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.
Having taken Shaduzup, the Chinese Army continued its advance down the Kamaing Road meeting sharp resistance from the Japanese. The 22nd Division, minus the 64th and 66th Regiments, lead the movement south. The 64th and 66th Regiments were left back at Shaduzup, but each regiment gave the 65th a battalion for reinforcement. The 65th Regiment (22nd Division), plus the 113th Regiment (38th Division), which was now detached from the Galahad Force (5307th Composite Unit), pressed on to Laban. At Laban, the 113th Regiment slipped behind the Japanese defenses and established a blocking position. By April 12 1944, the 65th and 113th Regiments cleared the area of Japanese forces and the front continued to advance south. The front had proceeded far enough south of Shaduzup by this time that Northern Combat Area Command headquarters were relocated to Shaduzup. At this point, the Area Command developed the following concept of operations for the remainder of this segment of the North Burma Campaign :
Plans were outlined for a drive which would take Kamaing, advance to Mogaung and Myitkyina, secure the Mogaung – Myitkyina line, and destroy not only the Japanese on the road between Shaduzup and Mogaung, but cut off the strong Japanese force which had gone up the eastern flank and was being engaged by the Marauders (Galahad Force] at Nphum Ga.
The 38th Division began the next drive by recalling the 2nd and 3rd Battalions of the 112th Regiment from Walawbum. These battalions, were ordered down the Mogaung Valley to block Japanese forces moving north from Warang to Npum Ga. The 1/112th Regiment, located at Hsamshingyang, was ordered to move south until it rejoined the 112th Regiment at Warang. As the 38th Division sent the 112th Regiment to block the Japanese forces, its 113th Regiment moved forward, with the 114th Regiment in divisional reserve. Movement was slow due to both heavy Japanese resistance and difficult terrain. Trails were so arduous that pack animals had to be sent to the rear after two days of labor. The 113th Regiment advanced to the east of the Kamaing Road and after hard fighting took Npadyuang on April 20 1944. After securing Npadyuang, the 113th Regiment split into three columns in order to cover the area between the Kamaing Road and the 112th Regiment on the left flank. To speed up the advance of the 113th Regiment, the 114th Regiment was brought into action. Both regiments pressed their attack against determined Japanese defenses and succeeded in securing the area down to Manpin, where they reestablished contact with the 112th Regiment on the left flank.
Meanwhile, the 22nd Division attacked through Japanese positions at Wakawng on the Kamaing Road and advanced until stopped at Inkangahtawng. To assist the 22nd Division, the 149th Regiment from the 50th Division was added to the attack. The 50th Division was added to Northern Combat Area Command upon its arrival from China on April 5 1944. Its 148th Regiment (50th Division) was employed as security for Area Command headquarters while its 150th Regiment was moved east to Naubam. Using the 50th Division’s 149th Regiment to launch a holding attack, the 22nd Division began an enveloping maneuver to take Inkangahtawng. The 149th Regiment’s holding attack began to make steady progress while the enveloping maneuver of the 64th and 66th Regiments (22nd Division) lost momentum. On May 4 1944, the 22nd Division finally took Inkangahtawng. Following the capture of Inkangahtawng, the 22nd Division dug in and remained in the area until nearly the end of the month.
On May 22 1944, General Stilwell issued orders for the 22nd Division to resume its advance toward Kamaing. The 22nd Division sent the 65th Regiment to circle the Japanese left flank to the west. The 65th Regiment would make this movement through the mountains and emerged on the Kamaing Road above Kamaing. The 64th Regiment was to advance along the mountains west of the Kamaing Road to force the Japanese left flank. The 149th Regiment (50th Division) was to advance south down the Kamaing Road. The 66th Regiment served as the divisional reserve. In conjunction with the advance of the 22nd Division, the 38th Division sent its 112th Regiment on a rapid flanking maneuver that took it past Kamaing to a blocking position at Seton. The 112th Regiment advanced so rapidly that the Japanese thought they were under airborne attack. The movement by the 112th Regiment effectively cut off the Japanese forces in Kamaing from their base at Mogaung and from the rest of Burma. Moving with uncharacteristic speed the 113th and the 114th Regiments of the 38th Division simultaneously advanced down the Japanese right flank and were north and east of Kamaing by June 10 1944. As the 38th Division moved, the 22nd Division also advanced down the Kamaing Road with its 64th and 66th Regiments, and the 149th Regiment of the 50th Division. As these regiments went past its blocking position on the Kamaing Road, the 65th Regiment circled west and took up new positions outside Kamaing.
The 22nd and 38th Divisions now occupied all roads and trails leading to Kamaing and completely encircled the city. Frantic counterattacks and massed artillery by the starving Japanese failed to break the encirclement, but did inflict heavy casualties on the Chinese. On June 14 1944, attacks by the 64th and 65th Regiment (22nd Division) cracked the Japanese defenses around Kamaing and the 64th Regiment entered Kamaing. The 149th Regiment of the 50th Division was left by the 22nd Division to mop up remaining Japanese forces and Kamaing was secured on June 16 1944. Pursing retreating Japanese forces, the 22nd Division pressed them against the blocking position established by the 112th Regiment of the 38th Division at Seton. As the 22nd Division pushed on, the 113th and 114th Regiments of the 38th Division reduced isolated pockets of Japanese on trails leading to Kamaing. The 22nd Division kept the Japanese retreat disorganized. On July 2 1944, the 65th Regiment of the 22nd Division reached Seton and the 112th Regiment of the 38th Division. Together, these regiments mopped up the remnants of Japanese Lt Gen Tanaka’s 18th Division, which had opposed the Chinese Army in the North Burma Campaign. The cost to the Japanese to hold North Burma was high. A Japanese division could vary in strength from 12.000 to 22.000 soldiers. The Japanese 18th Division was estimated to have lost over 50% of its strength by the time it succumbed to the Chinese. The key to the defeat of the Japanese forces in this phase of the North Burma Campaign was the use of maneuver warfare. Wide flanking movements continuously placed the Japanese defenders at a tactical disadvantage and led to their defeat.
With the fall of Kamaing, attention turned to Mogaung. The 38th Chinese Division was ordered to send the 113th and 114th Regiments to support the British 77th Brigade Chindits which was ordered by Gen Stilwell to attack Mogaung. The 77th Brigade was an (LRPU) long range penetration unit which was flown into western Burma in March 1944 and had come under the control of Northern Combat Area Command. The 113th Regiment secured roads and trails to the north and west of Mogaung. The 114th Regiment took up positions east of Mogaung. A coordinated attack began on June 22 1944 and a foothold into the city was gained by June 25 1944. By June 26, Mogaung was occupied with all units claiming credit for the victory.
