The entire Division had been reviewed from a medical standpoint prior to departure from the United States. All individuals not physically qualified for tropical duty, because of infirmities or actual physical handicap, were declared unfit for foreign service. All hands were thoroughly immunized against smallpox, yellow fever, and typhoid fever, and all received injections of tetanus toxoid.

Living conditions in New Zealand--under canvas in extremely bad weather--caused a number of upper respiratory infections. Contributing to this was the recent 29 day trip (for the First Echelon) under crowded transport conditions.

The Second Echelon, in part, was embarked on S.S. Ericsson. Food conditions for the Marine Corps passengers were bad. Insufficient food had been embarked, and men were given only two meals per day, with a total calorie content of less that 1500. Individuals lost from 16 to 23 pounds during the trip. The use of oil substitutes in place of proper shortening caused a minor epidemic of intestinal disorder. There had been an attempt to reload rancid butter and condemned eggs for use of the troops, but it was defeated by a strong protest lodged by Marine Corps officers. (Other references to the same conditions appear elsewhere in documents, but they differ in no detail from the above and hence are not quoted.)

The lack of proper opportunity for men to get in condition after their sojourn aboard ship is mentioned. "When the Division sailed on July 22, about half of its number had had continuous billets aboard crowded transports for one month and the other half had lived aboard ship for seven of the previous nine weeks without opportunity for any physical conditions."

Medical supplies and medical battalion personnel were landed between 1030 and 1100 on D-day--from two to three hours after the assault landings. no field hospitals or collecting stations were set up during the first twenty-four hours. Operation orders had called for evacuation via the beach of all casualties and their removal to ships as long as ships were in the vicinity. This transfer was supervised and coordinated by the Division Surgeon and the Transport Group Surgeon. Medical supplies seem to have been reloaded aboard ship at Fiji without the sanction or the knowledge of the Division Surgeon, and placed in the lower holds of the ships. This occasioned a delay in landing a good share of such supplies and in the loss of a good bit more when the transports withdrew. All supplies of E Company, 1st Medical Battalion were lost aboard the Eliot, but the company was re-outfitted without trouble by other units.

Troops and medical personnel were attempting to carry too much equipment.

Excessive salt loss through perspiration caused much discomfort and supply of salt tablets carried by medical personnel was inadequate.

Casualties suffered at Gavutu-Tanambogo were treated at aid stations and removed to ships.

By August 10th, 1942, a functioning field hospital was set up by B Company in a wooden building northeast of the airfield. Tent hospital was set u 500 yards to the east of the building and was operated by E Company. Foxholes and other protective positions were prepared and valuable medical supplies not so protected were disposed in two dumps about one mile apart. Each of these dumps or depots was again divided into small quantities and dispersed over the area, protected by canvas. Valuables such as quinine, atabrine, and the sulfonamides were placed in dugouts for safety.

Sanitation was a tremendous problem and was complicated by the fact that the retreating Japanese had left quantities of food so scattered about in the area that it was difficult or impossible to dispose of it. Fly-proof latrines were constructed at once.

Water was purified by stock chlorination solutions for the first 5 days, the water itself being taken from the Lunga River, a swift-flowing stream. On August 12th, a purification unit was set up on the banks of the Lunga. It was possible to make 12,000 gallons of potable water per day with a chlorine content of 1 to 1.5 parts per million. (Rated capacity of the unit was 6,000 gallons.)

Casualties within the perimeter from air strikes and surface craft bombardments were treated at the site. Corpsmen accompanied all small patrols, while those of over two-company strength were accompanied by a medical officer.

Prior to the attack on the perimeter by the Ichiki unit, 262 casualties were treated at the Division Hospital or by E or A Medical Companies. Two of these were evacuated by air, although regular evacuation by that means did not begin properly until September 3d, 1942. A small hospital was set up near the Ilu for the treatment of prisoners of war, who numbered at one time twenty-eight under treatment.

Transportation of wounded was taken care of by ambulance, of which six were landed during the initial period, and by Higgins boats in the cases where actions occurred away from the perimeter and close to the beaches.

A moderate amount of gastro-enteritis began to appear in the period following 20 August 1942. It caused one death, but was brought under control within three weeks, probably as a result of improvement in camp sanitation. Exact bacteriology was not determined because of lack of proper equipment for study. During the course of the illness, many men were made ineffective from its debilitating effects. Five cases of amoebic dysentery were found and evacuated at once, and two cases were reported to have been of the Flexner Strong type of bacillary dysentery.

Malaria did not appear clinically until the third week in August, although there had been cases of catarrhal fever and another fever resembling dengue. From the time of the appearance of four cases of malaria during the period 14-21 August, that disease became an increasingly grave problem. Suppressive treatment in the form of one and one-half grains of atabrine twice daily, given on two days per week, was begun on order dated 10 September 1942. The annex notes that it was impossible to get complete cooperation from either officers or men in the matter of taking this preventive course. Tablets were distributed with food, and large numbers of them were found where they had been thrown by the men to whom they were given. [IIRC, atabrine causes the skin to turn yellow; rumors abounded that caused impotence--pwc] Quinine was used as a suppressive only in the rare case where atabrine could not be tolerated by the man.

Solar radiation began to be a problem when activities of the perimeter were extended to the bare, grassy ridges of the foothills. Transportation of water (by five-gallon cans, manhandled to the troops in position on the ridges) was difficult and salt loss

through excessive perspiration was serious. (See remarks above on this same detail.) A few cases of personal intolerance to sunlight were noted, generally involving blond men with bright red hair. These intolerants were transferred to organizations where they would not be exposed unduly to direct radiation.

