Portable Surgical Hospitals
Northern Burma Campaign
Maj David A. Pattillo
Mobile Surgical Hospitals have been a part of the Army Medical Department (AMEDD) structure since World War I. During WW-II, especially in the China – Burma – India (CBI) and Pacific Theaters, the employment of portable surgical hospitals was in concert with many of the proposed health service support principles for Air Land Operations. In the European and other combat theaters, the 400-bed surgical hospital existing at the beginning of WW-II made no significant contribution to providing forward surgical support. Lacking the mobility of the smaller portable surgical hospitals, the few that were activated for WW-II were all converted to either station or evacuation hospitals by late 1943. Following WW-II, the 60-bed mobile surgical hospital has been the predominate operational model for providing forward surgical support on the battlefield. As the AMEDD prepares for future medical operations, the historical development of the mobile surgical hospital and the combat experiences of the portable surgical hospitals in the CBI Theater provides important lessons worth studying. The CBI Theater provides an example of a theater of operations that utilized nonlinear operations to successfully achieve theater objectives. The type of nonlinear operations practiced by the forces under General Stilwell in the North Burma Campaign is typical of the type proposed under Air Land Operations. The Portable Surgical Hospital (PSH) was successful when employed by the US Army to provide forward surgical support to nonlinear operations. The experiences of the Portable Surgical Hospitals during the North Burma Campaign in providing forward surgical support to combat forces in the CBI Theater provides a methodology for evaluating the 30-bed MASH designed to provide forward surgical support to nonlinear operations of Air Land Operations.
North Burma Campaign – December 1943 – August 1944
General Chennault’s Flying Tigers, Merrill’s Marauders, and the United States Army Air Corps’ C-47s flying the Hump are identified by most Americans with the CBI Theater. The contributions of most other US forces in the CBI Theater have largely been forgotten. A significant number of the US forces in the CBI Theater were medical units. These units included the 43rd Portable Surgical Hospital (PSH) and other PSHs assigned to the CBI Theater (*). Why have the contributions of most US forces in the CBI Theater been forgotten? This is due largely to the fact that the CBI Theater ultimately served a secondary role to the Pacific Theater in the war against Japan. The advance of America’s main forces in the Pacific eventually relegated the CBI Theater to this secondary role. Few American’s realize the longest continuous campaign against by far the largest body of enemy in the war against Japan ensued in the CBI Theater. In fact, more Japanese troops died in Burma than in the whole Pacific campaign.
The Quadrant Conference in Quebec, Canada, (August 1943), reaffirmed the conditions for continued participation of US military forces in the CBI Theater. At this conference President Roosevelt, with his Joint Chiefs, and Prime Minister Churchill, with his chiefs of staff, continued their compromise on decisions about the strategic goals for the CBI Theater. The significance of these compromise decisions was that they served to reaffirm the previous US position from the Trident Conference. The US position was that it was paramount to seize Burma to open the ground line of communications and keep China in the war. US troops assigned in the CBI Theater were there for purely political reasons. They were there to show US support to Generalissimo Chiang Kai-shek and Nationalist China. Without US troops and support the US Joint Chiefs of Staff felt that China might withdraw from the war with Japan. Besides keeping China in the war against Japan, the US felt the seizure of Burma would set the conditions to meet other goals decided at the Quadrant conference. With the defeat of Japanese forces in Burma, Allied Forces could then set up bases in North China. This would place Japan within range of bombers and landing craft from North China. Combined with operations in the Pacific, this would place pressure on Japan from both the east and west. The Quadrant Conference ended with plans that emphasized establishing Allied power in North China as the principal direction for the defeat of Japan. President Roosevelt’s strategy saw the shortest route to establishing Allied power in North China lay through Burma. This was the strategy affirmed by the Quadrant Conference.
Chain of Command
Understanding the contribution of US forces in the CBI Theater begins with an appreciation for the chain of command that controlled these forces. The CBI Theater had the typical command problems forecast for combined warfare in the future. Air Land Operations doctrine projects that coalition warfare will be a dominate characteristic on the future battlefield. The CBI Theater provides an insight into solving the problem of coalition command. The Quadrant Conference sought to delineate and clarify the command structure that would guide US forces in the North Burma Campaign. Admiral Lord Louis Mountbatten was designated Supreme Allied Commander, South-East Asia Command (SEAC). General Joseph Stilwell was named the Deputy Commander, SEAC. The chain of command at first appears to be simple and streamlined. In fact, the command relationships in the SEAC were extremely complex. Gen Stilwell, as Deputy Commander, SEAC, was also the senior US officer in the SEAC. The figure below illustrates the command structure for the SEAC. Despite being named Deputy Commander, SEAC, Gen Stilwell’s principle role was command of American and Chinese forces in the American CBI Theater. In fulfilling his role of commanding Chinese forces in the American CBI Theater Stilwell also served as one of Generalissimo Chiang Kai-shek’s chief of staffs. It was his role as Generalissimo Chiang Kai-shek’s chief of staff and Commanding General, Chinese Army in India, that served to create problems in designing a clean command structure for the SEAC.
