 The life of a family physician is intimately linked with the lives of his patients. His source of medical supply is close at hand. Nearby, the community hospital is well staffed and ready to serve. Many trained technicians in all manner of medical supplies and equipment are available. All of these elements are simple links in the personal chain of doctor-patient relationship, whether for a common cold or a major operation. But in time of war, the patient of civilian life is replaced by the casualty on the battlefield. The role of the physician and his aides materially change. Intimacy with his patients is neither prolonged nor continuous. From the moment the casualty is wounded, there is, of necessity, a continuity of medical effort. Personnel of the medical service will administer too many casualties, but usually only once to a single casualty. Along the well-organized chain of evacuation through which he passes. To provide adequate medical attention to members of the armed forces, large numbers of medical personnel are involved. A doctor becomes a member of a military team of doctors, nurses and technicians, each of whom may contribute but briefly to the care of the individual casualty. It is not surprising that a wounded soldier who may have been moved and treated five or six times from the battlefield to the general hospital would find it impossible to say who his doctor was, or he would have had many. To better understand the difference between medicine in the civilian community and in the army, we must visualize the amount of planning that is required. All of it must take place under a blanket of secrecy, since the success of any operation will be influenced by the element of surprise. Let us suppose a task force, an organization of army, navy and air force troops, literally thousands of men, has the problem of preparing an attack upon this area. Long in advance of D-Day innumerable questions must be answered. What military training will medical personnel require, such as physical conditioning and combat conditioning? How will these units operate as members of the armed forces team in combat? What specialized training will be required for such tasks as mosquito control? And the dusting of civilian populations to control louse-borne diseases. The testing of water for chlorine content. Then there must be training for the care of casualties in the field, as well as instruction for treating all types of serious wounds. And the handling of casualties over rough terrain. In addition to the training of personnel, many other aspects of medical service must be anticipated. How many hospitals will be needed? Where will they be set up? How many beds will be required? What will be the number of casualties? How much medical supply will be required? What is this new area like? What are the endemic diseases? What immunization steps must be taken? The answer to all these questions can be summed up in one word. Planning. And every page that has to do with the myriad plans of the staff will carry the vital warning, Top Secret. This Joint Task Force staff, including representatives of the Army, Navy and Air Force, meet to consider a directive that has been received. Ladies and gentlemen, the United States Joint Chiefs of Staff have directed a theater of operations be established. The Mid-Oceanic Theater, our force will be known as Task Force Flower. The initial operation in the campaign will be Operation Seagull. Task Force Flower will, by joint amphibious airborne assault, invade Black Area in order to establish facilities for further advances against aggressor-held positions. It is ordered that this staff begin immediate preparation of preliminary estimates together with the concept of the operation for Seagull. General Brown, the Chief of Staff, will give you further details. Attention! The Chief of Staff takes over to describe and detail certain aspects of the operation. Gentlemen, to begin with, I will show you the organizational scheme upon which, initially at least, the operation planning will begin. You will note that we've followed the typical Task Force organization. We will have Jays 1, 2, 3 and 4. Present at the meeting is the General Staff, J1 personnel, J2 intelligence, J3 operations, J4 logistics, and the Special Staff, the Task Force surgeon, ordinance, transportation and quartermaster officers, as well as the signal and chemical officers and the engineer. The objective is this section of the western coastal area of the aggressor-occupied territory. The aggressor's troop strength is estimated at 400,000. We expect further information on these forces from J2. Now, here is the information you've all been waiting to hear. Oh, gentlemen, it'll not be necessary to take notes. All of this material will be handed to you at the close of the meeting. Now, what is to be the size of our force? Gentlemen, Task Force Flower will have available for the establishment of the theater the following combat troops. Three field armies, two task fleets, three air forces. He explains that during the assault of Operation Seagull, one Army reinforced corps will be employed. This will include infantry, armored and airborne divisions. He then lists the Navy complement, a fast carrier force, submarines, hunter-killers, logistics support, an attack force, and a troop transport group. As for the Air Force, the exact number of wings is already known, including heavy and medium bombers, fighters, and a troop carrier wing. And even at this early stage of planning, there is a chart of theater buildup from D plus 30 all the way down to D