Navy Medicine July-August 1945
LCDR George Martin, USNR
In August, 1945, The Second World War was brought to an abrupt end by a pair of titanic flashes over Japan. The twin detonations over Hiroshima and Nagasaki brought closure to the most devastating conflict in human history and simultaneously ushered in the nuclear age. The first bomb was dropped by aircraft over Hiroshima on 6 August, 1945 and cost the lives of 80,000 of the cities 350,000 inhabitants.(1) On 9 August a
second device was used against the city of Nagasaki with great loss of life and presented the medical
community with the horror of treating not just those injured in the bombing, but the many thousands who would suffer and eventually die as a result of radiation poisoning.(2) As terrible as these events were, they prevented the invasion of the Japanese home islands, which with Russia still uncommitted to action would probably have been an all American show. The planned invasion would have involved an initial landing force of 13 combat divisions (10 army, 3 Marine) supported by an armada of 6,000 ships. The fanatical defense of Okinawa left little doubt in the minds of the planners that the cost of victory would have been to close to one million casualties.(3)
A tragic sidelight of the atomic bomb drops was the saga of the U.S.S. Indianapolis (CA-35). The ship was on a vital mission to deliver the components of the "Hiroshima Bomb" from San Francisco to the American forces on the Island of Tinian in the Marianas. After completion of this mission on 26 July, Indianapolis set sail for Leyte in the Philippine Islands for further assignment to Task Force 95 and the
eventual invasion of Japan.(4) The great ship never reached Leyte because of the damage wrought by multiple "Long Lance" torpedo hits compliments of the Japanese submarine I-58. The ship went down rapidly with approximately 850 of the 1200 men assigned making it into the water alive. Their fight for survival would touch off one of the liveliest controversies in modern U.S. Naval history. It took 84 hours to rescue the men who were constantly subjected to exposure, dehydration, death from wounds, and worst of all shark attack. By the time they were rescued on 2 August only 316 men remained alive. The survivors were treated aboard the hospital ship Tranquility (AH-14). Many questions remain concerning the incident. Did the ship's captain take proper precautions? Was the Navy at fault for not providing escort ships and minimizing the Japanese
submarine threat? Why wasn't the Indianapolis reported overdue in a timely manner? Was the ships
commanding officer, Captain McVay, used as a scapegoat?
The cessation of hostilities did not alleviate the Navy's Medical department of continuing to provide for wounded troops, civilians and liberated prisoners of war (POWs). While the repatriation of casualties had been occurring via air and sea transport throughout the war, the flow of wounded came in earnest
by the summer of 1945. In June more than 100,000 men arrived home, many to begin the ordeal of surgery and rehabilitation.(5)
Medical policy provided for the evacuation of the most serious casualties by air and left the arduous sea voyage to those less afflicted. Each wounded man arrived at stateside debarkation hospitals wearing a tag which contained his diagnosis. These receiving hospitals continued the multi-layered triage process which had begun at the battlefront. By war's end the arrival of almost 30,000 casualties a month gave the receiving
hospitals the added incentive to move quickly and ship to other facilities all those patients who could possibly
travel.(6) In the days prior to computers, rapid communications, and other miracles of modern science,
medical personnel relied on a great degree of flexibility and "command decision" making in order to provide quality integrated care. Collaboration of medical professionals was done at a distance of thousands of miles and without the benefit of personnel or even a telephonic conference. Treatment was based on the written diagnosis which accompanied the patient and "on the spot" observations of medical professionals.(7) Many of the returning wounded, who expected to be transferred to a facility nearest their home of record, were often sorely disappointed when these wishes were not granted. In fact, some ambulatory patients, when not
receiving a home assignment, went "over the hill". Some stations reported up to a 15 percent rate of
unauthorized absence!(8)
Medical personnel treated a legion of war related injuries. Wounds caused by concussion, shrapnel, or burning were common place. Many of the returning warriors were full of metal fragments which invaded every part of the body. Shrapnel was found embedded "in the brain, eye, sinuses, lungs, heart, liver,
scrotum, spinal canal, bones, joint, and muscles."(9) Amputations were common place, dwarfing the number of cases in the First World War. Plastic surgeons worked endlessly to repair horribly disfigured veterans.