Advance to Myitkyina
The battle for Myitkyina represents the last major combat operation for Northern Combat Area Command in this part of the North Burma Campaign. Elements of the Chinese Army played no significant role in the capture of Myitkyina. The battle for Myitkyina was largely fought by the Galahad Force, or 5307th Composite Unit (Provisional) (Merrill’s Marauders), with Chinese augmentation. The Myitkyina assault force was composed of the following forces :
5307th Composite Unit (Provisional)
– 150th Regiment, 50th Chinese Division
– 88th Regiment, 30th Chinese Division
14th Chinese Division
– 42nd Regiment
30th Chinese Division
– 89th Regiment
50th Chinese Division
– 149th Regiment
The Galahad Force started toward Myitkyina on April 27 1944. Making excellent progress by using K-Force as a blocking element, H-Force arrived on the outskirts of the airfield at Myitkyina on May 16 1944. The 1/5307 took the ferry terminal on the Irrawaddy while the 150th Regiment attacked the airport. By the end of May 17 1944 a stream of air traffic began to flow a in. The first unit to arrive was the 2nd Battalion, 88th Regiment (30th Chinese Division). This unit was flown in from Ledo when the airport was declared open. Attempting to capitalize on the element of surprise the 150th Regiment made an immediate attack on Myitkyina late on May 17 1944. An attack that night and the next morning by the 150th Regiment were beaten back by Japanese forces. On May 18 1944, the 89th Regiment (30th Division) arrived at the airfield at Myitkyina. Reacting quickly, the Japanese reinforced Myitkyina and before another attack could be launched, their defense had been significantly strengthened. K-Force and M-Force reached the airfield at Myitkyina on May 18 and 19. Additional forces poured into the airfield to include the 42nd Regiment (14th Division). Like the 30th Division, the 14th Division was another new unit to the Northern Combat Area Command that arrived from China in April 1944. Attacks against Myitkyina were made on the 20 and 21 May. A counter attack by the Japanese forces was repelled on the 22. By the 23, the Japanese had denied the Allies the opportunity for a swift victory at Myitkyina. An embittered battle for the airfield and Myitkyina would now take place for many weeks.
By June 4 1944, all the original members of the Merrill’s Marauders had been evacuated due primarily to health reasons. The tragedy of the personnel of the Merrill’s Marauders and their medical problems are a story unto itself. A decision was made to keep 5307th Composite Unit (Provisional) in existence through the exchange of new replacements. In additional to replacing the Galahad Force, new Chinese elements continued to arrive. On June 1, the Myitkyina Task Force was established for the assault on Myitkyina. It consisted of the following major fighting forces :
5307th Composite Unit (Provisional)
14th Chinese Division
– 42nd Regiment
– 2/41st Regiment
30th Chinese Division
– 88th Regiment
– 89th Regiment
– 90th Regiment
50th Chinese Division
– 149th Regiment
– 150th Regiment
American & Allies Forces
209th Engineer Combat Battalion
236th Engineer Combat Battalion
77th Brigade Chindits (elements)
Attacks and counterattacks characterized the fighting around Myitkyina during June and July 1944. With the fall of Mogaung on June 26, momentum swung to the Myitkyina Task Force. Cut off from their main source of supplies at Mogaung the Japanese garrison began to show the effects by the middle of July 1944. Like Kamaing, starving Japanese attempted to infiltrate through Allied forces surrounding Myitkyina. On August 3, the 50th Chinese Division launched the final assault on Myitkyina. By 1545, Myitkyina was declared secure. The attack on Myitkyina had been costly in terms of human losses and suffering. Losses to the Northern Combat Area Command from Myitkyina operations are as follows :
Killed – Wounded – Sick
Chinese : 972 KIA, 3184 WIA, 188 Sick
American : 272 KIA, 955 WIA, 980 Sick
Of the 980 classified as sick, 570 were from the 5307
With the fall of Myitkyina, all major combat operations for Northern Combat Area Command and Chinese Army India in the North Burma Campaign came to an end. The following quote best sums up this period of time before combat operations again resumed in Burma.
With the fall of Myitkyina, a period of relative quiescence descended on the American and Chinese in Burma. Troops in the vicinity of both Mogaung and Myitkyina went into bivouac or into training, with routine patrolling activity as the only tactical operation. Supply functions were continually increased to build up the Myitkyina base and restore communications in the area occupied by Allied forces. Reorganization of the Northern Combat Area Command was carried out, and a new American-Chinese penetration unit, the 5332nd Brigade (Provisional) was formed and trained. Plans were laid for reopening the campaign when the summer monsoon rains ceased, and although actual operations were curtailed to await the dry season, no one had much time to rest on his laurels.
Documents & Books used by Maj David A. Pattillo for this Archive
(1) United States, Department of the Army, Headquarters, United States Army Training and Doctrine Command, TRADQC PAM 525-5. Airland Operations. A Concept for the Evolution of Airland Battle for the Strategic Arm of the 1990s and Beyond, (Fort Monroe, Virginia, 1 August 1991)
(2) United States, Academy of Health Sciences, Health Service Support – Futures (Final Draft), (Fort Sam Houston, Texas, March 1989), p. 1 – 8. (Hereafter referred to as Futures)
(3) United States, Department of the Army, Field Manual 100-5. Qperation, (Washington: DC, 5 May 1986)
(4) Otha C. Spencer, Flying the Hump, (College Station, Texas : Texas A&M University Press, 1992), p. xi – xiv.
(5) Julian Thompson, The Lifeblood of War : Logistics in Armed Conflict, (London: Brassey’s, 1991), p. 99.
(6) Charles F. Romanus and Riley Sunderland, United States Army in World War II. China-Burma-India Theater. Stilwell’s Mission to China. (Washington, DC : United States Army, Office of the Chief of Military History, 1956), p. 357 – 360.
(7) SMC p. 355 – 389. United States, Department of the Army, United States Army. Medical Service in Combat in India and Burma 1942 – 1945, (New Delhi, India : Office of the Surgeon, Headquarters, United States Forces, India-Burma Theater, 1 January 1946), p. 36 – 37.
(8) Louis Allen, Burma. The Longest War. 1941-1945,(London : J.M. Dent & Sons, Ltd, 1984), p. 655.
(9) Burma, p. 655, 660. Viscount Slim, Defeat Into Victory, (Hong Kong : Papermac, 1987), p. 205 – 208.
(10) Charles F. Romanus and Riley Sunderland, United States Army in World War II. China-Burma-India Theater, Stilwell’s Command Problems. (Washington, DC : United States Army, Office of the Chief of Military History, 1956), p. 138 – 139.
