Origins and Development of the Portable Surgical Hospital

Soon after his arrival in Australia from the Philippines in February 1942, Col. (later Major General) Percy J. Carroll, the chief surgeon of U.S. Army Services of Supply (USASOS) and also the U.S. Army Forces Far East in SWPA (1942-43), had to face the realities of waging war in this primitive and hostile theater. The long distances, wide geographic dispersion of the Army's ground, air, and service forces in SWPA, and the rugged geographical features challenged the existing concept of the chain of evacuation and required a different approach to the location and use of the major mobile and fixed hospitals.  Accordingly, Carroll split the surgical and evacuation hospitals, which varied in size from 400 to 750 beds, into smaller units that were more mobile and better suited to supporting small units then scattered throughout Australia in anticipation of a Japanese invasion.  

Looking beyond Australia to the ground combat units then flowing into the Advanced Base in Papua, Carroll turned to the problems of providing adequate medical and surgical support for the forces that first had to stem the Japanese advance toward Port Moresby and then to assume the offensive north of the Owen Stanley Range.  The terrain, climate, and primitive nature of the existing transportation infrastructure of Papua and New Guinea severely limited the ability of the Allies to conduct successful military operations.  The harsh physical realities of the jungles, swamps, and mountains dictated that tactical operations would be conducted independently by battalion or regimental combat teams rather than entire infantry divisions concentrated for conventional land warfare, as the U.S. Army's prewar doctrine envisioned.   In such conditions, air transportation became critically important for movement and resupply.  However, only a limited number of transport aircraft were then available to move men, equipment, and supplies over the Owen Stanley Range and return the sick and wounded to Port Moresby and Australia.  This put large and heavy hospital units at the end of the line for deployment, well behind troops, weapons, ammunition, food, supplies, and so on.

The full-range of the Army's conventional medical and emergency surgical support could not be deployed.  The surgical, evacuation, or field hospitals would remain many miles in the rear, and the divisional clearing stations were never intended to provide emergency life-saving surgery. With the Army’s larger mobile hospitals unable to assume their traditional role in support of the front line combat units, the chain of evacuation was interrupted at a critical point.  Some sort of interim solution had to be found quickly to provide the necessary surgical services and care to the severely wounded directly behind the front lines. Otherwise, many wounded soldiers would die from either the lack of life-saving surgery at the front or from the long and arduous evacuation trek along jungle trails from the frontal clearing stations to the nearest surgical unit.

Operational necessity compelled Carroll to create a new link in the chain of evacuation that could provide the needed front line emergency surgical support between the clearing station and the mobile hospitals to the rear.  Carroll's solution was a light, highly portable, self-contained medical unit that could act as a small station hospital and also be deployed into combat with the troops.  Manned with skilled surgeons and located close to the fighting to render quick, life-saving surgical intervention, the unit could be moved by its own personnel to remain with the infantrymen during fluid operations.  Actually, Carroll envisioned these hospitals as only a temporary solution to a temporary problem presented by the difficulty of evacuating the seriously wounded in jungle warfare.  That problem would be solved as soon as the larger hospitals could move into the combat zone and resume their traditional surgical role in support of the front line troops....