(Above) : Figure 1 – (Below) : Figure 2
Gen Stilwell’s position as Deputy Commander, SEAC, was designed as a political compromise to bring Chinese forces under the operational direction of Admiral Lord Mountbatten, Supreme Allied Commander, SEAC. In reality, Gen Stilwell, while officially the Deputy Commander, SEAC, actually fell under the operational control of Field Marshall Viscount Slim, Commander, XIV Army. Admiral Lord Mountbatten directed Field Marshall Slim not to make it public that Gen Stilwell was under his operational control. Field Marshall Slim speculated that this was face-saving for Stilwell, on the lines of our Chinese allies, or to avoid the criticism that such an illogical set-up was bound to provoke. The actual operational chain of command that affected US forces in the SEAC appears in the figure below. The difference between the published and unpublished command structures identified in figures 1 and 2 reflects the confusion by US forces, especially medical, of the concealed role of Field Marshall Slim’s XIV Army in their chain of command. Lt James H. Stone, in writing United States Army Service in Combat in India and Burma 1942 – 1945, stated :
Not until all these headquarters – and perhaps a few more important ones such as 14th Army (British) … were passed did the semblance of a normal chain of command drop all the way down to the troops in the field.
The Northern Combat Area Command (NCAC) identified in figure 2 reflects the decision in February 1944 to create a command structure to control Chinese, American, and British forces under Gen Stilwell’s command. The Galahad Force (Merrill’s Marauders) was the principal American fighting force under the NCAC. Principle Chinese forces in the NCAC were the Chinese Expeditionary Force (Y-Force) (located in the Yunnan Province of southwest China) and the Chinese Army in India (X-Force). A third Chinese force of 30 divisions (Z-Force) planned for southeastern China never evolved as a Japanese offensive in the summer of 1944 suppressed its development. Figure 3, below, identifies the NCAC organization and chain of command in February 1944. It is important to understand the command structure in which AMEDD units functioned. Unlike current operations which normally place corps level and higher medical units under a medical command and control headquarters, in the CBI Theater, AMEDD units functioned under this atypical chain of command. Most AMEDD units in the CBI Theater were assigned to NCAC. Of the 19 units assigned to NCAC in July 1944, 15 were medical. These medical units were :
13th Mountain Medical Battalion
25th Field Hospital
44th Field Hospital
42nd Portable Surgical Hospital
43rd Portable Surgical Hospital
44th Portable Surgical Hospital
45th Portable Surgical Hospital
46th Portable Surgical Hospital
58th Portable Surgical Hospital
60th Portable Surgical Hospital
18th Malaria Survey Unit
45th Malaria Control Unit
46th Malaria Control Unit
49th Malaria Control Unit
73rd Malaria Control Unit
Hqs & Hqs Company, Northern Combat Area Command
5307th Composite Unit (Provisional)
96th Signal Battalion
988th Signal Operations Company (SPL)
The majority of the AMEDD units in the CBI Theater operated in support of NCAC combat operations. During the North Burma Campaign, these combat operations were carried out predominately by the Chinese Army in India, especially the Chinese 22nd and 38th Divisions. This is because, except for the Galahad Force, few other US combat forces were assigned to the CBI Theater. Again, according to Lt James H. Stone, in writing United States Army Service in Combat in India and Burma 1942 – 1945
The basic assumption underlying medical planning was that all types of medical services would be furnished American troops; third echelon (Level III) medical service and fixed hospitalization would be given to Chinese troops in India, and assistance with third echelon medical service would be given to Chinese troops in China; but no medical service would be furnished British or Indian troops.
