OFFICE OF THE SURGEON'GENERAL Report Of Medical Departaent Activities in grxshland ty 0. R. HILL Lt* Colonel, II* C. Surgeon, Greenland Base Coamand 6 September 1944 Copy Mo. Interview v/ith Lt, Col, O.it, Hill, 0-1184.01 Cur *oon of Greenland i- se Com and and 18,: th Otati'-n Hospital Iivtrt-ii- ct i.or,» Otho heed IP 11, Lt, Colonel, Pedicel Corps-bur y< on Greenland 3aso Gomr and; burgeon, iirmy Air b sc A.P.O. #858, He •' York, II, Y,; Commanding Officer, 188th Otation Hosoitel - from 9 Ilovcmbor 194.3, 1. Geo:'ranhy and Climate: A.P.O, ffS58 is in Greenland at the head of Tunugdlinrfik Fjord, The terrain is v< ry mountainous and rugged. The summers are rather short, mild and moist; the fall is short; th winters arc long and tempestuous. The spring is late, coming in Pay and June, The came applies generally '’or A.P.C, #615 and 'A. ',L, #679 but A.P.O, #859 is above the Arctic Circle and has a much colder end drier climate in winter. This b? se has more good weather for flying then any other base, ’ u,P,0, #015 is located 't Ivigtut on the west coast of Greenland, It will be cor nlet< ly closed up by winter and thu hospital inactivated. A, ,( , #859 is-at tha head of Condrestror F ord on the west coast of Greenlc nd and about 15 miles north or the Arctic Circle, A,P,0. #679 is at Ikatat and air, Lcch colony or settlement of any r,izc has a radio station and some of them have weather stations. 2. Organizat'on ; nd Personnel: The strength of the Command, so of 5 August 19AA was divided up ar follows; A.P.O. #858 2193 A.P.O. #859 539 A.P.O. #679 373 A.P.C, #615 203 Total: 3308 Peak strength of Command was 3 Oct /*.3 as follows; \!J: Weather nr 'ponhel on ,3, 3600 931 377 55 L Total; 5606 hr cl: '•ort in cordoned of service units, .leather, Air Corns, In’entry, (nearly all withdrawn now) and Anti-Aircraft (nearly all will Irawn no'.v,. In addition, rt A.P.0, #858 there are 200 Coast Guard and Mcvy person;.el stationed ashore. There are a number of Coast Guard Gutters, Sub-chasers and other boats stationed at A.P.O, #858 end A.P.O, #615 or that core in and out. The I.cdical Department Personnel is as follows: A.P.O. #858 188th Sta. Hospital 200 beds 15 Nurses 1A Officers 110 L.f., A,’\0, #859 190th Sta, Hospital 25 beds A Officers 25 F.I. • A.~*,0, #679 191st Sta, Hospital 25 beds A Officers 16 h.l . A.P.O. #615 189th Sta. Hospital 25 beds A Officers 25 B.M, Besides the 188th Station Hospital at A.P.O, #858 there ere 2 flight surgeons and 5 enlisted men of the medical detachment of the 1st Arctic Search and ilcscue Squadron, One Veterinarian is attached to the Greenland Base Command and he divides his time between A.P.O, #858 and A.P.O, #859 where the An y has sledge dogs. In addition, he periodically visits the other 2 base-', raking neat and meat products inspections. Finally, there his recently been one medical officer assigned to the Ice Gap Detachment. The base of operations for this group has been the east coast of Greenland but is being moved to A.P.O. #858, There are no civilian employees. The last of the civilian contractors left in February 19A4* In my opinion there is only one inadequacy in the Tables of Organizations, There is no provision made for ratings, or extra men, for outpost duty, waive outposts mainly weather stations and AACS Installations, are maintained oesides the A main bases. One medical aid man has been kept at each of these in the oast. As all grades and ratings in a hospital T/0 are for di ties in these hospitals, no provisions a.re made for men on Detached Service. The highest ratings available would be T/5 and it is ‘clt that 6 or 8 months continuous duty at an isolated outpost is deserving of better than this, nt rticularly t s the weather and AACS personnel at these outposts got ratings better than T/5# \/here possible ell hospitals have been operated under their T, 0 jft ’ength. 3. Operations: The re were several reasons why troops were sent to Greenland, among them being; a, securing the cryolite rine at Ivigtut-at one time this mine wos the principal source of cryolite (necessary for the manufacture of aluminum) for the United States and Canada; b, securing Greenland against occupation oy theGermans and thus protecting the North American Continent; c, providing airfields tor the ferrying of tactical planes to iAirone; d. providing weaiher stations and weather data; e, providing AACS facilities, a. and b. have been eliminated and a reduction of troop strength has been effected t! is summer as a result, t . The medical mission has been to provide care for these troons. In addition* to furnish hospital facilities for the Greenland Petrol (Coast Guard Vessels), Naval ships, merchant ships and employees of the civilian contractors, ilia was terminated early in 19AA but at one time there were 3200 civilian employees at the various bases. In caring for the troops, A hospitals were provided at the A main bases. In addition, an enlisted man of the Medical was provided for ei ch cu the outposts and at 5 of the larger outposts (3 now abandoned) a medical otficer was provided. At present only one outpost, where there is an emergency landing field has a doctor, Medical protection was provided for several small expeditionary forces stn to the northeast coast of Greenland to eliminate German weather stations. 