April 11, 2025 • 32 mins
This episode looks at the care of the wounded on the Kokoda Track.
What level of care did sick and wounded soldiers receive?
Why was the medical planning still being conducted whilst the Battle of Isurava was in progress?
What was the issue with medical logistics and how were casualties to be casevaced from the battlefield?
We listen to the story of CAPT Stan Bissett as he describes how his brother Butch was wounded just north of Isurava and later died of his wounds.
Medical care was provided under the most difficult conditions, in the jungle, in steep terrain and during the withdrawal. Important lessons for the planning and execution for the treatment of wounded during combat.
This episode continues our Kokoda Campaign Podcast series.
Check out the show notes for the podcast for all of the information that we cover in this episode as well as the images and other details that didn't make it into the podcast.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
How were sick and injured troops cared for during the Kokoda campaign? We look at medevac and medical and surgical treatment on the Kokoda track.
Speaker 2 (00:09):
This is the Principles of War podcast, professional military education for junior officers and senior NCOs.
Speaker 1 (00:21):
Ladies and gentlemen, welcome back to episode 126 of the Principles of War podcast. Last week we started to delve into some of the issues with providing medical support during large scale combat operations. One point that came out was the difficulty in providing casualty management during the withdrawal. It can be an insidious situation. You've got casualties that need evacuating whilst receiving more casualties, sometimes mass casualties. All the while, the enemy is still advancing. And this highlights the reason why. Medical services need to be positioned far enough behind the front lines to be secure and to have the time that they need to conduct their withdrawal. That withdrawal requires significant resources. This didn't happen during the Battle of Ishirava. Today we're going to unravel some of the reasons why that occurred.
(01:12):
I think it's worth highlighting the clinical skills, the improvisational skills, the endurance and bravery of the medical staff. They are doing everything that doctors and nurses would do in a normal hospital, except they're doing it often in a mass casualty kind of environment. They're doing it in the middle of the jungle and sometimes they're doing that within range of the enemy. That is an incredibly difficult task. And yet, reading through the war diaries, you see time and time again medics putting themselves out there to ensure that they're able to look after their patients. Secondly is thinking about casualty management in future large scale combat operations that could be conducted in the jungle environment. How would that care be provided? And critically, how would the troops be medevaced out, especially if they were denied the ability to use rotary wing assets.
(02:11):
That might because of weather, terrain or enemy action, particularly the risk from air defence assets. That medevac process may look very similar to the process that was carried out on the Kokoda track. And that's quite a sobering thought. If that's the case, we really want to look at the planning considerations so that the care of the soldiers can be the best care possible, given the circumstances. Jan McLeod, in her excellent book Shadows on the Track, has got a paragraph that describes the first instance where there are troops who are wounded in combat. She writes, on the 7th of July, 129 soldiers from Bravo Company of the 39th Battalion under Captain Sam Templeton were ordered to walk from Port Moresby to Kokoda to secure the village and its airstrip.
(03:00):
That they were ordered to do so without either a dedicated medical officer or a field ambulance unit suggests supreme confidence, complete ignorance or extreme neglect. Those troops were able to get some medical support. We discussed in the last episode the exploits of Captain Geoffrey Doc Vernon. It's important to remember that he is a member of Angau, so not attached to the 39th Battalion. He had established a hospital at Ilolo to manage the care of the Papuan natives. He travelled on foot from Ilololo to Daniki to offer his services to the 39th Battalion. When heard that they were there and without medical support, he married up with the lead elements of the 39th Battalion on 29 July, reported to the CO, Lieutenant Colonel Owen, and immediately began providing medical support to the troops.
(03:53):
On 23rd July, Charlie Company of the 39th was ordered to move to Kokoda and it was accompanied by the regimental medical officer, Captain Shearer. There was also a detachment of the 14th Field Ambulance comprising Captain William McLaren and five other ranks. They were sent to Kargi, south of Templeton's Crossing, to set up a medical dressing station. This was the only medical support that the battalion would have until the 8th of September, when they were relieved by the 2 6th field ambulance. This situation, which is certainly not ideal, has come about because of a confluence of circumstances. Firstly, and as always, we see the speed with which the Japanese are moving. They're well and truly within the Australians Ooda loop and they're landing unexpectedly and heading towards Kokoda.
(04:42):
Secondly, we've got the commander of New Guinea Force, Major General Basil Morris, probably failing his appreciation of the terrain, not understanding the importance of Kokoda. Otherwise he probably would have sent more troops than just the Papuan infantry battalion which he'd had up there in the first place. There was also a lack of strategic imagination within land headquarters. They'd been preparing for defence of Australia and had struggled to divine how they were going to manage the defence of Papua and New Guinea. It was from higher headquarters that Morris received the imperative around the importance of Kokoda in general and the airstrip in particular. The airstrip was the key terrain, and it may have been the decisive terrain of the campaign.
(05:29):
The main thing holding back the operational importance of the airfield was the fact that there was no formed road leading to it wasn't near a beach, so anything that was going to be brought in to improve the airfield had to be flown in, and that is logistically difficult. There was no easy way to build up a reserve of fuel or ammunition, it would all have to be flown in. For Kokoto to be that decisive terrain, there were two critical requirements. They're both fairly obvious. The first was actual retention of the airfield and the village, and secondly there was the requirement FOR aircraft.
Speaker 3 (06:03):
The First Battle of Kokoda was fought.
Speaker 1 (06:05):
Over the 28th and 29th of July, and the battalion was forced to withdraw to Denaki. It was briefly reoccupied between the 8th and 9th of August by Alpha Company, but it too was forced to withdraw again. So now we're going to look at the integration of the medical plan into the tactical plan. As we do this, it's important to remember the lack of experience within some of these headquarters that are doing this planning, as well as the difficulties of responding to the advancing Japanese. The ability of New Guinea Force headquarters to get accurate situational awareness would have been very difficult. Communications were quite parlous with any of its subordinate call signs. Once they started moving up the Kokoda track, there was significant pressure from above to retake Kokoda. And by above, I mean coming from MacArthur himself.