(11a) United States, Department of the Army, Medical Department. United States Army. Organization and Administration in World War II. Washington, DC : Office of the Surgeon General, 1963
(11b) United States, Department of the Army, Medical Department. United States Army. Organization and Administration in World War II. Washington, DC : Office of the Surgeon General, 1963
(12) United States, Department of the Army, Merrill’s Marauders, Washington, DC : Center of Military History, 1990
(13) United States, Department of the Army, United States Army in the World War. 1917 – 1919. General Orders. G.H.O.. A.E.F., (Washington, DC: Historical Division, 1948), p. 312 – 315.
Part Two – Surgical Support to the North Burma Campaign
The Beginning of Mobile Surgical Hospitals
The concept to rapidly apply far forward life saving surgical support to soldiers came into its own in World War I. This need resulted in the development of the first true field surgical units in the Army Medical department. Surgical hospitals and units trace their lineage to several different types of units developed in WWI to meet this requirement. In August 1917, the US Army Surgeon General received a proposal for
a mobile operating unit mounted on trucks and provided with a well-lighted and heated operating room, electrical lighting, steam and sterilizing plants, these to be fully equipped in such a manner as to insure the best hospital conditions and at the same time capable of being erected and in action in less than an hour.
An American businessman’s offer to donate a surgical unit resulted in the quick approval by the War Department of the concept for a mobile operating unit. This unit did not see service in WW-I because the armistice was signed shortly after it arrived in France, but this Mobile operating Unit No. 1 consisted of five complete sections. 64 officers, 50 nurses, and 218 enlisted men composed this unit. Equipment consisted of five touring cars, five motorcycles with side cars, 20 three ton trucks, 50 Ford trucks, and 20 one-half ton trailers. Each of the five sections was a complete surgical hospital capable of independent operation and for providing care for 40 patients. Figure 10 illustrates the mobile nature of this unit by highlighting one complete section of this organization.
Another idea for mobile ‘surgical’ hospitals and mobile surgical units borrowed concepts developed by the French. In February 1918, the Chief Surgeon of the American Expeditionary Forces contracted for 20 of these type mobile surgical hospitals and units. These units were designated Mobile Hospitals and Mobile Surgical Units by the AEF. General Orders, Number 70, AEF, stated, These units have been designed in order that facilities for immediate surgical aid to the seriously injured may be brought to the man …. One mobile operating unit, 21 mobile hospitals, and 16 mobile surgical units were activated for service in WW-I. Of these 38 units, twelve mobile hospitals and twelve mobile surgical units participated in actual combat campaigns. Table 1 identifies these units.
Table 1 – Listing of Mobile Surgical Hospitals/Units in World War I
Mobile Hospital No. 1
Mobile Hospital No. 2
Mobile Hospital No. 3
Mobile Hospital No. 4
Mobile Hospital No. 5
Mobile Hospital No. 6
Mobile Hospital No. 7
Mobile Hospital No. 8
Mobile Hospital No. 9
Mobile Hospital No. 10
Mobile Hospital No. 11
Mobile Hospital No. 12*
Mobile Hospital No. 13*
Mobile Hospital No. 14*
Mobile Hospital No. 39
Mobile Hospital No. 100*
Mobile Hospital No. 101*
Mobile Hospital No. 102*
Mobile Hospital No. 103*
Mobile Hospital No. 104*
Mobile Hospital No. 105*
Mobile Surgical Units (Complementary Groups)
Mobile Surgical Unit No. 1
Mobile Surgical Unit No. 2
Mobile Surgical Unit No. 3
Mobile Surgical Unit No. 4
Mobile Surgical Unit No. 5
Mobile Surgical Unit No. 6
Mobile Surgical Unit No. 7
Mobile Surgical Unit No. 8
Mobile Surgical Unit No. 9
Mobile Surgical Unit No. 10
Mobile Surgical Unit No. 12
Mobile Surgical Unit No. 100*
Mobile Surgical Unit No. 101*
Mobile Surgical Unit No. 102*
Mobile Surgical Unit No. 103*
Mobile Operating Unit
Mobile Operating Unit No. 1*
Note : (*) Organized or arrived too late to participate in WW-I
The mobile hospital consisted of eleven Medical Corps (MC) officers, one Sanitary Corps officer, 22 Army Nurse Corps (ANC) officers, and 80 enlisted personnel. A goal of the mobile hospital was to receive patient within six to eight hours of wounding. Mobile hospitals were planned on the basis of one per division. In the event of offensive operations the use of a second unit to allow mobile hospitals to leapfrog a, each other was suggested. A mobile surgical hospital had equipment for a light frame operating room, x-ray, electric-lighting plants, and tentage to establish a 120-bed surgical hospital. The mobile surgical unit consisted of one MC officer (roentgenologist) and twelve enlisted personnel. Its equipment consisted of surgical material, portable sterilizing and x-ray equipment, a light frame operating room and two trucks or one truck and one trailer. The mobile surgical unit was intended to be allocated on the basis of one unit per division. When assigned to the division it operated in conjunction with the field hospital. The mobile surgical unit was intended to supplement the medical capabilities of the divisional field hospital by providing another small operating room and ancillary staff to allow the staff of the field hospital to carry on additional surgical operations. The mobile surgical unit was not capable of independent operations. It was a predecessor of the current forward surgical team.
Mobile Surgical Hospitals in World War II
Military Medical Manual, 4th Edition, a WW-II military manual used to instruct Army Medical Department officers at the Medical Field Service School at Carlisle Barracks, Pennsylvania, identified only one type of surgical hospital, the 400-bed surgical hospital, in the force structure at the beginning of WW-II. Mobile Units of the Medical Department, another instructional WW-II Medical Field Service School manual, also identifies only this 400-bed surgical hospital in the Army Medical Department force structure. By 1944, the Military Medical Manual recognized a new type of surgical unit, the portable surgical hospital. Besides these two types of surgical units, another hospital unit provided forward surgical support. This unit, the Field Hospital, sent forward a platoon reinforced by surgical teams to provide forward surgical support. The majority of forward surgical support in the European Theater of Operations was provided by these platoons from Field Hospitals. These Field Hospital Platoons were attached to division clearing stations and worked on the most urgent emergency surgical cases. As with the mobile surgical unit of WW I, the Field Hospital Platoon is also a predecessor of the present forward surgical team. The 400-bed surgical hospital addressed in the instructional manuals were few in number, and operated mainly in the Mediterranean Theater of Operations and Southwest Pacific Area.
They were designed to augment the surgical capability of Field and Evacuation Hospitals in the theater. These surgical hospitals, identified by table of organization and equipment (T/O) 8-231, had a capacity of 400 beds. The 400-bed surgical hospital consisted of one mobile surgical unit and two hospitalization units. The two hospitalization units were capable of independent operation and could each support 200 beds. The mobile surgical unit had sufficient integral transport for its own movement. It was designed to operate with the hospitalization units or any other medical unit requiring temporary surgical support. The 400-bed surgical hospital was too large and non-mobile a unit to function in support of combat operations in the CBI Theater. To fill the requirement for far-forward surgical support in the CBI theater the Portable Surgical Hosîtal was deployed. Tactics employed in the North Burma Campaign mandated the use of highly mobile surgical hospitals to support combat operations. Combat operations were characterized by flanking maneuvers with fast-moving, relatively self sufficient jungle task forces.