4, bodies .1 sItuat Ion a, Hospitals y • d oil ,h; nterV5' I'1' ' r 1 (pOT '■ -40° > ■ ■ ore) : ' \ j arc i t T . iluiv is hot an.' cold running water In Uie main building onl , also In in outside Ifit: Lne for the enlisted men op the letaohment* This rater is him led in tank trucks to the inside tanks in thes< b : 1 1 s, In seven cold there have «on t’.moc when the water has frozen. There Is no scwng( system but chemical toilets arc used. Honey Wagons* drain these daily but r-vi’n in severe cold there in dif- ficulty with freezing. One warehouse, at the hosnital, is boated, Another, 9 miles away, is unheated. The first troops reached this location 7 October 1941. A small hospital was cormleted at the ’ort area 10 December 1941. The airfield was to be built 9 miles away but the head of fjord was so shallow that boots could not go any further. So, roads had to be built, from this nort area where all sup lies and building materials were landed, to the main camp and airfield site. The 190th Sti tion Hos- nital was activated, Ocotcmber 194.2, An elaborate, 200 bed hosnital was to be built at this 1 ort area and 7 or 8 br.ilHin *s were actually started. Corn on sense nrevailed and an. II t mo moss hall at the airfield was converted into a hospital of 50 beds in the summer of 1943. This was occurred 22 September 1943 and the old U.S.L.D, Hosnital at the Port area, (also a converted mess hall) was abandoned as well as the new construction that had been started. 29 September 1943 the T/0 w s reduced from 200 b d to 50 bed, 1 July 1944 the T/0 was further reduced to 25 beds. Cost of hosnital >632,000. At present 25 beds are set up but by using the other buildings available up to 100 beds could be set un. The highest census was 87, During the winter (1943- 44) the average census was 30-35, summer (1944) 15-20, (4) The 191st Station Hosnital, at A.P.0, is located about ■£. mile from the airfield, away from the main camp, on the lower slope of a mountain over- looking a lake. The drain well. There are 4 buildings, 3 of them con- nected by corridors that are noorly heated. Those buildings are all insulated modifications of the regular cantonement type hosnital. They are heated by spaced oil heaters. The heating is adequate. There is hot and cold running water in the hosnital, also a sewage system. In cold weather, (below-15°) there is some- times trouble with nipes freezing. There is one heated warehouse. The T/0 was set up in Sentember 1942 as 150 beds. On 17 July 1943 the T/0 was reduced to 50 beds. 1 July 1944 it was further reduced to 25 beds. The greatest patient census has been about 35. Avera e winter census (1943-44) was 10-15. Average summer census (1944) was 5-10. Un to 100 patients could be ac- commodated easily. 25 beds are kent set up. The first troops reached this location 2 November 1941. Shortly after a smell U.S.E.D, hospital- was set up. This was taken over 26 June 1943 by the Greenland Base Command (ASF), Cost of hosnital .>446,000, b. Professional Service XT)Surgery (a) Evacuation 1, Patients come to the 188th Station Hosnital by nost Inis Or by ambulance. If they are being evacuated from other parts of Greenland, they come to this nost by air or boat, as the other hosnitals evacuate to the 188th Station Hos- pital, ere evacuated from this hosnital to the Unted States by air mainly, but sometimes by boat, 2* Chest wounds are the only snecial problem in cases evncui tod by air. No chest injuries have been evacuated but one soontanoous pneumothorax was evacuated and oxygen (by mask) was furnished and a canula placed in pleural cavity so that air could be withdrawn in case of dyspnea at high altitude. 2» Ocoas' (>n. M y ncc'd< nts oc-ur In the nonnia’ns nnrroi;nM ’n * the ■ 'orl.n • r ■■ n • ; nd ir- i:• i, ■ Evacui ’ n by basket litter Is Laborious Mid two o ii. ni in • duo to the rue r d terra In# livacuoti on froi any pi rt of Green- land ir froqru nbl.y d< Utyc.d lx cm no of ?•ly to this commend. The only battle caS' ualtieb seen arc air evacuees from ii.T.t, to United Htati s, (d) Snecific Tyn»s of Wounds; 1, Gomnound fractures comnlic? ting oxtrer ity wounds have been infre- quent 2. 3i-malleolar fractur* s of the ankle hi ve been most common and are attributed to the rugged terrain, Fractures of the lower 1/3 of the filmla are next most common. Fractures of the shafts of long bones have been infrequent 2. Ho peripheral nerve injuries seen with wounds, L* Ho major vascular injuries complicating extrei ity wounds seen, 2, Ho chance for soecial observation on types of wounds of the chest abdomen and head, (e) ’lasma ; The supply is adequate and easily available. There have bee no reactions, (f) Whole Blood: On the infrequent occasions that whole blood has been used, the donors wore obtained from volunteers vn the org; nization, The blood can lx) stored for a short time in refrigerators or during the winter on'the outside There has been one reaction, with temper-ture of 106,4 three hours after tronsfusio His temperature was normal the following day. It is our observation that plasma is as*efficacious for treatment rtf shock as whole blood, (g) Specific Infections: 1. Gas Gangrene—Ho cases seen, 2. Tetanus—Ho knowledge of any case, 2» Amebic Hepatitis and abscess—One case of liver abscess hos been treated. Stool examinations were negative for parasites and the petient was ev- acuated to United States for further treatment. Ho other snecific infections. (h) 1, Sulfanilai ide powder is routinely used loo; lly in compound frac- tures, deep 