U.S. Navy Medical Department Battle Experiences at Iwo Jima

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Medical planning for the Iwo Jima campaign began in October 1944. In preparation for the operation, Medical Department representatives of the Navy, Marine Corps, and amphibious units that were to participate, held numerous conferences to discuss the tactical and logistic problems. The nature of the terrain on Iwo Jima was such that there could be no tactical surprise; the Marines had to land on the southeastern beaches, and make a frontal assault. Under the circumstances, heavy casualties were anticipated. For purposes of computing anticipated casualties, it was assumed that the period of active combat, from the beachhead landings to seizure of the objective, would be 14 days; that 5 percent of the entire attacking force would become casualties on the first and second days, 3 percent on the third and fourth days, and 1.5 percent on each of the remaining 10 days.

Casualty estimates, arrangements for hospital beds, and assignment of hospital and other ships for the evacuation of the injured from combat area were responsibilities of the Medical Logistic Section of CinC Pac POA.

On the basis of the Army Field Medical Manual, as modified by recent experience and the most reliable evaluation of enemy potential to be gained by aerial observation and combined intelligence, it was estimated that our losses would approximate 20 percent of the forces engaged. Of these 25 percent would be killed in action, 25 percent would be returned to duty locally, and 50 percent would be evacuated. Taking into consideration civilian casualties and enemy wounded to whom we were likely to be required to furnish medical care, definite plans were formulated with regard to evacuation policy, the number of beds and ships required for hospitalization and evacuation, and the volume of medical supplies to be ordered.

Each medical company and corps medical battalion had equipment for a 144-bed hospital, twice the number allotted prior to the Marianas campaign, making available approximately 3,592 beds. It was also planned by the Eighth Field Depot, scheduled to arrive about D-day-plus-10, to add to their stock a sufficient amount of cots, tents, blankets, and mess gear for another 1,500 beds.

The chain of evacuation of casualties included 4 LST(H)'s or evacuation control LST's, specially equipped with medical personnel and supplies and designated to make preliminary "screening" examinations of casualties and distribute them equally among the transports and hospital ships. One LST(H) was available for each of the invasion beaches, making two for each Marine division. All ships, LVT or DUKW, that evacuated wounded from beaches were to proceed to their respective evacuation control LST(H). Those casualties unable to endure the trip to a transport or hospital ship were to be transferred immediately to an LST(H) for treatment, while less seriously wounded patients were unloaded onto a barge alongside the LST(H) and then transferred to LCVP's for further transfer to transport or hospital ship.

Aboard each LST(H) were 4 surgeons and 27 corpsmen, increased on arrival at the objective by the transfer of one beach party medical section (1 medical officer and 8 corpsmen)

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from an APA, giving each LST(H) 5 surgeons and 35 corpsmen. At all times these beach party medical sections were on call by the Transport Squadron Commander.

Two hospital ships and one APH were designated to evacuate patients to Saipan, where 1,500 beds were available, and to Guam, where there were 3,500 beds. Air evacuation of casualties to the Marianas was to begin as soon as field facilities would permit. Experience gained in the Marianas campaign had emphasized the necessity of having the casualties screened by a qualified flight surgeon to insure proper selection of patients for evacuation by air. Medical personnel and adequate medical supplies and equipment were to be aboard each plane.

Sanitation

Because there was a possibility of epidemic typhus, scrub typhus, cholera, and plague at the objective, all personnel were inoculated against these diseases, in addition to the usual immunizations. The clothing of personnel of the landing force was impregnated with dimethylphthalate and DDT powder. As a means of controlling flies, which had been such a nuisance and a hazard to health in previous operations, the area was sprayed with DDT by carrier-borne aircraft and later, by land-based planes. A medical officer familiar with the procedure was detailed aboard a carrier as technical advisor, and the malaria and epidemic control team of the Fourth Marine Division was designated to furnish the technical ground supervision.

Supplies

The medical supply plan for the operation included an initial 30-day allowance carried with the assault forces, plus medical and sanitary supplies for 1,500 civilians, as well as the provision for "block" shipments which were to arrive at regular intervals. Approximately 50 percent of the supplies of the assault forces and all of the "block" shipments were to be palletized (packaged) and waterproofed. Plans also provided for adequate emergency resupply that could be sent by air if necessary.

