areas of China, this disease was always present-notably the Fukien Province. Supplies emanating from infected areas were rigidly restricted. While cholera was continuously present among the native population, regular immunizations afforded adequate protection for U. S. troops. Only four cases were reported, all occurring in small detachments situated at remote outposts. An excellent Chinese laboratory at Kunming provided vaccines not only for cholera, but for smallpox and typhoid-paratyphoid as well.

The single case of typhoid reported was that of a pilot on the 11th day after his arrival from India. Three cases of paratyphoid fever occurred at distant posts where maintenance of effective sanitation was difficult. Relapsing fever, contracted from head and body lice, affected nine individuals, six of whom had made a jungle trek after bailing out. DDT powder, provided with jungle kits, was an effective deterrent. A considerable number of asthma cases were reported among individuals not previously manifesting an allergy. At the end of the war, the problem was still under study. Mental and emotional disturbances were relatively of only minor importance. Of the 32 cases so diagnosed, 25 were returned to the United States for treatment. An effective preventive program kept personnel active at all times and dispatched those manifesting war-weary symptoms to the United States for immediate rest and care.

Two general classes of disorders affected the flying efficiency of personnel in the Fourteenth Air Force. There were, of course, those ailments resulting directly from flying; the other group consisted of ailments not caused by flying but which had a direct bearing upon flying efficiency. Of the particular disorders associated with flying, five were of some significance. The most widespread was aero-otitis, with flying fatigue second in importance. The other three were anxiety state, air sickness, and psychoneurosis. The average fighter pilot in the theater flew 70 to 100 combat missions in a year's time before showing signs of war fatigue. Among older pilots (27-35 years) less tension was observed. Tensions definitely increased during low-altitude strafing missions. Personnel who displayed the first signs of war weariness were sent to a rest camp or to India on a ferrying trip; if sufficiently serious, they were returned to the United States. Considering the scale and tempo of activities in China and the number of missions flown, a remarkably small number of men were afflicted with this condition. In one particular case, a pilot flew 187 hours in a single month and showed no signs of flying fatigue.

Heading the group of nonflying disorders adversely affecting flying efficiency were the common respiratory diseases. Two factors accounted for their high incidence. In the first place, flying personnel, always in motion, were

exposed to the elements of varying geographic areas. Thus, a pilot leaving the cool mountains of western China in August, could, within two hours, be exposed to the shattering heat of eastern China. The second factor was exposure to dust, thick in dry seasons, which was always laden with bacteria. The latter condition was responsible, as well, for the ailments second in incidence among the nonflying disorders-diarrhea and dysentery. Other ailments in this category, in order of incidence, were: fever (undetermined origin), malaria, injuries (nonaircraft), and syphilis.

Oxygen problems in the early days of the Fourteenth Air Force were chiefly those of supply. Frequently, the oxygen available was not enough to complete a particular combat mission. The problem of availability loomed large in connection with the long-range missions of F-5 photo-reconnaissance aircraft, which averaged 6 hours flying time at an average elevation of 27,000 feet. As the range of these flights increased, when it became necessary to reach distant targets in Japan, Manchuria, and the Philippines, the quantity of oxygen had to cover both flying time and emergency conditions. The increase in oxygen use was accompanied by a shift from the A-14 type mask to the A-13 pressure demand mask which permitted ascent above the heretofore critical altitude of 40,000 feet. Subsequent experience of pilots, however, indicated a preference for the A-14, inasmuch as the A-13 fitted too tightly and obstructed vision by protruding more from the face.

Among fighter units in China, the utilization of the demand system via the A-10 mask did not prove satisfactory. The chief reasons were the insufficient training of squadron oxygen officers in the use of demand-type equipment and the fact that the masks did not fit tightly. In one encounter, in which 8 P-40's and 1 P-38 engaged from 40 to 50 Zeros and 18 bombers at about 20,000 feet, two of the P-40's equipped with the demand system were compelled by oxygen failure to discontinue fighting. Conversion to the direct system was immediately ordered. In another instance, the 7th Bombardment Group reported oxygen leakage resulting from the effects of machine gun vibrations upon A-3 blinker flow-indicator diaphragms. This effect was especially noticeable in the flow indicators for waist gunners. Strong recommendations were submitted for the improvement of these conditions.

In the China Theater, proper flying clothing was never the problem it became in several other theaters. The clothing available was adequate for bombardment missions, generally carried out at medium altitudes, and sufficiently warm for the high-altitude reconnaissance aircraft, which utilized cockpit heating. What was a point of frequent complaint by pilots was the "severe discómfort" experienced by sitting in one position during long flights. A parachute seat

cushion fitting the contours of the body was devised by a flight surgeon and was apparently effective in reducing discomfort. In one liaison squadron, the plywood safety belt attachment was modified by using an "iron-bar to replace the two bolts" in order to prevent the belt from being torn away.

The poor transportation facilities of the China Theater made it difficult to obtain the desirable rations for flights. Most crews seemed to prefer a cold, dry ration, supplemented if possible by canned meats, canned fruit juices, and fresh bread. It was the experience of flight surgeons that bomber crews found the allotted "C" or "K" rations largely unpalatable and rarely consumed enough of them to sustain them on long flights. For fighter aircraft, the "D" ration had been standardized and was issued normally one bar per pilot for each flight. Although it was easy enough to distribute food during flight, hot meals were rarely prepared aboard aircraft because of the difficulty of preparation, an especial hazard stemming from the great load such preparation imposed upon the plane's electrical system, particularly craft equipped with radar. The only beverage carried was water, in individual canteens or thermos jugs.