1; aerations and intra-abdominally in sunnurative cases. The results have been good. This is supplemented by oral or intravenous administration in fe- brile cases. In clean c; ses that run a febrile course, sulfanamides art- used gen- erally, These dru-'s hove been very valuable, 2, Penicillin has not been used in the tr r trim nt of gas gingrene. There h? vc been no surgical infections at this hospital this year. (i) Special Surgical conditions: 1, Trench foot--No cases seen. Immersion foot: sixty-five casts were studied 14 months after immersion following the sinking of a transnort in the icy waters. The average time of immersion was five and one-half hours. Comic:' nts of rest main, numbness of lower extremity and increased perspiration of feet wore common. Plantar ischemia, sunrrficial varicosities and decreased peripheral arterial pulsation of the dorsa is pedis artery existed In a high proportion of cases and was thought to be due to fibrosis of the extremity, sec; ndary to initial inflammatory re- action after immersion rathrr than to sec ndary angiosrv sm. Frost bite is treated by uhe current recommended method i.e, elevation of extrei ity, ice bags, r»rot« cti n, and gradual thawing. We offer no criticism, of this procedure, 2, Blast injuries--No cases seen. 2* Bums; In general these cases ore Ire.- ted by cleaning with white soap, removal of loose skin and application of vaseline pressure dressings. This routine is preferred to other methods in most noses, (j) Anesthesia: 1, The agents used in order of frequency at the 188th Station Hospital ares (a) 56,8% local injection of novacaine (l$-2$} (b) 16,2$ procaine hydorch- loride (spinal) 100 mrs (A6$) and 150 mgm (54%), (c) 6,1$ Sodium Pentothal sol- ution, (d; Cocaine solution 2,7$ (4.) (e) 1,0$ Nunercaine, (f) 0./*$ Ether, (g) 0,2$ Pontocaine (h) 0.2$ Butyn, (i) 16.4$ No anesthesia, 2, Local and regional anesthesias are preferred if the case permits oecause the surgeon can act os his own anesthetist thus requiring less persrnncl. Sodium pentothal has been very satisfactory because of rapid, easy induct’< n, lack of post anesthetic nausea and easy administration. Cocaine and its derivities have been used mostly in LEN&T work. There have been no anesthetic deaths. (k) Surgical Supplies: 1. The TBA seems adequate for station hospitals in general. How- ever, the 188th Station Hospital is in a very separate category. If it were near a general hospital where patients could be readily evacuated for surgery all would be well. However, this hospital1s function is rather unique since it often fun- ctions in the manner of a regional hospital, cases are often referred hare for diagnosis, treatment and disposition from the other hospitals in Greenland, There- fore the TBA for a hospital of 200 beds is not adequate for the 188th -Station Hos- pital to perform its function. However, special items of equipment which were requisitioned were supplied in most cases, 2. No comment 2» Special instruments and supplies not called for in the TBA were requisitioned and received in most cases. (l) Surgical specialists have been available where most needed. The T/0»s are quite satisfactory in regards to surgical personnel. 2» No suggested changes, (m) No criticisms of surgical policies or suggestions, (2) Medicine (a) None of the diseases following have been diagnosed during my stay; amebic dysentery, bacillary dysentery, dengue, filcriasis, hepatitic, leishman- iasis, malaria, schistosomiasis or typhus fever. The few fungus have been epidermophytosis of the feet and sometimes of the hands or other areas. In this climate the ucual "athletes1 foot* is not as severe as in a warmer climate. They have responded to treatment well and I believe all returned to duty. Psoriasis becomes worse as do mild cases of ichthyosis, Several such cases have not responded to treatment have been returned to the United States* One case of meningococcus mengititis (so diagnosed but organisms never recovered) treated by penicillin and sulfonamides, recovered and returned to The few cases of peptic ulcer diagnosed have been tried on diet and powders. Most of them have been returned to the United States as few stay cured any length of time _ _ , , Tuberculosis has been infrequent, only 3 or A cases with a pos- itive diagnosis. All returned to the United States, b Penicillin and sulfonamides have cured all except one or two cases of gonorrhea. These were finally returned to the United State::. There is really no ven (3) Neuropsychiatry (n) Incidence of Neuropsychictric casualties, 1. No figures for battle casualtic s., 2, For the first 6 months of 1944> 4.1£ of all cases admitted to the 188th Station Hospital were neuropsychiatric, (total of 52 cases). This re- presented a number of transfers from the other 3 hospitals. The actual psych- iatric figure for the same tire was 3,2£., For the same length of time the psy- chiatric admissions for this command were 2,3£ of all admissions. The annual rate per 1000 for A,T5.0, #858 (188th Station Hospital for the first 6 months of 1944 is as follows: Jon, Feb, Mar, Apr, May June Psychiatric 11 17 4,0 20 42 25 Neurologic 0 0 22 16 5 0 It Is the concensus that mainly those individuals with predispos- ing factors ore those that breakdown, jj. Officers hold out perhans a bit better than enlisted men but pro- portionately they have 0 bit more freedom and more privileges so shouldn’t have the sense of discrimination that many soldiers complain of, 6, The cases referred to in par, 4b (3) (a) 2 above,.were divided as follows: Psychoneurotics (68.4$ of total) Type No of Cases & Anxiety 15 28.5 Nixed 12 22.8 Hypochondriasis 3 5,7 Psychopathic personality 3 5,7 Hysteria 2 3,8 Neurocirculatory asthenia 1 1,9 Psychoses (7,6$ of total) Schizophrenia 1 1,9 Paranoia 2 3*8 Manic depressive 1 1,9 The rest were neurologic cases. There ''ere no true ’’exhaustion” cases. % < -• A'r lu v*h. of ire or. I?'