Experience gained in previous operations had shown the great need for a blood bank. With the establishment of Whole Blood Distribution Center No. 1 at Guam, it became feasible for the first time to set up a blood center at the target area and plans were made accordingly. Up to this time whole blood had been obtained from hospital corpsmen, Marines, and occasionally from patients. LST(H) 929 was designated to carry the whole blood bank for distribution to the forces both afloat and ashore. When the military situation permitted, the blood bank was to be landed and

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established ashore. All ships were ordered to receive whole blood in the quantities shown: Each APA, 16 flasks; LSV Ozark, 500 flasks; LST(H) 929, 1,100 flasks (whole blood bank); each AH, 812 flasks; and LST(H)'s 930, 921, and 1033, 16 flasks.

Additional whole blood was to be furnished by incoming AH's, or was to be flown in from Guam when air facilities were organized.

Embarkation

Prior to the operation, medical battalions were instructed to carry an additional 1,500 blankets, 5 million units of gas gangrene antitoxin, and 50 million units of penicillin. An inspection was made of the jungle kits and identification tags of each man in the division of all Medical Department supplies and equipment. All shortages were corrected. Medical personnel were given additional instructions in first aid, in the keeping of medical records, in the automatic exchange of litters, and in the handling of casualties in and out of boats. At the close of the training period, a practice landing was made to give the medical personnel an idea of what to expect when landing on the target.

A serious problem was the fact that surgeons who were to be called upon to perform operations during the battle had had little opportunity to perform any surgery during the 6-month period prior to the campaign. To correct this situation, a division hospital was operated during the preparatory period.

The medical personnel were embarked with the regimental combat team, as designated by the unit medical officers. When practicable, hospital sections of the medical companies were embarked on ships with the largest bed capacity in order to facilitate the care of casualties during the initial stages of the battle. Basic vehicles were combat-loaded with essential items of equipment and supplies to supplement those designated as "hand carry." Seabags were packed with battle dressings, plasma, serum albumin, and other items essential during the early stages of the assault. These were to be carried ashore by the assault medical company. Two and one-half ton 6 by 6 trucks, for the first time part of the medical

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battalion, were combat-loaded with equipment and supplies necessary to establish surgical units ashore.

Ensign Jane Kendleigh, Nurse Corps, USNR: First Navy nurse to reach Iwo Jima, ministers to serious casualties awaiting evacuation on the air strip, March 1945. Naval History & Heritage Command Photographic Section #NH 95014.Landing of medical units

The Fourth and Fifth Marine Divisions, supported by the Fifth Fleet, began landing on the southeast shore of Iwo Jima at 0900, 19 February 1945. The Third Marine Division, which had been held in reserve, was landed on D-day-plus-2. Company aid men were debarked with platoons, battalion aid station personnel with battalion command posts, and regimental aid station personnel with the regimental command posts. Shore party medical personnel in support of battalion landing teams were debarked prior to H-hour. Four medical shore party evacuation teams were landed between H-plus-30 and H-plus-120 minutes (0930 to 1100). Other division and corps medical units were landed as rapidly as the military situation would permit. In the early phase of the assault, aid-station personnel were separated into small groups and worked in shell craters or foxholes in the sand.

The grueling experience of all battalion corpsmen and medical officers was typified by the following account:

"Landing with the troops, immediately following the assault group, the chief pharmacist's mate was shot in the jaw as he stepped out of the landing boat. The medical party, carrying seabags filled with medical supplies, pushed inland some 75 yards and picked a spot for their station in an antitank ditch. They left some of the bags on the beach on that first trip, and when they returned to get them, many of the bags had already been ripped by shell bursts. Boxes of valuable plasma were smashed, but the worst blow came when the boat carrying all the litters was sunk on the way in.