During the first year of the activation of the Fourteenth Air Force, the larger proportion of injuries resulted from combat. Thus, between March 1943 and May 1944, 52.6 percent of injuries were of combat origin and 47.4 percent, noncombat. This picture changed sharply after May 1944. Between that date and September 1944, the combat injuries totaled only 32 percent, the larger balance being noncombat sustained. From October 1944 up to June 1945, combat injuries remained the smaller group, although they rose to 40 percent. The decrease in combat injuries from their larger proportion at the beginning reflected an increase in the availability of base medical facilities and the speedier attention given those wounded in combat. These figures are the more impressive in view of the stepped-up pace of military activities during the latter period. The following data reflect the relative percentage of combat and noncombat injuries as well as days lost in hospitals between March 1943 and June 1945:

TABLE 93-Percentage of Combat and Noncombat Injuries-March 1943–

June 1945

The most important single causative factor in combat injuries was bailing out from burning or disabled aircraft. The parts of the body most frequently affected (76 percent of cases) were the lower extremities (mostly sprains of the ankles and knees, lacerations, and fractures), no doubt because of the cross winds and the treacherous terrain which caused the pilots to strike the ground off balance. The bulk of accidents, particularly fractures of the fibula, occurred in P-40's and in 33 percent of cases injuries were incurred when pilots struck the tail of the ship while bailing out. Improperly fitting harness (chiefly the horizontal chest strap and map) accounted for a considerable percentage of bail-out accidents.

The largest proportion of noncombat injuries stemmed from a variety of causes difficult to classify, and were thus generally referred to as "miscellaneous factors." These included such mishaps as falling into holes and slit trenches during the night, sunburn, and such unpredictable occurrences as “fractured bones in falling from top of bunks," "severe laceration of the palm of right hand caused by bottle shattering in the hand," and "skull fracture, simple, 60 days lost in hospital, resulting from patient slipping on wet latrine floor and striking head on the urinal.”

Among classifiable noncombat causes of injuries, motor-vehicle accidents ranked as the highest single factor. Most of such accidents were undoubtedly the result of the poor roads in China. Most of the injuries in the group were serious fractures or sprains; fractures were generally of the hand and forearm, sprains mostly in the lumbar-sacral area. Other important noncombat causative factors were recreation, accidental gunshot wounds, and aircraft accidents. Although most "recreation" accidents were minor sprains, their frequency certainly was noteworthy. Gunshot and fragment wounds were of two types generally: lacerated wounds from explosive shells and penetrating wounds from small caliber bullets, both types confined largely to the extremities. Accidents resulting from "working around planes" were mostly the result of jumping from the wing of a plane to the ground. A ground safety program was instituted to lessen the last-named type of injury.

For the period, 10 March 1943 to 10 March 1945, causative factors in order of frequency were:

2

3 Gordon S. Seagrave, Burma Surgeon (New York, 1943). Dr. Seagrave who had gone as a missionary became staff surgeon to General "Vinegar" Joe Stilwell, following him by foot and caring for the sick and wounded as best he could upon the occasion of the retreat from Burma. He also had served the sick and wounded of the China Volunteer Group organized by retired Col. Claire Chennault.

3

See 201 files, Correspondence files, and History, Tenth and Fourteenth Air Forces.

* Ltr., Major Robert C. Page (MC) for TAS, 20 Dec 43.

Ibid., p. 264.

Ibid., p. 265. Col. Flickinger had won the Distinguished Flying Cross for his actions at Pearl Harbor and the Philippines.

10 Ibid., p. 265.

11 Ltr., Dr. Ormand C. Julian to Col. Don Flickinger for record, 14 May 1954

12 This section incorporates the Manuscript History prepared by Maj. Morris Kaplan (MC) and Unit Histories of 803d MAES.

13

W. F. Craven and J. L. Cate, The Army Air Forces in World War II, (Chicago 1953) Vol IV, page 495. "Report of Major Robert C. Page, Surgeon for "Project 9”. Unless otherwise specified this section is based upon the book-length manuscript prepared by Major Page including observations and conclusions. Referred to hereafter as Page Report.

15 See n. 3.

16

Captain Taylor reported: "It was my privilege to accompany Col. Cochran and Capt. Taylor on the first double tow glider. This glider also carried radio equipment. I left the scene of the maneuvers in one of the early "snatches", which happened to be General Wingate's first glider ride. Upon entering the glider he looked around for a moment, sat down, put on his safety belt and with the appearance of one oblivious to his surroundings began to read Dark Harbour."

18 It was assumed that it would not be necessary to evacuate more than 48 people during the first night, and that during the second night an unlimited number of litter patients could be evacuated in C-47's which were to make at that time a hundred sorties.

20 Ibid, pp. 73-74.

21 Ibid, p. 74.

"Ibid., p. 76. Approximately 4 American and 27 British and Ghurkas had been killed, and wounded of whom 15 were evacuated. No deaths or injuries were due to enemy action.

23 Page Report, p. 82.

40

25

Page Report, p. 67. 2. See also "Saucy L-1's in Action Behind Nip Lines," in CBI Roundup,