Mobile Surgical Hospitals in the China – Burma – India Theater
The Portable Surgical Hospital employed in the CBI Theater operated under T/O 8-572. Col Percey J. Carroll, (Medical Corps), Surgeon for the US Army Forces in the Far East and West Pacific, is credited with designing the Portable Surgical Hospital to meet theater needs for a mobile surgical unit to replace the 400 bed surgical hospital. The low priority given to the CBI Theater by the War Department precluded the assignment of the normal number of medical units to support combat operations. To meet the requirement for surgical units in the CBI Theater, the Portable Surgical Hospital was employed. Two types of PSH were utilized in the CBI Theater. The first unit was the standardized T/O PSH. The other surgical unit was organized provisionally in the field along the T/O of the PSH. Medical personnel and equipment drawn temporarily from other medical organizations manned these provisional PSHs.
Eight officially organized PSHs and approximately an equal number of provisional PSHs served in support of Northern Combat Area Command in the North Burma. During the Campaign seven PSHs supported Chinese Forces fighting in the Combat Area Command. These PSHs were the 42nd, 43rd, 44th, 45th, 46th, 58th, and 60th PSHs. PSHs, provisional PSHs, and surgical teams were allocated to combat units on the basis of one per regiment actually in combat. The PSH was a highly mobile unit designed to meet the demands of the tactics employed by combat forces in the CBI Theater. Due to limited transportation assets, tactics employed by combat forces, and the physical characteristics of the CBI Theater, PSHs was designed to be transported by their organic transportation assets or human/animal carriers. The PSH was organized by T/O with four Medical Corps officers and 33 enlisted personnel. Of the four Medical Corps officers, three were surgeons and one was an internist-anesthetist. The PSH had a 25 bed capacity and was theoretically capable of major surgery. Figure 7 below, illustrates the rugged topography that characterized the North Burma area of operations and highlights some of the difficulty in transporting equipment, while Figure 12 below, illustrates the organization of the PSH.
(Figure 12. Organization of the Portable Surgical Hospital)
Capt / 1/Lt
Capt / 1/Lt
|Hospital Cdr / Surgeon
Total Commissioned 4
Mess and Supply
Driver Truck Light
Driver Truck Light
Driver Truck Light
Total Enlisted 33
Total Personnel 37
– Truck, 1/4 Ton 1
– Truck, 3/4 Ton 2
– Trailer, 1 Ton 1
Note : The WWII enlisted rank of Technician, Grade 3 is roughly equivalent to a Staff Sergeant; a Technician, Grade 4, to a Sergeant; and a Technician, Grade 5, to a Corporal.
Concept of Medical Support to The Chinese Army in India
US involvement in the CBI Theater was an economy of effort by the War Department. The goal was to have Chinese forces conduct the preponderance of combat operations in Burma with US forces providing a supporting role. US forces were present mainly for the political reason of showing US support and thereby helping to keep China in the war against Japan. This decision influenced heavily the concept of medical support for the CBI Theater. The goal of deployed US forces in the CBI Theater was … to take all measures possible to improve the combat efficiency of the Chinese Army. The objective of US medical forces in the CBI Theater was to develop the Chinese medical system supporting Chinese forces so that it could take care of itself and function satisfactorily in combat. Medical planners recognized from the beginning that a lack of sufficient numbers of trained Chinese doctors would prevent the Chinese from producing a complete evacuation and hospitalization system in the CBI Theater. To capitalize on Chinese medical system strengths and fulfill the US mission to China, medical units, predominately Level III (corps) hospitalization and evacuation units, would have to be obtained from the US.
The plan of US medical forces in the CBI Theater was to equip and train Chinese forces to provide their own Level I (unit) and Level II (division) medical support. US medical units would provide Level III (corps) and Level IV (Echelon Above Coprs) support and operate to the rear of the Northern Combat Area Command Chinese divisions engaged in combat operations. The US medical plan for providing surgical support to Chinese forces in the CBI a Theater would center on the use of small, highly mobile, portable surgical hospitals to support combat operations. What was originally planned by General Stilwell as a six-month campaign turned out to be a year and one-half campaign. Medical planners, to support this campaign, had submitted an initial requisition for twelve Portable Surgical Hospitals. Subsequent requests increased this initial request to 18 PSHs to support Chinese forces. Two factors drove the request for 18 PSHs. First, was the estimates of sick and casualty rates. More importantly, was the conclusion that every Chinese division would need at least one PSH. Eventually, PSHs would be allocated on the basis of one per regiment engaged in combat. The War Department decided initially to support the CBI Theater medical plan with nine PSHs. This decision was made because the CBI Theater was viewed as an economy of force by the War Department. Eight PSHs served in direct support of Chinese Army during the North Burma Campaign. The rest of the demand for PSHs in the Theater would be met using provisional units formed from assets in theater.
Employment of Portable Surgical Hospitals in Support of Combat Operations
The Portable Surgical Hospitals are the keys to the medical system. If they are lost the medical service is lost.
The first three PSHs to reach India from the US arrived in the last quarter of 1943. These units were the 40th, 46th, and 48th PSHs. The 40th and 48th PSHs were set aside for the Y-Force Chinese divisions and the 46th PSH was held in India. The 42nd and 43rd PSHs also arrived in India late in 1944. These five PSHs were divided between the Chinese X-Force divisions and the Chinese Y-Force divisions in southwest China. The 42nd, 43rd, and 46th PSHs were assigned to support the Chinese Army India. Other PSHs were divided between the Chinese X-Force and Y-Forces based on need as they arrived in theater. The deployment of the 43rd PSH provides an insight into how many PSHs were shipped to the CBI Theater. The 43rd Portable Surgical Hospital, activated June 7 1943, at Camp White, Oregon, departed Hampton Roads, Virginia, for India on September 23 1943. The unit arrived 23 days later in Bizerte, Tunisia, after a normal ocean crossing. Moving by train to Oran, Algeria, it set out again by ocean convoy to India on November 24 1943. The unit history of the 43rd PSH recounts key events in the voyage to India.
Said convoy underwent two serious bombing attacks by enemy aircraft in passing through the Mediterranean, once by radio controlled bombs, the other by 250 Kgs dropped from JU-88s. In the first attack the ship next to ours was sunk with the loss of over 1000 American lives. It was our baptism of fire and had a sobering effect on all … In the second attack, another ship was hit, fortunately by a dud.