Wounded men were lying all around. It was impossible to stand erect on the beach, and the corpsmen crawled from casualty to casualty to bandage wounds and administer morphine and plasma. Within an hour after the aid station had been set up, a shell exploded on one side and fragments injured several of the men. The medical officer, realizing that the revetment, though appearing to offer good protection for an aid station, was a logical target for Jap guns, ordered the men to pack up equipment, and to move to a large bomb crater, where the medical personnel continued their work."

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In the fury of the battle there were many dramatic instances of rescue and treatment. A Marine who had been blinded and had both hands blown off, was groping his way toward the beach when a corpsman saw him and ran a gauntlet of fire to get him to safety. A corpsman in battle for the first time sewed up four chest wounds under fire and undoubtedly helped save the lives of the four injured men. A corpsman crawled to the aid of Captain Dwayne E. "Bobo" Mears, who had been shot through the neck and was in shock from the loss of blood. He buried the lower part of the Captain's body in the sand so that he would offer a smaller target for the Jap riflemen. It helped, but the captain died later aboard a hospital ship.

Care and evacuation of casualties

The care and evacuation of casualties during the Iwo Jima campaign was handled better than in any previous operation in the Central Pacific area. Notwithstanding the extreme bitterness of the combat and a casualty rate in excess of 1,000 per day during the first 21 days, evacuation functioned as a well-integrated and coordinated operation and the wounded received the best medical care commensurate with the military situation. By

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D-day-plus-33, a total of 17,677 casualties had been treated and evacuated.

Casualties were assisted in walking down from the firing line, or were brought by hand-carry, jeep, ambulance, half-track, or weapon carrier. Because of the rugged terrain, hand-carry frequently had to be employed to move the wounded to the beachhead over the rough lava cliffs and sharp-edged blocks of stone and lava. While the beachhead was being secured, casualties were evacuated from battalion aid stations directly to the beach, where they were turned over to shore and beach party installations set up in shell holes or in small pits dug in the volcanic sand. Plasma and other first-aid measures were administered while bullets sang overhead and mortar shells burst in close proximity.

After the troops were well established on the beach, the distance from the battalion and regimental aid stations to the beach was so short that casualties were evacuated by sea. When division and corps hospital installations were established on D-day-plus-9, evacuation was from battalion and regimental aid stations to the division hospital and from there to the beach or to the corps hospitals. Casualties were so high and space to set up hospitals was so limited that many of the hospital sections of the medical companies supporting the regimental combat teams that were landed early, remained on the beach to assist in the shore party evacuation stations until division and corps hospital installations were functioning. Initial treatment of casualties in regimental and battalion aid stations was so efficient that many casualties who would otherwise have died reached the shore evacuation stations and corps hospitals in excellent condition. Serum albumin was exceptionally well suited for use by frontline medical units, because of the ease of administration, small bulk, and the excellent

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clinical response. Its therapeutic effect was equal to that of plasma.

Casualties in Hospital Corps personnel were very high. In moving about to care for the wounded, corpsmen were subject to intense enemy fire and frequently were shot down alongside their patients. Although each division was assigned approximately 5 percent more corpsmen than were provided for by Tables of Organization, this was often insufficient. In the Fourth Marine Division the casualty rate among corpsmen was 38 percent. Often, because of urgent need for replacements, personnel were obtained from medical companies. In one division this policy was carried to such an extreme that on D-day-plus-8 one medical company had been reduced to a point where it was almost inoperative. This practice was contrary to established doctrine and in some instances left insufficient personnel in other areas to render proper care to the wounded.

Close liaison between the attack force surgeon and the landing force surgeon resulted in

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a well-coordinated chain of evacuation from shore to ship. On D-day, 19 February 1945, 30 APA's, 12 AKA's, LSV Ozark, and 4 LST(H)'s were available for the evacuation of casualties. The general plan for sea evacuation provided that an LST(H) be stationed 500 to 2,000 yards off each of the 4 beaches and that all casualties be evacuated to one of these ships.

During the early phase of the assault, prior to the establishment of fully functioning shore evacuation stations, the primary duty of LST(H)'s, was to render emergency treatment and receive casualties at night. In previous operations, casualties had been known to ride all night in open boats before finding a ship to receive them. After shore evacuation stations were established, the main purpose of the LST(H) was to effect an equitable distribution of casualties to APA's and AH's.

