Aeromedical Challenges in the Offensive Against Japan

AAF medics in the Pacific theater of operations confronted many medical challenges: sanitation, malaria control, and medical resupply, as well as prevention and treatment of aircrew ailments such as aerotitis media and flying fatigue. Medical administration was also a challenge. Despite the importance of future air operations against Japan, the Army did not assign fixed hospitals to the AAF during the Pacific war, not even for the Very-Long-Range Bomber Program whose aircrews flew high-altitude B–29 missions. Medical support of U.S. fliers depended on Army medical facilities, which AAF medical leaders generally considered inadequate in many ways. The AAF medical response to these challenges, however, was flexible and appropriate, and the aerial fighting force was not seriously hampered by medical problems.

AAF medics were much more active in Asia and the Pacific than in Europe during the first year of the war. The Japanese had dealt the AAF heavy blows in Hawaii and the Philippines, and U.S. military leaders were eager to strike back and halt the Japanese advance southward toward Australia. In 1942, aiding the British in the China-Burma-India theater, AAF medics helped improvise aeromedical evacuations from Burma. They also helped sustain Claire Chennault’s Flying Tiger volunteers who were helping Chiang Kai-shek’s Nationalist Chinese forces resist the Japanese in southern China. AAF medics also supported the first efforts to create an aerial supply route from India to southern China.

The most severe medical challenges in the war against Japan occurred in the southwest Pacific. After the surprise Japanese attack at Pearl Harbor in December 1941, many U.S. airmen had evacuated from the Philippines to the mainland of Australia with Gen. Douglas MacArthur and his ground forces. In March 1942, the general took command of the Southwest Pacific Area (SWPA) theater. He intended to retaliate by seizing Papua, New Guinea, before Japanese forces could establish a hold there, and air power was one of his key weapons. Although the Japanese succeeded in occupying the northern Papuan coast, the advanced echelon of the Fifth Air Force set up at Port Moresby on the southern coast on September 15.

While MacArthur established a strong base of operations in New Guinea, more air forces joined the Pacific campaign. In mid-January 1943, the headquarters of the Thirteenth Air Force was established at Espiritu Santo in the New Hebrides islands. In June 1944, the Fifth and Thirteenth Air Forces combined to form the Far East Air Forces (FEAF), commanded by Lt. Gen. George C. Kenney, former commander of the Fifth Air Force. In the summer of 1945, the Seventh Air Force joined FEAF.

The first medical challenge was to get more qualified physicians for the Pacific units. Although this challenge was usually met, many units still lacked the uninterrupted support of a qualified flight surgeon. Early in the war, AAF units often activated without medical officers at all, and when these units arrived in the southwest Pacific, many received a medical officer who had no training in aviation medicine because not enough flight surgeons were available. This shortage was partially remedied by 30 denying many flight surgeons relief from combat duty. Some unanticipated needs for medical officer staffing in rest and recreation centers, convalescent training programs, and the FEAF combat replacement and training center were solved with much difficulty or were remedied inefficiently.

The staffing problem was made worse by fixed Tables of Organization (TO) that authorized the job specialties, including medical, for each AAF unit. Although some Pacific bases needed more medical officers than others, TO changes were not allowed. As a result, both Air Surgeon Grant and FEAF surgeon Col. Robert K. Simpson hoped to form a pool of flight surgeons for flexible assignments. When not assigned to operational units, these flight surgeons would be sent to general hospitals to attend refresher courses and work as consultants. But the AAF request to form a flight surgeon pool was not approved.

Early in the war, AAF medical leaders argued that Army hospital facilities in the Pacific were meager and situated too far away from AAF units to be of value. Because the AAF units needed ready access to at least some medical specialties and advanced services, expedients were required. In 1942, most units began to use their small medical section to organize a dispensary for the whole group, and many units of group or similar size expanded their dispensaries into infirmaries with forty beds. Infirmaries in the Thirteenth Air Force were almost as well equipped as were station hospitals.

The improvised AAF medical facilities saved workdays by keeping patients close to their unit rather than transferring them to a distant theater SOS facility. Unit doctors could better determine if a patient was fit to fly, whether to remove him from combat duty, and when to order a replacement. The patient’s morale was better in his own unit facility. Furthermore, for planning purposes the unit could expand medical statistics and the patient’s records.

A disadvantage, however, was that resupply for these units was slow, especially thirty to 120 days after a unit moved to a new forward area. Additionally, Army regulations prohibited almost all types of bedcare that could be given in such infirmaries. When mission needs were paramount, however, the Air Surgeon allowed some infirmaries to receive improved equipment designed for group aid stations and resume their hospital operations.

