Medical Services in New Zealand and The Pacific
III: Landing on Vella Lavella
III: Landing on Vella Lavella
The Division's first task, that of clearing Vella Lavella, fell to 14 Brigade. When the units disembarked on Guadalcanal two American divisions were engaged in eradicating the last of the Japanese from Arundel Island and the north coast of New Georgia. Munda airfield was operating and fighter planes based there supplemented those from Guadalcanal which daily pounded the enemy strongholds in the north. Units from one of the American divisions based on New Georgia had been in action on Vella Lavella for some time and had succeeded in driving the Japanese garrison into the north of the island, where they were holding an area in Paraso Bay on the north-east coast, and at Mundi Mundi on the west coast.page 39
Approximately 3700 troops of 14 Brigade made the landing on Vella Lavella on 18 September 1943. They travelled the 220 miles from Guadalcanal in two days in a convoy consisting of six Landing Ships, Tank (LSTs), six Assault Personnel, Destroyers (APDs) and six Landing Craft, Infantry (LCIs), escorted by five destroyers, and carrying with them large supplies of ammunition, petrol, equipment, stores and transport.
22 Field Ambulance and 1 FSU were established at Gill's Plantation
At dawn on 18 September, under an umbrella of fighter aircraft, many of them flown by New Zealand airmen, men and supplies poured from the landing craft on to beaches in the south-east of the island at Barakoma, the enemy having been pushed back by the page 40 Americans to the opposite side of the island. A Japanese air attack came shortly after midday, but by that time disembarkation had been completed.
General Barrowclough1 took over command of the island and its defences on 18 September, the Division being under command of 14 US Corps on New Georgia. The headquarters of 14 Brigade were established in Gill's Plantation behind Joroveto, midway up the east coast and within easy reach of Joroveto River, which was the principal water supply.
Action in Vella Lavella
Between 500 and 700 Japanese were cornered by American troops, supported by Fijian scouts, along the northern area of the island where the coast was deeply indented and mangrove swamps added to transport and communication difficulties. The task of 14 Brigade was to relieve the Americans and clear the island as quickly as possible. Vella Lavella was clothed in dense jungle from the water's edge to the mountain crests of the interior. In this jungle the enemy had to be found and attacked.
The plan of operation entailed the use of 35 Battalion and 37 Battalion as combat teams, with 30 Battalion in reserve. Each combat team had its engineers from 20 Field Company, medical sections from 22 Field Ambulance, and supply personnel from 16 MT Company, with artillery working in support. The method of attack was to make a pincer movement, bringing each battalion in from a flank and ultimately trapping the Japanese garrison when the two battalions affected a meeting.
By 21 September beach-heads had been established by 37 Battalion at Paraso Bay on the north coast and by 35 Battalion at Mundi Mundi River on the north-west coast. American units withdrew as the New Zealanders took over, and with them went the Fijian scouts. Then from the beach-heads units moved in bounds round the coast in small landing craft. Patrols crept through the jungle and swamps along the coast, paving the way for the advance of each battalion as the enemy was driven back on his main base at Timbala Bay.
1 Maj–Gen Rt. Hon. Sir Harold Barrowclough, KCMG, CB, DSO and bar, MC, ED, m.i.d., MC (Gk), Legion of Merit (US), Croix de Guerre (Fr); Wellington; born Masterton, 23 Jun 1894; barrister and solicitor; NZ Rifle Bde 1915–19 (CO 4 Bn); comd 7 NZ Inf Bde in UK, 1940; 6 Bde May 1940–Feb 1942; GOC 2 NZEF in Pacific and 3 NZ Div Aug 1942–Oct 1944; Chief Justice of New Zealand.
By 5 October the enemy garrison had been forced back into an area between Warambari and Marquana Bays. The following night, while the two battalions were preparing for a final assault, the encircled Japanese, numbering about 400–500, were evacuated by barge to destroyers which were waiting off the north end of the island. But the enemy did not escape unscathed. Three American destroyers attacked the Japanese convoy and sank many of the barges which were evacuating their men from Vella Lavella. By 9 October, when patrols from the two battalions met, all Japanese resistance was considered at an end.
Enemy casualties were estimated at 200–300 killed and wounded.
Fourteenth Brigade Group casualties were 3 officers and 28 other ranks killed, 1 officer died of wounds, and 1 officer and 31 other ranks wounded.
The task had taken nineteen days and on its completion 14 Brigade Group was made responsible for the prevention of Japanese re-entry into the island, and also for the prevention of any isolated Japanese escaping from the island.