The work performed by LST(H)'s can be appreciated by the following: LST(H) 931 was stationed approximately 400 yards offshore. A pontoon barge was tied alongside for receiving casualties. A Jacob's ladder led from the barge to the main deck of the LST. On the barge was a small covered area that served as a supply shack. A number of litter bearers, two medical officers, and a talker to communicate with the control tower of the ship were stationed on the barge. LCVP's, LCM's, and Amtracs bearing casualties, temporarily tied up alongside the barge while the medical officer on duty went aboard to examine the wounded. Casualties requiring immediate attention were taken aboard the barge, where emergency treatment was carried out. To load patients in need of immediate surgery aboard the LST(H) a metal frame accommodating 3 stretchers was lowered to the barge by a tractor crane mounted on the main deck, just aft of the cargo hatch. The patients were then brought up and lowered directly into the tank well through the cargo hatch, which was always open and was outlined by luminous painted lines to prevent accidents during blackouts.

About 220 patients could be cared for on the tank deck and another 150 to 175 in the troop quarters. Patients requiring an operation were moved from the tank deck through the open hatch forward to the operating room. The normal complement of an LST(H) was 4 medical officers and 26 corpsmen, but often this was insufficient. The use of LST(H)'s as evacuation control ships although representing an important step forward in the chain of evacuation, left much to be desired. Used for the transportation of LVT's to the target, they were converted for casualty handling only after these had been discharged and as a result, were often covered with dirt and grease when turned over to the medical department. The illumination on the tank deck was usually very poor and the medical facilities were unsatisfactory. The number of medical personnel assigned was insufficient to care for the large number of casualties, even when the staff worked day and night. On D-day, between 0900 and 1530, a total of 2,230 casualties were evacuated by LST(H)--an average of slightly less than 6 casualties per minute.

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The organization of LST(H) casualty evacuation control ships was as follows:

EVACUATION CONTROL LST'S FUNCTION

1. The primary functions of these ships are: (a) To control evacuation of casualties to available ships, maintaining adequate distribution for proper early treatment of casualties. (b) To act as a transfer station for transfer of casualties from LVT's and DUKW's to LCVP's where reefs intervene between ships and beach, in order to release LVT's and DUKW's for military operations. (c) For emergency evacuation from beaches when other ships are not available. (d) To expedite speedy resupply of strategic medical supplies to beaches and landing force. (e) To maintain an accurate record of evacuation, for Force and Corps Commands. (f) To render shock therapy to those casualties whose condition is so critical as to prevent further progress in the chain of evacuation.

ORGANIZATION

2. Each squadron of transports carrying assault troops will be provided with two evacuation control LST's. These ships are stationed 1,200 yards ahead of LST formation and 300 yards seaward of the TransDiv Control vessel centered off the colored beach it is serving and directly ahead of the transport division to which it evacuates. Each evacuation control ship

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is provided with a 3 by 12 pontoon barge alongside as a casualty transfer platform and unloading station for those casualties to be retained aboard the LST for treatment until their condition warrants transfer.

3. The TransDiv Commander will keep each evacuation control LST, serving his beaches, informed of ships available for casualty reception, notifying them 1 hour in advance of those ships departing from transport area, insofar as practicable.

4. Two LCVP's equipped as ambulance boats will be sent from each assault TransDiv to its casualty evacuation control LST as soon as assault troops are landed. These boats together with the two LCVP's on each evacuation control LST will serve as ambulance boats. Ambulance boats will fly a VICTOR flag at all times. One ambulance boat shall be sent to each beach area after assault troops have landed to stand by to land and receive casualties when directed by the Beachmaster. Litter and splint exchange should be made at each ship to which casualties are evacuated. All other resupply items for these boats will be made at the evacuation control ship except on request of Evacuation Control Officer.

