japanese in their area and later that evening were molested by three armed Japanese, who escaped capture.
The medical situation now resolved itself into caring for the growing garrison force, no further active operations being undertaken by the Division.
Hygiene and Sanitation
Water supplies proved the greatest problem on Nissan Island, as no water suitable for drinking or cooking occurs naturally there. For the first few days after landing there was an acute shortage and troops drank copious quantities of coconut milk. Water had to be provided by distillation plants which produced approximately two gallons per man per day. In a few places wells were bored and the water, though brackish and very hard, was used for washing. Tents were used for rainwater catchment, and thus the most satisfactory water for washing was obtained, although the number of containers was inadequate for some time. Extensive facilities for sea bathing were available to almost every unit on Nissan.
During the first three weeks units disposed of their rubbish and garbage within their own lines, but as roads permitted, dumps were established at suitable points along cliffs on the sea coast, with shutes leading straight into deep water. Inadequate disposal of empty coconuts and food refuse led to a large fly population. However, with clearing of camp sites and improvement of sanitation generally, the number of flies was reduced. Native pigs abounded on the island and proved a nuisance by rooting up refuse that had been buried.
There were anopheline mosquitoes on Nissan but the area of permanent breeding places was not great, though native wells, pig wallows and pools in low ground required careful search in jungle areas. The exception was the salt swamp area south of Pokonian, which was heavily forested and obstructed by tree roots and was difficult to traverse with oil and sprayers. The rapid increase in man-made breeding places required careful watching and effective control to prevent colonisation by anopheles from the scattered permanent breeding places. This was especially true of the jungle roads. Fortunately the greater part of the island was well drained and did not hold water unless the soil had been disturbed. Cases of malaria were few, although there was an increase to twenty in March. Troops were still failing to apply repellent
Skin disease was again troublesome. On the Treasury Islands a scrub mite had caused skin irritations, but on Nissan a small red-brown caterpillar caused lesions wherever it touched the skin. The pruritis lasted for several days, and often scratching, which was irresistible, left excoriations which became infected and caused temporary disability.
As on Vella Lavella and Mono Islands, New Zealand medical officers gave treatment to the native population on Nissan and Pinipel Islands. Several weekly visits were made to Pinipel on landing craft and the 200 natives were given injections for yaws and other medical treatment. A great improvement in their health, both mentally and physically, was noted. About seventy men worked under supervision for the New Zealand forces. Some 1200 natives were evacuated from Nissan Island immediately after the occupation.
The occupation of Nissan led to the detection in April of hookworm infection in the troops. The natives of the island were heavily infected with hookworm (ankylostomiasis), and the infection probably occurred in the first few days after landing when troops were sleeping in foxholes or on ground that had been infected by natives. It may perhaps have occurred through the wearing of unserviceable canvas jungle boots, most of which were by then in poor repair, with numerous defects in the seams through which infected mud and water could pass. Eosinophilia was also present, though it was concluded that this condition was not necessarily due to hookworm infestation.
Medical stores during active operations were supplied through the New Zealand Medical Stores Depot, which had its forward headquarters at Guadalcanal and a base store in New Caledonia. A section was on Vella Lavella for a time. Almost all supplies were page 62 drawn from American medical depots, under lease-lend agreement, although such items as field equipment and Red Cross hospital supplies came direct from New Zealand. Certain ordnance supplies were handled more satisfactorily by the Advanced Depot of Medical Stores. Some of the items issued in six months from Guadalcanal were: Petrolatum 718 lb.; Fuschin Basic 360 gms.; Zinc oxide 250 lb.; Calamine 240 lb.; Multivitamin capsules 330,000; Cresol Sap. Soln. 280 gals.; Mercury bichloride 28,000 tabs.; alcohol 640 gals.; Acid acetysal 350,000 tabs.; bandages, 3–in. 1000 doz.; 2-in. 800 doz., 4-in. 500 doz.; Cotton abs. 1200 lb.; Cotton abs., 1 oz., 5800 pkts.; gauze, 1 yd., 1300 pkts.; gauze, 100 yds., 128 rolls; plaster, 1-in. 2500 spls., 3-in. 2800 spls.; sponges surgical 2 × 2, bags of 200, 600; sponges surgical, bags of 500, 280.