Attending the sick and wounded in the jungle was full of difficulties and threw considerable strain on unit medical officers. With each of the two combat teams there was an advanced dressing station of 22 Field Ambulance. Sick and wounded were evacuated by barge to a main dressing station established by 22 Field Ambulance under Lieutenant-Colonel Shirer1 among the palms of Gill's Plantation. Attached to the MDS was 1 Field Surgical Unit. From the MDS, which also admitted American bomb casualties, sick and wounded were returned to the Casualty Clearing Station on Guadalcanal, 220 miles away, cases usually making the journey by plane.
1 Lt-Col W. F. Shirer, ED, m.i.d.; Wellington; born Wellington, 16 May 1898; medical practitioner; CO 22 Fd Amb Aug 1942–Nov 1943.
When battalion headquarters moved forward the RAP staff packed its equipment into haversacks and moved forward too. At the new site a tarpaulin was erected for protection against torrential rains, and under it medical equipment such as splints, dressings, instruments, drugs and blood plasma was set out in preparation for casualties. When a man was wounded, first aid was given on the spot by the company medical orderlies, and the man was taken to the aid post as quickly as possible. It usually took eight men to get one stretcher case back to the RAP, and the stretcher-bearers found their work difficult in the extreme. At the RAP additional treatment was given and the casualty sent on to the ADS.
The ADS was one mile behind the RAP, along a mud track. Evacuation took from one to two hours according to the condition of the patient. At the ADS wounds were dressed with sulphonila-mide powder, haemorrhage arrested, fractures splinted and morphia and ATS administered. There was a hold-up in evacuation between the ADSs and MDS. Both ADSs were five to six hours away by Higgins boat, and evacuation depended entirely on when these boats were available. In most cases this meant an all-night wait at the ADS for the patients, who left on barges in the morning after twelve to fourteen hours' delay. After a six-hour journey the barges landed patients at the MDS landing at Gill's Plantation, Joroveto. Thus patients did not reach the MDS until up to twenty-eight hours after wounding. Requests were made for casualties to be evacuated by boat at night to reduce the evacuation time by about half. Boats, however, were in short supply and this constituted a bottleneck for military movement, the forwarding of supplies and the evacuation of casualties. This also limited the number of medical personnel who could be sent to the forward area.
The first group of battle casualties to arrive at 2 CCS on Guadalcanal were five men from 35 Battalion, who reached the CCS on 1 October. Battle casualties continued to arrive until 15 October.
Most of the surgery was performed by 1 Field Surgical Unit. This unit, besides operating on New Zealand wounded from the forward areas, attended to numerous bomb casualties from the enemy strafing of American troops and barges on nearby beaches. A well-equipped resuscitation ward proved invaluable. Between page 43 25 September and 10 October seventy operations were performed under general anaesthesia in the theatre. Many blood transfusions were given, and about 150 infusions of plasma and many infusions of glucose and saline. Abbott's apparatus was used and proved very satisfactory.
The set-up of the surgical unit at this stage consisted of one IPP tent for the theatre, one IP 180 lb. tent at the rear end for stores, and another IP 180 lb. tent leading off from the side which provided space for scrubbing, sterilisation, linen and other supplies.
The operating theatre was an IPP tent with a coral floor and with sides attached so that it could be blacked out during a bombing raid. An operating table fitted between the tent poles, and round the sides were various shelves made of rustic saplings or undressed timber. Batteries in a corner provided the lights which were suspended over the table. Dressings and guards were sterilised in two small autoclaves which were heated over primus burners. Slightly forward of the theatre tent another IPP tent was erected for resuscitation and connected with the sterilisation tent. All tent floors were covered with white coral sand and well drained. There were some splinter-proof wards sunk to a depth of three feet in the coral. The tents were camouflaged and blacked out. This set-up proved eminently satisfactory.
One difficulty was sweating. Sweat literally poured from all the occupants of the theatre and it was difficult for a surgeon to bend over a wound without contaminating it.
The anaesthetic was usually ether (Squibb's) following an induction by either ethyl chloride or a mixture. The difficulty in hot climates of preventing the too rapid evaporation of ether did not prevail here on account of the excessive humidity. Very frequently pentothal sodium was given, up to 40 cc., and was invariably satisfactory.
Surgical treatment again was as simple as the nature of the case would allow. Débridement and sulphanilamide powder were the essentials. Wounds were not closed. Foreign bodies were removed only if easily accessible. Fractures were usually put up in plaster or Kramer wire. There was of course no X-ray.
Of the battle casualties that arrived at the MDS (where the field hospital was situated) only one New Zealander died. No case of tetanus was seen. Anti-tetanic serum was in very short supply and when not available tetanus toxoid (1 cc.) was given instead. Gas gangrene occurred in some neglected wounds and was treated by wide excision and heavy doses of sulphadiazine. One man died with gas gangrene, and in this instance the infection was secondary to multiple wounds from bomb splinters.page 44
The vigour of the wounded as they arrived was always a matter of surprise. They were filthy, unshaven, possibly starved and with flies crawling over their bloodstained dressings. Despite this they frequently walked or hopped to the ward, stood any amount of handling, took an active share in looking after themselves, rarely complained of pain and made a rapid recovery.