Perhaps the most heart wrenching medical cases were those presented by the liberated POW's. American prisoners in the European theater of operations (E.T.O.) were generally in better physical condition than their Pacific counterparts. The imminent defeat of Germany, and liberation by the on rushing Allied armies made repatriation and treatment comparatively easy. The only exception were those Americans freed by the Soviet Red Army who often experienced weeks of delay before being returned to their own forces. Even worse, hundreds of American G.I.s were shot, by their Soviet "liberators" who claim that they mistook them for Hungarians.(10) However, in general the average American P.O.W. in Europe, now known as R.A.M.P. (repatriated allied military personnel) were processed without incident. Delousing, medical exams, special diets, vitamins, and the inevitable filling out of military forms was the order of the day for the P.O.W.s.
By contrast the POWs in the Pacific Theater of Operations (P.T.O.) did not fair as well as their E.T.O. compatriots. Many were assigned to isolated camps in disease ridden jungles. The abrupt end of the war in Asia allowed for little preparation for the eventual release of prisoners. Also, the Japanese code of Bushido looked at any who surrendered as unworthy of soldierly treatment. Many POW's especially those held in Southeast Asia, were used as slave labor by their Japanese captors.
By war's end, a total of 176 POW camps holding 17,000 men existed in the Japanese home islands.(11) This did not include the camps of the Empire which stretched from Manchuria to Java and contained
thousands of additional prisoners. With no U.S. troops present at the time of surrender, the liberation of these
prisoners required several weeks to implement. In many camps the Japanese commanders could not bear the humiliation of surrender and refused to inform the POW's that the war was over. It was only the change in attitude of the guards; such as the issuance of extra rations, better physical treatment, and the return of
stolen Red Cross packages that tipped off the POW's that something was happening.(12)
The liberation effort in the P.T.O. was dual staged. The first stage was "Operation Bird Cage" which involved the airdrop of thousands of leaflets formally announcing the surrender and ordering all prisoners to remain on station in their compounds. Phase two, code named "Operation Mastiff," was the airdropping of
food, medical supplies, and rescue personnel into the camps.(13) Upon being liberated, prisoners were moved to hospital ships for examination, treatment, and further assignment. On 29 August 1945 the USS Benevolence (AH-13) entered Tokyo Bay and began its useful work of POW examination. In just 48 hours 1,520 men were evaluated. Of this group 320 men were considered ill enough for further treatment.. All of these men suffered from malnutrition. The remaining 1,200 were deemed well enough for stateside evacuation.(14)
Marked differences were apparent in the health of P.T.O. POW's depending on their length of captivity and their place of internment. Long term prisoners showed a much greater propensity for malnutrition,
muscular wasting, and skin ulcers. The health of those imprisoned in Japan varied according to the camp to which they were assigned. Camp Omori, Camp Ofuna, Shinegawa Hospital, and Kempi Headquarters had especially poor records of health and sanitation. The average Japanese camp provided a daily ration of 600 grams of a rice, barley, and rye mixture supplemented occasionally by greens, tea, soup and small fish. Working prisoners received an additional 100 grams of basic diet making the daily caloric intake between 2,100 and 2,450 calories.(15) The most fortunate prisoners were those who were "farmed out" as labor to local industrialists. These men had been comparatively well fed and were also in a position to steal additional food. A study on board USS Benevolence found that as a group B-29 fliers suffered a greater degree of
disability than their counterparts. This is because the air crews were viewed as war criminals by the Japanese and were therefore only issued half (300 grams) of the daily POW ration.(16) The average ailments
encountered by medical personnel included; weakness, diarrhea, edema, sore mouth, muscular wasting, rice belly, glossitis, hyporeflexia, and hypesthesia. The average POW weight loss was 45 pounds.(17)
After the critical medical treatment phase ended came the organized program of rehabilitation. The purpose of this program was to expedite complete recovery and return to duty of the maximum number of patients. When this goal was not feasible, the program made use of hospital time in preparing the patient for
adjustment to civilian life. Surgeon general Vice Admiral Ross T. McIntire ordered the establishment of an office of rehabilitation at the Bureau of Medicine and Surgery with purview over physical and occupational therapy, physical training, educational services, and civil readjustment.(18) Actual responsibility for implementation of such programs devolved on to the individual hospital commanders and their designated
rehabilitation officers. Programs varied in both content and quality from site to site. Patients were normally divided into two categories. The first group represented those whose return to active duty was anticipated while the second group consisted of men who would require long periods of hospitalization which normally resulted in discharge. All patients were generally provided with physical training and therapy as well as
occupational therapy. Those returning to active service were sometimes given practical instructions in their Navy related duties Special programs had to be developed for the blind and deaf.(19)
Physical therapy was not new in Naval hospitals, but the excessive number of orthopedic cases
necessitated wide expansion of programs and the procurement of special equipment for treatment. A
continuous problem was the lack of trained physical therapists in the Naval service. To help remedy this shortfall, special arrangements were made to offer commissions in the Women's Reserves to qualified
graduates of approved institutions.(20) Additionally, members of the Hospital Corps were trained to help
alleviate the manning problem in physical therapy.