(06:56):
And we're going to look at that because it does have significant impact for the troops on the ground. And so the inability to communicate, the lack of proper intelligence about the Japanese locations and their capabilities and numbers, combined with a lack of planning experience in all of the headquarters from Company Battalion up to New Guinea Force Headquarters, combines to see the development of a tactical plan that has a significant amount of hope in it. Hindsight's always 20. However, hope is not a task verb, and when it is used, there should be some risk management. How does the enemy's most dangerous course of action impact your plan? We should always be looking at the impact of the enemy's most dangerous course of action and then have mitigations in place to minimise the impact of that.
(07:47):
If the mission is to retake Kokoda, then the most dangerous course of action that the Japanese could have taken was that they could concentrate on Kokoda in such numbers that. That the Australians would be unable to achieve the combat power ratios to evict them. What actually happened was the Japanese were able to get so many troops into the AO that the Australians were unable to stop their advance. The medical plan was still under development on 28 August. This is during the Battle of Ishirava. So whilst the 39th Battalion is continuing to take casualties, and on top of that, we've now got the two 14th and two 16th and they are unable to stop the advance of the Japanese as well. While all of this is happening. The medical plan is still being developed and it's a doozy.
(08:37):
So I'll read a small excerpt from the official history. A medical plan was adopted to fit into the general tactical plan by which the capture of Kokoda was envisaged, together with the cutting of Japanese communications between Kokoda and oivi. Medical evacuation to suit these tactics was therefore planned on the unusual method of sending patients forward instead of rearward so that they might be transported to bases by air from Kokoda. The 2nd 14th and 2nd 16th Battalion casualties would thus be taken by regimental stretcher bearers to the forward posts and thence by native carriers to the regimental aid posts. It will be seen that this plan could be fully implemented only if Kokoda was captured from the Japanese. This explains why the casualties were held so close to the front lines.
(09:29):
When we look at the tactical picture, we see that the 2nd 14th and 2nd 16th battalions have just joined the 39th and 53rd battalions. However, when we looked at their combat performance, we saw that it wasn't as good as what New Guinea Force headquarters was expecting, and that was because of the fact that they hadn't been trained to fight in the jungle. Coming straight from the desert into the jungle makes for a very difficult transition because it is fundamentally different combat. The withdrawal from Ishirava would now force the medical staff to adopt a traditional rearward patient evacuation process. This was going to be done with.
Speaker 3 (10:09):
Very limited resources and very limited time. This brings us to the topic of expectant casualties. These are casualties who have suffered injuries.
Speaker 1 (10:19):
That are so severe and or the.
Speaker 3 (10:22):
Resources to treat those injuries are so limited that they are unlikely to survive.
Speaker 1 (10:28):
The official history has the story of.
Speaker 3 (10:31):
A situation that occurred during the withdrawal from EORA Creek. Two patients had abdominal wounds and one a sucking wound of the chest. Since they had no apparent chance of survival and no surgical measures were possible, Majori advised a large intravenous dose of morphine, the action of which illustrated the extreme tolerance of persons with such injuries, but ensured at least comfort in their last hours. Though abdominal wounds have always had a higher mortality, it is one of the tragic frustrations of medical services at war that some men who might have had a possible chance of survival are doomed under the conditions such as prevailed on the Kokoda trial. So these are very tough decisions being made by the medical officers under extreme circumstances. I've got an excerpt of an interview with Stan Bissett.
(11:21):
He was a captain in the 2nd 14th Battalion, and he's got a personal story about this Kind of circumstance.
Speaker 1 (11:27):
This is about his brother Hal, who.
Speaker 3 (11:30):
Was known throughout the second 14th as Butch. I'll let Stan tell the story.
Speaker 4 (11:36):
I was going up on my way up to see my brother's platoon because I hadn't got there. I got out to the other platoons and SEO and I had gone forward. We'd gone past our forward troops. I ran into a Jap patrol and forced them off the track in front of us. But we had a platoon in the bush in the jungle beside us, and we withdrew then. But I then asked Sierra if I'd like to go up and just check on position of Vikanko. I knew that they'd been confronted by some of the stronger forces and the Japs were desperate to get that high ground because that dominated the whole battle area. I got within about 30 or 40 meters of the position we had to go. There's two or 300 meters.
(12:20):
We had to go through a combination of shrub and open country. And I met one of butcher's men, Tommy Wilson, who was one of two brothers, and they were Bren Gunners actually in 10%. And he'd just lost his hand with a faulty bakelite grenade. The tape hadn't come off properly and had blown off in his hand and he'd lost his hand. So I had to just stop and bind it up. And he was disoriented. He didn't know where the rap was. So take him back to the rap, to the dock. And when I got there, colonel Key and to see orders from Potts that were to withdraw that night to a position just south of the rest house, which was back towards Lola, getting back towards the Lola.
(13:07):
He wanted me and Ralph Oneack, the CEO of 39 Battalion, to go back and select the position, get the position ready for our withdrawal. So I did this. And as I was going back, I had a word from one of the wounded coming back that Butch had been wounded and shot. And I knew that the fellows were bringing him out. They were carrying him out.
Speaker 5 (13:30):
What do you think at this stage when you heard the first use, what did you think?
Speaker 4 (13:35):
That he had been wounded. And, well, I was just concerned and worried and I had him. I felt that he'd been shot, mentioned that he'd been shot in the tummy. And I thought, well, that was the end because an abdominal wound up there was absolutely fatal because had no way of getting medical treatment to treat it. And I felt, well, if his memory of bringing him out, I'd love to be with him before he died. Anyway, went back in some of.
Speaker 5 (14:07):
The 53rd, just before we move on from that. So you went and saw him?
Speaker 4 (14:11):
Not at that stage, no, I couldn't go. I had to go with Ralph on the back to select this position for our troops to withdraw. That was urgent. That was the priority at that time. That was about perhaps a thousand meters back and perhaps less. And we selected a position which was the only suitable position there.
Speaker 5 (14:32):
Why was it suitable? How was it?
Speaker 4 (14:34):
Because of the nature of the ground and we had features which we could spread out. It was defiled. It was only a limited area. It was deep on both sides for the enemy to have to get up and we could have a reasonable field of fire over the approaches in which they could come. The only approaches they could come. 53rd Battalion were lying in that area. They'd been sent forward to help to relieve us. But there was only two companies in them. And I asked. I tried to find an officer, but I couldn't find an officer. No problem. And they wouldn't want to tell me anyway. They were tired, flake that they'd had it.