plus 360. All of this information is of vital importance to the Task Force surgeon, General Cross, whose job it is to conserve fighting strength of all personnel involved. With a final total of well over a million men, training areas for these troops will be located as follows. Pennsylvania, New York, and the New England areas. Others will be in Virginia, South Carolina, with Louisiana and Texas, making up the remaining areas. Amphibious and airborne training will be staged at Panama and Texas, respectively. Bases for departure will be from ports of New York, Norfolk, New Orleans, and Panama. All planning details are embraced. For planning purposes, the staff will base its computations on an estimated timetable as follows. Today is D minus 200. D-day landing. D plus 15. Port captured. D plus 45. Port facilities restored. D plus 90. Operation Seagull terminated. We will then have an advanced base for future operations against aggressor. However, gentlemen, in resisting invasion and in counter-attacking, we can expect the enemy to employ all the tricks of the trade. Every known means of waging modern warfare. Consequently, our plans must include defense against biological, chemical, and atomic warfare. These three monsters of modern warfare are of direct concern to the surgeon, General Cross, for he must estimate what they will demand of the medical service in the way of men and equipment. Protection from common diseases and treatment of wounds are still the basic concern of the Army doctor, but are no longer his only concern. Ever since World War I, gas masks have been effective weapons against gas attack. But the possibility of masses of troops becoming non-effective from disease, endemic, and native populations could result in disaster to the entire operation. General Cross speaking? Oh, yes. Yes, right away. Now the wheels begin to turn. Again and again, members of the staff will meet informally to exchange information which will enable them to coordinate their plans. J3 is at the first of these meetings in the office of General White, J4. Yes? General Cross is here. All right, have him come in, please. General Cross, so that the quality of building materials necessary can be determined, would you give us your estimate on the number of fixed beds to be constructed in the objective area? Very well, General White. We're now on fixed beds as soon as we arrive at the evacuation policy. According to the chief's estimate of the kind of warfare we can expect, biological, chemical, atomic, the requirements will be higher. Tell me, General Strong, what troop ceiling are you assigning to the medical service? For Operation Seagull, General Cross, I believe 3% of the total strength will be allocated to you. 3% eh? Does that include Navy and Air Force? Yes, we are planning that Navy will handle all sea evacuations. The Air Force, all those by air. But hospitalization for the entire task force will be furnished by Army Medical Service. A large order, General White. A large order, General Cross. Good afternoon, Colonel. General, have you had lunch? Yes, sir, just finished. Good, so have I. Sit down. Thank you, sir. I wanted to have a word with you before the conference about the communicable diseases that Task Force Flower will run into. Yes, sir. I've been doing some research on that. Oh, by the way, General, you remember Dr. Whitney? Oh, yes, isn't he the public health officer who spent some time in the area of Operation Seagull? Yes, sir, that's the man. Well, he's working now with General Green in medical intelligence for the Department of Defense. Oh, I see. The general and I were at his house last night to see some films he'd taken down in the area. He's quite a character. He brought back a lot of native curios. Odds and ends of weapons, artwork, things like that. You ain't even fellas picked yourself a Godforsaken pest-hole to attack, I suppose you know that. Well, he certainly should, Dr. Whitney. Colonel Darker here tells me he has enough fingers to count the endemic diseases. They're toes, either. I'll switch off the light, General. Oh, I'll get it. Oh, sit down, Bill. The general's got to get a little exercise once in a while. It's all right, Doctor. No fancy titles, words, or music. So I'll just gab right along with the film. This is about how it's likely to look from the outside going in. This wasn't from our boat, it was from the mail boat. Yes, it's a typical tropical paradise where the mosquitoes are as thick as... Well, the hair is on your head, not mine. Dampness, vegetation. You'll find the anatheles, of course. And malaria is endemic. I'll give you some idea of how high the trees grow. We had to keep boys with machetes constantly clearing around the station. These people live back in the high country. You couldn't put your finger on a Karnsarn native who wasn't lousy, body lice, and the entire population. What about typhus, Doctor? Half the patients we treated had the fever. Epidemics of smallpox often decimate entire villages. But fortunately, there's not much travel between villages. It's too difficult. Travel means but one thing, walking. Would you class smallpox as a major health problem in the area, Doctor? No, we did some vaccination, but it's still a major hazard. This is back on the coast again, the native marketplace. The rat population is extremely high. And it's in this area that you run into sporadic outbreaks of plague. What about water? We used rainwater. We even chlorinated that. For you fellows, it'll be a huge problem. But water supply is extremely dangerous. But diarrheal diseases. That's