These boats shall be equipped with the following prior to leaving the mother ship:

Tarpaulin   1
Life jackets   17
Water canteens   6
Struts for litter loading   ---
Hospital corpsman with first-aid kit   ---
Bandages, 3-inch   36
Bandages, 2-inch   36
Plasma, units   10
Morphine syrettes   20
Cotton rolls   6
Sulfadiazine, bottles   2
Flashlight   1
Litter units   10
Tongue blades, box   1
Scratch pad and pencil   1

5. The evacuation control LST duty officer will keep an up-to-date record of location of all ships assigned him for casualty reception. He will direct coxswains of ambulance boats to ships assigned by the Evacuation Control Officer. He will also direct coxswains of ambulance boats to exact location on the beach to deliver medical supplies and receive casualties as shown by beach markers (VICTOR flag).

6. Each evacuation control LST is recognizable by a large white "H" painted amidships on both sides. They are located 300 yards directly seaward of their corresponding TransDiv control vessels. They fly an oversize VICTOR flag and display a GREEN light at night. They have pontoon barges alongside and stand out 1,200 yards ahead of the LST formation.

7. Four surgeons and twenty-seven corpsmen are attached to each evacuation control LST. The senior surgeon is designated as the Evacuation Control Officer and is responsible for proper distribution of casualties to available ships assigned by the TransDiv commander. Two-section 4-hour watches will be maintained, beginning at 0800 on D-day, until ships are relieved by orders from Attack Force Commander, relieving at 0800, 1200, 1600, 2000, 2400, and 0400. The appended watch bill will serve as a guide giving titles, number of personnel, and times of watches.

8. Evacuation Control LST's shall make a dispatch report to Squadron Commander and Attack Force Commander at 0900 and 1700 daily, giving a report of casualties on board at that time, using the following form:

(Example: Bed 65 X NE 20 Total 150 X Dead 7 X 0900)

9. Copies of Form A (copy appended) giving date, name, rate, serial number, and disposition of each casualty evacuated will be sent to Landing Force Commander (Corps Hdqts.).

The casualty evacuation officer on the casualty evacuation control LST(H) endeavored to distribute the casualties among the different ships so that no one transport would be overburdened at any time. Unfortunately, this did not always work out. Sometimes the coxswain failed to heed the directions given him or misunderstood them, and sometimes when he arrived at a designated location the ships were not there. Some casualties spent as many as 8 hours in small craft before being taken aboard a ship.

The APA, although not designed for casualty handling, or properly equipped for this purpose, often bore the brunt of the initial casualty load from the beach assault. In the Iwo Jima operation, they received 4,956 wounded by 1745 of D-day-plus-2. The experience of APA 118 was typical of the transports in casualty evacuation. APA 118 dropped anchor about 20,000 yards offshore on D-day and unloaded its troops on schedule. It then moved in to about 4,000 yards from shore and began discharging cargo and supplies. At 1400 on D-Day casualties were received aboard, the majority of whom were severely injured and required emergency treatment. During the next few days, casualties were loaded aboard the ship in groups of from 3 to 75. Throughout much of this period, the medical staff worked day and night operating on and caring for the wounded. As a general rule the ship withdrew out to sea at night, but on two occasions she

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anchored about a thousand yards offshore and obtained protection by a smoke screen.

The large number of wounded at Iwo Jima emphasized the need for hospital ships, two of which were originally USS Hansford (APA-106): Burial at sea of a Marine who died on board of wounds received on Iwo Jima. Photo was taken on 25-28 February 1945, while Hansford was evacuating Iwo Jima casualties to Saipan. Naval History & Heritage Command Photographic Section #80-G-K-15862. scheduled for the operation. Commencing on D-day-plus-1, these ships, the Samaritan (AH 10) and the Solace (AH 5), augmented by the Pinkney (APH 2), and Bountiful (AH 9), and the reserve hospital ship, Ozark (LSV 2), inaugurated a series of shuttle trips from Iwo Jima to Saipan and Guam. By 21 March (D-day-plus-30) a total of 4,879 casualties had been evacuated on these ships.

The only function of the hospital ships was the transportation and care of the sick and wounded, and if some of them could have remained in the area during the early phases of the operation to care for the slightly wounded, many casualties could have been returned to duty in a few days. The loss of manpower occasioned by their departure aboard hospital ships and transports to Saipan or Guam, would have been obviated.