(15:14):
They'd been marching for a few hours and in the end I had to pull my revolver and ask them to move because I tried to explain to them that were the front line troops were all withdrawing to that position that was going to be our defensive position. Some of them, they saw the light immediately and then they moved back and they were okay then. And then we established the position. And then I went forward a couple of hundred meters to where I'd met our stretcher bearer, the carrying Putyard. And I met him and helped us. Helped him with a stretch of bearers from our platoon that were carrying him. It was about eight of my mates and were doing it. They'd had to fight their way through. And we put him on a. I saw Don Duffy by medical Ops here.
(16:01):
I had him and he was a great friend because he had powerhouse before the war. And he said, we'll put him on the track just about 15 meters off the side of the track and had a look at him and we looked together. He shook his head and I could tell that there was no but. And he gave him morphine. And I said, doc, I'll stay with him, don't worry. And you tend to the others. He came back several times over the next six hours. That was from 10:00, night time, that was it, and dark. And I was with him till 4 o'clock in the morning. And when he passed away, he died. But we talked and he was good at times, but Don came back and gave him off to easy pain quite a few times.
(16:45):
And we talked about quite a few things, Mum and Dad and other times, good times we'd had, and that's some of our rugby, but we had just held hands and were very close. We'd been through lots of things, good and bad things together. And then we buried him. Padre Daly came along and we buried him in a little clearing just the side of the track and put a little cross up to mark the spot and took his tablets off him and that was it. And that time onwards, at the 30th, we established. I went to the position we'd established. I directed all our troops to the near position.
Speaker 5 (17:27):
And did you have much time, though, after you'd buried him? Did you have much time to kind of think of that or did you have to move on?
Speaker 4 (17:35):
No, were right into it from there. The Japs at this time had moved up on our western flank and looked like getting around behind us. And we would have been in real trouble if we didn't get and establish our defensive positions very quickly. So we had to be ready for the. Another attacks by the first light.
Speaker 5 (17:57):
After just having been through that, did you kind of go on with a different approach to what you were doing there, or.
Speaker 4 (18:04):
I just had. I went on with what we had to do and that was to just check our positions and make sure every company was in the correct position. We wanted them to be in and platoon's position, that they had a reasonable field of fire, that they had their. Their pits, they could scrape some sort of a pit to give them cover, as much cover as possible for them to get, and protection.
Speaker 3 (18:30):
That story really highlights the incredible devotion to duty of the soldiers who fought during the battle of Ishirava. Stan, faced with a terrible situation, and yet after the passing of his brother, he is right back into the fight. I want to take a look now at the 14th Field Ambulance. The CO, Lt. Col. Malcolm Earlham, wrote an extensive report about the difficulties in providing medical services to the troops. It was the 14th field ambulance that was the first up the Kokoda track, and as such, they were the tip of the spear when it came to supporting the troops in the field. The 14th was a militia unit because they were a militia unit, they hadn't seen combat yet and so were relatively inexperienced and they were also fairly poorly equipped.
(19:16):
They disembarked at port Moresby on 3 June 1942, but they had no vehicles and there were no attached Australian Army Service Corps personnel. These would have been their drivers and their cooks. None of the medical officers had any experience in the management of tropical diseases. And now that they were in the.
Speaker 1 (19:38):
Tropics, that was going to be a.
Speaker 3 (19:39):
Fundamental part of their work. So straight after disembarkation, two were detached to the camp hospital in Port Moresby so that they could get experience in managing predominantly malaria. There was a staffing shortfall within the field ambulance. Another doctor was sent to the infectious diseases hospital, and a recent change in the establishment of the field ambulances meant that one medical officer in each of the forward companies was converted to a bearer officer. Field ambulance staff were also required to fill the gaps that had been left by the departure of the female army nurses from the hospital at port Moresby. On 19 February 1942, Japanese aircraft bombed Darwin. One of the ships that was attacked was the second first Australian hospital ship, Manunda.
(20:33):
Twelve people were killed on the hospital ship and one of them was Sister Margaret Augusta de Mestra of the Australian Army Nursing Service.
Speaker 1 (20:42):
Her death would see the withdrawal of.
Speaker 3 (20:45):
All of the female nurses from Darwin and also all of the female nurses from Port Moresby. There were six who had been working at the hospital at Murray Barracks. Erlan would later write a report about the provision of medical services and it was a wide ranging discussion about medicine. But it also highlighted seven key areas of concern in the provision of medical support. They were the conduct of waifs and strays, the incidence of accidental wounds, supply problems, the composition of medical detachments, the rate of sickness among the soldiers, the collection and evacuation of the wounded, and the protection of non combatant medical units.
Speaker 1 (21:26):
Firstly, we've got the management of the waifs and strays. A waif is a homeless, neglected or abandoned person, especially a child. There shouldn't be any of those on the Kokoda track. What Erlam is euphemistically referring to is the malingerers and deserters. These were soldiers who arrived at the aid posts without any authorisation. Many of the soldiers exaggerated or fabricated the impact of their diarrhoea. But as one of the doctors noted, it was difficult and often impossible to prove one way or the other, especially with the limited conditions and large number of casualties that many of the doctors were trying to treat. We're not going to condemn the individual conduct of soldiers because it's important to remember that many of the militia troops had already been in Papua for over six months later in the war.
(22:23):
Six months would be seen as well in excess of the amount of time that a Formed body of troops should be kept in the tropical and jungle conditions before seeing a decrease in health and morale. For the second AIF troops, they had very little time to acclimatise to the conditions in Papua. Less than one month before the battle of Ishirava, the troops of the 2 14th and 2 16th had been playing football in Queensland. So very little time to acclimatise and a very rapid approach march up the Kokoda track. Some soldiers would walk out of the front line, bypass their RAP and other medical posts in an attempt to get themselves evacuated. For those troops advancing towards the Japanese, there would be inevitably some stragglers. They would drop out of the march at an advanced dressing station looking to be evacuated back.
(23:16):
The problem was that there were no provost marshals on the Kokoda track. There was no one to get the soldiers to continue moving. There was no one to give them direction. This was left to the medical officers and they had no authority nor any means but by which to enforce any of the orders given to the soldiers. Erlen wrote that because there was no one with the authority, some soldiers spent much of their time in this part of the campaign wandering up and down the line between staging posts and the situation was not rectified during the withdrawal.