The 43rd PSH arrived in Bombay, India, on December 19 1943, and moved two days later to a staging area near Calcutta. Here the unit received its first notice of its ultimate destination, the China Burma India Theater and Northern Combat Area Command. By the middle of February 1944, the 43rd PSH arrived in Ledo, India, where it underwent a two week indoctrination to prepare for combat. The 43rd PSH’s unit history recalls this movement as important in preparing the unit for the many transportation difficulties that lay ahead.
The officers and men of the unit were shipped in small groups as train guards from Calcutta to Ledo and developed a deep sense of appreciation of the Indian transportation difficulties.
Prior to the arrival of the first Portable Surgical Hospitals into the CBI Theater far-forward surgical support was provided by adhoc surgical teams and provisional PSHs. These units, the 13th Mountain Medical Battalion, 151st Medical Battalion, 25th Field Hospital, 73rd Evacuation Hospital, and the Seagrave Hospital were the primary manpower and equipment sources for fielding provisional PSHs used during initial stages of the North Burma Campaign. Even after the deployment of PSHs, these units would continue to provide provisional PSHs and surgical teams to support combat operations.
(Above) 13th Mountain Medical Battalion.
(Source : Sam Cox militaryhorse.org)
Operations Around Walawbum
The 22nd Chinese Division has the significance of being the first Chinese unit to be directly supported by a American PSH in the North Burma Campaign. Three PSHs were deployed in the later stages of the attack on Walawbum and mopping operations between Maingkwan and Walawbum. The 42nd PSH began supporting the 66th Chinese Regiment on March 28 1944, at Lakyan Ga. The 43rd PSH reached Ngamaw Ga on March 11 1943, and supported Chinese forces cleaning up Japanese remnants caught between Maingkwan and Walawbum. The 46th PSH supported the 65th Chinese Regiment at Yawngbang Ga beginning March 1 1944. It received casualties there until March 10 1944, when it moved to Maingkwan. The unit history of the 43rd PSH describes the action between Maingkwan and Walawbum as follows :
The first functional set up of the unit was located at Ngamaw Ga in support of the 22nd Division on March 11 1944. In five days, 93 battle casualties were operated on by the officers of the unit with the aid of technicians who, with one exception, had never before seen an operation. It was their training period in actuality. As one enlisted man wrote in his diary, ‘the officers seemed to have the know-how already but it was a few nights before the enlisted men operated with the nonchalance of veterans too’. Here as at nearly every point throughout the campaign most of our surgery was done at night with the aid of kerosene lanterns and flashlights.
As the 22nd Division continued combat operations down the Hukawng Valley a pattern for providing surgical support by the three PSHs emerged. From March 16 until March 23 1944, the 42nd, 43rd, and 46th PSHs all supported the 22nd Division. The PSHs would leapfrog each other so that two PSHs were always operational while the other PSH was relocating. The 43rd PSH unit history describes this tactic :
… this unit leapfrogged with the 42nd and 46th Portable Surgical Hospitals in such a fashion that there were always two units set up to operate – the forward unit never more than a few miles behind the front … Several hundred casualties received surgical care at these busy set-ups. To work around the clock was not uncommon.
The 42nd, 43rd, and 46th PSHs continued to support the 22nd Division during the rest of the Hukawng Valley operation. As noted by the 42nd PSH’s unit history, it was not usual for surgical operations to be performed from 16 to 22 hours daily and on one occasion for as long as 46 hours. After March 23 1944, the 43rd PSH moved to a location beyond Tingkawk Sakan for rest. After a few days there it moved to Hkawnglawnyang where it remained for two weeks. To prepare for the start of Chinese Army combat operations in the Mogaung Valley the 43rd PSH received orders reassigning it to support the 38th Chinese Division. Besides the technique of leapfrogging PSHs to ensure continuous forward surgical support to the 22nd Division, other aspects of the employment of the PSHs unfolded in this phase of the campaign. The 42nd PSH unit history states that the unit was normally established near the division headquarters. Patients generally arrived at the PSH by Chinese ambulances and were evacuated from the unit by ambulances of the 13th Mountain Medical Battalion, or occasionally by the 151st Medical battalion. Wounds requiring surgery were only an average of two to four hours old upon arrival at the PSH, although wounds arriving at the PSH could range from as little as 30 minutes to as long as eight hours old. The unit could move forward with its own vehicles (two 3/4 ton trucks and two 1/4 ton trucks), although it required shuttling. Security for the unit came from its proximity to the division headquarters, although … danger from enemy action in the area did not necessarily come from the forward direction, but from any and all directions, usually (sic) consisted of individual (sic) sniper’s or small patrols.
The 42nd PSH’s unit history described the operational setup of the unit while supporting combat operations as follows :
The physical installation, although never the same, followed the same general setup. Cover consisted of tarps, usually two, eighteen by twenty four, supported by bamboo or small trees. Sidewalls (for blackout) consisted of blankets, 6X6 tarps, 12X18 tarps, and whatever could be found… Under the cover were arranged four to five operating tables.
Figure 13 illustrates the floor plan for the general setup of the 42nd PSH’s surgical suite as diagrammed in its 1944 unit history.
Operations in the Mogaung Valley
Following operations around Walawbum, the 42nd, 43rd and 46th PSHs followed Chinese forces down the Kamaing Road to Shaduzup. The 43rd PSH, which operated as the rearmost of the three units during the battle of Walawbum, moved down the Kamaing Road on March 16 1943. Located five miles below Walawbum it functioned as the most forward PSH until March 23 1944. The 43rd PSH then went into bivouac until the end of March 1944 when it joined the 42nd PSH and relocated to Hkawnglawnyang to receive casualties from Shaduzup. The 46th PSH, which had remained at Maingkwan to support Chinese mopping up operations around Walawbum, remained in the rear until April 1 1944, when it shifted to Tingkawk Sakan. The 43rd PSH located at Hkawnglawnyang was working around the clock and handling as many as 40 casualties in a single day from the battle for Shaduzup. After two weeks at Hkawnglawnyang the 43rd PSH was assigned to provide forward surgical support to the 38th Division on Chinese’s east flank. On April 14 1944, the 43rd PSH moved to Laban in support of the 114th Regiment. On April 21 1944, the 43rd moved east toward West Tingring. Here the 43rd PSH would demonstrate the flexibility inherent in the organization of the PSH. This flexibility was necessary to support a new tactic that evolved to provide forward surgical support to regimental size units that operated independently or in isolation of other units. This technique was to split the PSH into two sections capable of independent operation.