Chinese Army in India
The focus of this research concentrates on the medical support provided by the Portable Surgical Hospitals supporting the Chinese Army in India (CAI). To appreciate contributions of the PSHs to the CAI, basics of the combat operations of the CAI must be covered. In particular, the focus will be on the Chinese 22nd and 38th Divisions. Figure 4 illustrates the organization of the CAI under NCAC at the start of the North Burma Campaign. The North Burma Campaign occurred between December 1943 and August 1944. Figure 5 illustrates the disposition of forces in December 1943 at the start of this campaign. On Gen Stilwell’s left flank were the divisions of NCAC’s Chinese Expeditionary Force (the Y-Force). They were to move toward Burma from the Yunnan Province. On Gen Stilwell’s right flank were troops of the British IV and XV Corps from Field Marshall Slim’s XIV Army. In Gen Stilwell’s center was NCAC’s CAI (X-Force), which on the central axis was to attack along a single usable road (Kamaing Road) as the main line to Mogaung and Myitkyina. The Allies planned to follow three lines of penetration into North Burma – western, central, and eastern. These lines of penetration were designed to converge on the east-west line of Myitkyina – Mogaung. The methodology or tactics employed during the North Burma Campaign mirror the doctrine of Air Land Operation’s nonlinear operations espoused for future combat. Lt Stone’s 1946 explanation of the mode of combat operations in the North Burma Campaign provides an excellent summary of nonlinear operations.
Units involved in the campaign were often like beads on the threads of attack, joined to one another administratively and sometimes by actual lines of communications on the ground but, as often, virtually intact and separate until nodal points were reached. Units on flank missions were on their own until they swung back, further south, to the main line of advance. They had to be virtually complete task force units except that they had no viable tails lines of communication. The cord which connected them to the base was an invisible airline between supply points in the rear and dropping fields or hastily constructed airfields in the forward zone. Even units on the main axis were frequently somewhat separated, particularly the small American sections which were embedded in regimental or divisional Chinese organizations.
Note : In Chinese formations, an Army was the equivalent of a British division (13.700 troops), a Chinese division the equivalent of a British brigade (2.500 troops), and a Chinese regiment was the equivalent of a British battalion (800 troops).
Northern Hukawng Valley
Figure 6 below, illustrates the combat operations of the Chinese Army in the North Burma Campaign from December 1943 through August 1944. Figure 7 below, shows the topography of North Burma and helps explain why the campaign evolved as it did. Terrain had a major influence on the tactics employed in North Burma. Combat operations for the Northern Combat Area Command and the Chinese Army in India can be divided into nine major periods during the North Burma Campaign. The Chinese Army began its combat operations in the Northern Hukawng Valley. The major Japanese force opposing Gen Stilwell and Chinese Army would be Gen Shinichi Tanaka and the three regiments of his 18th Division. The 112th Regiment of the 38th Chinese Division carried out the opening action. The 1/112 made the central thrust past Shingbwiyang toward Taipha Ga. The 2/112 on the right flank was given the objective of Sharaw Ga. The 3/112 followed the West Axis Refugee Trail along the mountainous western flank. All three battalions of the 112th Regiment operated separately from each other. The 22nd Chinese Division and the remainder of the 38th Division were kept in reserve at Ledo and Shingbwiyang. The first attack by the 112th Regiment was a failure. The three battalions failed to achieve their objectives, dug in, became isolated, and failed to extract themselves from contact with the Japanese.
The 113th and 114th Regiments the 38th Chinese Division were sent to break the stalemate. The 113th Regiment attacked the Japanese positions around Sharaw Ga and relieved the 2/112. The 114th Regiment and the 1/112 carried out a series of attacks and forced the Japanese forces to withdraw. With this series of actions the “blitzkrieg” which characterized the opening of the North Burma Campaign ended and the 38th Division moved forward toward its first major objective, Taipha Ga. The Chinese moved toward Taipha Ga from the east, north, and west. The attack on Taipha Ga was given to the 38th Division. The 113/38, assisted by the 112/22 attacked Taipha Ga from the left flank. The 114/38 attacked from the right flank. Steady pressure from all three regiments pushed the Japanese from their defenses around Taipha Ga. By February 1 1944, all resistance had ceased and the operations in the Northern Hukawng Valley subsided.