(23:51):
For some of the soldiers, the lack of conditioning that they had received in conjunction with the incredibly arduous conditions and the psychological strain of being in a jungle combat area saw them resorting to self inflicted wounds as a means of getting themselves out of this parlor situation. We've already discussed this in episode 109 of the podcast Operational Mistakes on the Kokoda Track where we referenced David Woolley's excellent paper not yet diagnosed Australian psychiatric casualties during the Kokoda campaign. Because of that, I won't belabor the point, but there's a couple of points that I want to bring out.
(24:29):
Erlam talks about the fact that the incidence of suspected self inflicted wounds would increase during heavy fighting and that put an inordinate strain on an already struggling to cope advanced dressing station so the concerns is partially for the individual soldiers and partially for the ability for all of the soldiers to get the care and treatment that they need and deserve. Secondly, at one point suspected self inflicted wounds were patched up and returned to their units. At this point there was a dramatic decrease in the number of self inflicted wounds. It was almost eliminated. However, there were concerns about this procedure and shortly that policy was rescinded. As we've alluded to many times, one of the issues that exacerbated the situation for the soldiers and for the medics was that of logistics support.
Speaker 3 (25:22):
They were always short of plaster of.
Speaker 1 (25:23):
Paris, strapping morphine, quinine, sulfur, guanidine. The supplies of them were always inadequate, possibly because of losses in dropping and requisitions going astray. There was no supply of blankets for the field ambulance, which means that when soldiers came in they'd often lost all of their personal kit, so they wouldn't have a blanket for them. High up in the jungle, the wetness and the coldness added to the misery of the disease the injuries and the wounds that they had suffered in the jungle. Practically at no time was there an adequacy of stores, mainly due to the nature of the action, misunderstanding as to the requisition stores lost in scrub and swamp, and breakages due to dropping requisitions from the front were for quantities urgently required. The practice of the base medical stores of chopping down, which happened on practically every occasion, made forward supply very difficult.
(26:18):
On reordering, the balance of the original requisition was forwarded, showing no acute shortage at base. It was found necessary quite frequently to break into battalion reserve rap stores to enable us to carry on. The breakages that he referred to was because they were trying to airdrop supplies into places like Myola. Airdrops in support of Australian troops had first been used at the Battle of hamel in. In 1918. And yet, despite the intervening 44 years, it doesn't look like there'd been a lot of advancement in the techniques and procedures for parachuting supplies into troops. It was clear that there was a lack of experience in using parachute as a mechanism for supply. Some of the initial techniques used were very haphazard and highly likely to fail. Glass bottles with no protective wrapping were dropped in sacks.
(27:15):
Often entire requisitions were lost because the aircraft would drop it in a location that had already been abandoned by the Australians. Some of the equipment they did receive was just no good. When used in the jungle. Both the standard Thomas arm splint and the army stretcher were far too cumbersome for use on jungle tracks. As usual, as Australians are so good at doing, the troops of the field ambulance innovated. As much of the detritus of the.
Speaker 3 (27:45):
Battlefield as possible was recycled.
Speaker 1 (27:48):
Objects such as bully beef tins and helmets were used to create cooking utensils, water containers and even bed pans. Not only do we see that some of the equipment is inappropriate for use in the jungle, but there isn't enough of the medical logistics supplies that is required for the number of casualties that are being taken and there aren't enough officers trained in the management of medical logistics. The first half of the Kokoda campaign is a withdrawal in very arduous terrain. We are seeing here just how difficult the provision of those essential combat service support roles, such as medical support for troops, how difficult this is in the withdrawal. Where are the supply dumps located? How far back do they need to be? What is the likely rate of withdrawal over the next 48 hours?
(28:40):
What amount of supplies are going to be needed at the front lines? What resources are available to move the supply dumps further back when that is required? The management of these dilemmas as best as possible requires a well functioning headquarters, ideally one with significant combat experience, and that is able to affect command and control ably across all of the forces with which it commands. I don't think that we had this at Isurava. Brigadier Potts had come to Port Moresby as the commander of the 21st Brigade. He replaced Porter as the commander of Maroubra Force on 23rd August. The Battle of Ishirava commenced on 26th August. He does not have a lot of time to complete his appreciation of the situation. On his way up to Ishirava, he had found a nasty surprise about the number of rations that were available at Myola.
(29:40):
This was meant to be the main supply dump and yet there were only 5,000 rations available there. This would limit the number of troops that he would be able to bring up to the front line. As a consequence, the 2 27th was left out of the battle at Ishirava. Maroubra Force is operating in unfamiliar terrain. Very few of the troops have been trained in jungle combat. It was pretty much only the Papuan infantry battalion that knew what they were doing. When it came to jungle warfare, he was struggling with a lack of logistics of all sorts. The problem for Brigitte Potts is that his Ooda loop is large and unwieldy. Observe, orientate, decide, act and remember. Major General Horiyi is advancing relatively aggressively.
(30:29):
There's a couple of combat pauses for him to be able to bring up further supplies, but they are nowhere as great as the time that is required for the Australians to prepare themselves to defend Ishirava. In this episode, we've looked at how that Ooda loop, that ponderous decision making and execution cycle, has impacted the provision of medical support to the troops. But we're also seeing how the medical support to the troops is impacting on the Ooda loop of Maroubra Force. It is placing constraints on Brigadier Potts as he looks for viable courses of action. We're only halfway through Earlham's report of the issues in the provision of medical support to the troops as he saw them as the commander of the 14th Field Ambulance.
(31:19):
Next week we will return to look at the composition of the medical detachments, the collection and evacuation of the sick and wounded. We're going to take a quick detour to look at the arrival of the 2nd 9th Australian General Hospital to Port Moresby. That will answer the question, how long does it take to build a 1200 bed hospital? We'll continue on with the protection of the medical personnel and the rate of sickness amongst the troops. That's going to lead into a focus on the bloody flux, dysentery and how it impacted the troops. And then we're going to finish off with a look at the terror of the Papuan jungle. How did the Anopheles mosquito almost bring New guinea force to the point of culmination?