Some hospital ships lacked proper equipment for taking patients aboard. These ships received many boatloads of injured men from LCVP's, but some had no Welin davits with which to lift the boats to the ship's deck level, and the transfer of patients had to be made over the ship's gangway. This slowed the rate of transfer of patients and as a result, boats loaded with wounded gathered off the gangways of the hospital ships and were obliged to stand for hours in the hot sun with their patients unprotected.

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Air evacuation from Iwo Jima to the Marianas, which supplemented evacuation by hospital ships and transports, was initiated on D-day-plus-12 and was originally planned for 350 patients per week. The very high casualty rate, however, together with the shortage of ships for transporting casualties, necessitated revision and as many as 200 a day were evacuated by air. There were times when, because of unfavorable sea conditions or lack of facilities afloat, air evacuation was the only means of getting casualties off the island. With the first casualty evacuation planes, there was an air evacuation unit, consisting of two flight surgeons and several hospital corpsmen who screened all casualties to be evacuated by air. By 21 March (D-day-plus-30), a total of 2,393 patients had been evacuated by air. The casualty evacuation planes also brought in whole blood from Guam.

The weakness of a fixed policy for evacuation was again demonstrated at Iwo Jima where a "15-day evacuation" policy had been established. In the early stages of the invasion, there was no place to segregate casualties who would be ready for duty in 15 days or less, and when hundreds of casualties were being evacuated over beaches that were under heavy enemy fire and clogged with vehicles and equipment of all kinds, sorting was not feasible. Time, space, and the combat situation did not permit convalescent camps to be established and such beds as were available ashore were needed for those seriously wounded.

There were a number of ways in which the effectiveness of the chain of evacuation might have been improved. The communication system could have been more efficient during the first days. Casualty evacuation officers aboard the LST(H) often did not receive reports as to which transports were available for loading casualties, with the result that some ships received more than their share while others received very few. Ambulance craft experienced great difficulty in finding the proper vessels. In many cases, the APA stood well offshore,

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and during rainy, rough, or foggy weather they were difficult to contact. It sometimes occurred that by the time the ambulance craft had reached the approximate station where the transport was supposed to be anchored the ship had already moved.

Despite difficulties such as these, the chain of evacuation operated more smoothly than in any previous action in the Central Pacific. The use of LST(H)'s as casualty evacuation ships represented a most important factor in medical care and unquestionably saved many lives.

Hospitalization

US Naval Hospital, San Diego, California: "WAVE" Pharmacist's Mate Third Class Winifred Perosky X-Rays Marine Private First Class Harold E. Reyher, circa Spring 1945. He had been wounded by a sniper on Iwo Jima. Naval History & Heritage Command Photographic Section #80-G-K-5460.
NEWS from your NAVY
From
Eleventh Naval District
Public Relations Office
(San Diego)

SERIAL SD (a)-3320 45

FOR IMMEDIATE PUBLICATION
5460
WAVE Winifred Persoky, Pharmacist's Mate Third Class, of Stamford Conn., on X-Ray duty at the US Naval Hospital in San Diego, Calif., administers to a Marine who was wounded overseas.
Struck by a Jap[anese] sniper's bullet on Iwo Jima, he is Pfc. Harold E. Reyher, 22, USMCR, oh Holyoke, Colo.
Pharmacist's Mate Perosky is one of 1000 WAVES assigned to the Naval Hospital in San Diego, the Navy's largest medical center.
Daughter of Mrs. Rachel Innes, of High Ridge Road, Stamford, she is married to Marine Pfc. Robert Perosky, of Springfield, Mass., who now is on duty in North Carolina. He had been wounded in action on Saipan and the couple met and were married while he was a patient at the San Diego hospital.

The establishment of hospital facilities on Iwo Jima was delayed because of limited space, difficult beach conditions which interfered with the landing of supplies and equipment, and the constant hazard of enemy artillery and sniper fire. As a result, until D-day-plus-9 nearly all hospitalization was provided by the units afloat. During the early days of the operation, effective hospitalization was provided by four LST(H)'s.