what's likely to demand your constant attention. Venereal diseases, Doctor? I'd say 98 to 99% of all prostitutes in the area have venereal disease in one type or another. Yes, there'll be many opportunities for contracting VD. But fortunately, I understand today's soldier is a little bit fussier than the old army. Doctor Whitney, you said before that half the patients had typhus. What about the other half? Smallpox, typhoid, dysentery. I see. Yes, gentlemen, you are looking at a hellhole without a name. To this place, add men and guns and, well, get all the supplies you can. You'll need them. Well, that gives us a lot of information. Oh, by the way, we'd better get over to my office for that meeting. Yes, sir. I've been funny busy. Good afternoon, gentlemen. Good afternoon, sir. Please be seated, gentlemen. This meeting is for the purpose of informal discussion of certain factors that should be considered in the planning of Operation Seagull. General Banner, as personnel, I want you to provide and screen out in coordination with the Surgeon General's office the most highly qualified professional personnel that can be obtained. Yes, sir. I'll contact personnel division in SGO immediately. Marek, as plans and operations, you will supply a troop list with a breakdown of medical units for the assault and follow-up forces based on 3% for medical troops. 3%? Is that the limit? I know, Colonel Marek, but 3% is all that we've been allocated. Very well, sir. Colonel Diker and I have already discussed the preventive medicine problem, which I must say is a very serious one. Affecting you, Colonel Jacobi, as supply officer, you will have to provide the additional material required as a result of the various diseases endemic in the area, of which there are many. Yes, sir. I'll discuss the situation with Colonel Diker. What about water? Polluted. All our supply must be purified or brought in. You'd better consult the engineers on purification and take up your problem of water supply into the beachhead with Captain Pearson. We'll do that, sir. Also, we'd like to know about additional supplies to be brought over the beach in amphibious shipping. Colonel Jacobi? Well, we'd like to have each LST carry one medical supply unit to include blankets, litters, splints, dressings, and plasma. For Cross, I'd like to have Colonel Marek give me his plans for moving casualties to the airfield for air evacuation. Army will establish holding companies as near the airfield as possible for the delivery and loading of patients. Air Force will be responsible for care and treatment in flight. Jacobi, what plans have you made for property exchange in air evacuation such as blankets, litters, splints? Dumps will be provided for these exchange items and such items will be replenished as they are used in the transportation of the wounded. In that connection, aircraft going forward to evacuate casualties will, whenever possible, bring these items for replenishment to the dumps. Fine. And now one more thing. Colonel Banner, I know you're aware of the high rate of disease in the projected theater of operations. Because of it, and because of the possibility of biological warfare, I want you to consider the necessity of supplying additional preventive medicine personnel and other specialists. Very well, General. Colonel Diker and I will get together. Any questions? Very well, gentlemen. That is all for now. I will expect your preliminary estimates next Monday at the same time. Good day. Many conferences and many hours of study are necessary before General Cross and his staff are ready for the next meeting. There will have been much research for upon the consideration of all factors affecting the health of the command will rest much of the success of Task Force Flower. All published data must be scanned. All established doctrine and policies will be reexamined and restated in the light of this specific operation. Night and day the planning goes on, for the overall study will take much time, many minds, and many hands. As the work progresses, reports pile up, all pertaining to the answers to these questions. How can sickness be held to a minimum? In the event of an epidemic, how can we prevent disease from destroying more troops than bullets ever could? And how can we best care for casualties as they occur? Finally, all the massive work of the surgeon's staff will be interrelated. It is for this purpose, gentlemen, that J3 and I have called you all together and presented the logistic plan. This completes a general outline of the administrative plan. We will now hear from the various technical services beginning with the surgeon who will present the medical plan. General Cross. By definition, our mission is to provide medical service for Task Force Flower in Operation Seagull. In support of Task Force Flower and during Operation Seagull until it is terminated on D plus 90, all general type hospitalization will be located in rear-based sections of the communication zone, Mid-Oceanic Theater. In Puerto Rico, there will be an allotment of 4,000 beds. In the Canal Zone, 2,000. At St. Thomas Virgin Islands, 2,000 beds. In Jamaica, 2,000 beds. Subsequent Operation Seagull hospital facilities will be constructed in the objective area. And together with other areas available, we will have a total of 91,500 beds by D plus 360. As a point of information, I might say here that air evacuation will terminate in Puerto Rico. Yes, medical planning at the Task Force level includes broad outlines for the future care of a million men. Such a plan must define responsibility