(32:02):
So roll down your sleeves, take your quinine and we'll be back next week to continue our look at the medical factors in the Kokoda campaign.
Speaker 2 (32:11):
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How were sick and injured troops cared for during the Kokoda campaign? We look at medevac and medical and surgical treatment on the Kokoda track.
Speaker 2 (00:09):
This is the Principles of War podcast, professional military education for junior officers and senior NCOs.
Speaker 1 (00:21):
Ladies and gentlemen, welcome back to episode 126 of the Principles of War podcast. Last week we started to delve into some of the issues with providing medical support during large scale combat operations. One point that came out was the difficulty in providing casualty management during the withdrawal. It can be an insidious situation. You've got casualties that need evacuating whilst receiving more casualties, sometimes mass casualties. All the while, the enemy is still advancing. And this highlights the reason why. Medical services need to be positioned far enough behind the front lines to be secure and to have the time that they need to conduct their withdrawal. That withdrawal requires significant resources. This didn't happen during the Battle of Ishirava. Today we're going to unravel some of the reasons why that occurred.
(01:12):
I think it's worth highlighting the clinical skills, the improvisational skills, the endurance and bravery of the medical staff. They are doing everything that doctors and nurses would do in a normal hospital, except they're doing it often in a mass casualty kind of environment. They're doing it in the middle of the jungle and sometimes they're doing that within range of the enemy. That is an incredibly difficult task. And yet, reading through the war diaries, you see time and time again medics putting themselves out there to ensure that they're able to look after their patients. Secondly is thinking about casualty management in future large scale combat operations that could be conducted in the jungle environment. How would that care be provided? And critically, how would the troops be medevaced out, especially if they were denied the ability to use rotary wing assets.
(02:11):
That might because of weather, terrain or enemy action, particularly the risk from air defence assets. That medevac process may look very similar to the process that was carried out on the Kokoda track. And that's quite a sobering thought. If that's the case, we really want to look at the planning considerations so that the care of the soldiers can be the best care possible, given the circumstances. Jan McLeod, in her excellent book Shadows on the Track, has got a paragraph that describes the first instance where there are troops who are wounded in combat. She writes, on the 7th of July, 129 soldiers from Bravo Company of the 39th Battalion under Captain Sam Templeton were ordered to walk from Port Moresby to Kokoda to secure the village and its airstrip.
(03:00):
That they were ordered to do so without either a dedicated medical officer or a field ambulance unit suggests supreme confidence, complete ignorance or extreme neglect. Those troops were able to get some medical support. We discussed in the last episode the exploits of Captain Geoffrey Doc Vernon. It's important to remember that he is a member of Angau, so not attached to the 39th Battalion. He had established a hospital at Ilolo to manage the care of the Papuan natives. He travelled on foot from Ilololo to Daniki to offer his services to the 39th Battalion. When heard that they were there and without medical support, he married up with the lead elements of the 39th Battalion on 29 July, reported to the CO, Lieutenant Colonel Owen, and immediately began providing medical support to the troops.
(03:53):
On 23rd July, Charlie Company of the 39th was ordered to move to Kokoda and it was accompanied by the regimental medical officer, Captain Shearer. There was also a detachment of the 14th Field Ambulance comprising Captain William McLaren and five other ranks. They were sent to Kargi, south of Templeton's Crossing, to set up a medical dressing station. This was the only medical support that the battalion would have until the 8th of September, when they were relieved by the 2 6th field ambulance. This situation, which is certainly not ideal, has come about because of a confluence of circumstances. Firstly, and as always, we see the speed with which the Japanese are moving. They're well and truly within the Australians Ooda loop and they're landing unexpectedly and heading towards Kokoda.
(04:42):
Secondly, we've got the commander of New Guinea Force, Major General Basil Morris, probably failing his appreciation of the terrain, not understanding the importance of Kokoda. Otherwise he probably would have sent more troops than just the Papuan infantry battalion which he'd had up there in the first place. There was also a lack of strategic imagination within land headquarters. They'd been preparing for defence of Australia and had struggled to divine how they were going to manage the defence of Papua and New Guinea. It was from higher headquarters that Morris received the imperative around the importance of Kokoda in general and the airstrip in particular. The airstrip was the key terrain, and it may have been the decisive terrain of the campaign.
(05:29):
The main thing holding back the operational importance of the airfield was the fact that there was no formed road leading to it wasn't near a beach, so anything that was going to be brought in to improve the airfield had to be flown in, and that is logistically difficult. There was no easy way to build up a reserve of fuel or ammunition, it would all have to be flown in. For Kokoto to be that decisive terrain, there were two critical requirements. They're both fairly obvious. The first was actual retention of the airfield and the village, and secondly there was the requirement FOR aircraft.
Speaker 3 (06:03):
The First Battle of Kokoda was fought.
Speaker 1 (06:05):
Over the 28th and 29th of July, and the battalion was forced to withdraw to Denaki. It was briefly reoccupied between the 8th and 9th of August by Alpha Company, but it too was forced to withdraw again. So now we're going to look at the integration of the medical plan into the tactical plan. As we do this, it's important to remember the lack of experience within some of these headquarters that are doing this planning, as well as the difficulties of responding to the advancing Japanese. The ability of New Guinea Force headquarters to get accurate situational awareness would have been very difficult. Communications were quite parlous with any of its subordinate call signs. Once they started moving up the Kokoda track, there was significant pressure from above to retake Kokoda. And by above, I mean coming from MacArthur himself.
(06:56):
And we're going to look at that because it does have significant impact for the troops on the ground. And so the inability to communicate, the lack of proper intelligence about the Japanese locations and their capabilities and numbers, combined with a lack of planning experience in all of the headquarters from Company Battalion up to New Guinea Force Headquarters, combines to see the development of a tactical plan that has a significant amount of hope in it. Hindsight's always 20. However, hope is not a task verb, and when it is used, there should be some risk management. How does the enemy's most dangerous course of action impact your plan? We should always be looking at the impact of the enemy's most dangerous course of action and then have mitigations in place to minimise the impact of that.