.ml frou July 1 19/,* to July 1 19/,yf ‘U,r< 'V,.' UX' 'V' * °* ' }w,'r>v.' Court !; ‘ibis, /, 3 inert;. 1 Court 1 art iuln, “ ' ' ' n I m . or *c f suapec I self inflict* >1 i! Hi ' l t ■ i r ’• ;; liri'Vi'U, (*0 : L' ' nt rue. r-nor i tl >'*n of u< iu* oppyc!» i;;trie c- ,y , **• 1 01 'syebone;?, 10 of' the nsynhonrurotics and one ' 1 ror< rt t\ m< : to th< Uni tod . 11 r. ho < x u rionce —• vj<'ii:' i.v a, ivnp;nirnncc, psyc} lotherr.ny n«l on cup? Lionel * d, 11 turn 1 uty, « he v< u jed no jroi p ns rcho— *■' v ■ ' '• such 'lot • p< t l< i t i’ s to th© h< . tal theatre, orientation lectures] and reconditioning classes with otlu r tynos of' pi tionts, it* Hu-w lr. no neuropgychiti trie reconditif ni ng center in tills command 0. 1 hi re Is no •!onand Tor ”lb ited service” personnel but In so far ! s possible men in this former classification are used rather than being sent liack, (c) Dynamics of Neuronsychiatric cases, • 1*. There is no corniest in our area. Practically ev« ryone ./outs to go homo. Many men and some officers can not see ; ny reason for their being long in Greenland since the war is going so well. All nersonnel belli ve that troop strength could lie reduced further and that maybe they will be the lucky ones to profit by such a reduction, A sense of duty keeps most individuals going and is quite evident from ooroorals on up. No esnecial anger against Germans, many would like to fight against the Japs, Not many officers or men exhibit much spon- taneous aggressiveness, Perhaps this would change in a more active theatre. Telling why”, in my oninion works much better than giving orders arbitrarily, 2» No mass nanic or group fear reactions recorded, /k. I!d say that the majority accent the idea that every one is afraid in certain circumstances. The only enemy propaganda we are exnosed to are German broad- casts in English, I don*t think it has much or any effect, except possibly ■in- crease homesickness, 6, Most officers and men that I have heard exnress themselves are rather bitter and antagonistic toward strikes. Much of this is automatically laid against Labor, The General opinion is that Labor (and other grouns, as farmers management, etc,) have been selfish and have profited financially even to slowing and impeding the war effort. Many of the enlisted men feel that the country "owes them” nlenty to make up for this and intend to ”do something” about it when they can. Much of this is undoubtedly just talk but there is a decn seated resentment against strikes and a firm conviction that in cash and benefits the country con not do too: much for them (soldiers). The former American Legion rctivitifs may look small cor pared to the future demands of present soldiers, 2. Most tactical troops h; ve been removed and there is no com- bat, However, I think there is some talk among the troops about neaco terms. Few have any definite nroposals or even much knowledge of the complexities of making a lasting peace. The few ideas I hive heard h: ve been for harsh and drastic treat- ment of both Janan and Germany, so is to prevent rny possible recurrence of another wqr with them. There has been a little loose talk about an Inevitable” war with Russia, 8, Admiration of the Russian fighting qualities is g. nernl. Also rather general approval of letting Russia deal v'ith Germany after the war. The British are accented rather as a matter of fact and not too warmly. a few feel that the British are using us for their own Kmnire building. Churchill In 'i in i*!i ny /.i iji li*i i ‘, iM r i; >s i • ire' t ;; S l,nl m, Cana?I;. ? 1 ,< ’ An n’t* *a.l.ia * ■< m !.d in 1 ore < nt< < r than l,he . ‘.r 11, ‘ ah, nee .* n>! < l.h- r noun tries r< nrtt 'i ci see d 1 inch ■ r 1 Mbs, V[, Al l. p« rso n< I in Greenl, nd <• n convinced th? 1 r« rv" ng the re subj» cts I- i in to nnurir 1 mental tr» sr : nd r.tra ‘ n, I'm;/ • re In ro o< cl‘vf l.y on Du outlook ’or 1 ooottjJ 1 ' i' n in th< 1 :?1« v< s and ; 11 ; re 1 ore tl an usu/ lly alert iji detect In pt cul.i; rvlli n I n otlu re, l,.uch jokin' in. done • 1>m t tW tut it 's not .’VI in llu so.ir't of fun. The -eM-ral .