Medical Battalion, Company A, landed on D-day-plus-6, just south of Green Beach, and began to set up an operating room and hospital facilities with provision for expansion. Within 8 hours a hospital unit with 110 beds was established and began to receive casualties. During the next few days, hospital facilities were expanded.

A neurosurgeon, an ophthalmologist, and a neuropsychiatrist were included in the staff of the corps medical battalion and the services of these specialists were made available for all troops engaged in the Iwo Jima operation.

A detailed account of the activities of the Fourth Marine Division Hospital will illustrate the work of hospital units at Iwo Jima. On D-day-plus-6 the division surgeon and commanding officer of the medical battalion located a site for the Fourth Marine Division Hospital, near a good road leading to the front lines and to the evacuation beaches. The Fourth Engineer Battalion bulldozed 5 long trenches, providing space for 4 batteries of 6 storage tents each, 1 battery of 3 storage tents, and the division medical dump. On either side of the road were uncovered water reservoirs. Two of these were used as operating rooms, one as a receiving room, and the other two for Headquarters and Staff Medical Battalion and for the malaria and epidemiology control team. Many times while mortar shells were landing nearby, surgical operations were going on. The engineers had constructed an entrance ramp and erected a wooden framework over each reservoir, with a tarpaulin stretched over the framework. The hospital was receiving casualties on D-day-plus-9, and 6 operating rooms

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and 350 beds were available on D-day-plus-15. It was staffed by 3 medical companies and surgical detachments from 2 companies.

A division central medical supply room was established in the hospital area and the surgical instruments of all five medical companies were pooled, permitting simultaneous sterilization of many sets of instruments, thereby materially lessening the delay between operations.

Sanitation

Because of the porosity of the soil, sanitation presented no major problem. Sunken barrels with prefabricated tops served as heads [toilets]. The water supply was adequate, being obtained from water trailers.

No outbreaks of intestinal or communicable disease occurred and there were no epidemics. Neither the interrogation of prisoners nor the study and laboratory findings of malaria and epidemic control teams revealed evidence of malaria, dengue, filariasis, typhus fever, cholera, plague, yellow fever, smallpox, diphtheria, or venereal diseases in serious proportions.

Supplies and equipment

One of the innovations was the mobile blood bank facility. The main items of equipment were two 150-cubic-foot refrigerators, one flake ice machine, three electric generators, one 21/2-ton truck, and one 1/4-ton truck. The initial supply of whole blood was received aboard on 14 February at the Saipan staging area. Guam furnished 1,456 units, and ships departing from the area furnished an additional 406 units to the bank. Beginning on D-day, the facility furnished whole blood on request to all units ashore or afloat. At all times throughout the operation, the supply of whole blood was ample. This was undoubtedly a material factor in saving many lives.

The field medical unit was of high quality. Oxygen units were extremely valuable because of the high incidence of penetrating chest wounds. Improvised portable fracture tables were used to great advantage. Portable plywood operating rooms proved extremely useful; when water seeped into some of the medical installations at high tide, the slightly elevated deck in these huts kept them dry.

The carbine which was issued to Medical Department personnel in the field for defense purposes was not satisfactory. It was impossible to treat a patient and handle a carbine at the same time; .45-caliber pistols were better suited for this purpose.

The jeep ambulances proved to be the most valuable single piece of motor transport in the medical organization. The Army's 3/4-ton ambulance, used by the 38th Field Hospital,

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demonstrated its superiority over the Navy's 1/2-ton ambulance for casualty evacuation. The Army ambulance could go anywhere that the Navy ambulance could go and transported the casualties in much greater comfort. The Weasels were most valuable in the early stages of the operation; they were among the few vehicles able to get off the road and negotiate the soft volcanic sand. Many DUKW's were also used in the evacuation of casualties, but not enough were available in the early period of the campaign. They were capable of negotiating heavy surf without difficulty and were more manageable alongside a ship than were the amphibious tractors. For days at a time, when no small boats were able to get through the surf, nearly all casualties had to be removed by means of amphibious vehicles, for the most part DUKW's. In almost every operation undertaken in the Pacific area, the DUKW saved the day for casualty evacuation.