Casualty Clearing Station
While the unit was on Guadalcanal from 14 September 1943 to 19 May 1944 2 NZ CCS admitted 2210 patients with only two deaths occurring. Twelve hundred and fifty-four patients requiring prolonged treatment or convalescence were evacuated to New Caledonia to 4 General Hospital and 2 Convalescent Depot. The policy was laid down that patients with a convalescent expectancy of less than thirty days (reduced in January 1944 to twenty days) were to remain at the CCS until discharged fit to their units, others being transferred to New Caledonia; air evacuation was used throughout the whole of the period on Guadalcanal, thanks to the co-operation of American air headquarters on the island. The first casualties from the Treasury action were back at 4 General Hospital within forty-eight hours of being wounded. The number of battle casualties from actions by 3 NZ Division was not large, but they were augmented by Fijian wounded admitted from actions on Bougainville. Fijians were cared for in New Zealand medical units where possible and a suitable line of evacuation from New Caledonia to Fiji was in operation. Sickness, notably skin diseases, neurosis and malaria, contributed largely to keep the average bed state of the CCS at 130, with ten to fifteen admissions each day. There was very little sickness in the Division and no epidemics.
The CCS site was originally cleared with a bulldozer by engineers, who also built kitchens, mess huts and recreation huts. Later, in January 1944, the tented wards were replaced by prefabricated wooden buildings. The unit put in much work under the leadership of Lieutenant-Colonel S. L. Wilson, making its camp site a model page 63 area. Later COs were Lieutenant-Colonel Comrie (in January 1944) and Major Riley1 (in April 1944). Early in March 1944 a team of eight nursing sisters was attached to the CCS from 4 General Hospital. Unfortunately they were not sent forward during the period of active operations to nurse the seriously wounded cases.
The CCS was well staffed and equipped to carry out both medical and surgical treatment. Full knowledge of war wounds as seen in the Middle East was possessed by Lieutenant-Colonel Wilson. Tulle gras dressings were supplied from New Caledonia. X-ray facilities at the adjoining United States hospital were used until an apparatus was available at the CCS. (The X-ray plant was not installed until December 1943 after the Vella Lavella and Treasury actions. The delay was occasioned by scarcity of plant in New Zealand, and then by slow shipment. It was realised that a radiologist and equipment should have been available for the CCS when it was established.) Although the majority of cases had already been operated on by the FSUs or field ambulances, there were batches of wounded admitted for primary treatment.
From 16 October to 31 January 139 wounded were admitted, 80 of them being sent on later to New Caledonia. There was only one death in these cases in the CCS.
End of Active Operations
The possible role of 3 Division in future operations planned for the seizure of Kavieng and the final neutralisation of Rabaul did not eventuate owing to the early and successful occupation by the Americans of the Admiralty Islands and Emirau Island. The campaign in the south-west Pacific was then virtually ended. From New Zealand instructions were received in March for the withdrawal of troops of 3 Division for work in essential industries in New Zealand. A regrouping of forces at the end of May saw the Division taken out of the combat area and brought back to its old base in New Caledonia, where arrangements were made for its disbandment and return to New Zealand.
Because of its size and composition, 3 Division was not used in the larger operations of the Solomons campaign – Munda and Empress Augusta Bay – but it found its niche and did its work well in the smaller, very valuable, if less spectacular sallies into Vella Lavella, the Treasuries and Green Islands.
1 Maj C. G. Riley; London; born Dunedin, 16 May 1912; medical practitioner; medical officer 2 Gen Hosp Nov 1940–Oct 1941; 1 Gen Hosp Oct 1941–Dec 1942; 4 Gen Hosp Feb–Sep 1943; 2 CCS Oct 1943–Jun 1944.