(07:47):
If the mission is to retake Kokoda, then the most dangerous course of action that the Japanese could have taken was that they could concentrate on Kokoda in such numbers that. That the Australians would be unable to achieve the combat power ratios to evict them. What actually happened was the Japanese were able to get so many troops into the AO that the Australians were unable to stop their advance. The medical plan was still under development on 28 August. This is during the Battle of Ishirava. So whilst the 39th Battalion is continuing to take casualties, and on top of that, we've now got the two 14th and two 16th and they are unable to stop the advance of the Japanese as well. While all of this is happening. The medical plan is still being developed and it's a doozy.
(08:37):
So I'll read a small excerpt from the official history. A medical plan was adopted to fit into the general tactical plan by which the capture of Kokoda was envisaged, together with the cutting of Japanese communications between Kokoda and oivi. Medical evacuation to suit these tactics was therefore planned on the unusual method of sending patients forward instead of rearward so that they might be transported to bases by air from Kokoda. The 2nd 14th and 2nd 16th Battalion casualties would thus be taken by regimental stretcher bearers to the forward posts and thence by native carriers to the regimental aid posts. It will be seen that this plan could be fully implemented only if Kokoda was captured from the Japanese. This explains why the casualties were held so close to the front lines.
(09:29):
When we look at the tactical picture, we see that the 2nd 14th and 2nd 16th battalions have just joined the 39th and 53rd battalions. However, when we looked at their combat performance, we saw that it wasn't as good as what New Guinea Force headquarters was expecting, and that was because of the fact that they hadn't been trained to fight in the jungle. Coming straight from the desert into the jungle makes for a very difficult transition because it is fundamentally different combat. The withdrawal from Ishirava would now force the medical staff to adopt a traditional rearward patient evacuation process. This was going to be done with.
Speaker 3 (10:09):
Very limited resources and very limited time. This brings us to the topic of expectant casualties. These are casualties who have suffered injuries.
Speaker 1 (10:19):
That are so severe and or the.
Speaker 3 (10:22):
Resources to treat those injuries are so limited that they are unlikely to survive.
Speaker 1 (10:28):
The official history has the story of.
Speaker 3 (10:31):
A situation that occurred during the withdrawal from EORA Creek. Two patients had abdominal wounds and one a sucking wound of the chest. Since they had no apparent chance of survival and no surgical measures were possible, Majori advised a large intravenous dose of morphine, the action of which illustrated the extreme tolerance of persons with such injuries, but ensured at least comfort in their last hours. Though abdominal wounds have always had a higher mortality, it is one of the tragic frustrations of medical services at war that some men who might have had a possible chance of survival are doomed under the conditions such as prevailed on the Kokoda trial. So these are very tough decisions being made by the medical officers under extreme circumstances. I've got an excerpt of an interview with Stan Bissett.
(11:21):
He was a captain in the 2nd 14th Battalion, and he's got a personal story about this Kind of circumstance.
Speaker 1 (11:27):
This is about his brother Hal, who.
Speaker 3 (11:30):
Was known throughout the second 14th as Butch. I'll let Stan tell the story.
Speaker 4 (11:36):
I was going up on my way up to see my brother's platoon because I hadn't got there. I got out to the other platoons and SEO and I had gone forward. We'd gone past our forward troops. I ran into a Jap patrol and forced them off the track in front of us. But we had a platoon in the bush in the jungle beside us, and we withdrew then. But I then asked Sierra if I'd like to go up and just check on position of Vikanko. I knew that they'd been confronted by some of the stronger forces and the Japs were desperate to get that high ground because that dominated the whole battle area. I got within about 30 or 40 meters of the position we had to go. There's two or 300 meters.
(12:20):
We had to go through a combination of shrub and open country. And I met one of butcher's men, Tommy Wilson, who was one of two brothers, and they were Bren Gunners actually in 10%. And he'd just lost his hand with a faulty bakelite grenade. The tape hadn't come off properly and had blown off in his hand and he'd lost his hand. So I had to just stop and bind it up. And he was disoriented. He didn't know where the rap was. So take him back to the rap, to the dock. And when I got there, colonel Key and to see orders from Potts that were to withdraw that night to a position just south of the rest house, which was back towards Lola, getting back towards the Lola.
(13:07):
He wanted me and Ralph Oneack, the CEO of 39 Battalion, to go back and select the position, get the position ready for our withdrawal. So I did this. And as I was going back, I had a word from one of the wounded coming back that Butch had been wounded and shot. And I knew that the fellows were bringing him out. They were carrying him out.
Speaker 5 (13:30):
What do you think at this stage when you heard the first use, what did you think?
Speaker 4 (13:35):
That he had been wounded. And, well, I was just concerned and worried and I had him. I felt that he'd been shot, mentioned that he'd been shot in the tummy. And I thought, well, that was the end because an abdominal wound up there was absolutely fatal because had no way of getting medical treatment to treat it. And I felt, well, if his memory of bringing him out, I'd love to be with him before he died. Anyway, went back in some of.
Speaker 5 (14:07):
The 53rd, just before we move on from that. So you went and saw him?
Speaker 4 (14:11):
Not at that stage, no, I couldn't go. I had to go with Ralph on the back to select this position for our troops to withdraw. That was urgent. That was the priority at that time. That was about perhaps a thousand meters back and perhaps less. And we selected a position which was the only suitable position there.
Speaker 5 (14:32):
Why was it suitable? How was it?
Speaker 4 (14:34):
Because of the nature of the ground and we had features which we could spread out. It was defiled. It was only a limited area. It was deep on both sides for the enemy to have to get up and we could have a reasonable field of fire over the approaches in which they could come. The only approaches they could come. 53rd Battalion were lying in that area. They'd been sent forward to help to relieve us. But there was only two companies in them. And I asked. I tried to find an officer, but I couldn't find an officer. No problem. And they wouldn't want to tell me anyway. They were tired, flake that they'd had it.
(15:14):
They'd been marching for a few hours and in the end I had to pull my revolver and ask them to move because I tried to explain to them that were the front line troops were all withdrawing to that position that was going to be our defensive position. Some of them, they saw the light immediately and then they moved back and they were okay then. And then we established the position. And then I went forward a couple of hundred meters to where I'd met our stretcher bearer, the carrying Putyard. And I met him and helped us. Helped him with a stretch of bearers from our platoon that were carrying him. It was about eight of my mates and were doing it. They'd had to fight their way through. And we put him on a. I saw Don Duffy by medical Ops here.