Medical records

Deficiencies in the handling of medical records in earlier operations led to a reorganization of this work prior to the Iwo Jima landing. A program of indoctrination for personnel handling records under combat conditions was inaugurated and the importance of making legible entries on emergency medical tags and in aid-station logs and reports was stressed. Nevertheless, reliable records could not be maintained during the first few days because the battle was so intense and loss of personnel and equipment so great that it was difficult or impossible to maintain complete records at regimental and battalion aid stations or at evacuation stations.

Dental service

At Iwo Jima, as on all combat operations, the work of dental officers and technicians was invaluable. Dental officers, in addition to carrying out their regular duties, also assisted in the sick bays and operating rooms. They administered supportive therapy, gave anesthetics and aided in identifying the dead.

Casualties

Table 21 lists casualty and evacuation figures.

On 24 March (D-day-plus-33), there had been a total of 24,244 casualties (20,950 incident to battle), including 4,893 deaths. Of these casualties, 17,677 had been evacuated. Casualties among medical personnel were very heavy;

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in one division alone, casualties of hospital corpsmen in each of 6 battalions exceeded 50 percent. In 4 battalions, casualties exceeded 60 percent, and in 1, they were in excess of 68 percent. Battle casualties for all division medical personnel exceeded 25 percent.

Table 21.--Casualties and evacuation--Iwo Jima

1. Casualties to 13 March 1945 (D-plus-22):

  KIA WIA MIA Total
Officers Enlisted Officers Enlisted Officers Enlisted Officers Enlisted
3d MarDiv 35 633 127 2,673 2 120 164 3,426
4th MarDiv 84 1,481 272 5,647 1 95 357 7,223
5th MarDiv 78 1,390 225 5,185 4 197 307 6,772
Corps Troops 1 7 10 83 0 3 11 93
Corps Artillery 0 5 0 11 0 0 0 16
Total 198 3,516 634 13,599 7 415 839 17,530
Grand total 3,714 14,233 422 18,369

2. Total battle casualties to 1800, 21 March 1945 (D-plus-30):

  Strength KIA WIA MIA Total Percent of
strength
3d MarDiv (less 3d Marines) 15,681 316 3,182 92 4,070 25.9
4th MarDiv 21,737 1,731 6,058 74 7,863 36.1
5th MarDiv 23,218 1,893 6,188 180 8,261 35.5
VAC LanForc (less 3d, 4th, 5th MarDiv) 9,491 63 324 7 394 4.1
Total 70,127 4,503 15,732 353 20,588 29.3
Percent of total casualties --- 21.9 76.4 1.7 100 ---

3. Evacuated by water to 21 March 1945 (D-plus-30):

Ship Stretcher Ambulatory Total
wounded
Dead Total
dead and
wounded
Samaritan 1st trip 400 212 612 11 623
Samaritan 2d trip 400 201 601 8 609
Samaritan 3d trip (1) (1) (1) (1) 603
Samaritan 4th trip (1) (1) (1) 5 603
Solace 1st trip 490 147 637 3 640
Solace 2d trip 400 269 669 9 678
Solace 3d trip (1) (1) (1) (1) 568
Bountiful (1) (1) (1) (1) 555
Pinkney (APH) 390 232 622 8 630
Ozark (LSV) 199 208 407 1 408
LSTs (H) 7 1 8 5 13
Transports (APA) 2,606 2,213 4,819 18 4,837
Other ships (1) (1) (1) (1) 4,240
Total 4,892 3,483 8,375 68 15,007

4. Evacuated by air to 21 March 1945 (D-plus-30): 2,393 casualties.

5. Summary of casualty evacuation to 21 March 1945 (D-plus-30):

    Hospital ships   4,879
    Other ships   10,126
    Air   2,393
    Total evacuated   17,398

    (1) No breakdown available.

    --104--

    Source: History of the Medical Department of the United States Navy in World War II. vol. 2. (Washington, DC: US Government Printing Office, 1953): 89-104 [Navmed P-5031].