One of the major difficulties was post-operative treatment. Most of this was done by trained orderlies, who were competent in most nursing techniques and were able to give injections and in some cases plasma and blood transfusions. No nursing sisters were available in the forward areas and orderlies were undergoing their first experience in nursing seriously wounded men.
Cots, mattresses and linen were available at the MDS, but it was found impossible to continue using sheets owing to the difficulty of washing and drying them.
The correct time for evacuation provided a nice problem in surgical judgment. Serious cases required very gentle handling and it might be dangerous to transfer them too soon, especially as the journey to the airfield was a long one over a track axle deep in mud and studded with large lumps of coral. Despite this, early evacuation was preferred. The main reason was that the conditions were entirely unsuitable for a smooth convalescence. Rain, often torrential, fell daily and no blankets or clothing could dry properly. The area was infested with ants, flies, crabs and rodents. During the time these casualties were being accommodated bombing raids occurred every night. To lower all these casualties into foxholes was not practicable, nor was the field ambulance, despite all its efforts, able to supply at the time enough foxholes for all the patients. Later, surgical wards were constructed below ground level. This gave fair protection except against a direct hit or falling shrapnel.
Another problem was diet. All food was tinned and was devised more for front-line troops than for invalids. Another factor that helped to determine evacuation was the limit of accommodation. It was necessary at all times to reserve a large amount of space for a sudden emergency. As a result of all this any man whose incapacity was liable to be at all prolonged was evacuated at the earliest moment that was consistent with safety. One such case, an abdominal injury, died though it was doubtful if his evacuation was a contributing factor. The condition of a few others deteriorated on the way though all subsequently recovered.
At Vella Lavella 22 Field Ambulance actually received more casualties from air attack than from ground fighting, but these page 45 casualties were mainly Americans. On 25 September enemy aircraft bombed an LST that was unloading and wounded some troops, and a week later inflicted more serious casualties among a small concentration of troops on a supply ship. Fifty-five cases were admitted on the second occasion, most of the wounded being gravely injured — buttocks blown away, traumatic amputations of arm or leg, pneumo-thorax, perforation of abdomen and diaphragm, fracture dislocation of spine, etc. Most had some form of compound fracture and all had ugly flesh wounds, often multiple, yet forty-eight cases survived and were later evacuated by air, nearly all within a week. Some had to be evacuated prematurely so as to obtain special nursing attention. Treatment of the New Zealand battle casualties was a welcome contrast – their wounds were mainly from bullets, and only those who survived surgical shock during evacuation from the jungle were received at the MDS. The bomb casualties were brought in promptly over a short distance by truck, ambulance car and jeep. The mounting superiority of the Allied air force soon minimised bombing dangers and only an occasional bomb casualty was received later.
Use of Red Cross
In regard to the Japanese attitude to the Geneva Convention, the ADMS 3 Division made exhaustive inquiries from American officers and officers of the South Pacific Scouts who had had extensive experience of jungle fighting. It was found that the treatment accorded to the Allies in Japanese hands depended largely on the attitude of the particular Japanese commander in the area concerned. At the same time it was known that Japanese troops in the Solomons area included large numbers of fanatics whose one aim was to kill as many men as possible, wounded or otherwise, before they themselves were killed.
The field of vision in jungle fighting was so extremely limited, and parties of both sides came upon each other so suddenly, that shooting commenced before any question of the recognition of medical units arose.
The policy laid down by the ADMS in forward areas was that the Red Cross emblem was not to be shown and red crosses on ambulances were to be painted over. Stretcher parties going into the jungle were convoyed by ASC personnel attached to field ambulances, armed with tommy guns. These precautions had been found necessary by American medical units.
(Note: Experiences during the Treasury Islands operations, when Japanese on patrol were found infiltrating into the lines of medical units, and publications indicating the active hostility of Japanese medical personnel and the general attitude of the Japanese to this subject, led to authority page 46 being granted for the issue of suitable arms to members of the New Zealand Medical Corps, if they so desired, for the protection of their patients and of themselves. All NZMC personnel, whether in base or forward areas, were early in 1944 given instruction and practice on a voluntary basis in the use of pistol, rifle, bayonet, hand grenade and Thompson sub-machine gun.
Stretcher-bearers effecting long carries in the jungle would have been considerably hampered by having to carry arms, and to obviate this the practice was often followed of sending an armed escort with stretcher-bearer parties in the jungle.)