* ttltvde to a neuroosychi; trie p<* I i ( nt in n 1 ,ni l.hetic -.nd he Infill’, w rhaps x o/mn many , ,, rell It could h; ve hnivn ned to mc " • Thin in < v< n •< *1 ct< d In the doc torn, root of thorn giving the non Die benefit of the doubt in va ne cot nlainto* Although 1 t v; go to the otlu r extreme end think qvi te often ?l 'oldbi-icks11 take 1 I vent rc of the ryrr. pathe- tic attitude toward neuropsyebiat *ic problems, (/,) K< pond 1 tionlnn. • fuJ In' our hoc •••it? Is only 2 h; ve Inrt’tuVd : roconditie .ring program, the 188th Station Hon ital ?nd 190th htrtV n Hoc*ital, 'he other 2 he vc inform; 1 programs hut the* number of p; Hants in the se hosnit; In liave not ;juat ified a forne.il program. I have f* It that the nr op ram h; s been handled adeq- ua teily. (b) Physical rccondittoning in started -./bile the patient is still confined to bod in the l-18th rtation Hon dial. All of the. answers be low pertain to this lion dtal, (c) Adequate attention is given to corrective exercise chirr ctcd toward restoration of function of a disabled part, (d) Ph sicel training in progressive so that when a oatient is discharged to duty lie shoi Id lx" able to resume -full duty that day. (e) Library facilities ere available in the hospital, (f) There are no educational classes conducted except orientation, (g) We do not keep patients long enough for the U.S. Armed Forces Institute Courses, On this nost (A,”*.0, #858) the orientation officer estimates that perhaps AOf of the men are interested in such courses and that almost 5'^ are taking come courses now, (h) The d iversional handicraft program of the Red Gross has been suppleme nted a bit by ad V.ng a small carpenter shop, I think the pro-ram is adequate for orthopedic and neuropcychiatrlc patients, (i) From 1 Janurry 79/+3 to 30 June 19d4, inclusive, 3695 p* tirnts were admitted to the hospitals in Greenland, ’•’ere returned to duty. Of those returned to duty, I'd estimate perhaps 2rfi hod participated in a reconditioning program. The2 formal programs ./ere not set up until this ,rear. Prop' now on lOOg of the patients in the 188th Station Hospital and 190th Station Hos ital will participate, (j) The patients really seem to enjoy the program, (k) An unused ward lias been convert'd in to a -"(con itloning v/ard. (l) The program is sup* rvised find operated by 1 medical officer, 2 fei f 1c Red Cross Workers and. 1 enlisted man, all well trained, (1 ) (n) c: (o) There are no blind or deaf casualties. No pro- virions are made for such cases or any need. Such cases would be promptly evac- in ted to the United States, (5) Dental (a) Dental supplier r nd equipment have been satis Tdory and ade- quate (b) Replenishment requisite ns for dental equipment /ere received when required, (c) Two of the hospitals had medium facilities for making pros- thetic dental appliances, one, the If8th, lias excellent Vci itics, (d) True Vincent's Stomatitis is rare in Gremlanc . < 1’ the per- manently stationed personnel we have had about 18 cases of a v< ry mild type, in the jpast year. Hospitalization was not necessary for any of the cases, bTien transient personnel increases there is always a slight nick up in a very mild form of Stom- atitis, No severe cases were encountered, A conservative method of treatment was fol lowed, No instrumentation at the first visit, mouth cleaning and spra;d.ng with mild antiseptics and a dye, usually Gentian Violet applied freely and the pa tic nt instructed in home care, mouth baths of peroxide and perborate alternately. At the second or third visit the teeth are scaled and chromic acid 3% used at the d~ied 1 gingiva. Mouth baths we re continued and patient watched for a period of 10 days, (e) Of the total injured military personnel .001$ had fractures of the maxillae and mandible. All of these were accidents and not battle casualties* (f) One case required a denture and service record Indicated he had i one made, (g) The replacements recently arriving from the States are in much |better dental condition than they have been heretofore. A more careful inter- proximal examination should be made to eliminate the possibilities of extensive "hidden cavities, (h) There is adequate dental personnel in number at present, how- ever, it seems there should be majority open for a Base Denual Surgeon. (1) Replacements for dental officers returning to United States furnished prior to their departure. (j) The promotions from 1st Lt, to Captain was satisfactory, How- | ever, those men who arrived in this area in the grade of Captain had no cliance for promotion as Captain was the highest grade authorized, (k) There was not a sufficient number of dental laboratory techn- i icians, (067) available. Practically all, with one or two exceptions, had to be itrained by the dental officers. (6) Nursing (a) i* It was thought advisable to only obtain nurses for the 188th Station Hospital. If they had been requisitioned for the others, A or 6 Nurses would hove been the only women at isolated bases, I feel that the nursing service was adequate, 2 Or 3 nurses were sent out periodically for 2 or 3 weeks TD at the 3 smaller hospitals. They instructed enlisted personnel in various techniques end it was felt such trips were helpful. A reduction of the T/O of the 188th Station Hospital from 250 to 200 beds did not affect that unit, as pertaining to nursing, as only 15 nurses hod been requisitioned. They arrived in January 19AA* 2* The clothing equipment provided for the nurses was quite suitable for the climate and type of work,* The brown seersucker uniforms have ! proved to be very satisfactory. Our particular group of nurses were somewhot handicapped because only 2 or 3 of them had been in the army more than 6 or 8 weeks when they • were sent to Greenland, As a group they were not conversant with Army Nursing routine nor with customs of the Service, However, they learned quickly through continuing lectures and have adjusted themselves satisfactorily to Amy life and i our peculiar position* % 4. There was very little loss of time by Nurses because of I illness* , . 5 There are 'no rest camps for Nurses (or other personnel; in Greenland. The trips mentioned in par. (6)‘ (a) i. above provided some change for the Nurses making such trips* . ' _ . , , . , . 