Even though occupational therapy was utilized after World War One, the outbreak of the Second World War found the Navy without either a program in existence, or any occupational therapist on duty. Once again a limited number of therapists were commissioned via the Women's Reserves. While much of the treatment was left to the imagination of individual therapists, most programs included wood and metal work, printing, and hand weaving. The purpose of the program was curative benefit for patients and not the production of articles. The rehabilitation activity also offered a wide range of educational services. Correspondence courses, self-training materials, classroom instruction, and visual aids provided instruction in everything from American history to navy rate training and were well received by patients.(21)
Naval Hospital Philadelphia was designated as the center for rehabilitation of all cases of blindness in the Department of the Navy. The program was run by an ophthalmologist and was administered by specially chosen and trained corpsman who provided individual attention to each patient. The blind sailors
and Marines came from all walks of life. They were all males and had levels of educational attainment that varied from college graduates to fourth grade dropouts. The blindness they suffered from was not just the result of battle wounds, but also accidental trauma, and ocular diseases. Patients were trained in the use of the typewriter,the study of Braille, and walking with a cane. In order to expedite social adjustment, they also
attended sponsored social functions and went on shopping trips. The success of this program depended greatly on the skill, compassion, and dedication of the "orientors". As previously stated, these people were normally enlisted men whose job it was to orient the patients to where everything in the hospital was located. They assisted in all aspects of daily life from getting dressed and going to the head, to eventually traveling in the
outside world. The best orientors allowed and encouraged their patients the freedom to teach themselves while keeping a watchful eye to render assistance as necessary. The display of either sentimentality or paternalism was to be strictly avoided. It was the decency and common sense of the orientors that helped to complete the healing process after medical science had reached its limit.(22)
Naval Hospital Philadelphia was also chosen as the site for rehabilitation of the deaf. With the help of state-of-the-art equipment and the advanced scientific procedures of Abbington Memorial Hospital's Dr. Walter Hughson, the Navy developed a well organized and effective program. The aural rehabilitation
program was considered to be a pioneering undertaking. It's purpose was to enable patients to overcome
psychological reactions to deafness and to supplement the patients residual hearing with mechanical and visual aids to the perception of sound. Extensive tests were run on each patient to accurately determine the nature and extent of the hearing loss. Each patient was provided with a hearing aid which was personally designed for him in the hospital laboratory from a cast of his external ear and auditory canal. Classes were given in lip reading and in the correction of speech impediments.(23) The advances made by this program made major contributions to the post-war study of Audiology.
Rehabilitation for amputees was assigned to Naval hospital Mare Island, California and the ubiquitous Naval Hospital Philadelphia. As most of the amputees required several surgical procedures, full advantage was taken of the intervals to implement educational and work trial programs both onboard the command and in the local community. All artificial limbs were manufactured in the hospital facilities and many improvements in
prosthesis resulted from this work. As with other rehabilitation programs, the amputee program was geared to prepare the patient for a successful reassimilation to civilian life. All patient were taught the operation of specially equipped automobiles and the states of California and Pennsylvania granted driver's permits to those who could meet their requirements.(24)
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References
1. Stokesbury J. A Short History of World Two, p 375.
2. Ibid.
3. Ibid., p 374.
4. Van de Vat D. The Pacific Campaign, p 392.
5. Cowdrey AE. Fighting for Life, p 317.
6. Ibid., p 318.
7. Ibid., p 319.
8. Ibid., p 320.
9. Ibid., p 321.
10. Bailey R. Prisoners of War, p 177.
11. Ibid., p 183.
12. Ibid., p 183.
13. Ibid., p 192.
14. History of the Medical Department of the United States Navy in World War II, Vol. I: A Narrative and Pictorial Volume, p 367.
15. Ibid., p 369.
16. Ibid., p 371.
17. Ibid.
18. Ibid., p 360.
19. Ibid., p 358.
20. Ibid., p 359.
21. Ibid., p 360.
22. Cowdrey, p 328.
23. Ibid., p 363.
24. Ibid., p 364.