The air forces’ requests for small, mobile hospitals were partly satisfied starting in 1943 when the Army theater SOS agreed to attach several of its “portable surgical hospitals” to the operational control of the Fifth Air Force. These 25-bed facilities were staffed by four medical officers, one internist, three surgeons, and thirty-three enlisted men. The Thirteenth Air Force began to use such facilities in late 1944 when it had to close some of its group infirmaries temporarily. Both numbered air forces usually expanded the portable surgical hospitals into small station hospitals with fifty to one hundred beds when circumstances warranted. The hospitals sometimes functioned as holding stations for air evacuation. The AAF even tested various ways of transporting the hospitals by C–47s and small L–5 observation planes. The Army portable surgical hospital proved more useful to AAF tactical units in the Pacific than did the aviation medical dispensary created for the Mediterranean and European theaters.

Another Army concession was to earmark two Army general hospitals as reception points for most AAF patients entering the theater SOS medical system. In August 1944, the 51st General Hospital in Hollandia, New Guinea, was set aside for AAF patients. In July 1945, this hospital moved to Fort McKinley in Manila, the Philippines, FEAF headquarters. The hospital was near an AAF replacement depot, the Second Central Medical Establishment, and a convalescent training program. In January 1945, the 126th General Hospital at Leyte, the Philippines, was also earmarked for AAF patients. The theater SOS continued to administer and control both of these 2,000-bed facilities. Although valuable to the air forces, these two hospitals could not have handled all AAF inpatients in the Pacific theater, if it had been possible to transport them there. The Army also assisted in several experiments for tracking AAF patients through the theater SOS hospital system, but none of the experiments worked well.

The B–29 bombing campaign against Japan also produced a minor Army concession to AAF needs. Starting in November 1944, the AAF began to use the central Pacific Mariana Islands as a base for striking Japan with the high-altitude, long-range B–29 bombers of the Twentieth Air Force. In early 1945, on the island of Saipan, home of the XXI Bomber Command, the Army allowed the AAF to pool some wing dispensaries into a 100-bed hospital. The overcrowded hospital run by the AGF nearby was able to handle only critical AAF patients. The hospital’s surgeon and even the Army Surgeon General agreed to permit a pooled AAF facility at West Field. About the same time, the Army agreed to a similar arrangement for a 150-bed hospital in Hawaii.

Despite these administrative problems, the war in the Pacific taught the AAF much about medical practice in the tropics. Casualties from disease were much higher than in Europe. Mosquito-borne diseases, particularly malaria, were the greatest single cause of workdays lost to the air forces. In this case, as in many others, commonsense prevention tactics were critical. General Kenney, commander of the Fifth Air Force in the Southwest Pacific, wrote that

When the Americans first came to New Guinea and saw the Aussies wearing shorts and shirtsleeves cut off above the elbow, it appealed to them as a smart idea for that hot, humid, jungle service. Just as an experiment, I put long trousers and long-sleeved shirts on one squadron of a fighter group and shorts and short-sleeved shirts on another squadron for a month. At the end of the trial period, I had two cases of malaria in the long-trousered, long-sleeved squadron and sixty-two cases in the squadron wearing shorts. The evidence was good enough for the kids as well as me, so I issued the order [to wear long trousers and long sleeves].

Spraying insecticides from airplanes was first tried in February 1944 in New Guinea, using a compound known as Paris Green. The greatest chemical weapon against mosquito-borne diseases, however, was a new insecticide called DDT. Beginning in April 1944, DDT was sprayed from airplanes. It was especially effective in open and cleared areas and in cities, eliminating the flies and mosquitoes that carried malaria. But not enough ever became available to fill all sanitation needs. Starting in 1943, more conventional methods had also been used by malaria control and survey units. With the aid of DDT and other preventive measures, these units reduced the malaria rate to the point that it was no longer a serious handicap to operations by the end of 1944.

Another medical problem—maintaining aircrew fitness and morale— was less tractable. AAF crews had to fly until they were killed, wounded, or sidelined by some physical illness or mental problem caused by stress. The U.S. Army command in the Pacific—unlike the Navy, the Marines, and the Army command in Europe—did not create a rotation policy for their aircrews. Battle casualties were actually low compared with those in Europe. Pacific theater airmen survived far more time in combat than did their counterparts in Europe, only to be grounded by psychological problems, particularly low morale and fatigue. More than 30 percent of nonbattle casualties were psychological. After eighteen months in theater, more than 20 percent of the AAF personnel experienced some form of psychiatric problem. Often in such cases, the AAF medical role had to end with a proper diagnosis and treatment of symptoms, followed by grounding or reassignment for medical reasons; essential preventive measures were the responsibility of line commanders.