Forward Surgical Support of the 22nd Chinese Division
Before picking up the operations of the 43rd PSH in support of the 38th Division a quick account of forward surgical support to the 22nd Division is provided. Pending the reassignments of 42nd and 43rd PSHs, the 46th PSH continued to provide forward surgical support to the 22nd Division as it advanced down the Kamaing Road. Initially, the 46th PSH supported the 22nd Division as the only PSH. Later, to replace the loss of the 42nd and 43rd PSHs, the 46th PSH was reinforced by two new PSHs. These units were the 45th and 60th PSHs. The 45th, 46th, and 60th PSHs would then continue to provide surgical support to the 22nd Division.
On April 9 1944, the 46th PSH moved from Tingkawk Sakan to Shaduzup. At Shaduzup, the 46th PSH received casualties from Laban. From Shaduzup, the 46th PSH then moved south of Laban to Wakang to treat wounded from Warazup. The unit remained at Wakang until June 3 1944, then moved down to Warazup. After the fall of Warazup the 46th PSH was joined by the 45th and 60th PSHs in providing forward surgical support to the 22nd Division. The 45th PSH established itself to provide surgical support to the 64th Regiment. The 45th PSH notes in its unit history that The number of casualties here were very heavy, and due to the (sic) Monsoons being well under way, evacuation was nearly impossible. The 60th PSH arrived at Wakang on May 19 1944 to provide surgical support to the 22nd Division. The 60th PSH noted in its unit history that … in the course of the next two weeks they operated on one hundred and fourteen casualties. The 45th, 46th, and 60th PSHs established positions at Wakang in late May to receive casualties from battles on the approaches to Kamaing. In the second week of June 1944, the 45th and 60th PSHs moved to Pakhren Sakan, northwest of Kamaing. The 60th PSH documented the difficulty of moving in the monsoon in its unit history.
In the early part of June the 22nd Division started to push ahead rather rapidly and we made preparations to follow them. While in the process of acquiring motor transportation heavy rains started and by the time the trucks were packed and ready the road below Warazup was impassable. In a few days horse transport was arranged for and at this stage it was found necessary to reduce our equipment. Our supply sergeant and three truck drivers were left behind at Shaduzup to care for equipment we could not take.
The 45th PSH also noted in its unit history the difficulties the monsoon added to the North Burma Campaign. In its move to Pakhren Sakan, the 45th PSH had to be moved by shuttling its personnel, equipment, and supplies because it lacked sufficient transportation assets. Additionally, the unit noted the effect the monsoon had on the patient evacuation system. According to the 45th PSH unit history … patients had to be moved with the unit and evacuated back up river by boat after the capture of Kamaing. With the fall of Kamaing the 45th, 46th, and 60th PSHs were given new orders. The 45th PSH moved into Kamaing on June 23 1944, where it was relieved from support of the 22nd Division. The unit next provided support to British Chindits until July 15 1944. On this date the 45th PSH was reassigned to support the 38th Division at Mogaung. With the capture of Kamaing the 46th PSH moved into its final position during the North Burma Campaign to await the end of the monsoon. The 46th PSH moved from Warazup to Nanyaseik, northwest of Kamaing. From this location the 46th PSH provided forward surgical support to the 65th Regiment of the 22nd Division. During its participation in the North Burma Campaign the 46th PSH … handled 966 casualties. Like the 45th PSH, the 60th PSH also moved into Kamaing on June 23 1944. During the ensuing months the 60th PSH was assigned to provide surgical support to the British Chindits and subsequently the British 36th Division.
Forward Surgical Support of the 38th Chinese Division
On April 14 1944, the 43rd PSH arrived at Laban to provide forward surgical support to the 38th Division. Up until this time the 38th CH DIV operated without a PSH in direct support. While the 43rd PSH was at Laban an inquiry came as to the feasibility of splitting the unit to send a fast moving surgical team with the 114th Chinese Regiment through the mountains while the other half remained behind in support of the 113th Chinese Regiment. On May 14 1944, the 43rd PSH received orders for the unit to split into two units to support the 113th and 114th Regiments. The history of the 43rd PSH from May 14 1944 until June 6 1944 is the story of two separate surgical units. As it had with the 42nd and 46th PSHs in supporting the 22nd Division, the 43rd PSH found it necessary to leapfrog itself to support the 38th Division. One half of the 43rd PSH, with Major John M. Noecker, MC, unit commander, and Captain Hans E. Heymann, MC, supported the 113th Regiment and the 38th Division headquarters. The other half, with Captain Sunderland, MC, Captain Fair, MC, and 14 enlisted personnel supported the 114th Regiment in its flanking movement through the mountains on the left flank.
The story of the half of the 43rd PSH under Maj Noecker, MC, is the more sedate story, but it still includes a march of 70 miles in five days while supporting the 113th Regiment. The half of the 43rd PSH under Captain Sunderland, MC, is the story of men under enemy fire, nearly constant movement of facilities, exhaustion of medical supplies, rations, and personal deprivations. An average of 25 pounds per man was lost by members of this half of the 43rd PSH. For their actions in providing surgical support to the 114th Regiment, Captain Sunderland, MC, and Captain Fair, MC, were each awarded the Bronze Star. Many individuals are unaware of the dangers faced by Army Medical Department units, especially hospitals, during combat operations. Many feel that corps-level Medical units have been historically immune from the rigors and dangers of combat except during exceptional circumstances. Excerpts taken from the unit histories of the PSHs in the CBI Theater and other mobile surgical units are highlighted throughout this thesis as a reminder to all that Medical units are often in the thick of combat. The following excerpts from the unit history of the 43rd PSH during this phase of the North Burma Campaign serves to reinforce this point.
May 17 1944 : at dusk, the hospital area was attacked by an enemy combat patrol. Because of the proximity of the engagement the resultant casualties had to be treated under blackout conditions which were accomplished by hanging personal blankets about the operating room and using flashlights dimmed by handkerchiefs or gauze. Firing continued intermittently throughout the night until the following morning… During the first setup 65 patients were operated upon, with no deaths…
May 21 1944 : On the morning, the unit proceeded … a distance of about 8 miles. Again, hospital equipment was carried by pack horses. Due to steep grades and deep mud resulting from several days of heavy rain, the move was a difficult one. Part of the supplies were spoilt because of horses rolling down hills into streams.
May 30 1944 : Here the unit’s rations, which had been consumed sparingly during the past 3 1/2 days, were exhausted.
June 1 1944 : … Regimental CP and the hospital were established on the tip of a finger-like spur, bracketed by enemy artillery positions a few hundreds yards to each side. Although harassment was expected and prepared for, only a few shells were fired… A small amount of rice was obtained from the Chinese and from that time until the evening of June 4, when Chinese rations were air-dropped, hospital personnel subsisted on one cupful of rice and water twice a day each. The writer, the Commanding Office of the 43rd, has never been so heartsick as he was the night the two sections rejoined near Tumbanghka. The enlisted men and officers of the forward unit were virtually skeletons – they must have lost an average of 25 pounds per man – they staggered when they walked… Next day, some of the Liaison Officers of the 38th Division told the Commanding Officer of the unit that several of the men in this group should be ‘broken’ for complaining about short rations. The officers of the same unit were decorated – what rational?