clearly and retain flexibility at all times. The Army will assist ship personnel in providing medical service while en route to the objective area. Provide medical service to all casualties in the beachhead or airhead, landward of the High Watermark. Deliver casualties to holding units convenient to airfields, and load casualties aboard aircraft. The Air Force will provide medical care from the time casualties are loaded until they are unloaded. They will make available transport type aircraft returning from forward areas to evacuate wounded unless the military situation prohibits such action. The Air Force will also deliver whole blood and biologicals to the objective area as required. Navy Force Flower will provide medical service to all casualties delivered to beach party medical installations. It will furnish evacuation ships and small craft for transportation of casualties to hospital ships. The Navy will also equip certain craft to the amphibious force to transport and care for casualties from objective area to designated ports in the communication zone. General Cross then takes up the problem of preventive measures. The next chart I wish to show you is the immunization chart. Notice that all personnel will be immunized as indicated. Tetanus D minus 180. Smallpox and typhoid D minus 120. Yellow fever and typhus D minus 90. Collar D minus 60. Plague D minus 30. General Cross, are all of these immunizations necessary? For example, does the threat of plague actually exist in the objective area? Yes, it does exist there. Available medical intelligence indicates that plague, as well as typhus and malaria, are endemic throughout the entire area. Thank you. Malaria's suppressive therapy will commence on D minus 5. Each individual will be issued insect repellent, foot powder, mosquito bar, and water purification tablets. Insect and rodent control measures will be initiated. There will be a careful screening of mess personnel to eliminate possible disease carriers. This completes a description of the preventive medicine measures. Now let's have a look at our evacuation policy. D to D plus 5. All casualties will be evacuated from the objective area. D plus 5 to D plus 30. A 15-day policy of evacuation. D plus 30 to D plus 120. A 30-day policy. This is the termination of Operation Seagull. And then from D plus 120, when a 90-day policy will be in effect, to a maximum of 120-day by D plus 360. Only those casualties capable of being returned to duty within 120 days will be held by the theater. In the case of atomic enemy attack, casualties will be held in unit areas and have medical personnel and facilities available until this headquarters issues a supplemental evacuation directive. This is in order to avoid swamping the patient load capacities of hospitals, which will unavoidably be overloaded in the event of atomic explosions. In such a situation, casualties remaining in unit areas will receive far better medical care than could be obtained in badly overcrowded hospital installations. As to our hospitalization measures, in the objective area, there is one building suitable for conversion to our hospital, housing at least 1,500 beds. We estimate that this hospital can be placed in operation by D plus 45. Ask the mama, General Cross. Yes, General White. How do you propose to do this conversion? Have you consulted with the engineers? The engineer section assures us that the job can be done by D plus 45. Yes, that is correct. General Cross provided us with a blueprint of this building. No construction material will be necessary except for minor modifications in the plumbing. Very well. Carry on. Having established the coordination of plans with the engineer, the surgeon now considers the vital matter of hospital construction and availability of beds. Hospital construction will be programmed with varying degrees of permanency, from flawed tents to semi-permanent construction. Construction will begin by D plus 30, based on 7.34% of the entire theater's strength in fixed beds to be available for operation if required by D plus 360. General, 7.34% in fixed beds seems a little high to me. Can you justify that figure? I'll let Colonel Matic answer that question. Colonel Matic. If we calculate on the basis of 7%, there will be insufficient beds in the theater to hold the patients who will accumulate during the 120-day evacuation policy that has been recommended for the theater. Now, it's possible to reduce this percentage to 6.8% if we reduce the evacuation policy to, say, 90 days. But in doing that, our losses of experienced personnel to the theater will be excessive. Very well. We'll plan on a 120-day policy with 7.34% in fixed beds. You may continue. In the amphibious phase, medical supplies will be packaged in waterproof containers and be so marked. Navy will deliver to the beachhead one exchange unit of medical supplies containing bandages, splints, dressings, and plasma. The surgeon goes on to discuss resupply, supply level, buildup, and property exchange. And so goes the planning, month after hard-working month for a solid, grueling year in every branch of the service involved in Task Force Flower. Finally, the planning is behind us in the wake of the first ship to head for Operation Seagull on D-Day. And now, men, medicine, and machines combine to meet the aggressor on his own ground. Fighting men are alerted. This is the hour. All of us in the medical service that there will be well-trained medical personnel, proper facilities, and ample supplies. All of this for a single purpose. To conserve fighting strength.