(16:01):
I had him and he was a great friend because he had powerhouse before the war. And he said, we'll put him on the track just about 15 meters off the side of the track and had a look at him and we looked together. He shook his head and I could tell that there was no but. And he gave him morphine. And I said, doc, I'll stay with him, don't worry. And you tend to the others. He came back several times over the next six hours. That was from 10:00, night time, that was it, and dark. And I was with him till 4 o'clock in the morning. And when he passed away, he died. But we talked and he was good at times, but Don came back and gave him off to easy pain quite a few times.
(16:45):
And we talked about quite a few things, Mum and Dad and other times, good times we'd had, and that's some of our rugby, but we had just held hands and were very close. We'd been through lots of things, good and bad things together. And then we buried him. Padre Daly came along and we buried him in a little clearing just the side of the track and put a little cross up to mark the spot and took his tablets off him and that was it. And that time onwards, at the 30th, we established. I went to the position we'd established. I directed all our troops to the near position.
Speaker 5 (17:27):
And did you have much time, though, after you'd buried him? Did you have much time to kind of think of that or did you have to move on?
Speaker 4 (17:35):
No, were right into it from there. The Japs at this time had moved up on our western flank and looked like getting around behind us. And we would have been in real trouble if we didn't get and establish our defensive positions very quickly. So we had to be ready for the. Another attacks by the first light.
Speaker 5 (17:57):
After just having been through that, did you kind of go on with a different approach to what you were doing there, or.
Speaker 4 (18:04):
I just had. I went on with what we had to do and that was to just check our positions and make sure every company was in the correct position. We wanted them to be in and platoon's position, that they had a reasonable field of fire, that they had their. Their pits, they could scrape some sort of a pit to give them cover, as much cover as possible for them to get, and protection.
Speaker 3 (18:30):
That story really highlights the incredible devotion to duty of the soldiers who fought during the battle of Ishirava. Stan, faced with a terrible situation, and yet after the passing of his brother, he is right back into the fight. I want to take a look now at the 14th Field Ambulance. The CO, Lt. Col. Malcolm Earlham, wrote an extensive report about the difficulties in providing medical services to the troops. It was the 14th field ambulance that was the first up the Kokoda track, and as such, they were the tip of the spear when it came to supporting the troops in the field. The 14th was a militia unit because they were a militia unit, they hadn't seen combat yet and so were relatively inexperienced and they were also fairly poorly equipped.
(19:16):
They disembarked at port Moresby on 3 June 1942, but they had no vehicles and there were no attached Australian Army Service Corps personnel. These would have been their drivers and their cooks. None of the medical officers had any experience in the management of tropical diseases. And now that they were in the.
Speaker 1 (19:38):
Tropics, that was going to be a.
Speaker 3 (19:39):
Fundamental part of their work. So straight after disembarkation, two were detached to the camp hospital in Port Moresby so that they could get experience in managing predominantly malaria. There was a staffing shortfall within the field ambulance. Another doctor was sent to the infectious diseases hospital, and a recent change in the establishment of the field ambulances meant that one medical officer in each of the forward companies was converted to a bearer officer. Field ambulance staff were also required to fill the gaps that had been left by the departure of the female army nurses from the hospital at port Moresby. On 19 February 1942, Japanese aircraft bombed Darwin. One of the ships that was attacked was the second first Australian hospital ship, Manunda.
(20:33):
Twelve people were killed on the hospital ship and one of them was Sister Margaret Augusta de Mestra of the Australian Army Nursing Service.
Speaker 1 (20:42):
Her death would see the withdrawal of.
Speaker 3 (20:45):
All of the female nurses from Darwin and also all of the female nurses from Port Moresby. There were six who had been working at the hospital at Murray Barracks. Erlan would later write a report about the provision of medical services and it was a wide ranging discussion about medicine. But it also highlighted seven key areas of concern in the provision of medical support. They were the conduct of waifs and strays, the incidence of accidental wounds, supply problems, the composition of medical detachments, the rate of sickness among the soldiers, the collection and evacuation of the wounded, and the protection of non combatant medical units.
Speaker 1 (21:26):
Firstly, we've got the management of the waifs and strays. A waif is a homeless, neglected or abandoned person, especially a child. There shouldn't be any of those on the Kokoda track. What Erlam is euphemistically referring to is the malingerers and deserters. These were soldiers who arrived at the aid posts without any authorisation. Many of the soldiers exaggerated or fabricated the impact of their diarrhoea. But as one of the doctors noted, it was difficult and often impossible to prove one way or the other, especially with the limited conditions and large number of casualties that many of the doctors were trying to treat. We're not going to condemn the individual conduct of soldiers because it's important to remember that many of the militia troops had already been in Papua for over six months later in the war.
(22:23):
Six months would be seen as well in excess of the amount of time that a Formed body of troops should be kept in the tropical and jungle conditions before seeing a decrease in health and morale. For the second AIF troops, they had very little time to acclimatise to the conditions in Papua. Less than one month before the battle of Ishirava, the troops of the 2 14th and 2 16th had been playing football in Queensland. So very little time to acclimatise and a very rapid approach march up the Kokoda track. Some soldiers would walk out of the front line, bypass their RAP and other medical posts in an attempt to get themselves evacuated. For those troops advancing towards the Japanese, there would be inevitably some stragglers. They would drop out of the march at an advanced dressing station looking to be evacuated back.
(23:16):
The problem was that there were no provost marshals on the Kokoda track. There was no one to get the soldiers to continue moving. There was no one to give them direction. This was left to the medical officers and they had no authority nor any means but by which to enforce any of the orders given to the soldiers. Erlen wrote that because there was no one with the authority, some soldiers spent much of their time in this part of the campaign wandering up and down the line between staging posts and the situation was not rectified during the withdrawal.
(23:51):
For some of the soldiers, the lack of conditioning that they had received in conjunction with the incredibly arduous conditions and the psychological strain of being in a jungle combat area saw them resorting to self inflicted wounds as a means of getting themselves out of this parlor situation. We've already discussed this in episode 109 of the podcast Operational Mistakes on the Kokoda Track where we referenced David Woolley's excellent paper not yet diagnosed Australian psychiatric casualties during the Kokoda campaign. Because of that, I won't belabor the point, but there's a couple of points that I want to bring out.