The two halves of the 43rd PSH rejoined at Tumbanghka on June 6 1944. At Tumbanghka the 43rd PSH functioned as a field hospital because the monsoon rains prevented evacuation of patients. The 43rd PSH maintained a patient load between 90 and 140 patients at Tumbanghka. Near the end of June 1944, a large segment of the 43rd PSH moved south to Numnawn. On July 14 1944, the rest of the 43rd PSH relocated to Numnawn and established an 80 bed field hospital within the defensive perimeter of the 38th Divison. The 43rd PSH remained at Numnawn for the rest of the monsoon. Of minor note, while at Numnawn, a small team on temporary duty with the 113th Regiment at Mogaung reunited with the 43rd PSH by using elephants as transportation.
Operations Around Myitkyina
Two Portable Surgical Hospitals were involved in providing forward surgical support to Northern Combat Area Command Myitkyina Task Force besieging Myitkyina. These units were the 42nd and 58th PSH. The 58th PSH was a recent addition to the PSHs providing surgical support in the North Burma Campaign. Also providing forward surgical support in operations around Myitkyina were provisional surgical units from the 25th Field Hospital, 73rd Evacuation Hospital, and the Seagrave Hospitals. On May 19 1944, the provisional surgical unit from the Seagrave Hospital supporting H-Force (1/5307 Galahad – Red & White Teams) and the 150th Chinese Regiment (50th Chinese Division) reached the airfield at Myitkyina. North of the airfield the 42nd PSH and a provisional surgical unit from the 73rd Evacuation Hospital were supporting K-Force (3/5307 Galahad – Orange & Khaki Teams) and the 88th Chinese Regiment (30th Chinese Division). On May 23 1944, a provisional surgical unit from the 25th Field Hospital deployed to the airfield at Myitkyina to support the entire 5307 Galahad. This unit would remain at Myitkyina and augment the 42nd PSH and the Seagrave Hospital until the fall of Myitkyina in August 1944. On May 29 1944, the 42nd PSH collocated with the Seagrave Hospital at the airfield. Except for a brief separation from June 7 through June 14 1944, when the 42nd PSH moved to support the concentrated Galahad Force, the two units operated together. These units gradually developed a large hospital which handled medical and surgical cases. In general, the Seagrave Hospital handled Chinese casualties while the 42nd PSH received American casualties. Both units maintained a heavy workload until the fall of Myitkyina in August 1944.
On June 10 1944, a new unit, the 58th PSH, arrived at Myitkyina and was assigned to relieve the 42nd PSH supporting the 5307 Force concentration. While supporting the 5307 Force the 58th PSH handled 662 surgical and 729 medical cases. The following excerpts from the unit history highlight the experience of this unit while at the Airfield in Myitkyina.
The first hospital was set up in a deserted basha less than two hundred yards from the first lines. After operating in this building for a few days, an air dropped package crashed through the roof; and besides almost killing the occupants of the hospital made the building unfit for occupation. Because of the proximity of the Japanese, the hospital was repeatedly subjected to artillery, mortar, and small arms fire. When enemy fire began to come in, the patients were placed on the ground where the surgical team continued the surgical procedure on it’s knees. This was definitely hard on ones knees to say nothing of one nerves.
The fall of Myitkyina on August 3 1944, effectively marked the end of the North Burma Campaign. Of the seven Portable Surgical Hospitals assigned to Northern Combat Area Command during the campaign, six provided forward surgical support to the Chinese Forces. These units were the 42nd, 43rd, 45th, 46th, 58th and 60th PSHs. Based on the allocation of one PSH to each regiment in combat the demand for PSHs was greater than the number of units available to Combat Area Command. To compensate for a shortfall of PSHs, provisional PSHs and surgical units were created from medical units such as the 13th Mountain Medical Battalion, the 151st Medical Battalion, the 25th Field Hospital, the 73rd Evacuation Hospital and the Seagrave Hospital. The medical support concept plan and forward surgical support scheme developed for the North Burma Campaign derived its success directly from the use of these portable surgical units in support of highly mobile combat forces.
Analysis of PSH Employment
An analysis of the employment of the PSHs in the North Burma Campaign quickly focuses on several aspects of their capabilities. The performance of the PSHs are evaluated in terms of their mobility, flexibility, and adequacy in providing forward surgical support to nonlinear operations. The techniques utilized by combat forces typify nonlinear operations as defined in Air Land Operations. Northern Combat Area Command combat forces in the North Burma Campaign continuously employed flanking maneuvers lasting from weeks to months. More often fighting isolated from each other than together on a continuous front, the Chinese Divisions and Regiments nevertheless maintained a continuously advancing front by use of self-contained task forces. This is the kind of fluidity forecast for the battlefield of the future. Mobility was a strength of the PSHs in the North Burma Campaign, both in terms of their ability to maintain contact and to echelon multiple units to support combat forces. PSHs in the dynamic North Burma Campaign never lost contact with the combat force they supported. This advantage was especially important on a steadily moving front, and in connection with the extensive use of penetration and flanking operations by isolated, self sufficient task force. Additionally, as demonstrated by the PSHs supporting the 22nd Division, the ability to echelon these surgical units by medical planners resulted in continuous forward surgical support at all times to combat forces as they fought.
The capability to conduct independent operations by the PSH can not be underestimated. Although limited to 37 personnel, the PSH was capable of conducting prolonged stand alone operations and operating isolated for extended periods of time. Th~s is a critical element of the PSH’s overall capability, as it was frequently called upon to accompany brigade-size units on wide, independent flanking maneuvers for weeks at a time. The nature of nonlinear operations during the North Burma Campaign in the CBI Theater demanded that key medical units be capable of sustained operations devoid of the usual methods of logistical support. The ability to operate independently is a pivotal component of any mobile surgical hospital designed to support nonlinear operations.
Flexibility was another feature demonstrated by the PSHs. Dr James H. Stone, PhD., summed up the flexibility of PSHs in October 1949 by stating :
Flexibility and adaptability appeared as primary characteristics of the portable surgical hospitals. They could be quickly assembled, rapidly supplied and equipped by air if necessary, fitted into any normal chain of evacuation, or set aside to provide the (sic) principal medical element of a jungle combat team. If necessary the unit could be split into two equivalent surgical detachments to provide service at the regimental level. At full strength, the portable surgical hospitals served divisional needs under the combat conditions typical in the … Burma Campaign. They could operate more or less efficiently as mobile surgical units, medical headquarters (regimental or divisional), collecting stations, clearing stations, medical supply points, air or motor ambulance centers, and – except in battle – field hospitals.