A method was evolved and followed for the treatment of casualties suffered during inland actions. These were treated at forward aid stations, and evacuated along the axis of communication by whatever means were at hand. This took the various forms of transportation by jeep, by ammunition carrier, by prime mover, or by hand (stretcher). As has been noted above, in those actions which took place near the beaches, ramp boats were used with great success between the scene of the actions and Kukum, whence the wounded were transported to the hospital by ambulance. Coordination was through the regimental medical officer in all cases. The collecting sections of the medical companies were not used as such, but were employed as bearers. Jeeps were sent into areas well forward of the ambulances that were used.

All wounds were treated without the use of iodine. Front line treatment consisted of the application of sulfanilimide powder to the wound and the administration of sulfathiazol by mouth in amounts of from thirty to sixty grains. A dry dressing was then applied. Exceptions to this treatment was abdominal wounds, which were treated without the use of any orally administered medicaments. Morphine and tetanus booster shots were given where indicated. Time elapsing between wounding and hospitalization rarely exceeded two hours. (Compiler's note> Hospitalization here must mean aid station treatment, for under optimal conditions the wounded could not have been returned from the upper Matanikau, for instance, to the perimeter within the time quoted herein.)

Malaria became the greatest single medical problem after the subsiding of the gastro intestinal outbreak and the occurrence of catarrhal fever and dengue. One death was reported from cerebral malaria, but in general the infection was benign tertian.

Fungus infection of the feet, the groin, and the ear assumed minor importance. The conclusion was reached that there was an insufficient supply of socks and the source quoted recommended that they have a high place on future priority lists.

A curious fact is noted with regard to me matter of intestinal infection. It will be recalled that after the first few weeks, such infection had subsided entirely on Guadalcanal. One of the battalions which had taken part in the Tulagi action arrived in Guadalcanal after the outbreak was over, entirely free from that type of infection. Two weeks after its arrival, it was suffering from approximately the same percentage of cases of the same ailment as had been noticed during the first outbreak on Guadalcanal.

Food situation at opening of the operation was very bad. "Captured enemy supplies were the difference between a starvation diet and one well above that point in calorie value during the early phases." Food approaching the state where it normally would have been condemned was eaten without apparent ill effects. "At no time was there any evidence of disability caused by food during the entire operation."

During the period 18 September--9 December, the disease incidence rose sharply. "Medical diseases, particularly in the form of malaria, reached alarming proportions in the latter part of this phase." The Medical Annex contains a table of admissions of First Division personnel only, excluding admissions from Second Division units and from Aviation and Army organizations. The

figures, even though they are incomplete, in a sense, give a valuable picture.

Psycho-neurosis and the various war neuroses have attained such wide spread publicity of late months that the entire remarks of the Medical Annex may be of interest.

The psychoneuroses and war neuroses were evacuated at once if severe. The relative small number of these, when compared to other groups, is an indication of excellent mental stability among the officers and men of the First Marine Division. Two groups of this type of case were treated on the island by a few days rest in the sick bay area until the acute symptoms had subsided and then they were transferred to the Quartermaster and used as a labor unit. A very few severe cases from among these groups were evacuated. It is the feeling of the medical officers who were in charge of these groups that the results were excellent. Approximately seventy-five men were so treated and made available for useful and necessary labor, which in turn released an equal number of men for front line combat duty.

Malaria, benign and malignant tertian, was the greatest single medical problem and continued to be so for both the 1st and 2d Division for some months after these units had left the island. The 2d Division, in fact, suffered more heavily after leaving than it did on the island, for its stay was very little longer than the incubation period. (An exception must be made in the case of the 2d and the 8th Marines. These suffered under the same conditions as did the 1st Division units.)

Only three deaths from malaria occurred on the island. Many cases had to be evacuated, but most of the men who turned in wee returned to duty. The Annex sets forth the theory that the introduction of large numbers of natives as laborers into the perimeter may have contributed to the high rate of infection. (See Appendix on Native Help, a part of this monograph.) Surgeons of the 2d Division later ascribed the high rate of incidence in that organization to the fact that the advance was over ground that had long been held by highly infected enemy personnel.

The 1st Division moved from Guadalcanal to Australia, where it came under the aegis of the Commander Southwest Pacific. Camp areas had been assigned the division in the neighborhood of Brisbane, the conditions of which impelled General Vandegrift to write as follows:

After two weeks of camp--particularly with the rains coming down and the weather getting hotter--the mosquitoes came in droves. They are really so bad it is almost unbearable in the camp area. In addition to the pesty mosquitoes, a large number of them are the malaria bearing kind. This was a surprise to us and I really believe a surprise to the Army. . . . Fortunately for us, the Director of Public Health Services for the state of Queensland had written a letter to the Base Commander drawing attention to the fact that there were a tremendous number of malaria carrying mosquitoes present, and to have large numbers of men from malaria countries would be a menace to the civilian population. . . . Our hospitalization for malaria increased 249 in twenty-four hours. We now have over 500 in the hospital here with malaria. . . . (Letter, A.A. Vandegrift to General Holcomb, 26 December 1942.)

As a result of the protest implied in the General's letter, the division was finally based near Melbourne, far to the south and outside the anopheles belt.

The story of evacuation of casualties from Guadalcanal is an interesting one. "Occasionally the transfer of patients from hospital to plane was done while the airfield was actually under artillery fire." Up to 1 December 1942 a total of "2879 patients were evacuated by air without any additional casualties." This evacuation reached its peak in November, when 1582 patents were sent out. In one seven day period 485 patients left the island by plane.

Here follows a tabulation of such evacuations by month:

The planes used in these operations were transport planes that could accommodate eighteen stretcher or 36 sitting or ambulant cases. The method was preferable to transportation by sea because of the smaller amount of handling necessary for stretcher cases, and because of the more speedy arrival of the patients at rear area hospitals.

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