6. The morale of the Nurses was not affected adversely bv work- ing conditions, living conditions, clothing equipment or If ok of recreational faculties. However, the sense of isolation and monotony of the every day life did have a depressing effect. They did not mind the weather, as they all came from New England or northern states. However, the long nights of darkness in wxnter onii no c.arkness in sumr. r also caused some alight, depression, r?t times. On the whole, I Teel we have been unusu; I.1 y fortunate in our rrour- of nurr.es as there have been no ra,! or or obi • ns of health, n< ntul conditi'- ns or conduct, I would say their i orcle hi s en rener* lly good, 7, I would suggest that 'Tester care be exercised concerning the length of service in the Amy before Nurses arc sent overseas, I would also strongly urge the t in our thoat ‘e the nurses be replaced after a year. The 18 months service now expected of all ho Greenland, is not conducive to maintaining a high sti te of efficiency. It would be best not to replace the whole group at once but a few at a tire in order to hi vc less ccnf\ sicn in the nursing service, (7) Veterinary (a) There is one Veterinary Corps Captain for the Command, That is enough for officer personnel but he should have 2 enlisted men, one at AdC 85S and one at id C 859. There is no T/O vacancy for this. The veteriiu ry officer is assigned to Greenland ■3c se Command Headquarters, (b) Sledge dogs and m< our only animals, witli the ex- cention of a few cats, and our diseases arc the usual ones with them. liable s has not been encountered although pseudorabi< s has been reported dogs north of our northern most base, Worm infects V’cn is very common, (c) War dogs not used. The sledge dogs are for rescue oa.rtic s on the ice can. They have not been used very often, (d) There arc no work animals other than the dogs. No food animals raised by or available to the Army, In southeastern Greenland there are a thousand sheep. The possibility of buying mutton and lamb v,as investigated this * past snring. Inadequate facilities for nroper refrigeration in shinning caused us to turn i his down, Ptarmigan are killed and eaten by Army and Navy per. onnel. No diseased ones have been found, (c) No problem with animal diseases, (f) The quality of meat, meat-food and dairy products received from the United States is good. Due to shipping and storage difficulties there is not a constant supnly of fresh frozen neat and eggs. The whole neat received is poorly wranped. Personally, 1 think boned frozen meat is preferable to the carcass meat as it is less bulky, and weighs It ss. The neat, etc, is received in good condition, (g) See (d) above. Since the lamb as turned down, there is no other local meat, meat-food or dairy products available to the Army. Some salmon, trout and cod-fish are caught from time to time. Usually therm is not enough to feed a whole mess hall. These fish are eaten soon 1 ftcr catching by the indi- viduals catching them and their friends, c. Preventive Pedicine (l) Venereal Disease Control Venereal Disease is no problem in Greenland, Before the first troops arrived there was an understanding between the Greenland Adi inistration and the United States that no syphilitic personnel would be rent to Greenland, If they did arrive, they would be promptly sent back. This policy has been followed strictly, I recall sending back a cantain who had only been In Green- land ? days. This understanding was made on the basis that there was no syp- hilis in the Greenland population (according to their doctors) and they did not want any introduced. Gonorrhea is encountered rarely, as all native settlements are II off limits*, except on official business, Occi sional cases develop in newly arrived troops from the Gtat<0, returnees from furloughs or stamen. In the oast year only once case of gonorrlu a has developed In a soldier-tin t was acquired from a m Live women. (?) lor -1 cl o;rv . 4 .. U) This is one or the e hi v< soldi. ,• ,ui th< re lust arn t any prevalent diaoacos. Golds ore not os common : 3 in the United Stat r end the uw 1 expiratory epidemics we have are usually directly traceable Ao the arrival oJ a s Ip or plane movement. Pneumonii Is v re. Under and, this , r- tnlns to the *rmed Forces. The native population has a very high tuberculosis ’A1?* . l> ‘t or ‘jld me that by the t me th< native population reached the aye of 15 all had a nositive tnburenlin test, Since our contacts with tho native population are so few there is practically no danger (b) All required immun^zations are kent np including those of tlio Air Corps• (3) Tronica! Diseases Control This does not apply. (A) Sanitation and Hygiene {"a) There i s no problem of field sanitation as all troops live in barracks and cat in'permanent ness hulls. (b) There is no dysentery. Gastro-Intestinal food upsets are very rare with only an occasional case due to individual indiscretion, (c) I do not know of any cases of louse infestation, A very few cases of scabies or phthirus pubis have been observed, always in freshly arrived troops from the United States. (d) Screening for mosquitoes and flios is done in the hospitals and messes but not throughout each base as it is not necessary. Insect repellents ore available and used, as are head nets, for outdoor activities during about 3 summer months (June, July, August), As nuisances the insects are very bad out of doors. (5) Sanitary Engi necring (a) Water supply sources are primarily lakes that fill in the winter from ice and snow. At A,P,0, i/858 there are wells sunk in the gravel flats near a river from a glacier. There i6no tre- tment of water at any of the A main bases. Sometimes, in the late summer the supply of water may be low. At several of the outposts an adequate quantity of rater is a problem and the water is chlorinated in Lyster Bags, Regular bacteriological tests ar» run on water specimens at the A main bases and no contamination has been found. In general, the water supplies are adequate, (b) Waste di snossl at 2 of tho main bases is by emptying sewage into fjords. The other 2 use pit latrines or chemical toilet? that are emptied into the fjord. Garbage is dumped into the fjord. Trash is burned. The methods used are effective but not ideal. (c) I do not believe it possible to eliminate mosquitoes or flies in the Arctic. I quote from Information Bulletin # 13 entitled ’’The Mosquito and Fly Problem in The Arctic’1, ’’Can these flies be exterminated? The answer is—No, not in the Arctic, The region is too vast. There is too much sliallow water and other favorable breeding places”, I am in complete agreement after living in Labrador end Greenland, True we do not hrve the tundra with its shallow pools in Greenland but in its place we have innummerablc pools in rocky pieces in the early spring and summer that have no drainage and many are inac- cessible to man. In spite of this at several bases and outposts all possible pools of water near the ca’ ns have been covered with oil. The decrease in the number of mosquitoes has been questionable, (d) At no time has there been any Sanitary Corps Personnel on duty in Greenland, At this late date I do not think it necessary to send any, (6) Occupational Health Xa) The Army, N: vy and Coast Guard maintain their own repair shops for vehicles and planes. No civilians are- employed. All loading and unloading of ships is done by the Army and the personnel of the ship. 00 VJhc n the civil ini contractors* > r•» ilnyeos irra pre sent they’had exactly the same t;n>« of medical care; an the Any, dv Any nerron-ir 1 and in Any ’Ion dtals, But as at? ted above the Tart of tl esc left in Februar r 1 944# (7) Laboratori * s \u) I t) ’: nk the la bora ton/- nervier in adequate. However, it would h; ve iron nice to be able to do certain aggli tinat 1on and titre tents. The V w times tills war. necess/ry for diagnosis, it r,ac necessary to send th< blood to the United states, The t'ne involved wan 2. or 3 weeks. Ilov/ev' r, there lias been only one technician in Greenland able of this type of v/ork, f nd he is now gone, (b) The personnel has been adequate for the routine urines and blood counts iTLit not for more cor plicated nroccdurc s, The personnel .has born properly utilized and all except one or two were trr int.d locally by doctors, (c) No complaints about equipment or sup'd ies were heard, (d) We shipped a few specimens to the Army Medical School but not to the Army i edical Museum, (e) Autopsies are done in 100$ of Army deaths. Fortunately, these arc few, (8) Medical Intelligence (a) Lot bong in a combat theatre there was no medical intelligence data coll, cted. There arc 11 Danish Physicians in Greenland and I have met 5 of them. 4 others have been on our b? ses or visited by our doctors. There been close cooperation between the Army Doctors and this '*roup with exchange of ideas. Professional assistance and supplies have been furnished by the Army from time to time, (9) Nutrition (a) All posts are on a field ration. This is a mixture of A and B with C supplementation necessary at times dur’ng the late winter. The hospital rations are the same, with any extras that are available through the Quarter Master or by purchase from hospital funds from ships or Post Exchanges, There is no local source of food except fish occasionally served in individual rnesses,g (b) There has been no evidence of nutritional diseases among the soldiers cxcent rs follows; During the late winter of 1943-44 an armrecible number of mild secondary anemias were found among soldiers who had served over a year in Greenland, No def.nite cause h? s meen found for this. Studies are being mode of personnel returning from isolated outposts after 6 or 8 months of duty. The diet at these outposts is the poorest and most monotonous of any. So far only a few sub-clinical manifestations (soft gums and ecchymotic areas in the skin with the cuff test) of a low vitamin C intake have been found, (c) There is always some grumbling about the monotony of the diet but I,think it is good, all things considered, (d) If possible, more fresh fruits and vegetables would be desirable but this defends a "ref t deal on the availability of refrigerator shirs. In 194-3 several cargoes of such foods had high want e due to poor packing, insufficient air curcvlation, faulty refrigeration or time necessary for the vo^rage, (e) The hospital diets have of necessity been very siniliar to the field ration and the r» gular overseas hospital ration has not been available. The light, liquid and special diets for the hor itals have been adequate, d. Medical Equipment and Supplies ITT Medical Maintenance Unit not used by this Commt nd since nugust 943* the last part of any ’xnng received in February 1944* (a) Items b. low