Advance to Walawbum
The Chinese Army continued to move after a brief pause for reorganization and advanced down the central axis on the Kamaing Road with the 22nd Division on the right flank and the 38th Division on the left flank. Although the Japanese had suffered a series of losses they were successfully conducting a series of delaying actions to halt the advance of the Chinese. The Japanese objective was to hold the Chinese in the Hukawng Valley until the monsoon season began. The Chinese Army made consistent progress in its advance toward Walawbum. The 22nd Division, on the right flank, sent the 64th Regiment south along the Kamaing Road. The other two regiments of the 22nd Division, the 65 and 66, were in position to the west of the Kamaing Road. The 65th Regiment chased enemy forces along the Ahawk Trail and caught up with the 66th Regiment at Yawngbang. The 66th advanced then along the Lakyan Ga – Yawngbang Trail. Together, the 65th and 66th Regiments attacked Japanese positions at Yawngbang then continued south and emerged on the Kamaing Road between Maingkwan and Walawbum. The 38th Division, on the left flank of the Chinese Force, advanced south in positions to the east of the Kamaing Road. The 112th Regiment moved in the area next to the Kamaing Road on the division’s right flank. The 113th Regiment, advanced along trails in the center. The 114th Regiment moved on the extreme left flank of the 38th Chinese Division. In a series of actions, the 113th Regiment defeated Japanese forces at Lalawn Ga, Gaehang Ga, Tsumphawng Ga, Tingkrai Ga, Jahntang Ga, and Makaw. When the 112th Regiment took Taring Ga the 38th Division was positioned to begin its final drive toward Maingkwan and Walawbum.
The Chinese Army continued its advance on Walawbum in the closing days of February 1944. On the right flank, the 64th Regiment of the 22nd Division advanced down the Kamaing Road, closed the trail leading to Maingkwan by securing Ngam Ga, and then attacked Maingkwan. The 65th Regiment attacked and took Hpunguye, southwest of Maingkwan. The 66th Regiment bypassed Maingkwan and took up blocking position on the Kamaing Road south of Walawbum. Another position covered a different stretch of the road from a point across the Maitawng River. Following the 22nd Division’s successful attack on Maingkwan, the 64th and 65th Regiments arrived at Walawbum and secured strong points on the western flank of the town and along the eastern edge of the Kamaing Road. On the Chinese Front’s left flank, the 38th Division sent the 113th Regiment past Maingkwan to establish a blocking position south of Walawbum. This position at Chanol was to prevent the withdrawal of a large ammunition dump by Japanese forces. The 112th and 114th Regiments (38th Division) assisted the 22nd Division in the attack that took Maingkwan on March 5 1944. Following Maingkwan, the 112th and 114th Regiments arrived at Walawbum and operated to the east in support of operations aimed at destroying Japanese forces. During the first week of March 1944 the Chinese Army concentrated its actions on defeating Japanese forces and ending the battle for Walawbum.
The Chinese Army continued to advance south following combat operations at Walawbum. Figure 9 (below) illustrates operations in the Mogaung Valley. The 38th Division, minus its 113th Regiment which was assigned to the Galahad force (5307th), was left to consolidate gains at Walawbum. The 22nd Division led the avance, and moved down the Kamaing Road with the 64th and 66th Regiments. The 65th Regiment served as the divisional reserve. Attacking south the 22nd Division found Japanese forces in defensive positions across the Kamaing Road. The 66th Regiment bore the brunt of attacking through the Japanese positions which allowed the 22nd Division to take Jambu Bum on March 19 1944. Pressing on through Jambu Bum the 66th Regiment took the heights north of Shaduzup with heavy fighting. The 64th Regiment took over from the 66th Regiment and pressed on to Hkawnglawnyang. At Hkawnglawnyang the 64th and the 66th Regiments placed continuous pressure on the Japanese forces in the hills and at the river crossing of the Hkawnglaw River. At this point the 65th Regiment was called up from divisional reserve on March 26 1944. Leading the attack, the 65th Regiment fought hard for several days before finally entering Shaduzup on March 29 1944. Upon entering Shaduzup, the 64th and 66th Regiments went into bivouac for a well desired rest.
What was the cost in terms of manpower to the Chinese Army up to this point in the North Burma Campaign? The following quote best summarizes it best.
By April 15 1944, the cost to the Chinese of the North Burma Campaign was : 800 men KIA and 2000 men WIA for 22nd Division. The casualties suffered by the 38th Division was 650 men KIA and 1450 WIA.
At this point in the North Burma campaign the use of nonlinear operations was emerging as the key to operational success. Flanking maneuvers that sent Chinese regiments on isolated operations around Japanese defenses were becoming a favored tactic. Pinning down Japanese forces while rapidly maneuvering to obtain the tactical advantage became tantamount to victory. Additionally, the terrain in North Burma supported maneuver warfare while placing a premium on a unit’s ability to conduct independent operations. The type of warfare waged in the North Burma Campaign mirrors the concept of nonlinear operations outlined in Air Land Operations.