(24:29):
Erlam talks about the fact that the incidence of suspected self inflicted wounds would increase during heavy fighting and that put an inordinate strain on an already struggling to cope advanced dressing station so the concerns is partially for the individual soldiers and partially for the ability for all of the soldiers to get the care and treatment that they need and deserve. Secondly, at one point suspected self inflicted wounds were patched up and returned to their units. At this point there was a dramatic decrease in the number of self inflicted wounds. It was almost eliminated. However, there were concerns about this procedure and shortly that policy was rescinded. As we've alluded to many times, one of the issues that exacerbated the situation for the soldiers and for the medics was that of logistics support.
Speaker 3 (25:22):
They were always short of plaster of.
Speaker 1 (25:23):
Paris, strapping morphine, quinine, sulfur, guanidine. The supplies of them were always inadequate, possibly because of losses in dropping and requisitions going astray. There was no supply of blankets for the field ambulance, which means that when soldiers came in they'd often lost all of their personal kit, so they wouldn't have a blanket for them. High up in the jungle, the wetness and the coldness added to the misery of the disease the injuries and the wounds that they had suffered in the jungle. Practically at no time was there an adequacy of stores, mainly due to the nature of the action, misunderstanding as to the requisition stores lost in scrub and swamp, and breakages due to dropping requisitions from the front were for quantities urgently required. The practice of the base medical stores of chopping down, which happened on practically every occasion, made forward supply very difficult.
(26:18):
On reordering, the balance of the original requisition was forwarded, showing no acute shortage at base. It was found necessary quite frequently to break into battalion reserve rap stores to enable us to carry on. The breakages that he referred to was because they were trying to airdrop supplies into places like Myola. Airdrops in support of Australian troops had first been used at the Battle of hamel in. In 1918. And yet, despite the intervening 44 years, it doesn't look like there'd been a lot of advancement in the techniques and procedures for parachuting supplies into troops. It was clear that there was a lack of experience in using parachute as a mechanism for supply. Some of the initial techniques used were very haphazard and highly likely to fail. Glass bottles with no protective wrapping were dropped in sacks.
(27:15):
Often entire requisitions were lost because the aircraft would drop it in a location that had already been abandoned by the Australians. Some of the equipment they did receive was just no good. When used in the jungle. Both the standard Thomas arm splint and the army stretcher were far too cumbersome for use on jungle tracks. As usual, as Australians are so good at doing, the troops of the field ambulance innovated. As much of the detritus of the.
Speaker 3 (27:45):
Battlefield as possible was recycled.
Speaker 1 (27:48):
Objects such as bully beef tins and helmets were used to create cooking utensils, water containers and even bed pans. Not only do we see that some of the equipment is inappropriate for use in the jungle, but there isn't enough of the medical logistics supplies that is required for the number of casualties that are being taken and there aren't enough officers trained in the management of medical logistics. The first half of the Kokoda campaign is a withdrawal in very arduous terrain. We are seeing here just how difficult the provision of those essential combat service support roles, such as medical support for troops, how difficult this is in the withdrawal. Where are the supply dumps located? How far back do they need to be? What is the likely rate of withdrawal over the next 48 hours?
(28:40):
What amount of supplies are going to be needed at the front lines? What resources are available to move the supply dumps further back when that is required? The management of these dilemmas as best as possible requires a well functioning headquarters, ideally one with significant combat experience, and that is able to affect command and control ably across all of the forces with which it commands. I don't think that we had this at Isurava. Brigadier Potts had come to Port Moresby as the commander of the 21st Brigade. He replaced Porter as the commander of Maroubra Force on 23rd August. The Battle of Ishirava commenced on 26th August. He does not have a lot of time to complete his appreciation of the situation. On his way up to Ishirava, he had found a nasty surprise about the number of rations that were available at Myola.
(29:40):
This was meant to be the main supply dump and yet there were only 5,000 rations available there. This would limit the number of troops that he would be able to bring up to the front line. As a consequence, the 2 27th was left out of the battle at Ishirava. Maroubra Force is operating in unfamiliar terrain. Very few of the troops have been trained in jungle combat. It was pretty much only the Papuan infantry battalion that knew what they were doing. When it came to jungle warfare, he was struggling with a lack of logistics of all sorts. The problem for Brigitte Potts is that his Ooda loop is large and unwieldy. Observe, orientate, decide, act and remember. Major General Horiyi is advancing relatively aggressively.
(30:29):
There's a couple of combat pauses for him to be able to bring up further supplies, but they are nowhere as great as the time that is required for the Australians to prepare themselves to defend Ishirava. In this episode, we've looked at how that Ooda loop, that ponderous decision making and execution cycle, has impacted the provision of medical support to the troops. But we're also seeing how the medical support to the troops is impacting on the Ooda loop of Maroubra Force. It is placing constraints on Brigadier Potts as he looks for viable courses of action. We're only halfway through Earlham's report of the issues in the provision of medical support to the troops as he saw them as the commander of the 14th Field Ambulance.
(31:19):
Next week we will return to look at the composition of the medical detachments, the collection and evacuation of the sick and wounded. We're going to take a quick detour to look at the arrival of the 2nd 9th Australian General Hospital to Port Moresby. That will answer the question, how long does it take to build a 1200 bed hospital? We'll continue on with the protection of the medical personnel and the rate of sickness amongst the troops. That's going to lead into a focus on the bloody flux, dysentery and how it impacted the troops. And then we're going to finish off with a look at the terror of the Papuan jungle. How did the Anopheles mosquito almost bring New guinea force to the point of culmination?
(32:02):
So roll down your sleeves, take your quinine and we'll be back next week to continue our look at the medical factors in the Kokoda campaign.
Speaker 2 (32:11):
The Principles of War Podcast is brought to you by James Ealing. The show notes for the Principles of War podcast are available at www.theprinciplesofwar.com. For maps, photos and other information that didn't make it into the podcast, follow us on Facebook or tweet us at surprisepodcast. If you've enjoyed this podcast, please leave a review on itunes and tag a mate in one of our episodes. All opinions expressed by individual are those of those individuals and not of any organization.
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