contained in Medical Maintenance Unit lu ve been found to e in excess of our needs in a non-combatant area arter the first pew units were received. Field Dressings Abdominal Packs Alcohol 5 end 5A Gallon Glycerin Magnesium Sulfate, A and 50 Lb. Naptholene Flakes Oil, Ca stor Oil, Cod-Liver Oil, Cottonseed Bandage, Triangular Cotton, Absorbent, and Batting Gauze, Plain, 100 Yards Packet, First Aid Plaster, Adhesive, 1 Inch Plaster of Wadding Sheet Stockinette Applicator, Wood Balkan Frame Rope Cup, Paper Pin, Safety, Large and Tedium All of Class #9 Petrolatum, 1 and 10 Lb. Petrol;.turn, Liquid, Heavy, Gallon Powder, Developing and Fixing Protein, Silver, Mild and Strong Soft Soan, 1 and 25 Lb. Sulfathiazole Tablets Talc, Purified Plaster, Adhesive, 3 Inch Muslin Depressor, Tongue, Wood Gloves, (all sizes) Razor, Safety, Blades Splint, Basswood Stcthosocope Tubing Suture, Catgut, Chromic & Plain, #0,1,2. Syringe, Urethral, Prophylaxis Tubing, Rubber Pad, Prescription Bag, Hot Water Button, Large and Small Clothesline (2) (a) No Anti-Malarial Drugs needed within this Command, (b) Biologicols should be on a requisition basis only and should be transported to destination by air* (c) Surgical instruments and appliances are sufficient for all routine work, but not sufficient for elective surgery or General Hospital work. (d) Operating lamps ere excellent. (e) Sterilizers are good and in sufficient quantity. (f) X-Ray equipment is very good, but extra tubes should be kept in stock in- isolated commands such as Greenland (g) Dried blood plasma is in excess of needs for a non-combatant area. (h) Except for special projects end outposts. Medical kits and chests (except chest 60) are not needed within this Command, What chests are needed should be modeled along the lines of Cose, First Aid (Armed Guard) Medical Depart- ment, U.S. Navv, Stock Number S2-510. (i) Pole litters are in excess. Anesthesia apparatus of the Heid- brink type is not liked by some doctors. These machines were not used much in our Command. (j) Field dressings are not needed. (k) Tentage is not needed or used. (l) Generators and electrical .apparatus is good. (m) Tables are in sufficient quantity, (n) Field equipment not needed after first few months, (3) Quinine supplies have all been returned to the United States, (A/ Packing lists of complete contents of each container should bo nlaced both on the outside and inside of each container so that they will be available to the receiving office. A consolidated shipping ticket should accompany each shipment. Each shipment should be stored as much as possible os one unit. Med- ical Maintenance Unit should not be divided into loss than one-half a unit and items that have lost their usefulness by this cut should either be excluded or not cut at all. (Example; Once we received one foot of clothesline in a fractional shipment, this was useless for all practical purposes.) (5) Spare parts Id be included on all itemsthat have a short life span. Rusting has not a problem. (6) Optical Repair Unit is not on hand nor is there need for any 5. Observations. Data and Recommendation a. I recommend arranging a t/o for the 3c se Command I odical Detachment providing in numbers and by ratings for E.M, for out most Rity and clerks for the Base Surgeon, 3? se Veterinarian and Base Medical Supply Officer, b. l ore extensive ori( ntetion sorvj.ee for all personnel psrticul* rly needed since the war in Europe is going so well. The need for come to stay In Greenland should he brought out because everyone is thinking of going hone. c. Nurses shoi Id only serve in Greenland one 'rear in my opinion, d. As soon cs possible tr ing to establish a or/ year tour of duty for oil pcrromel - particularly needed in connection with b above, e. I.ore careful selection of nurses to go overseas is needed, I don11 think it wise to send them overseas with only 6 or B weeks service in the Army as our group was, .> f. Extra X-Ray tubes should be provided for isolated Commands where there is no r edical utvly denot or sub-depot, g. I would sug est considering the case. First Aid (Armed Guard) Medical Dent., U.S.N,, Stock Number 32-510 as a pattern for medical kit for small isolated outposts, as weather stations, etc. h. A better system of sending racking lists with shipping containers should be devised. The outside list is often torn off, a duplicate list could be put in each container, i. It is suggested that a consolidated shipp-' ng ticket be sent with each shipment, j. It is also suggested that Medical Maintenance Units not he ivided into It ss than -J- a unit. k. It is recommended that numbered station hospitals in semi-permanent buildings be permitted to requisition complete dental units and not be dependent on chest 60 alone. 1, I would like to state here that the E, T, I ,D, report is one of the best reports we have in the field. We feel that it is the one report that is really read and tlirough which action can be obtained. m. In conclusion, I would like to surest that come one from the S.G.C , visit Greenland and other isolated commands (it nay Ixj other commands have heen visited but Greenland has not) from time to time. Reports can he submitted and read indefinitely but a true picture and a subsequent understanding o'f the pec- uliar situation, difficulties and problems can not be re: ched without actually seeing the places in question. OTHO R, HILL ' Lt. Col. r.c.