The high mobility of the PSH, combined with the ability to split into two surgical units, allowed medical planners unparalleled flexibility in their ability to rapidly shift surgical units based on the tactical situation. Using several PSHs, or a PSH split into two surgical units, medical planners were able to leapfrog units as combat forces advanced rapidly or operated independently on flanking maneuvers. The flexibility to rapidly shift and echelon PSHs was a key advantage as medical units quickly became non mobile the moment they begin to actively receive patients and do not regain their mobility again until patients are finally evacuated from the unit. The ability to echelon PSHs allowed extreme flexibility in the provision of forward surgical support during the Burma Campaign.
The insufficient level of PSH support in Burma was of considerable concern to medical planners. This deficiency resulted not from its mobility or flexibility, but from the fact that insufficient numbers of PSHs were made available to the medical planners to support its combat operations. Medical planners had established early during CBI Theater operations that combat tactics and casualty rates would require an initial allocation of one PSH per each Chinese Division. Actual combat experience in the North Burma further showed medical planners that one PSH was required for each regiment that became involved in combat. This was especially true when combat tactics required the use of extended flanking and combat maneuvers that resulted in isolated, self-contained task forces. Medical planners maintained the forecast basis of allocation for PSHs by inventively creating provisional surgical units from medical assets in theater to support those combat forces that lacked an assigned or supporting PSH. By maintaining approximately one PSH to each regiment committed to combat the time for a casualty to reach a surgical unit after wounding averaged two to four hours.Another key to the success of the PSH was the organizational emphasis on maximizing surgical workload. The heart of the PSH was the employment of between four to five operating room tables for its three surgeons during an operational setup. Having more operating room tables than surgeons allowed the unit to utilize all surgical staff members simultaneously and maximize surgical procedures when the medical situation demanded the capability to save the large numbers of wounded soldiers that can be generated in a short time by combat operations. The post-op recovery section of the PSH was specifically geared to evacuating the patient by ground or air as soon as the patient was stable enough to survive evacuation. Post-op time for a stable patient was held to the absolute minimum time that the tactical situation allowed.
Summing up the performance of the PSHs in the North Burma Campaign is no small task. Dr Stone, best enumerates the many contribution of the PSHs when he states :
Under conditions prevailing in Burma, the small mobile surgical hospital was a highly flexible organization, well adapted to jungle and mountain warfare on an advancing front – nonlinear operations. It supplied a link in the chain of air-ground evacuation when no larger or smaller unit could have filled as well under the existing logistical conditions. Its performance was far above rated capacity. Judging by the reports of observers and of hospitals receiving patients from the surgical units, the portable surgical hospital was remarkably effective in terms of treatment and of conservation of manpower.
30-Bed Morbile Army Surgical Hospital – MASH
Evolution of the Mobile Army Surgical Hospital
The 30-bed MASH replacing the 60-bed MASH in the Army Medical Department structure can trace its lineage to WW-II. The very success of the PSH (T/O 8-572) in providing far forward surgical support in the CBI and Pacific Theaters demonstrates the rationale for developing, employing, and maintaining small, highly mobile surgical hospitals. Tables 2-6 show the 70 PSHs that received official campaign credit during WW-II. Of the 70 PSHs credited with I official WW-II campaign participation, 18 PSHs served in the CBI Theater and 52 PSHs served in the Pacific Theater. Six PSHs also received WW-II occupation credit for service in Germany. While the PSH flourished in the CBI and Pacific Theaters, it was the Field hospital in the ETO that was the primary unit for successfully providing far forward surgical support through its platoons reinforced by surgical teams. Unlike the PSH, the 400-bed surgical hospital (T/O 8-231) played no significant role in providing far forward surgical support in any theater. It is a commonly held belief in today’s Army Medical Department that this type of surgical hospital was widely employed in WW-II. Only eight surgical hospitals of this type were actually activated for WW-II and only three functioned as such. Table 7 shows the list of eight surgical hospital activated for WW-II, the three that received official campaign credit, and the unit to which they were eventually redesignated. The decision to eliminate 400-bed surgical hospitals (T/O 8-231) began when The Surgeon General’s Office recognized a need for ‘… a combat zone hospital that was more mobile and required less personnel than … the 400 bed surgical hospital’.
Table 2 – Listing of Portable Surgical Hospitals (PSH) (T/O 8-572) Serving during WW-II (CBI Theater)
Table 3 – Listing of Portable Surgical Hospitals (PSH) (T/O 8-572) Serving during WW-II (Pacific Theater)
Table 4 – Listing of Portable Surgical Hospitals (PSH) (T/O 8-572) Serving during WW-II (ETO Theater)
Table 5 – Portable Surgical Hospitals (PSH) (T/O 8-572) Not Credited in DA PAM 672-1 dated July 1961, w/Changes 1-4, with Campaign Participation as Confirmed by Official and Unit Histories
Table 6 – Portable Surgical Hospitals (PSH) (T/O 8-573 Not Credited in DA PAM 672-1 dated July 1961, w/Changes 1-4, with Campaigns Authorized by Department of the Army General Orders
The Surgeon General’s Office response to the need to provide a more mobile, less personnel intensive, combat zone hospital resulted in the development of the 400-bed motorized evacuation hospital. The motorized evacuation hospital was capable of forming two self-contained 200-bed surgical hospitals operating under a single headquarters. The motorized evacuation hospital soon superseded the surgical hospital in the troop basis, although the table of organization of the latter was not rescinded until August 1944. Medical planners in the ETO recognized the need for a surgical unit, like the PSH, that was specially designed to provide forward surgical support. Even with the field hospital providing forward surgical support and the evacuation hospital replacing the surgical hospital, medical planners saw that a void nevertheless existed. The emphasis for developing a mobile surgical unit in the ETO was fueled by successful experiences of the British Royal Army Medical Corps. But, the development and employment of a mobile surgical hospital was delayed because the Surgeon General opposed this development, believing that the reinforcement of available units – such as platoons of field hospital – with surgical teams met the need adequately and at the same time promoted flexibility in the use of scarce categories of officers. The former view prevailed and on August 23 1945 a table of organization for a 60-bed mobile army surgical hospital was published. It is this 60-bed MASH that is the progenitor of the MASH concept currently used in the AMEDD force structure. It is from this 60-bed MASH that we can trace the lineage of the 30-bed MASH.
Note : this archive not finished. It is for our part of the history (1945) but there is a lot more to read on Korea and Vietman. I will post a link bellow to this archive.
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European Center of Military History
Gunter ‘Doc Snafu’ Gillot
rue des Thiers 8
Email : gunter [at] eucmh.be
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(NB : Published for Good – March 2019)