Hygiene and Sanitation on Vella Lavella
Active operations of 14 Brigade Group on Vella Lavella showed a remarkable lack of appreciation by the individual soldier, in spite of training, of matters of field hygiene, and in particular the disposal of faeces and the treatment of water for drinking. This resulted in many cases of dysentery during the operations. Sanitary policing of any newly occupied areas or beach-heads came to be regarded as of the utmost importance as gross fouling could occur in the first hour, and the resultant damage to health could be out of all proportion to the short time of occupation. Where possible the Field Hygiene Section endeavoured to include some sanitary personnel from the unit with the initial body of troops making a fresh beach landing or moving a camp site. The primary object of these men was to establish latrines on the beach-heads for immediate use and to arrange a rubbish dumping area. Two types of field latrines were advocated – either a simple hole to be filled in after use, or a hole with a covering of a simple hinged lid over a foot-square piece of board with a latrine hole in the centre. Units, especially combat units, required individual chlorination tablets and platoon water filters of German or Italian pattern.
Supervised rubbish dumps on the Bradford tip system were liberally provided by 6 Field Hygiene Section on Vella Lavella. With a bulldozer a hole was cut out of the coral, 50 yards long and 10–12 feet deep. Trucks could be run into it and the rubbish placed at one end. The rubbish was burned and later covered with coral by the bulldozer. Owing to difficulty in keeping this constantly covered, it was necessary to insist on all tins being crushed to prevent insect breeding in retained water. As the troops were on American rations there were large numbers of tins to be disposed of, and they were potential fly and mosquito breeding places. At first on Vella Lavella flies were troublesome, but the problem was gradually controlled. Breeding occurred in decaying coconuts and other vegetable matter, and partly in unsatisfactory food dumps and latrines. Fly traps and safes at first were too few in number, but units remedied this as page 47 supplies of material came to hand. Unfortunately most of this type of equipment was left behind by units as ‘unessential’ for the forward move.
Health of Troops
In the first month on Vella Lavella skin diseases were very prominent, and in some units 40–50 per cent of the troops were on sick parade daily with these complaints. It was impossible to state the aetiology, but it was thought that all the following factors were involved: poor conditions of living during combat, combined with lowered resistance from exhaustion and exposure and poor food during this period; insufficient personal cleanliness, including washing of clothes; rapidity-of bacterial growth in the tropics. The climate was hot and humid but not unbearable.
A large number of cases of dysentery occurred in the early stages of the fighting but later only sporadic cases were seen. The dysentery was of a mild bacillary type and the epidemic affected 37 Battalion while in combat. It was controlled by the use of sulpha-guanidine. In such circumstances Lieutenant-Colonel Sayers, the Consultant Physician, thought it would be well worth while giving sulphaguanidine or sulphathiazole prophylactically.
There were twenty-eight new cases of malaria in the Division in October, a number occurring in 35 Battalion which was in combat on Vella Lavella. This to some extent was inevitable as it was impossible to carry or use nets during actual operations. October was stated by Colonel Sayers to be always a good month as regards malaria. There were few anopheline mosquitoes although a certain amount of larval breeding was going on, mainly in streams. Excellent work was done by 1 NZ Malaria Control Unit. Very soon after arrival the unit had roughly surveyed the whole area, marked the breeding places, and started oiling and other control measures. It contacted the American control unit and divided up the territory to be covered by each organisation. Blood films of samples of troops were taken to estimate the true malaria rate. Malaria discipline at first was deficient. Atebrin was taken regularly under supervision, but there was some laxity in enforcing dress regulations. Officers did not set a good example to their men and punishment was not inflicted on offenders. Repellent was not used and washing and bathing after 5.30 p.m. was widespread. Discipline, however, was tightened up and malaria was not a real problem, even with the advent of the wet season later.
The general health of the troops, however, deteriorated and they became listless due to the climatic conditions and unsatisfactory food. There seems little doubt that insufficient attention was paid to hygiene by combatant officers.
Japanese Medicines and Foods
On Vella Lavella Lieutenant-Colonel Sayers was able to examine captured medicines and foods. Quinine hydrochloride in tablets of 1½ grains was supplied in large quantities, but the reason for the small dosage could not be ascertained. Ampoules of intravenous quinine and atebrin were also found. Other drugs were stock lines such as were used in any RAP.
Japanese tinned foods were of good quality, especially the vegetables, and multi-vitamin pills and vitamin powders for adding to soup were found.
When Colonel Sayers talked with captured Japanese labourers he learned that they had no regular suppressive quinine or atebrin, were not issued with nets, and had only a very little repellent cream. Fighting troops were given some nets and officers had spray guns. They had seen no oiling of breeding places carried out.